Maybe there's a little-publicized reason for medical malpractice suits: there's way too much medical malpractice.
Health Grades, Inc., an independent healthcare quality company, recently reported that "[a]n average of 195,000 people in the U.S. died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002." A summary of its report of its study of 37 million patient records is included in its news release.
According to Dr. Samantha Collier, Health Grades' vice president of medical affairs, "The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S."
Again according to Dr. Collier: "If the Center for Disease Control's annual list of leading causes of death included medical errors, it would show up as number six, ahead of diabetes, pneumonia, Alzheimer's disease and renal disease."
Health Grades' full study, published last month (July 2004), cited a 1999 study by the Institute of Medicine (part of the National Academy of Sciences). That IOM study had estimated that "[b]etween 44,000 - 98,000 Americans die from medical errors annually." (I discussed that study in my first medical malpractice posting. The IOM study concluded that "Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents.")
Here, without the footnotes, are the last two paragraphs of the Health Grades study:
"Until . . . best practices are developed, disseminated, and adopted to prevent medical errors and injuries, focused improvement efforts on four key areas - Failure to Rescue, Decubitus Ulcer, Postoperative Sepsis, and Postoperative Pulmonary Embolism or Deep Vein Thrombosis - will significantly improve patient safety in our hospitals and reduce costs. If we focused our efforts among Medicare beneficiaries on these four areas only and were able to reduce excess attributable mortality and costs by just 20%, we would prevent almost 18,000 avoidable deaths and save Medicare and society $380 million in excess inpatient costs annually. The enormity of just 20% of this situation is analogous to turning a deaf ear and blind eye to 35 jumbo jets filled with Medicare beneficiaries crashing each year. This should result in an outcry from every American demanding the right to patient safety in our hospitals.
"In conclusion, our results illustrate and validate previous studies that medical injuries in hospitals continue to be a real threat to Americans and are associated with significant negative economic consequences. Most disturbingly, similar to previous study conclusions, these figures likely represent an underestimation of the true mortality and costs attributable to patient safety incidents within our U.S. health care system. As such, we recommend that more research be done to assess patient outcomes beyond death and costs, to understand circumstances and risk factors associated with medical injuries, and to develop strategies to prevent medical injuries."
The full study of the Institute of Medicine of the National Academy of Sciences is entitled "To Err Is Human: Building a Safer Health System" and may be purchased, downloaded in a pdf format, or even read online at no charge. An eight-page summary of the report can also be downloaded or read online.
IOM had a one-paragraph summary of its 1999 study that expressed optimism about cutting down the death rate:
"This report lays out a comprehensive strategy by which government, health care providers, industry, and consumers can reduce preventable medical errors. Concluding that the know-how already exists to prevent many of these mistakes, the report sets as a minimum goal a 50 percent reduction in errors over the next five years. In its recommendations for reaching this goal, the committee strikes a balance between regulatory and market-based initiatives, and between the roles of professionals and organizations."
Unfortunately, the Health Grades study found that not only had the error rate not decreased, it had, in fact, increased.
The IOM has a number of reports with recommendations for improving patient care and safety. Those reports with IOM's descriptions include:
"Keeping Patients Safe: Transforming the Work Environment of Nurses identifies solutions to problems in hospital, nursing home, and other health care organization work environments that threaten patient safety through their effect on nursing care. The report puts forth a blueprint of actions that all health care organizations which rely on nurses should take."
and
"Patient Safety: Achieving a New Standard for Care provides a detailed plan to facilitate the development of data standards applicable to the collection, coding, and classification of patient safety information. This report addresses key areas related to the establishment of a national health information infrastructure, including: a process for the ongoing promulgation of data standards; the status of current standards-setting activities in health data interchange, terminologies, and medical knowledge representation; as well as the need for comprehensive patient safety programs in health care organizations."
It's obvious that there is malpractice and that thousands upon thousands of people die in hospitals as a result. And the figures from IOM and Health Grades do not even include people who die as a result of medical negligence that occurs not in hospitals but in doctors' offices away from hospitals. Moreover, the IOM and Health Grades figures only include deaths and do not include tragedies such as patients whose wrong arm, leg, lung or other part of their body has been amputated or removed. Perhaps more attention should be paid to delivering safer health care instead of blaming the attorneys who file the lawsuits on behalf of the victims and the survivors of the victims.
For instance, in the delivery of health care, how many times have patients been given the wrong medication or the wrong dosage because a pharmacist could not read a physician's handwriting. In order to prevent these misreadings, perhaps all states should require, as Florida does, that all prescriptions that physicians write must be "legibly printed or typed so as to be capable of being understood by the pharmacist filling the prescription." Florida statutes, Section 456.42. So obvious a solution, but so little has been done to enact that type of statute nationwide.
Stay tuned to this blog for a third posting on medical malpractice, maybe on the handwriting problem. In the meantime, you might take a look at a newspaper article that cited a study that found that about 6 percent of U.S. hospital patients hurt by medication could be linked to bad handwriting.
ADDENDUM:
The Health Grades study also included in its report what it rated as the "best" hospitals for safety and costs.
ADDENDUM NUMBER 2:
There are, of course, critics of the study. For instance, one article discusses some of that criticism. One of the physicians who is quoted is Robert M. Wachter, "a professor in the Department of Medicine at UC San Francisco and the author of a well-respected book on medical errors, Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes." (If you want to learn a lot about what Dr. Wachter calls the "Terrifying Epidemic," take a look at his book.) According to the article, Dr. Wachter says the Health Grades study is "flawed in some truly fundamental ways." However, the article also points out that both Dr. Collier (of Health Grades) and Dr. Wachter "acknowledged that there was no reliable way to truly know how many people die each year from medical errors, and Wachter acknowledged that the figure could well be as high as 200,000 a year."
LINKS:
For those who receive a printed version of this posting:
Health Grades' press release is at http://www.healthgrades.com/public/index.cfm?fuseaction=mod&modtype=content&modact=Media_PressRelease_Detail&&press_id=135. Its full study is at http://www.healthgrades.com/media/english/pdf/HG_Patient_Safety_Study_Final.pdf.
The summary of the IOM estimate of from 44,000 to 98,000 deaths is at http://www.iom.edu/subpage.asp?id=14980.
My first posting on medical malpractice is at http://www.outoftheboxlawyering.com/archives/000042.html.
The IOM report may be purchased at http://www.iom.edu/report.asp?id=5575 and its eight-page summary may be downloaded at http://www.iom.edu/file.asp?id=4117.
The IOM's reports with recommendations for improving patient care and safety are at http://www.iom.edu/focuson.asp?id=8089.
Florida's statute may be found at http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0456/SEC42.HTM&Title=->2004->Ch0456->Section%2042#0456.42.
The newspaper article on handwriting and Florida's solution is at http://www.sptimes.com/2003/08/02/State/Clearly_curing_the_co.shtml.
The article quoting Dr. Wachter is at http://www.eweek.com/article2/0,1759,1631136,00.asp.
Posted by ajlevy at August 10, 2004 5:00 PM