	Background

Medical malpractice and malpractice insurance continue to be issues of great concern tophysicians, consumers, legislators, and others. (1) Most of the discussion about the rising cost of malpracticeinsurance has centered on limiting the damage awards in malpractice suits. Some attention has beengiven to insurance market reforms. A third, related area that has received less consideration inmalpractice discussions is patient safety. Patient safety refers to the panoply of rules, practices, and systems related to the preventionof patient injury, also known as "adverse events." (2) While patient safety and medical errors have generated a great dealof discussion in the media and in legislatures in the past several years, such discussion typically hastaken place separately from the vigorous debates concerning malpractice litigation. 109-41 on July 29, 2005. However, medical liability issues are addressed in otherlegislation -- specifically, H.R. 5 / S. 354 , the Help Efficient, Accessible,Low-Cost, Timely Healthcare (HEALTH) Act of 2005; S. 22 , the Medical Care AccessProtection Act of 2006; and S. 23 , the Healthy Mothers and Healthy Babies Access toCare Act. (4) 
The separation of patient safety concerns from medical malpractice issues has not alwaysbeen the case. Therefore, it may be appropriate to consider these issues collectively, and re-visit therole patient safety initiatives could play in the prevention of both medical errors and medicalmalpractice. The link between malpractice and medical error has its detractors. Others, however, question the quality of the NPDB data. Voluntary Reporting. Individual initiatives have resulted in promisingoutcomes, but the overall impact of these efforts has been mixed. To some degree, this is the casebecause implementation has not been as pervasive as initial intentions suggested, and also becausenot enough research has been done to identify, enumerate, and assess patient safety efforts. Tracking and Reducing Medical Errors. Specific IT initiatives also have enhanced patient safety. S. 720 also established a voluntary system for the reporting ofmedical errors to patient safety organizations. During the first session of the 109th Congress, Senator Jeffords introduced S. 544 , the Patient Safety and Quality Improvement Act of 2005. S.544 became P.L. (61) 
While the majority of patient safety and medical malpractice bills address problems relatedto only one of these issues, a few bills have included provisions that address both issues. State Patient Safety Centers.
Medical malpractice and malpractice insurance continue to be issues of great concern tophysicians, consumers, legislators, and others. Most of the discussion about rising malpracticeinsurance premiums has centered on limiting the damage awards in malpractice suits, though someattention also has been given to insurance reforms. A third, related area that has received lessconsideration in malpractice discussions is patient safety. Patient safety refers to the panoply ofrules, practices, and systems related to the prevention of medical injury. Intrinsic to patient safetyefforts are strategies to prevent medical errors.
While patient safety and medical errors have generated a great deal of discussion inlegislatures in the past several years, such discussion typically has taken place separately from thedebates concerning malpractice. For example, S. 544 , the Patient Safety and QualityImprovement Act of 2005, encouraged the voluntary reporting and analysis of medical error data. S. 544 became P.L. 109-41 on July 29, 2005. However, medical liability issues areaddressed in other legislation -- specifically, H.R. 5 / S. 354 , the HelpEfficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2005, S. 22 , theMedical Care Access Protection Act of 2006, and S. 23 , the Healthy Mothers andHealthy Babies Access to Care Act.
The separation of patient safety concerns from medical malpractice issues has not alwaysbeen the case. Several states have passed legislation that included provisions that addressed bothmalpractice and patient safety issues. Research studies have explored the links between the twoissues, and a few bills introduced during the 109th Congress, such as S. 1337 and S. 1784 , address those links. Therefore, it is appropriate and timely to reconsider theseissues collectively, and revisit the role patient safety initiatives could play in the prevention of bothmedical errors and medical malpractice.
Strategies to enhance patient safety differ according to the specific provider type targeted. For instance, physician education includes providing clinical guidelines about appropriate treatmentsfor specific medical conditions, while hospital education involves performance feedback from anexternal organization. At the same time, general approaches may apply to both physicians andhospitals. For example, medical error reporting is a key component for patient safety enhancement,regardless of the provider focus.
The impact of patient safety initiatives on the quality of care provided continues to be anopen question. Individual initiatives have resulted in promising outcomes, but the overall impactof these efforts has been mixed. To some degree, this is the case because implementation has notbeen as pervasive as initial intentions suggested, and also because not enough research has been doneto identify, enumerate, and assess patient safety efforts.
This report will be updated periodically.