Health

California penalizes hospitals for medical errors

Since last summer, California has withheld nearly $1 million in Medi-Cal reimbursements from at least 85 hospitals that have reported mistakes while treating patients.
Since last summer, California has withheld nearly $1 million in Medi-Cal reimbursements from at least 85 hospitals that have reported mistakes while treating patients.
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The state of California has financially penalized dozens of hospitals for mistakes committed while treating Medi-Cal patients. 

The Department of Health Care Services provided KPCC with a list of 145 hospitals that reported errors between July 2013 and August 2014. The Department has penalized at least 85 of those hospitals, withholding a total of nearly $1 million in Medi-Cal reimbursements.

Under state and federal law, hospitals are required to report when a patient under their care suffers harm due to a medical error – things like leaving an object inside a patient after surgery, giving a patient incompatible blood during a transfusion or causing an embolism by allowing air into an IV line.

When a hospital reports one of these so-called “provider preventable conditions” for a patient whose care is paid for through the publicly funded Medi-Cal program, the state will refuse to reimburse the hospital for the care needed to fix the mistake.

The data the state released to KPCC includes a list of the hospitals that have been penalized and the total amount -- $912,935 – but it does not provide individual dollar figures for each hospital. KPCC has requested that information.

A spokesman for the Department of Health Care Services said the number of hospitals penalized, the total dollar amount, and even individual dollar amounts for each hospital are likely to change as the state continues reviewing other cases, and as some hospitals file appeals.

The Department also did not provide information on how many patients were harmed by the hospitals' mistakes.

It’s estimated that as many as 440,000 Americans die from preventable medical errors in hospitals each year. And preventing such errors has become a greater focus of the government’s efforts since the passage of the Affordable Care Act.

The hospitals had to report their mistakes to the Department of Health Care Services under new reporting requirements imposed by the federal health law.

Jan Emerson-Shea, a spokeswoman for the California Hospital Association, said the association supports the goals behind the new reporting rules.

“We fully agree that if there are preventable conditions that occur, hospitals should not be paid for treating them,” she said.

But she added that the current requirements leave a lot of grey area in terms of what hospitals must report. That has led different hospitals to define "provider preventable conditions" differently, she said.

This lack of consistency makes it hard to use the data to draw firm conclusions about how hospitals are performing, as well as making it difficult to determine how best to improve performance, Emerson-Shea said, adding that hospitals are taking a variety of steps designed to reduce mistakes.