Could it be true that avoidable medical errors by doctors and hospitals are the third leading cause of death in the US? According to a story written by Ariana Eunjung Cha on May 3 for the Washington Post, entitled “Researchers: medical errors now third leading cause of death in United States”, doctors from prestigious medical institutions such as the Johns Hopkins University School of Medicine have concluded this to be a fact. Does 700 deaths a day _ not from injury or illness but from avoidable treatment errors _ shock you!? It does me. Professor Martin Makary from Johns Hopkins said in an interview that this shocking statistic includes “bad doctors”, and “communication breakdowns when patients are handed off from one department to another.”
“It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” Makary said.
The analysis that is the basis of the Washington Post article comes from the British Medical Journal (BMJ) and is entitled “Medical error—the third leading cause of death in the US“, BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i2139 (Published 03 May 2016) Cite this as: BMJ 2016;353:i2139.
Let’s be clear here. We are talking about people who go to doctors or hospitals and end up dying as a result of substandard treatment. That excludes patients who die without any negligence or cause other than the condition that caused them to seek medical care. Many patients die who are provided excellent medical care but medical science did not have a way to save them, and even the most skilled doctor could not avoid the inevitable outcome. What we’re talking about here, however, is negligence. Negligence is defined in the law as doing something that a reasonably prudent person in a given situation wouldn’t do, or not doing something that a reasonably prudent person would do in that situation. It is a “situational” concept that takes into account that in an emergency situation a reasonably prudent person will be given more latitude given the circumstances. Negligence means that the end result was avoidable through normal practices and standard diligence. The patient should have lived but didn’t. The death could have been avoided if the doctor and hospital followed the rules and provided the treatment that a competent doctor or hospital was supposed to provide.
It has been 17 years since a similar report shocked the medical profession. The Washington Post story above reports that “[I]in 1999, an Institute of Medicine report calling preventable medical errors an “epidemic” shocked the medical establishment and led to significant debate about what could be done.” How “shocked” was the medical profession? What has been done by the medical profession? If anything the situation has gotten worse and patients face great risk of death and injury in US hospitals.
According to Ms. Cha in her story:
The IOM, based on one study, estimated deaths because of medical errors as high as 98,000 a year. Makary’s research involves a more comprehensive analysis of four large studies, including ones by the Health and Human Services Department’s Office of the Inspector General and the Agency for Healthcare Research and Quality that took place between 2000 to 2008. His calculation of 251,000 deaths equates to nearly 700 deaths a day — about 9.5 percent of all deaths annually in the United States.
At 700 deaths per day you would think this would be front page news and a part of the debate in the presidential campaigns. But it isn’t and I ask myself “why not?”
The Washington Post story of Ms. Cha sheds light on the problem:
Makary said he and co-author Michael Daniel, also from Johns Hopkins, conducted the analysis to shed more light on a problem that many hospitals and health care facilities try to avoid talking about.
Though all providers extol patient safety and highlight the various safety committees and protocols they have in place, few provide the public with specifics on actual cases of harm due to mistakes. Moreover, the Centers for Disease Control and Prevention doesn’t require reporting of errors in the data it collects about deaths through billing codes, making it hard to see what’s going on at the national level.
The CDC should update its vital statistics reporting requirements so that physicians must report whether there was any error that led to a preventable death, Makary said.
“We all know how common it is,” he said. “We also know how infrequently it’s openly discussed.”
I know the doctors are terribly busy and that the economics of medicine have become very difficult with insurance company reimbursements dropping in doctors being asked to do more record-keeping and reporting to the government. But I also know that in the past 30 years I have witnessed doctors and hospitals alongside their insurance companies lobbying at state legislatures and in Congress to change laws making it harder for patients to hold negligent doctors and hospitals accountable for the injuries they cause. For 30 years we have all witnessed doctors and their insurance companies complaining that there really isn’t any medical negligence and that anyone who files a lawsuit against the doctor or hospital is probably bringing a frivolous claim. Along with the many private foundations funded by billionaires like Karl Rove and the Koch brothers, the medical profession has denied that they have a problem with medical negligence at all. What do they have to say about 700 deaths per day? They want to cover it up and they want laws passed that in the end will protect bad doctors and bad hospitals. The data shows that nine out of 10 patients who are victims of these avoidable medical errors cannot find an attorney because the laws have been changed by the doctors who lobby with insurance company money and their own at the legislature in ways that make it impossible to file a lawsuit. The families of these dead and injured patients who suffer immeasurable loss of love and affection, and often incur huge medical expenses all due to the bad doctors and bad hospitals, are left with the insult of no justice and no ability to recover because elected officials caved into the pressure of the well-connected medical profession, their lobbyists and the all-powerful insurance industry. For them it’s all about money. But I think it’s even worse than that.
It’s one thing to have some bad doctors, some bad hospitals and some significant problems in communications that all are causing injury and death to patients. If they spent their time getting to work to stop 700 people from dying every day in the country due to their profession we would all applaud them and offer help. It’s completely another thing to cover it up, to deny it even though it’s true and then to try to get laws passed that protect these doctors and hospitals from being accountable for the harm they cause. We are talking about death here. And if there are 700 deaths per day in the United States because of avoidable errors by incompetent doctors and careless hospitals, can you imagine how many people live but have traumatic brain injuries, or paralysis or other lifelong tragic conditions?
We all know that if there is going to be change the first thing that has to happen is for the responsible party to acknowledge the problem. The medical profession was apparently “shocked” by the 1999 report by the Institute of Medicine, but nothing happened to improve patient safety. Perhaps the doctors should stop organizing marches on the state capital or the Congress in Washington DC, and hold seminars identifying how to reduce avoidable medical errors, find and educate the bad doctors, institute quality control measures that would catch the errors that are now killing people and take responsibility for a profession that has lost its way. A leading doctor from Harvard quoted in the Washington Post story shares his dismay at the lack of improvement:
Kenneth Sands, who directs health care quality at Beth Israel Deaconess Medical Center, an affiliate of Harvard Medical School, said that the surprising thing about medical errors is the limited change that has taken place since the IOM report came out. Only hospital-acquired infections have shown improvement. “The overall numbers haven’t changed, and that’s discouraging and alarming,” he said.
Some of my greatest heroes are medical doctors that I have met throughout my life. Most doctors never injure a patient through carelessness. But few doctors will speak up for patients when one of their peers commits malpractice. I know that the good doctors are not offended by the irritation that I express here, because in candid discussions they acknowledge that there are problems of competence and communication that plague the medical profession. They know the bad doctors and bad hospitals are protected by the insurance industry and the “conspiracy of silence” that pressures good doctors from testifying against bad ones. They have chosen to believe false and unproven statistics created out of thin air by the insurance industry into believing that there is an epidemic of frivolous lawsuits filed against doctors. Just the opposite is true. Suffering families cannot file claims to bring justice to the death of a loved one from medical negligence because of legal roadblocks thrown up by the insurance industry and the medical profession to avoid accountability by doctors and hospitals. One cannot look at this shocking set of facts and not see that the medical profession faces a moral crossroad. Who will speak up for patient safety and injury prevention? Who will apologize to the millions of families who suffered a wrongful death at the hands of a bad doctor or hospital?
One cannot look at this shocking set of facts and not see that the medical profession faces a moral crossroad.
