Since the Institute of Medicine released its report on deaths due to medical errors almost a decade ago, there has been some action. But California has gone a step further, and it's a step worth emulating here in Wisconsin.

The Institute report estimated that about 98,000 people die every year because of medical errors. It was a topic which the health care community was reluctant to talk about, and still is to a degree, but the publicity which the report generated produced pressure for action.

As a result, hospitals re-examined their procedures, and we now have voluntary care quality reporting. Yet, while what is reported is useful, it's not the most telling information, for it does not generally include fatal problems. A Web site may report what error-prevention procedures are in place to, for example, prevent medication errors, but there is no corresponding measure of problems. In other words, there is no indication of how often error-prevention systems fail.

In California, for the 10 months ending in May, hospitals reported 1,002 cases of serious medical harm. The state requires reporting on 28 types of errors, such as leaving things inside patients. That happened 145 times. In 41 cases, doctors did the wrong procedure, operated on the wrong part of a patient or on the wrong patient.

The question is whether a California-like law would make a constructive difference instead of simply discouraging hospital workers from reporting errors. A survey of 203 hospital leaders reported in the Journal of the American Medical Association in 2005 found that any type of public error reporting - mandatory or not - would discourage internal hospital reporting and encourage lawsuits. But most respondents said there would be no effect on patient safety with the remainder split between increasing and decreasing it.

Mandatory error reporting would be worth a try, however, and it may even help in a way. How often are our impressions of the worth of a facility formed by word-of-mouth tales, which are bound to be the remarkably good or the conspicuously bad, based on the experience of one person, and not necessarily reflective of the whole institution?

For the most part, we should require mandatory error reporting, because it will help patients. Many hospital leaders may believe it will have no effect, but the reason for having laws like this is similar to the rationale for having full disclosure on financial investments:

It is as much reassurance for the public, and reminder for people to be careful, as it is the basis for any discipline or punishment.