The great majority of Massachusetts residents who enter a hospital will receive quality care and leave healthier than when they were admitted. When something goes terribly wrong, they reasonably expect that the cause of the mishap will be investigated and the results of the investigation made known to them.

• Who else but the members of the medical institution where a mishap may have maimed or killed a patient, have the best ability to discover why it occurred?
• Who else has a higher moral obligation to the victim or to the victim’s family to uncover and disclose the truth?
• If a patient was harmed because of a doctor’s negligence or because the big business of health care, rather than patient care, was preoccupying a hospital’s administrators, who else has a greater mandate to reveal the causes of a blunder so that it will not occur again?

In this state, an alliance of doctors, hospital and insurance executives, special-interest lobbyists, and their friends in the legislature, have decreed that secrecy is best for our health. Most people are unaware of the fourteen year old “peer review privilege” law, Massachusetts General Laws chapter 111, sections 204 and 205. Hospital investigations into medical catastrophes within their facility are completely shielded from public disclosure. Not even the victims of acknowledged medical malpractice are permitted to learn what the investigators discover. The shroud covering “peer review” is so dark that in most cases, not even judges in the privacy of their chambers, are permitted to review the results of hospital peer review and quality assurance committee proceedings.

The remarkable premise behind the law is that doctors and hospital administrators will not tell the truth if their candor becomes public. They would rather, the rationale goes, continue to practice poor medicine than be embarrassed or give unwitting aid to a victim who brings a malpractice action, even if the “aid” is nothing more than the facts. While every responsible physician agrees that patients are best served when involved in their own care, the medico-insurance coalition preaches that the public must be excluded from efforts to improve our healthcare system. America’s two hundred twenty-five year experience as a democracy has taught us that secrecy dulls the impetus for needed change. The peer review secrecy statute grants to physicians a status generally held only by persons engaged in matters of the highest national security. It is an unjust law.

The legislative changes which should be made are straightforward. In the statute as it should be revised, hospitals would still be required to investigate incidents resulting in unexpected death or serious injury to patients. The reports of their investigations would be filed with the Department of Public Health and become public documents. Licensed health care professionals would be required to cooperate fully and truthfully with any peer review or quality assurance investigation, as a condition of licensure. Reasonable people might disagree as to whether the reports should be shielded from medical malpractice juries. Since only a minute percentage of cases involving patient harm ever wind up before juries, concern over malpractice litigation provides no justification for the continuation of secrecy law which has impeded the improvement of health are in our state.

The peer review secrecy law patronizes the public. It sows needless mistrust of doctors and hospitals. The law defies our common experience with the evils of secrecy in government and industry, and is antithetical to the bond of honesty which doctors and patients must share. Repeal of the statute and its replacement with a full disclosure in medicine law, is essential to the cause of medical error reduction and the overall improvement of our health care system.