Marshall Allen wrote an interesting piece for the Washington Monthly about the epidemic of medical malpractice. We encourage readers to read the whole article but below are some excerpts.
Twelve years ago, the Institute of Medicine issued a landmark report showing that medical errors in U.S. hospitals kill up to 98,000 Americans a year. In 2000, another estimate, published in the Journal of the American Medical Association, which included fatalities resulting from unnecessary surgery, hospital-acquired infections, and other instances of harmful medical practice, put the total annual death toll at 250,000.
By that figure, contact with the U.S. health care system was the third leading cause of death in the United States, just behind all heart disease and all cancer. People responded to the alarm. Task forces were convened, congressional investigations launched, op-eds written. Yet as hard as it may be to believe, American medicine is, if anything, even more dangerous today.
In November 2010, the U.S. Department of Health and Human Services issued a study that covered just the 15 percent of the U.S. population enrolled in Medicare. It found that each month one out of seven Medicare hospital patients is injured—and an estimated 15,000 are killed—by harmful medical practice. Treating the consequences of medical errors cost Medicare a full $324 million in October 2008 alone, or 3.5 percent of all Medicare expenditures for inpatient care. Another recent study looked at the incidence of avoidable medical errors across the entire population and concluded that they affected 1.5 million people and cost the U.S. economy $19.5 billion in 2008. The Centers for Disease Control and Prevention have estimated that almost 100,000 Americans now die from hospital-acquired infections alone, and that most of these are preventable.
In health care, by contrast, patient safety experts often remark that the death toll from medical errors in U.S. hospitals is equivalent to three jumbo jets falling out of the sky and killing all the passengers on board every forty-eight hours. But even the most egregious errors go largely unreported, and when they are reported, they are often buried and ignored. For the most part, all the public gets to hear about are industry-wide estimates and statistical averages of the kind presented above. Because we lack specific knowledge of where these injuries are occurring and under what circumstances, we can’t know precisely what to do about the ongoing catastrophe or whom to reward when specific solutions are found.
Public reporting will be bolstered, to a limited degree, under the fine print of Obama’s Affordable Care Act. The new law says that certain injuries and infections that take place in hospitals will be published on Medicare’s Hospital Compare website. Hospitals will also be rewarded or penalized according to how certain readmission rates and hospital-acquired injuries compare to national averages.
Moreover, the new law applies only to acute care hospitals, leaving out nursing homes and other long-term care facilities. It will only include harm to Medicare patients, a subset of the overall population. And the system will not be able to capture some of the most common types of injuries to patients, such as those caused by medication errors.
Done right, a fully digitalized and integrated medical record system would also by itself prevent many serious errors, such as the thousands that occur every year when pharmacists misread a doctor’s scribbled prescription. Lest you think such matters are no big deal, the Institute of Medicine estimates that the average hospital patient in the U.S. is subject to at least one medication error per day (wrong med, wrong dose, wrong time, wrong patient), and that the financial cost of treating the harm done by these errors conservatively comes to $3.5 billion a year. An integrated digital records system would also make it much easier to monitor and curb the overuse of treatments that are both costly and dangerous. For example, Americans are exposed to so many CT scans, many of them redundant, that, according to the New England Journal of Medicine,the resulting radiation exposure may be responsible for as much as 2 percent of all cancer deaths in the country.
We all understand that medicine is increasingly complicated and that hospitals are increasingly filled with patients who would have died years ago were it not for the wonders of modern medicine. But the Hippocratic oath says, “First do no harm.” Precisely because health care is becoming more and more complex, and therefore inherently dangerous, it will continue to cause more and more and more deaths and injuries until we put safety first.
