Medical Malpractice: the Preventable Death

In 1999, The Institute of Medicine (IOM), a prestigious organization composed of doctors and scientists, made headlines by reporting that 44,000 to 98,000 hospital deaths in the United States every year were caused by “iatrogenic injuries” – which is medical speak for injuries caused by medical care providers.

Lawyers call that malpractice.

The IOM investigation made headlines partly because of the chilling metaphor it used to illustrate the significance of the death toll, equating it to over 400 jumbo passenger jets crashing each year, killing all on board.

The 1999 IOM study resulted in a few attempts to limit medical negligence, and a slew of books and papers suggesting patches and Band-Aids for hospital and medical procedures. Unfortunately, the only cause of medical malpractice that seems to have statistically declined over the years since the IOM study is “nosocomial” infections, which is a medical term for infections contracted from the environment or staff of healthcare facilities.

The Center for Disease Control (CDC) still estimates that as many as 99,000 deaths per year in U.S. healthcare facilities are directly caused by infections the patient developed while in the hospital, nursing home, rehabilitation center, or outpatient surgical suites. The improvement in percentages of patients who acquired nosocomial infections came about because the problem was publicized and, because of public outcry, systemic changes were made in many U.S. hospitals to reduce this largely preventable source of suffering and death.

Even before the IOM findings were published, studies were conducted by several groups that suggested the number of deaths linked to medical errors was substantially higher than previously believed. The U.S. Department of Health and Human Services had conducted a study of the records of Medicaid patients in 1988, concluding that there were 180,000 deaths caused by medical errors among Medicaid patients that year! This only included patients who died in hospitals.

According to a more recent study published in Lancet, a leading British medical journal, it now appears that the death rate for medical errors in the U.S. may be nearer to 400,000 per year! This stunning figure does not take into account the number of patients who have been crippled, scarred, had limbs amputated, lost work time, and have been subjected to huge medical bills as a result of non-fatal medical errors.

The reason for the nearly four-fold increase in estimated annual deaths from medical malpractice since 1999 is not due to four times more malpractice. It is because there has been closer study and improved methodology for identification of iatrogenic deaths.

These astonishing numbers have now demonstrated injuries to be the third leading cause of death in America, behind only heart disease and cancer.

The primary reason that this epidemic of unnecessary deaths continues, according to the new study, is that the public and the families of most victims never learn that their loved ones were killed by medical errors.

This is because death certificates, which must be signed by doctors, do not have cause of death codes that include or indicate anything but the underlying reason a patient was being treated as the cause of death, Therefore, a patient who undergoes successful cardiovascular surgery, but dies later because an unnecessary post-surgical test perforated her liver and caused a fatal internal hemorrhage, is shown on the death certificate to have died of cardiovascular disease. The family never knows that the patient died from medical mistakes.

Only around three percent of people injured or killed by medical mistakes ever call a lawyer, file a suit, and boards of medicine often find no reason to investigate or sanction perpetrators. Legislatures are unaware of this epidemic because they are either misled or are more influenced by heavy lobbying from medical associations and insurance companies than by concern for healthcare recipients.

If this scandal is ever to be repaired, it has to begin with identification and proper documentation of the real causes of death and injury.

Human error will never be completely eliminated, but systems that are publicly shown to be broken can be repaired if there is sufficient public outcry.

To reduce the number of unnecessary deaths, it is first necessary to make them more visible. When the nature of a problem is well known and understood, safer systems can be designed, and defenses against common mistakes can be developed.

Currently, the vast majority of deaths and injuries caused by medical errors are not accurately reported and useful discussions on how to mitigate this national tragedy are not taking place. Recognition of medical errors in patient death and injury would heighten awareness among regulations and the public, and would stimulate the advancement of proposed solutions and investment in research and prevention.

Laws that require investigation and accurate reporting of causes of death and unexpected injury in medical facilities would be a huge step in the right direction toward lessening the toll of this outrageous upsurge.