February 4, 2012

Hospital Errors - Part I

While some politicians were posturing about "frivolous lawsuits", claiming they were a cause of increased health care costs (despite the absence of any reliable studies so finding) a 1999 National Institute of Medicine report told a real tale of healthcare costs, a shocking tale based on hard data:

Two large studies, one conducted in Colorado and Utah and the other in New York, found that adverse events occurred in 2.9 and 3.7 percent of all hospitalizations. 6.6 percent of adverse events in Colorado and Utah led to death, as compared with 13.6 percent in New York hospitals. In both of these studies, over half of these adverse events resulted from medical errors and could have been prevented.

When extrapolated to the over 33.6 million admissions to U.S. hospitals in 1997 the studies implied that at least 44,000 Americans die each year as a result of medical errors. The results of the New York Study suggested the number may be as high as 98,000. Even when using the lower estimate, deaths due to medical errors exceed the number attributable to the 8th-leading cause of death.More people die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516)

Not all of the victims died anonymously. The knowledgeable health reporter for the Boston Globe, Betsy Lehman, died from an overdose during chemotherapy. Willie King had the wrong leg amputated. Ben Kolb was eight years old when he died during "minor" surgery due to a drug mix-up.

In our firm we have handled cases involving wrong-sided brain surgery, wrong-sided stereotactic trigeminal nerve radiation, wrong level back surgery, the death of a young mother following transfusion with blood intended for another patient, and patients who sustained serious and disabling injuries when ordered tests weren't run, when tests run weren't read or reviewed and where tests which should have been ordered were overlooked - the polar opposite of defensive medicine.

While these horrific cases made the headlines, they're just the tip of the iceberg.

Total national costs (lost income, lost household production, disability and health care costs) of preventable adverse events are estimated to be between $17 billion and $29 billion, of which health care costs represent over one-half.

In terms of lives lost, patient safety is as important an issue as worker safety. Every year, over 6,000 Americans die from workplace injuries. Medication errors alone, occurring either in or out of the hospital, are estimated to account for over 7,000 deaths annually.

One recent study conducted at two prestigious teaching hospitals, found that about two out of every 100 admissions experienced a preventable adverse drug event, resulting in average increased hospital costs of $4,700 per admission or about $2.8 million annually for a 700-bed teaching hospital.If these findings are generalizable, the increased hospital costs alone of preventable adverse drug events affecting inpatients are about $2 billion for the nation as a whole.

These figures offer only a very modest estimate of the magnitude of the problem since hospital patients represent only a small proportion of the total population at risk, and direct hospital costs are only a fraction of total costs.

More care and increasingly complex care is provided in ambulatory settings. Outpatient surgical centers, physician offices and clinics serve thousands of patients daily. Home care requires patients and their families to use complicated equipment and perform follow-up care. Retail pharmacies play a major role in filling prescriptions for patients and educating them about their use. Other institutional settings, such as nursing homes, provide a broad array of services to vulnerable populations. Although many of the available studies have focused on the hospital setting, medical errors present a problem in any setting, not just hospitals.