Leadership and public health issues

Yesterday I was reading a book review, written by Jouni Tuomisto, in the latest issue of the journal Science. The book he was reviewing is called Toms River: A Story of Science and Salvation, by Dan Fagin. This book is about a chemical factory that was built in the town of Toms River, New Jersey in the early 1950s for the purpose of producing dyes. This dye factory (as well as another chemical factory) carelessly disposed of hazardous wastes, which contaminated the river, soil, and groundwater. Eventually the area became so contaminated that it was designated as a Superfund site. (The Superfund program was established by congress to clean up areas of hazardous wastes.)

What is the connection with disclosure of medical errors? It is in how Dr. Tuomisto describes the reasons that the contamination was not dealt with earlier.

Dr. Tuomisto writes, “So why did the chemical companies go on dumping and the authorities keep ignoring future trouble? There seem to be two main reasons. Either the existing information did not reach the decision-makers, or the decision-makers’ outlook prevented them from recognizing the hazards and opportunities… This implies that we should systematically promote an open flow of environmental information, especially among people holding different views and different interpretations. In Toms River, fear that open information would cause public outrage was repeatedly expressed. But the book shows that when at some point the information leaked out anyway, the largest outrage usually stemmed from the secrecy, not the bad news per se.”

Did you catch something that sounds like an argument for disclosure of medical errors?

The chemical factories were not an evil villain in the case of Toms River, just as our physicians, nurses, and hospitals are not villains in our own cities. Both produce benefits: the factories created products, and our healthcare workers help to restore our health when we are ill or injured. But there are downsides to these industries. As a by-product of manufacturing, the factories were producing hazardous wastes. Because the delivery of healthcare is complex, errors will be made.

So how did the factory respond to producing these wastes? By doing the easiest, cheapest thing: dumping them. In the early years, that may have been a rational decision. Because the factory was built decades ago, it is unlikely that at the beginning anyone realized how hazardous the waste was. But as evidence of the toxicity grew, the dumping was allowed to continue.

How is the healthcare industry responding to the huge number of medical errors that are made? There are excellent efforts in some institutions to reduce medical errors (and when errors do happen, to acknowledge those errors, apologize, and compensate the injured patients). But that is not a typical approach to medical errors. Decades ago, brushing medical errors aside may have been a rational decision. After all, maybe patients really don’t want to know about errors because it would just upset them. Maybe errors are very rare, so it is not worth creating policy to address them. But today the evidence is in. We know that patients expect honesty from the healthcare system, and that the rate of errors is alarmingly high.

How did the leadership of Toms River respond to the contamination? In Dr. Tumisto’s words: “Either the existing information did not reach the decision-makers, or the decision-makers’ outlook prevented them from recognizing the hazards and opportunities.” Let me speculate on the second possibility. Perhaps the factories were a significant part of the economy and one of the area’s largest employers. Perhaps the factories didn’t want to go to the trouble and expense of disposing of their hazardous waste appropriately. Perhaps the town’s leaders found it easier to continue with business-as-usual rather than to confront the leaders of the area’s largest businesses. Whatever the reasons, the town’s leaders neglected to act in the best interest of the public.

How will the leadership of Kansas respond to my family’s legislative bill to require disclosure of medical errors? (I am assuming, of course, that the bill will make it out of committee in a form that preserves my family’s intentions.) At this point I don’t know what the response will be, but I will keep you informed.

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