Martin Makary, a cancer surgeon and professor of health policy and management at Johns Hopkins University School of Medicine, has recently asked the Centers for Disease Control and Prevention to correct its records and list medical errors as the third most common cause of death in the United States, after heart disease and cancer. Currently, chronic lower respiratory disease holds the third spot. Makary examined four separate studies involving medical error from 2000 to 2008 and found that more than a quarter of a million (251,454) U.S. hospital patients die each year as a result of a medical error.
As a trial lawyer who has handled dozens of tragic medical-malpractice cases over my 40-year career, this comes as no surprise to me. But it may to you, because the CDC does not allow physicians, medical examiners, coroners and funeral directors to list medical error as a cause of death, resulting in underestimation of these numbers, according to Makary.
Makary describes medical error as falling in one of four categories:
- An unintended act (either of omission or commission) or one that does not achieve its intended outcome;
- The failure of a planned action to be completed as intended (an error of execution);
- The use of a wrong plan to achieve an aim (an error of planning);
- A deviation from the (standard or accepted) process of care that may or may not cause harm to the patient.
In a paper published in the British Medical Journal, he goes on to say “the U.S. government and private sector spend a lot of money on heart disease, research and prevention. They also spend a lot of money on cancer research and prevention. It is time for the country to invest in medical quality and patient safety proportional to the mortality burdens it bears.”
I couldn’t agree with him more. Not only would acknowledgment of the depth of this problem by both the CDC and the health-care community be a gigantic step forward, it would also be a way to reduce costs associated with medical error. Medical errors cost taxpayers some $4.4 billion each year, according to the Department of Health and Human Services.
In the meantime, conservative politicians and insurance companies continue to spin their fabricated story that lawsuits against doctors and hospitals are the reason health-care costs rise. In fact, the civil justice system is the only mechanism in place to hold those accountable who make tragic, often deadly, mistakes.
Yet, as Makary points out, hospitals are more interested in attributing cause of death to a medical coding system designed to maximize billing for services. Hospitals are not interested in collecting accurate health statistics for the purpose of maximizing medical benefits to those in need of medical care. And one could easily state that their failure to admit to the death toll from medical error is because they would rather protect the bottom line than the patients they serve.
What does this mean? When a patient dies from cancer that went undiagnosed, the hospital will likely code it as cancer, when in fact the real cause of death may be medical error, and that patient may have been saved had the diagnosis been made in time. The result is that the same mistake is likely to happen over and over again with hospitals and health-care providers ignoring the underlying problem.
Currently, what the CDC identifies as the leading causes of death — heart disease (614,348 deaths per year), cancer (591,699) and chronic lower respiratory disease (147,101) — receive the bulk of the country’s research funding.
However, deaths due to mistakes made in hospitals surpass those related to respiratory disease by more than 100,000 deaths per year. Preventative measures to avoid these errors should be a primary focus in providing adequate health care.
Not all deaths due to medical error are caused by bad doctors, even good doctors who have a bad day. As Makary points out, “Developing consensus protocols that streamline the delivery of medicine and reduce variability can improve quality and lower costs in health care.”
Without doubt, hospital staff often require oversight, direction and safety nets when they vary from protocol, but none of this will happen unless those in the medical field themselves are willing to admit that mistakes are made.
Transparency will bring about better medicine, will start to rein in medical costs and will help patients undergoing a procedure in a hospital setting feel more safe.