Plan B Forum

Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care.

Lest you assume those cases are the exceptions, a new study by patient safety researchers provides some context.

Their analysis, published in the BMJ on Tuesday, shows that "medical errors" in hospitals and other health care facilities are incredibly common and may now be the third leading cause of death in the United States -- claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimer's.

Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, said in an interview that the category includes everything from bad doctors to more systemic issues such as 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 seeing care," Makary said.

The issue of patient safety has been a hot topic in recent years, but it wasn't always that way. 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.

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.

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."

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.

Scooter wrote: But lumping a disparate group of incidents into an amorphous blob and labelling it "medical error" doesn't help to fix anything.

MajGenl.Meade wrote:Medical ERROR. 251,454?

OK, let's say each MEDICAL ERROR CASE was settled at $5million (a conservative estimate). Johns Hopkins apparently suggests that in one year, the medical industry paid out $1,257,270,000,000 in damage claims?

Isn't that rather more than the annual amount spent on medical care?

MajGenl.Meade wrote: 5.72 billion is a good (hugely so) deal less than my finger in the wind number, even if it is as of 8 years ago! However, my hesitation remains slightly vibratory; does in excess of 250,000 deaths per year due to medical error really only translate to less than $6 billion in judgements?

That's less than $24,000 dollars per, and that doesn't even take into account the number of medically caused injury cases (short of death) that lead to compensation which are also included in that 5.72 billion.

In 2013, PBS reported on a study that estimated anything from 200,000 up to 440,000 medically preventable deaths per year - the third leading cause of death, even then. So either doctors are doing a terrible job or lawyers are doing a terrible job - the only benefit seems to be to insurance companies which collect about 55 billion a year.....

Sue U wrote:In the first instance, a majority of states have statutory caps on med mal damages that typically prevent a claimant from obtaining more than $250,000 or $500,000 in non-economic damages. Furthermore, doctors' liability policies around here, where we have no statutory limit, are typically no more than $1 million per occurrence, so as a practical matter payouts are capped at the available coverage.

So if you think every med mal case is somehow automatically "worth millions" and that plaintiffs routinely "hit the jackpot," you are very, very, very wrong.

Sue U wrote:Your ideas about what a medical negligence case is worth and how many of them actually result in any compensation at all are wildly exaggerated...So if you think every med mal case is somehow automatically "worth millions" and that plaintiffs routinely "hit the jackpot," you are very, very, very wrong.

5.72 billion is a good (hugely so) deal less than my finger in the wind number

MajGenl.Meade wrote:Er no... perhaps you misunderstood my follow-up (although you quoted it) which corrected my first wildly wrong one:

MajGenl.Meade wrote:It does seem to me that if there are 251000 deaths (in addition to injuries) there should be more than $5.72 billion paid out. That's why I suggested the only people really making out are insurance companies who (figures from reliable sources) collect in excess of 55 billion every year in malpractice insurance premiums. Doctors ain't doing well at keeping folks alive (apparently) and lawyers ain't doing so well at getting compensation awards - for whatever reason.

Scooter wrote:I'm sorry, but when you classify stuff like hospital-acquired infections as "medical errors", then every other claim takes a credibility hit. Yes, people get infections in hospitals, yes, people have bad reactions to medications, yes, unexpected complications occur during surgeries, but that doesn't mean that all of them were mistakes of some kind or even that they were preventable. Some of them are, and whatever steps are necessary to prevent them should be undertaken. But lumping a disparate group of incidents into an amorphous blob and labelling it "medical error" doesn't help to fix anything.

Scooter wrote:I'm sorry, but when you classify stuff like hospital-acquired infections as "medical errors", then every other claim takes a credibility hit. Yes, people get infections in hospitals, yes, people have bad reactions to medications, yes, unexpected complications occur during surgeries, but that doesn't mean that all of them were mistakes of some kind or even that they were preventable. Some of them are, and whatever steps are necessary to prevent them should be undertaken. But lumping a disparate group of incidents into an amorphous blob and labelling it "medical error" doesn't help to fix anything.

rubato wrote:People are in the hospital because they already suffer from heart disease, cancer, stroke, diabetes, dementia, respiratory failure, severe trauma, & c so on the whole we are not talking about medical error killing otherwise healthy people expected to live a long time yet.

Guns do that.

Yrs,
Rubato