We've all read that President Clinton wants to mandate that all medical errors be reported to Washington under the rubric of the new Center for Quality Improvement and Patient Safety. Hospitals will be affected first, but if history is any guide, surgery centers will be next. Serious errors only, we are told, will be reported. How serious is serious? To be determined by our brethren in law and administration. Why the need? Seems that the venerable Institute of Medicine has published data showing that almost 100,000 souls may perish yearly from our mistakes.

We all are of course concerned about medical errors. But based on the evidence provided, is it fair to impose the harsh solution that President Clinton proposes on surgery facilities? After a closer look, I have my doubts.

First, though the media widely reported the number of deaths per year at 98,000, the Institute of Medicine report freely admits that the number could be less than half that high. The higher rate represents extrapolations from New York hospitals. The lower ones represent extrapolations from studies done in Colorado and Utah. Forty-four thousand is still far too many, but not as many as 98,000.

It's very difficult to know how many of these deaths occurred as a result of surgery, but it appears to be only a small fraction. The closest the report comes to identifying this number is a reference to a study of 44,603 patients who underwent surgery over a period of 13 years. Seven hundred forty-nine of these patients died. Fifty-six, or about one tenth of one percent of the total sample, were attributable to error.

Even one tenth of one percent is still too high for me. But looking a little deeper, I have to wonder if the figure is relevant. The data upon which the study was based were collected between 1977 and 1990. A few things have changed between that period and this. Most remarkably, the American Society of Anesthesiologists promulgated a list of best practices and required vastly more sophisticated monitoring equipment in the OR as a standard of community care. Deaths due to anesthesia error subsequently fell by 90 percent. Similar, if less dramatic changes have occurred in nursing and all medical specialties. Surgery centers in particular have worked hard to acknowledge the fungible and quantifiable nature of their product, and to measure and improve where it can be done.

We all know that errors do occur, and we all are working to eliminate them. What would help us most is time. Unfortunately, an additional layer of bureaucracy such as that proposed by President Clinton will only make that scarce commodity even scarcer.