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Recent criminal charges against nurses create worrisome implications for patient safety. Unintentional human errors occur in clinical practice and are inevitable. The vast majority of errors reflect system problems that need to be addressed. Harm to patients can only be reduced or avoided when modern safety theory is used to respond to adverse events. It is essential that errors be reported and analyzed. Punitive approaches deter error-reporting and endanger patients by allowing latent failures to continue. The fear of criminal charges undermines an organization's attempts to create a culture of safety and improve dangerous systems. Criminal prosecutions have a potentially chilling effect on error reporting and analysis and accelerate the shortage of health care providers. A review of several cases demonstrates the political nature of these indictments and the destructive impact they have on patient safety. Suggestions are made for TAANA's involvement in the issue.
Keywords: criminalization; culture of safety; system failure; TAANA implications
Law and medicine typically intersect in the civil arenas of malpractice litigation, health law, or regulation. Criminal prosecutions have been reserved for intentional activities such as billing fraud, patient abuse, or assisted suicide/euthanasia. Recently, however, unintentional human error in clinical practice has given rise to criminal indictments in many parts of the country. The implications for patient safety are staggering. Criminalizing unintentional human mistakes undermines error reporting and the creation of a culture of safety, demoralizes providers, accelerates the exodus from clinical practice, contributes to a culture of blame, and perpetuates the unachievable expectation of perfection in practice.
As the Institute for Safe Medication Practice (ISMP) has stated,
[T]he most recent wave of criminal investigations into errors made by healthcare practitioners is cause for concern. The law clearly allows for the criminal indictment of healthcare professionals who make errors that harm patients, despite the lack of intent to cause harm. But it will long be debated whether this course of action is required or beneficial. Its potential impact on patient safety is enormous, sending the wrong message to healthcare professionals about the importance of reporting and analyzing errors. Further, if this is just the beginning of an upward trend of criminal investigations and indictments in the wake of medical errors, it could also have a chilling effect on the recruitment...