Physicians Seek Protection When Reporting Errors : There are legal avenues for physicians to pursue if they observe quality problems or wrongdoing.

In hospitals with a culture of safety this isn't a problem, Dr. Powers said, but there are some hospitals where economics are placed above patient care.

Dr. Powers proposes doing away with the databank and introducing external, financially independent, and specialty-specific peer review to hospitals.

For example, a thoracic surgeon should be able to call the Board of Thoracic Surgery to request a review of a patient safety issue, she said.

This system could mimic the Accreditation Council for Graduate Medical Education reviews that already occur in teaching programs.

In addition, if hospitals want to strip physicians of credentials, the institution should allow physicians to call for a review of the entire department by the specialty society, Dr. Powers said.

The American Hospital Association urges physicians and other hospital employees who have seen an error or a potential risk to report that without fear of retaliation, said Don Nielsen, M.D., senior vice president for quality at the AHA.

It is “unacceptable” for hospital administration to punish someone for reporting, he said.

To prevent this, all hospitals have an appeals process in place if privileges are restricted or if a physician is fired, Dr. Nielsen said.

For its part, AHA has been providing tools to hospitals to encourage the creation of a culture of safety.

Changing the culture won't happen overnight, said Paul Schyve, M.D., who is senior vice president at the Joint Commission on Accreditation of Healthcare Organizations.

“Hospitals are making clear positive steps in that direction,” he said.

But the legal culture of the United States continues in the name, blame, and shame culture, Dr. Schyve said.

Congress is beginning to address this through patient safety legislation, he added.

In March, the Senate's Health, Education, Labor, and Pensions Committee approved the Patient Safety and Quality Improvement Act (S. 544). The bill would allow hospitals and physicians to report information to a patient safety organization without its being disclosed and used against them in court.

In addition, the legislation would prohibit employers from taking action against an employee who makes a report.

The bill still needs approval from the full Senate and House. In the last Congress, the House and Senate each passed versions of this legislation but could not come to agreement on a final bill.