A high level of safety at the hospital that treated Trump should be a minimum for everyone

Update, Nov. 23, 2024: This story has been updated with information about President-elect Donald Trump’s Health and Human Services nominees and the correct date of Trump’s assassination attempt this summer.

When the Leapfrog Group published its latest patient safety scores, I looked up the hospital where Donald Trump was taken bleeding after an assassination attempt in western Pennsylvania last summer.

The now president-elect was lucky in more ways than the obvious: a high-powered rifle bullet barely missed his head. Butler Memorial Hospital, from which Trump was safely discharged late on the night of July 13, has a long history of above-average patient safety performance. Happiness, however, should have nothing to do with avoiding damage caused by treatment.

Ensuring consistently safe care in every hospital nationwide should be a conscious policy choice by the Trump administration. Proposed nominees for key posts at the Department of Health and Human Services provide cautious optimism that this will be the case.

Patient safety came to the forefront almost exactly 25 years ago. During the slow news period after Thanksgiving 1999, the Institute of Medicine released a report stating that 44,000 to 98,000 Americans died annually from preventable medical errors in hospitals. The errors also caused financial costs to rise between $17 billion and $29 billion. Subsequent research has pushed the death toll much higher, with Leapfrog estimating 160,000 preventable hospital deaths in 2018, or more than three times the number of people killed in car crashes.

Butler Memorial has regularly earned an “A” on Leapfrog’s mid-year report card, although it received a “B” in the spring 2024 and recent fall 2024 reports. Although the hospital fell short in some areas, it still succeeded fully achieved the Leapfrog standard in “effective leadership to prevent mistakes.” That category includes providing resources to implement a patient safety program and developing “systems and structures to support actions to improve patient safety.”

The financing of damage prevention is seriously faltering

This systemic attention to damage prevention is where health policy comes into play. The first report from the Institute of Medicine (now known as the National Academy of Medicine) sparked public outrage. In response, Congress provided $50 million to what is now the Agency for Healthcare Research and Quality. Since then, however, patient safety funding has failed to even match inflation, let alone reflect the pervasiveness of preventable harm repeatedly documented by researchers. For example, a 2015 National Academy of Medicine Report said it is “likely that most people will experience at least one diagnostic error during their lifetime, sometimes with devastating consequences.”

In fiscal year 2024, the AHRQ The budget for the patient safety office was $89.6 millionwith the same amount requested by the President for the 2025 budget year. To put that in perspective, that modest funding does not even equal half of the net patient revenue of an average hospital. AHRQ’s total budget request for fiscal year 2025 was $513 million for all of its activities, including providing data and analysis to policymakers and research in digital health, primary care and behavioral health. Again, in perspective, it’s about the sale of a few Costco warehouses as the total amount allocated to research into improving the safety and effectiveness of a nearly $5 trillion healthcare system.

A political problem AHRQ faces in terms of funding is that the ineffective or harmful care it helps avoid is invisible to the patients and families who benefit from it. The Leapfrog Group estimates that 50,000 lives could be saved annually if all U.S. hospitals achieved an “A” patient safety score, but it takes some digging to understand how the public perception of safe care diverges from reality. When you look at the list Of the 12 hospitals that have received an “A” from Leapfrog every year since the initial scores in 2012, the most famous names in American medicine are conspicuously missing. For example, there is the Mayo Clinic in Phoenix, but not the famous home clinic in Minnesota; a Kaiser Permanente outpost in Orange County, but none at its headquarters in Oakland or in Los Angeles; and there are no Harvard Hospitals listed in Massachusetts.

While Trump’s assassination attempt was dramatic, the subtler lesson of health policy was that none of us—president, presidential candidate, or billionaire—can guarantee where we will be if we suddenly need medical care. Therefore, it is crucial that certain standards are respected everywhere. But since 2012 as I have writtenHouse Republicans have tried to eliminate AHRQ altogether, largely because the agency was an easy target for budget cuts. Unfortunately, it’s a classic example of penny-wise and pound-foolish.

In his book Saving lives and money: transforming health and healthcareformer GOP House Speaker Newt Gingrich — a former member of the AHRQ National Advisory Council, where I am a current member — emphasized the importance of individuals “having access to high-quality, results-based information.” As an individual I completely agree with that. However, policymakers also need that kind of information.

In late 2023, the Department of Health and Human Services launched a National Action Alliance for Patient and Worker Safetycoordinated by AHRQ. The Trump Administration’s HHS representatives are uniquely equipped to build on and accelerate those efforts. Dr. Martin Makary, who will be nominated to head the Food and Drug Administration, is a respected figure patient safety expertafter writing that medical errors are “the third leading cause of death” and calling for more transparency about hospitals’ performance. Dr. Mehmet Oz, tapped to lead the Centers for Medicare & Medicaid Services, has certainly seen his share of patient safety problems as a former cardiac surgeon at a major academic medical center. Meanwhile, Robert F. Kennedy Jr., nominated to be HHS secretary, was suffering from a much-discussed diagnostic erroralmost undergoing unnecessary surgery for a suspected brain tumor until a second doctor examined the images and determined that his symptoms were caused by a parasite that had infiltrated his brain and subsequently died.

Donald Trump’s ‘zero damage’ experience; the professional expertise of Makary and Oz; and the medical malpractice suffered by Kennedy, should motivate the new administration to put funding and political influence behind demanding that hospitals have the “systems and structures to support actions to improve patient safety,” as was the case with Butler Memorial, should be the minimum. every American can expect.