Hospital mistakes killing patients (44,000 to 98,000 people die annually)

The Knox News Sentinel ^ | 5/19/03 | Charles Ornstein

[GailA]

Hospital mistakes killing patients

Usual cause is a string of related mistakes, study says

By CHARLES ORNSTEIN, Los Angeles Times May 19, 2003

LOS ANGELES - Just over a year ago, 16-month-old Delaney Lucille Gonzalez walked with her family into UCLA Medical Center for routine surgery to repair a cleft palate.

Three days later, she was disconnected from life support and died in her mother's arms.

"To bring a healthy child in there for surgery so minor," her mother, Jodi, said recently, clutching a headband she had made for Delaney, "you just don't accept that she's going to die."

The simple explanation is that a breathing tube had been misplaced and had pumped air into the child's stomach rather than her lungs, according to Delaney's medical and autopsy records. Because her body was deprived of oxygen, Delaney's heart stopped. She suffered irreversible brain damage.

The misplaced tube was just the first in a series of errors leading to the child's death, according to California state health inspectors who reviewed the case in response to a complaint from Delaney's mother.

According to their report, the radiology department waited hours before reviewing chest X-rays that would have pinpointed the problem because they were "too busy." In addition, staff members detached and did not replace a carbon-dioxide breathing monitor that they believed to be broken, gave the girl medications that ran counter to doctors' orders and failed to alert supervisors as her condition deteriorated, inspectors said.

"There is absolutely no question that these violations led to the baby's death," said Brenda Klutz, deputy director of licensing and certification at the California Department of Health Services.

Even in the most prestigious hospitals, medical errors sometimes kill patients. According to a landmark report in 1999, 44,000 to 98,000 people die annually in hospitals because of mistakes ranging from performing surgery on the wrong organ to prescribing the wrong type or dosage of medication.

Patients don't usually die from a single mistake. They die from a series of oversights, faulty assumptions and missed opportunities - what some experts refer to as a systemic breakdown.

"One single problem is usually not sufficient. It requires a chain reaction," said Dr. David G. Nichols, a professor of anesthesiology and critical-care medicine and pediatrics at Johns Hopkins University School of Medicine.

[GailA]

Since this is a LAT article it is excerted.

[alloysteel]

What this article is saying, then, is that people should stay home and die. That makes sense.

People go to hospitals because they are in desperate need of medical attention, and may have a condition that is life-threatening already. They are making a bet that the medical professionals there won't make an error, or that the aseptic conditions presumed to be maintained at the hospital won't be breached by a failure in housekeeping, or that they won't be turned away because of some rules set by a third party, or because there is no other place for them to go.

Mostly, they make good on the bet. When they don't, only the lawyers win.

[E. Pluribus Unum]

Number of physicians in the US - 700,000
Accidental deaths caused per year - 120,000
Accidental deaths/physician = 0.171


Number of gun owners in the US = 80,000,000
Number of accidental gun death / year (all age groups) = 1,500
Accidental deaths/gun owner = 0.0000188

Therefore, Doctors are approximately 9000 times more dangerous than gun owners.

[Beck_isright]

Don't worry. According to many, each death is only worth $250,000.

[Beck_isright]

"Therefore, Doctors are approximately 9000 times more dangerous than gun owners."

Brilliant analysis!!!!!!!

[WilliamWallace1999]

Stupid analysis too. The data from that "LANDMARK" study has been disputed ever since its publication. It was generated by the Institute of Medicine, which is sorta like the National Education Association of medicine. They are red to the core. They counted cases that were terminal on arrival to the hospital and did nothing to establish cause and effect between death and events. Getting your Tylenol 30 minutes late would have been counted as an error. If you later died of your dissecting aortic anuerysm; voila, another medical error related death.

WW---physician AND concealed handgun permit holder. 9000 times more dangerous only to muggers.

[Beck_isright]

Regardless if it's a handgun or a doctor, the politicians and lawyers will destroy your choice of either.

[WilliamWallace1999]

Great, another shill for the lawyers blurring the lines between economic and punitive damages. Get a better shctick. The public is getting wise to the nonsense of the legal profession.

[Beck_isright]

Reread my posting. I stated that between lawyers and polticians they will remove our choice (freedom) of owning a handgun or picking a doctor. I defend neither. Doctors are as corrupt as lawyers. Neither profession does a good job of self-regulation. Stick your shill garbage where the sun doesn't shine.

There are bad doctors and bad lawyers. Both are costing the American consumer as much financially as the bad politicians.

[WilliamWallace1999]

I agree with that point about loss of choice and freedom. Why did you make the comment about life only being worth $250,000? Tort reform is not about limiting the cap on actual damages to the family. The proposed cap is only on the non-economic punitive damages that spiral out of control and enrich the litigators.

[TomB]

120,000

The article quotes a questionable study that says between 98,000 and 44,000. Where did you get 120,000?

And since we're all extapolating today, here's some more. The 98,000 number was arrived at by examining hospital records in New York in 1984 and the 44,000 number is from Colorado and Utah hospitals in 1992. We can clearly see that in less than a decade, deaths declined by more than HALF. Following that trend, we can be assured that medical errors are now gone.

Obviously, my analysis is done in jest, but it does demonstrate the problems of taking these kinds of "studies" too seriously.

[WilliamWallace1999]

Where you aware of the fact that doctors are not ALLOWED to police their own? The law acts to protect bad doctors and state regulatory boards have been take over by consumer advocates. If an individual or group of doctors tries to force out a bad doctor on staff, their reward is a federal restraint of trade suit. How often does that have to happen before they say screw it?

Remember, it is the consumer that pays the price for lawsuits with higher costs and reduce access to healthcare.

Yes, both profession are full of dishonest slimeballs. Support stronger control by state boards. In Texas, only 20% of our annual fee goes back to the board for enforcement. The last Demoncrat Gov. Ann Richards put the remainder in general revenue. The Texas State Board of Medical Examiners in now 18 months behind looking into cases of egregious malpractice. The system is broken, but the Doctors as a group are not being allowed to fix it.

[Beck_isright]

Yes, it is about proposed limits on damages to the family. Keep in mind that financial losses are taxed at the full rate so if a settlement is concocted, no matter what the increases in inflation, etc., the settlement will be taxed annually. The punitive cap of $250,000 basically gives doctors and hosipitals a free hand to do whatever they want because they are self-regulating. The problem is not the outrageous damages awarded to families due to negligence by doctors. The problem is that insurance companies are stupid enough to keep writing policies for repeat offenders and the state boards refuse to revoke the right to practice of these doctors who have no business practicing medicine.

My objection to the trial lawyers is identical. Instead of facing any consequences for numerous garbage lawsuits, they refuse to regulate themselves either. The state BAR in almost any state is a social club which does nothing to evict a practicing member unless he commits murder or worse (usually only if on a fellow lawyer, well, maybe not j/k).

The bottom line is that the public has allowed these two self-regulating professions to spiral out of control. Tort-reform cures nothing. The real reform needs to come on a state by state level, with citizen run regulatory boards having an equal say with the professional groups. It's time to take a stand. Too bad the sheeple will take that stand by continuing to pay financially and with their health for the mistakes of insurers, lawyers, doctors and corrupt politicians.

[Beck_isright]

The problem you're missing is that they are self-regulating. Who is sitting on the Florida state board? That's right, doctors. The state BAR? Lawyers. With the insurance commissioner? That's right ex-execs and buddies who receive massive contributions from the insurers. Until citizens have an equal voice on these boards, the corruption within the insurance, medical and legal regulatory agencies will continue. CYA is their motto. And they are living their motto every day.

[TomB]

Here is a letter to the editor to the American College of Physicians–American Society of Internal Medicine that addresses the problems in that study:

Patient safety

I read the recent Institute of Medicine (IOM) report on patient safety with dismay, then increasing skepticism and concern. I've reviewed the research from which it concludes that between 44,000 and 98,000 Americans die in hospitals annually due to preventable adverse effects of medical care. I've found that the conclusion is based entirely on adverse event death rates from two studies and an extrapolation of those figures to the 33.4 million annual hospital admissions in the United States.

The first study, from a 1991 issue of the New England Journal of Medicine, estimated that in 30,195 "randomly selected" hospital admissions in New York in 1984, 80 deaths occurred because of negligence. Researchers then applied these percentages to the 2.67 million admissions that occurred in New York state in 1984 and estimated that 6,895 deaths took place because of adverse events. IOM researchers applied the same formula to the 33.6 million admissions in the United States in 1997 to arrive at 86,736, which they rounded up to 98,000, for reasons known only to the authors.

The second study, from a 1999 issue of Inquiry, found that in Utah and Colorado in 1992, death occurred in 6.9% of all preventable adverse events, which occurred in 3.1% of all hospital discharges studied. Applying these researchers' findings yields a national rate of 41,731, which the IOM inexplicably rounded up to 44,000.

I have practiced internal medicine for 24 years, and I have not seen evidence of these statistics. Neither have my partners and colleagues. Why?

First, the selection process of both studies was not random. In another issue of the New England Journal of Medicine, the New York researchers acknowledged that they oversampled births with complications, as well as cases treated by physicians in high-risk specialties like neurosurgery, thoracic surgery, peripherial vascular surgery, cardiac surgery, orthopedics and urology. In short, the researchers said that they deliberately designed their study to target high-risk admissions. You can only speculate to what extent this process inflated the adverse event rate.

The Utah/Colorado study, which found the preventable death rate to be less than half of that found in the New York study, also did not use random selection. Researchers excluded psychiatric, rehabilitation, and drug/alcohol diagnosis-related groups and hospitals that exclusively provide these services. Excluding these lower-risk admissions tended to concentrate adverse events in the admissions that were studied.

The IOM report and the news coverage that followed have assumed that whenever a death occurred in an admission where an adverse event took place, the death was caused by the event. The studies, however, offer no proof of this. Because critically ill patients have more numerous and complex medical interventions, there is a greater chance that an error will be made at some point during the admission. These patients are also more likely to die from their illness.

The IOM report urges Congress to create a new national center for patient safety similar to the Federal Aviation Administration or the Occupational Safety and Health Administration. The center would contain a new national mandatory reporting system for all serious medical errors, and all reports would be open to malpractice attorneys. The stated goal is to reduce errors by 50% within five years.

I submit that the IOM report substantially overstates the extent of medical injury in the U.S. Moreover, the figures in the report already show a greater than 50% reduction in preventable deaths from 1984 to 1992. I would argue that states, hospitals and medical staffs already have extensive record review and quality assurance programs in place and running effectively. If Congress feels a need to do more, a good place to start is to fund a truly random study of adverse events in hospital admissions.

Judging by all the "extrapolation" that goes on in these studies, my analysis that there are no deaths due to medical errors should be pretty accurate.

[LeftIsSinister]

...said Brenda Klutz, deputy director of licensing and certification at the California Department of Health Services.

I apologize if it seems I'm making light of this tragedy, but, this is truly an unfortunate name for someone in this position!

[TaxRelief]

I believe that the problems, when they do occur, come from the fact that some members of the surgical team are "behind the scenes players" that have had no contact with the awake patient or the family. Anesthesiologists, in particular, often meet their patients two minutes before they knock them out. Someone that important to the patient's survival should at least see the patient as a person prior to treating them. It is because of this "person-patient theory" that our family members usually make an appointment with the anesthesiologist prior to surgery.

[Beck_isright]

Hell, I didn't even know who my anesthesiologists until 2 minutes before the IV was put in. In all my surgeries, they walked in, shook my hand and said "this might sting a little".

[TaxRelief]

There is one more attack that must be made to prevent these frivolous lawsuits and that is the jury selection process. Juries are typically make up of bleeding heart types for two reasons: (1) business people and conservatives are notorious for doing every thing they can to avoid jury duty and (2) those left to serve are the unemployed, the community-conscious liberals, those on Social Security, those on the dole of some sort and (progesterone charged) stay-at-home Moms who are suckers for a "hurt kid" story.

No offense meant to common-sense FReeper moms.

[Richard Kimball]

The IOM report urges Congress to create a new national center for patient safety similar to the Federal Aviation Administration or the Occupational Safety and Health Administration. The center would contain a new national mandatory reporting system for all serious medical errors, and all reports would be open to malpractice attorneys.

Thanks for your analysis of this report. I've seen references to this report floating around the net, and the LA Times referencing a "landmark" study without giving any footnoting or other supportive evidence sent my BS detector into overdrive. The numbers just seemed too much like the "more women are beaten during the Super Bowl" stories and other nonsense spouted. Your post makes it clear that this is a study done of the doctors by the trial lawyers for the trial lawyers. They want the government to create a sue me list for them at taxpayer expense. Isn't that special.