Volume 2, No. 3 • Fall 1987

Good News and Bad News on Safety

Ellison C. Pierce, Jr., M.D.

For several years, anecdotal evidence has strongly suggested that the incidence of anesthesia mishaps in the United States, as well as other countries, is declining significantly. In the December, 1986 issue of the APSF Newsletter, Mr. Mark Wood of St. Paul Insurance Company provided data supporting this premise.

Again, in this issue, information from the Doctors’ Company in California provides additional support. Moreover, several insurance companies have lowered the anesthesiology premium relativity recently. CRICO, the Harvard company, has reduced anesthesia from 5.0 to 4.0 and the Massachusetts Joint Underwriting Association has tentatively planned to lower, in the remainder of Massachusetts, the relativity from 5.0 to 4.0 in 1988, to 3.5 in 1989, and to 3.0 in 1990. The latter three reductions would result in a combined decrease in premiums of about 35%, this on top of the some 20% discount for anesthesiologists promising to utilize pulse oximetry and end tidal PCO2 measurement whenever possible.

On a sour note, in recent months it has come to my attention that certain anesthesiologists use no instrument monitoring whatsoever, not even an EKG, and frequently leave the room with a patient on a ventilator unattended by an anesthesia person. It has also come to light that far too frequently the state of anesthesia apparatus is grossly inadequate. I ask you, who are interested in furthering safety, what can we do to turn around these last two situations?

Ellison C. Pierce, Jr., M.D. President Anesthesia Patient Safety Foundation