A 1999 study
by the Institute of Medicine, "To Err Is Human," said
that 98,000 Americans are killed per year by in-hospital medical
errors. Now, according to a new study from Colorado-based Healthgrades
Inc., a company that specializes in tracking patient outcomes and
giving awards to hospitals that they assess as performing the best,
the Institute of Medicine's estimate of preventable in-hospital
deaths was wrong by half.
data on nearly half of all hospital admissions from 2000 through
2002 in all 50 states and the District of Columbia, Healthgrades
puts the number of annual deaths from medication errors and other
in-hospital mistakes at 195,000. That's more than three Vietnams
every year, more than triple the total number of Americans killed
in Vietnam in over a decade of war.
report, "Patient Safety in American Hospitals," includes
the deaths of low-risk patients from infections as well as the mistakes
made in attempts to rescue dying patients, things that were missing
from the Institute of Medicine report. "If the Centers for
Disease Control and Prevention's annual list of leading causes of
death included medical errors," says Dr. Samantha Collier,
vice president of medical affairs at Healthgrades, "it would
show up as number six, ahead of deaths from diabetes, pneumonia,
Alzheimer's disease and renal disease."
195,000 may be too low. "We're relying on data that hospitals
submit," explains Collier, "and that might be a reason
to under-document" the actual number of mistakes and resulting
in-hospital deaths. "And we were only looking at in-hospital
errors," says Collier, suggesting that medical errors made
in outpatient settings would take the death toll to even higher
we'd do as a nation if a U.S. passenger jet was crashing every day,
or if a gang of jihadist shoe-bombers was successful in bringing
down a fully-loaded U.S. passenger plane every day. The 195,000
figure, explains Collier, is "the equivalent of 390 jumbo jets
full of people dying each year due to likely preventable, in-hospital
medical errors, making this one of the leading killers in the U.S."
In total, the
United States had 292,000 combat deaths in all of World War II.
In America's hospitals, according to the Healthgrades report, we're
losing that many people to medical errors every 18 months.
In the face
of this massive death toll, the Bush administration is seeking to
put a $250,000 cap on recoveries for non-economic damages due to
medical errors, place time restraints on a patient's right to sue,
limit the level of punitive damages, and block lawsuits filed by
patients seeking compensation from manufacturers for harm caused
by medical devices or drugs.
On the point
of preventing people from suing the manufacturers of defective medical
products, the administration is arguing that patients lose the right
to sue once a product has been approved by the Food and Drug Administration.
"The FDA is not infallible," countered The New York
Times in a recent editorial. "It seems poor policy to assume
that once the agency has judged a product safe enough to use, the
manufacturer should be insulated forever from lawsuits that could
force improvements. Simple justice suggests that victims harmed
by a product should be able to seek compensation."
"a culture of lawsuits in America, a litigation culture,"
President Bush stated in a speech earlier this year to a group of
health care professionals in Little Rock that the American health
care system "looks like a giant lottery," and "somehow,
the trial lawyers always hold the winning ticket." In fact,
what looks more like a lottery is taking a chance on a hospital
and hoping to come out alive.
don't heal patients – that's a fact," said Mr. Bush in his
Little Rock address. "We can have balance in our society when
it comes to a good legal system and a good medical system. It's
not that way today. The pendulum has swung way, way too far."
the numbers, one has to wonder if the pendulum has swung far enough.
Most studies show that only a very small percentage of negligently
injured patients ever file a lawsuit. And with the equivalent of
a World War II in America's hospitals every 18 months, one also
has to ask why Mr. Bush is saying that the way to reduce bad performance
is through a reduction in the penalties for bad performance.
R. Reiland [send him mail]
Pittsburgh Tribune-Review columnist and the B. Kenneth Simon
Professor of Free Enterprise at Robert Morris University.