Those who know what issues the health care community and its patients are facing presented their views Monday to the Wyoming Health Care Commission at a meeting in Casper.

The nine-member commission, a state agency formed by the Legislature and the governor, is charged with conducting a broad-based study of health care issues affecting Wyoming.

The commission has been asked to explore issues such as access to health care, problems with the uninsured, medical patient safety issues, quality of care, doctor and nurse shortages and medical malpractice, according to Commission Chairman T. Chris Muirhead.

For instance, he said, there are three communities in Wyoming that offer no OB/GYN coverage.

"How do you address those things? So, this commission is to issue a report, preliminarily, to the state Legislature in June of 2004, with a final report in December of 2004," Muirhead said.

The commission's recommendations will serve as a blueprint for the Legislature and the governor to use in policy decisions and, hopefully, in future legislation, he explained.

The commission heard presentations from the Sheridan VA Medical Center; the Wyoming Hospital Association; United Medical Center; Mountain Pacific Quality Health; Keith Skatrud, a nursing home administrator; a Rawlins family physician; the Wyoming Trial Lawyers Association; and the Wyoming Commission on Nursing and Nursing Education.

It also absorbed reports from the Labor, Health and Social Services Committee; the Healthcare Access Subcommittee; and the Tort Reform/Medical Malpractice Insurance/Medical Errors Subcommittee, according to the commission agenda.

In its third such meeting, the commission focused on issues that directly relate to patient safety, Muirhead said.

Each presenter was asked to share specialized knowledge based on his own area of expertise.

The reliability of incident reports, which are made after medical or nursing errors are realized, was a subject of great interest to commission members during the early morning session.

"Up until now, the system we've had is that, if you report, there's retribution," Muirhead explained.

"Reporting is now a positive thing - it's a way of improving patient safety," he said. "And we need to do the things as a state and as a local community to where we encourage recording of errors. Unfortunately, we have a tort system that interferes with that. So, the question is, is that tort system a detriment to patient safety?"

Muirhead said, in the long run, the commission will probably decide that a voluntary, non-punitive type of incident reporting is what the state needs to ensure patient safety.

Jan Pope, a quality improvement coordinator for Mountain Pacific Quality Health Foundation, told the commission that her company's goal is to help health care organizations in Wyoming, Montana and Hawaii to avoid making patient care errors.

Mountain Pacific develops and implements ideas it thinks will better prevent incidents and omissions, she said.

Pope, who specializes in the care of Medicare patients, told the commission that there is room for improvement in the state's incident reporting.

On the other hand, Wyoming doctors have been very responsive to the need for quality reporting, she said.

"Tracking them, looking at them, analyzing and looking for trends or problems are very much what needs to be done," she told the commission.

The American Medical Association in early July declared Wyoming a crisis state because of the escalating costs of medical malpractice insurance.

Next month, the commission will meet again in Casper to conduct a study on the feasibility of establishing a joint underwriting association (JUA) to provide medical liability insurance on a self-supporting basis, Muirhead reported.