Medical Errors: Third Leading Cause of Deaths in the U.S.

Health Editor’s Note: The option of medical error, as a cause of death on death certificates, is not listed. This option should be listed on death certificates since 225,000 Americans per year have died due to dire results from their medical treatments.  According to several research studies in the last decade, a total of 225,000 Americans per year have died as a result of their medical treatments. This article mentions 440,000 deaths per year. I am sure that you agree with my statement that medical error is definitely a cause of death with that many people dying from it. 

According to the World Health Education Initiative those deaths can be further broken down into categories such as: medication errors in hospitals (7,000 deaths per year), unnecessary surgeries (12,000 deaths per year), infections in hospitals (80,000 deaths per year), other errors in hospitals (20,000 deaths per year), and negative effects of drugs (106,000 deaths per year.)   When coupled with increased lack of health care due to lack in ability to afford health care, America’s health care system has become the third leading cause of death, behind heart disease and cancer. Good grief!!! This post covers medically related deaths in the U.S., but you can be sure that these preventable deaths happen all over the world.

Medical errors, beside causing the unconscionable injuries and deaths, also cost billions of dollars. Lost productivity, from missed work days, alone may cost $1 trillion not to mention that people who are harmed or killed have lost their homes and may become bankrupt while trying to pay medical bills for services that have harmed them.

While the numbers of deaths per year attributed to medical errors vary, depending on which article or the author of the article, you are reading, just one death would be too many for me to stomach. Doctors are not always correct, just because they are “doctors.” They obviously make mistakes due to hurrying, not seeing your entire health care picture, lack of interest, hubris, carelessness, etc.  Choose your doctor with as much care as you choose the person who works on your car. Actually, be more picky. As a consumer of health care, you are inadequately prepared to navigate the heath care road. You practice defensive driving.  Be defensive and very thorough with your choices of medical care.

At this point all I can think to do is to give you some ammunition to not become a medical error statistic:

• If you have questions, ask them and keep asking until you get an answer that makes sense to you. Take as much time as you want, until you fully understand.
• Make sure that one competent person coordinates your heath care (primary care , spouse, trusted friend).
• Make sure that all doctors have ALL of your medical records.
• Take someone with you to all of your appointments.
• Make sure you know why a test or treatment has been ordered.
• Always check back for results of a test.  Do NOT assume that no news is good news.  Yes, you have to check, even though you may be scared to find out the results.

For Medications:

• Make sure that ALL of your doctors/practitioners/therapists know what medications you are taking, including herbals and supplements.
• Bring your medications to a visit or at least a very detailed list with name, dosage and number to times per day you take the medications.
• For a new prescription, find out why it is being prescribed,how many times are you to take it per day, when, what are side effects, are there other medications, foods, drinks, that you should not take this new medication with, are there any activities you should avoid?
• Make sure you can read the prescription so you will know if the pharmacy is filling the correct prescription.
• Ask the pharmacist if this is the medication that your doctor prescribed, as there can be confusion between the use of actual and generic drug names.  Ask the pharmacist the best way to measure any liquid medications.

For Surgery:

• Make sure your doctor, surgeon, and you all know why you are having surgery….i.e. for left hand and not right, etc.
• If you can, choose a hospital where the procedure that you are having done is commonly done there. You want experienced hospital staff for pre-op and post-op care.  You also want a strong anesthesia group.

For Hospital Stays: 

• Since hand washing is your primary defense from infections, you can ask health care workers if they have washed their hands if they do not do that in front of you. 
• Get detailed instructions about medications, treatments, etc. for what you are to do when you are discharged.

These hints can help you to avoid getting a medicine that could harm you.

• What is the medicine for?
• Make sure anyone treating you knows if you have any allergies. This includes the pharmacist.
• Ask “How am I supposed to take it and for how long?”
• What side effects are likely? “What do I do if they occur?”
• “Is this medicine safe to take with other medicines or dietary supplements I am taking?”
• “What foods, drink, or activities should I avoid while taking this medicine?”
• Be sure you understand the directions of when and how to take the medications.
• Get that list of possible side effects of the medication and read it.
• Read, print, and remember this list as if your life depended on it. Because it does…….Carol

Film Shines Light on Deadly Errors in Medicine

Death toll in U.S. as high as 440,000 per year

by Ian Ingram, Deputy Managing Editor, MedPage Today

Can a film help shift the conversation on reducing deadly errors in medicine?

The documentary To Err Is Human, which is currently in previews and opens to wide release in the fall, attempts to answer that question, highlighting the obstacles, consequences, and attempts to address the myriad factors on both the institutional and individual level responsible for errors in medicine.

“It’s a massive topic to address,” said director Mike Eisenberg, following a recent screening of his film. “We really wanted to maintain a singular focus — what would my dad have done if he made this movie?”

His late father, John Eisenberg, MD, MBA, was one of the early directors for what is now the Agency for Healthcare Research and Quality (AHRQ). He launched AHRQ’s evidence-based practice centers and was viewed as a pioneer for his work in healthcare research. In 2002 he died from a brain tumor, at the age of 55.

To Err Is Human gets its title from the landmark 1999 report on deaths from medical error from the Institute of Medicine, which estimated that between 44,000 and 98,000 hospitalized Americans die from medical errors each year.

Medical error isn’t currently a CDC-approved option when listing cause on death certificates — only diseases, morbid conditions, and accidents can be listed.

In 2016 an open letter from Martin A. Makary, MD, MPH, of Johns Hopkins Medicine in Baltimore, and colleagues urged the CDC to change this policy.

The authors of the letter — who defined death from medical errors as “1) errors in judgment or skill, coordination of care, 2) a diagnostic error, 3) a system defect resulting in death or a failure to rescue a patient from death, and 4) a preventable adverse event” — pointed to the fact that funding for medical research is often based on mortality figures. As such, patient safety gets a short shrift, and little public awareness.

The CDC says its methodology is in keeping with international standards of reporting on the causes of death.

More recent (though controversial) estimates put the number of deaths due to medical error at 400,000 per year or higher, but even conservative estimates would still make it the third leading cause of death in the U.S. following heart disease and cancer.

“In 2006, I had my own medical error and became part of that statistic,” said Sally Roumanis, RN, a patient-safety specialist at Yale, who shared her experience during a panel discussion that followed the screening.

Her husband Dean ended up in the ER at Yale following a cardiac event while cycling. A stent was put in and everything had seemingly gone well. It was late at night and Dean urged Roumanis and their daughter to head home for rest. “I can’t stand you hovering,” he joked, Roumanis recounted.

But at 5 a.m. Roumanis received a call saying her husband’s condition had drastically worsened. She arrived back at Yale to see a team rushing toward the cath lab, then doctors performing chest compressions on her husband.

A couple of days later she was told her husband’s death was a result of medical error.

A coronary artery had been perforated during the stent procedure resulting in bleeding and pericardial collection. “That wasn’t the error — it was a complication,” explained moderator Harlan Krumholz, MD, of Yale’s Institute for Social and Policy Studies. “But throughout the night, as Dean began to struggle, the junior doctors failed to escalate the problem to a higher level and didn’t appreciate the seriousness.”

It was early in the morning and the doctors handling the situation were early in their careers. “Nurses were advocating for escalation,” Krumholz continued, “but didn’t feel empowered to override the situation.”

The inexperienced doctors were treating the symptoms without understanding the cause. Dean’s condition continued to spiral downward until 5 a.m. when he went into cardiac arrest. “His pressure drops dramatically — they realize it needs to be escalated,” Krumholz said. “They rush him to the lab, but it’s too late.”

“This can’t be happening,” Roumanis told herself. “You just think, ‘no, he’s in a hospital, he’s in a safe place.'”

Talking About Medical Errors

In the past, doctors were trained not to talk about mistakes, but that attitude has shifted. The film features one institution that uses actors to train physicians delivering news of a medical error made during care.

Marna P. Borgstrom, MPH, president and CEO of Yale New Haven Health System, said that nothing has changed in the way of medical malpractice litigation, but that organizations — and individuals within organizations — have made the decision that it’s the right thing to do. “Now, whenever there is an error made, whether or not there is identifiable harm to the patient, we encourage the responsible clinicians to talk with the patients about that,” she said.

“Patients still sue us when that happens,” she added, “and that’s not wrong, because in some cases people are entitled to damages.”

Borgstrom, who spoke during the panel portion, recalled that when Yale first started tracking medical errors in an internal patient safety-reporting database there were about 14,000 events the first year,

across the network of providers. “That sounds like a lot,” she said. Three years later it was 24,000 and growing.

“We viewed that as a good sign,” she said. “Rather than being afraid of telling people we made a mistake, people are talking about it.”

AHRQ

AHRQ, which has been under constant threat of defunding by Congress, is still in trouble and could possibly be rolled into the National Institutes of Health (NIH). “If AHRQ is dissolved into the NIH, there will still be some form of patient safety effort going on in NIH, where people who worked at AHRQ will hopefully be able to continue their work, but the budgets will be decreased, their efforts will be pared down,” Eisenberg said. “The way it is right now will no longer exist if that happens.”

However, as part of the omnibus bill, Congress passed a 3% increase to AHRQ’s budget for the next fiscal year ($334 million total), the first increase in 10 years. “So this is good news. There are caveats — I’m sure that those increases come with responsibilities that are not only focused on patient safety,” Eisenberg said. “The entire budget is never only about patient safety anyway.”

He said there are still people in very powerful positions who don’t think AHRQ’s work is important.

In 2012 AHRQ released a report detailing that a combination of best practices, improved safety culture, and a bigger focus on teamwork could cut central-line-associated bloodstream infections (CLABSIs) in hospitals by 40%. Borrowed from lessons learned in the aviation industry, one of the components included use of a procedure checklist, and during the film and panel discussion — countless comparisons were made to the Federal Aviation Administration’s ability to improve safety.

“A lot of these problems are engineering problems,” said Kevin M. Johnson, MD, of the Department of Radiology & Biomedical Imaging at Yale School of Medicine, chiming in from the audience. “And we have almost no engineers around.”

The Film

Between interviews with experts in the field of patient safety, To Err Is Human weaves in the story of Susan Sheridan, whose family’s intersection with the healthcare system was met with two medical errors.

First, jaundice (a sign of too-high bilirubin) in her newborn son, Cal, was ignored and led to brain damage and development of cerebral palsy. Sheridan’s experience led her to become a patient-safety advocate. Today hospitals routinely tests for elevated bilirubin.

Years later her husband Patrick was diagnosed with and treated for a benign brain tumor. Additional tests from pathology had revealed a malignant tumor, yet this was never communicated to Patrick’s physician. Left untreated, the disease aggressively spread until it was too late. He died in 2002.

While the plan is for wide release in the fall, the trailer is now available online and various upcoming screenings have been scheduled in select cities — including Cleveland on Monday, Tuesday and Wednesday next week, and Philadelphia on April 20. The latter will include a panel discussion.

Carol Duff, MSN, BA, RN

Carol graduated from Riverside White Cross School of Nursing in Columbus, Ohio and received her diploma as a registered nurse. She attended Bowling Green State University where she received a Bachelor of Arts Degree in History and Literature. She attended the University of Toledo, College of Nursing, and received a Master’s of Nursing Science Degree as an Educator.

She has traveled extensively, is a photographer, and writes on medical issues. Carol has three children RJ, Katherine, and Stephen – one daughter-in-law; Katie – two granddaughters; Isabella Marianna and Zoe Olivia – and one grandson, Alexander Paul. She also shares her life with her husband Gordon Duff, many cats, and two rescues.

• Carol’s Archives 2009-2013