As many as 98,000 americans die unnecessarily every year from medical mistakes made by physicians, pharmacists and other health care professionals, according to an independent report by the National Academy of Science released in November, 1999. Being admitted to a hospital puts you at more risk than car accidents or AIDS. Only cancer and heart disease are more likely to kill you. The dangers in the report made by the Academy's Institute of Medicine fall into two categories: physician error and mistakes in medications. It does not include infections picked up at the hospital or mistakes by medical personnel outside the hospital.
Astonishingly, hospitals are not even required to report their errors that result in death. The Institute strongly recommended federally mandated reporting. "These stunningly high rates of medical errors, resulting in deaths, permanent disability and unnecessary suffering, are simply unacceptable in a medical system that promises first to 'do no harm,'" said William C. Richardson, president of the W.K. Kellogg Foundation and chairman of the expert committee that compiled the frank, 223-page report, titled "To Err is Human."
On January 23, federal health officials said they were unwilling to endorse a law requiring hospitals to report all mistakes that cause serious injury or death to patients. Their reasons appear to be aimed at protecting the industry by avoiding the disclosure of information that could result in large lawsuits. Dr. Donald M. Berwick, a member of the National Academy of Sciences panel, countered, "Suppose an airline could crash a plane and not tell anybody about it. That would be wrong. Likewise, if people are seriously injured because of errors in medical care, don't they or their families have a right to know?" It would require one airplane accident per day killing 268 people each time to reach the yearly total killed by medical error.
"To err is human, but errors can be prevented," the report concludes. "Any error that causes harm to a patient is one error too many," said Dr. Nancy Dickey, past president of the American Medical Association, which has already started a National Patient Safety Foundation designed to address some of the issues.
About 33.6 million people are admitted to hospitals each year in the U.S. According to the report, somewhere between 2.9 percent and 3.7 percent of these suffer an "adverse event" while in the hospital. An "adverse event" is defined as an injury caused by medical management rather than by the disease or condition of the patient. Somewhere between 8.8 percent and 13.6 percent of all "adverse events," are fatal. Between 53 percent and 58 percent are attributable to mistakes. Based on these figures, an average of one out of every 500 people admitted to a hospital in the US is killed by mistake. By comparison, the chances of being killed in a commercial airline accident is one per 8 million flights.
The report also acknowledges that the actual situation may be much worse. The 1-in-500 figure is based on information disclosed in patient records, but many medical mistakes are never acknowledged in patient records. "Most errors and safety issues go undetected and unreported, both externally and within health care organizations. Silence surrounds this issue," the report says. One study cited by the report of 815 patients in a university hospital found that 36 percent had an iatrogenic illness--literally, "physician produced," defined as "any illness that resulted from a diagnostic procedure, from any form of therapy, or from a harmful occurrence that was not a natural consequence of the patient's disease." Among the 815 patients, nine percent suffered an iatrogenic illness that threatened life or produced considerable disability. For another two percent--one in fifty patients--iatrogenic illness was believed to contribute to their death.
Another class of medical mistakes is medication errors--giving a patient the wrong medication, the wrong dose or inappropriate combinations of medications. A 1998 report in the Journal of the American Medical Association estimated an astounding 106,000 deaths were caused in 1994 by adverse drug reactions alone, both inside and outside of hospitals.
Deaths are occurring because doctors have not read patient records, pharmacists have misread the handwriting on prescriptions or nurses have not washed their hands after touching infectious patients. The Institute's report sets a goal of reducing deaths from medical mistakes in hospitals to 1-in-1,000 within 5 years--hardly reassuring to a patient, but a start. The report's recommended way to achieve the goal is to make medical errors expensive: "The combined goal of the recommendations is for the external environment to create sufficient pressure to make errors costly to health care organizations and providers, so they are compelled to take action to improve safety," In layman's terms: "sue them."
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