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Death Toll From Preventable Hospital Mistakes Ranges Between 210,000 and 440,000

| September 23, 2013

Too late. (Dan Cox)

Too late. (Dan Cox)

It seems that every time researchers estimate how often a medical mistake contributes to a hospital patient’s death, the numbers come out worse.

In 1999, the Institute of Medicine published the famous “To Err Is Human” report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media.

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In 2010, the Office of Inspector General for Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.

Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says.

That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second.

The new estimates were developed by John T. James, atoxicologist at NASA’s space center in Houston who runs an advocacy organization called Patient Safety America. James has also written a book about the death of his 19-year-old son after what James maintains was negligent hospital care.

Asked about the higher estimates, a spokesman for the American Hospital Association said the group has more confidence in the IOM’s estimate of 98,000 deaths. ProPublica asked three prominent patient safety researchers to review James’ study, however, and all said his methods and findings were credible.

What’s the right number? Nobody knows for sure. There’s never been an actual count of how many patients experience preventable harm. So we’re left with approximations, which are imperfect in part because of inaccuracies in medical records and the reluctance of some providers to report mistakes.

Patient safety experts say measuring the problem is nonetheless important because estimates bring awareness and research dollars to a major public health problem that persists despite decades of improvement efforts.

“We need to get a sense of the magnitude of this,” James said in an interview.

James based his estimates on the findings of four recent studies that identified preventable harm suffered by patients – known as “adverse events” in the medical vernacular – using use a screening method called the Global Trigger Tool, which guides reviewers through medical records, searching for signs of infection, injury or error. Medical records flagged during the initial screening are reviewed by a doctor, who determines the extent of the harm.

In the four studies, which examined records of more than 4,200 patients hospitalized between 2002 and 2008, researchers found serious adverse events in as many as 21 percent of cases reviewed and rates of lethal adverse events as high as 1.4 percent of cases.

By combining the findings and extrapolating across 34 million hospitalizations in 2007, James concluded that preventable errors contribute to the deaths of 210,000 hospital patients annually.

That is the baseline. The actual number more than doubles, James reasoned, because the trigger tool doesn’t catch errors in which treatment should have been provided but wasn’t, because it’s known that medical records are missing some evidence of harm, and because diagnostic errors aren’t captured.

An estimate of 440,000 deaths from care in hospitals “is roughly one-sixth of all deaths that occur in the United States each year,” James wrote in his study. He also cited other research that’s shown hospital reporting systems and peer-review capture only a fraction of patient harm or negligent care.

“Perhaps it is time for a national patient bill of rights for hospitalized patients,” James wrote. “All evidence points to the need for much more patient involvement in identifying harmful events and participating in rigorous follow-up investigations to identify root causes.”

Dr. Lucian Leape, a Harvard pediatrician who is referred to the “father of patient safety,”was on the committee that wrote the “To Err Is Human” report. He told ProPublica that he has confidence in the four studies and the estimate by James.

Members of the Institute of Medicine committee knew at the time that their estimate of medical errors was low, he said. “It was based on a rather crude method compared to what we do now,” Leape said. Plus, medicine has become much more complex in recent decades, which leads to more mistakes, he said.

Dr. David Classen, one of the leading developers of the Global Trigger Tool, said the James study is a sound use of the tool and a “great contribution.” He said it’s important to update the numbers from the “To Err Is Human” report because in addition to the obvious suffering, preventable harm leads to enormous financial costs.

Dr. Marty Makary, a surgeon at The Johns Hopkins Hospital whose book “Unaccountable” calls for greater transparency in health care, said the James estimate shows that eliminating medical errors must become a national priority. He said it’s also important to increase the awareness of the potential of unintended consequences when doctors perform procedure and tests. The risk of harm needs to be factored into conversations with patients, he said.

Leape, Classen and Makary all said it’s time to stop citing the 98,000 number.

Still, hospital association spokesman Akin Demehin said the group is sticking with the Institute of Medicine’s estimate. Demehin said the IOM figure is based on a larger sampling of medical charts and that there’s no consensus the Global Trigger Tool can be used to make a nationwide estimate. He said the tool is better suited for use in individual hospitals.

The AHA is not attempting to come up with its own estimate, Demehin said.

Dr. David Mayer, the vice president of quality and safety at Maryland-based MedStar Health, said people can make arguments about how many patient deaths are hastened by poor hospital care, but that’s not really the point. All the estimates, even on the low end, expose a crisis, he said.

“Way too many people are being harmed by unintentional medical error,” Mayer said, “and it needs to be corrected.”

–Marshall Allen, ProPublica

See how you can help ProPublica investigate patient safety and join our Facebook group on the topic.

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9 Responses for “Death Toll From Preventable Hospital Mistakes Ranges Between 210,000 and 440,000”

  1. one who knows says:

    I have saved my life several times from medically induced errors and blatant negligence in medical situations. Often times instead of apologizing to me ,they would act to demean me and try to paint me as a non compliant ‘ patient! A national grievance procedure needs to be uniform and made available in all medical settings. The way I managed to win was by writing notes and making corrections in my chart. The patient has a legal right to do so. Some very incompetent ‘medicalists’ as I call them, say they own the chart not the patient which is a huge problem that needs to be addressed.

  2. That's alarming! says:

    And they say marriage is for better or worst!!

    Seems hospitals should have that somewhere when you have to sign the dotted line!!!

  3. In a Heart Beat says:

    Great…Now I’m cancelling my scheduled surgical procedure.Heck, I don’t need a triple by-pass that bad !!!

  4. Florida Native says:

    Misdiagnosed drugs and hospital negligence are the two biggest killers of Americans after cancer and heart disease.

  5. Sherry Epley says:

    Thanks “One who knows”. . . we all need to assert ourselves into managing our own health care! Long gone are the days of placing one’s life in the hands of a good GP who really knows your medical situation personally. Remember, the current “fee for service” model, used in the USA, motivates doctors and hospitals to get rich by “treating” you, NOT “curing” you!

  6. snapperhead says:

    We pay the most for medical anywhere in the world and this is the best we can do? Keep waving the big foam #1 finger while the rest of the world laughs at us.

  7. Sherry Epley says:

    Most other civilized “first world” countries have excellent health care for every single citizen. That health care system has doctors who earn very good “salaries”. Their doctors cannot make more money by ordering un-necessary tests, often conflicting drugs, or prescribing any old treatment. . . just because your insurance will pay for it. In those other countries, pharmaceuticals are carefully prescribed and costs often less than 30% of what we pay for them here. . . for the “exact” same prescription, in the exact same package. Yes, there are times when citizens of other countries have to wait longer than we do for treatment. Each system has its weaknesses, but our’s could and should be completely over hauled. . . we all deserve much better health care!

  8. Genie says:

    Just wait a few days until the government is in charge of it. You ain’t seen nothing yet!

    Did most of you people miss the wars with the HMOs in the 80s? Check the death rate on that one.

  9. Geezer says:

    Worry not, Floridian doctors! Go ahead and amputate the wrong limb,
    do brain surgery for hangnails-we have tort reform!
    Are you a loser doctor from parts unknown? Been sued for malpractice or misconduct?

    We have tort reform!!!! Limit your liability, throw caution to the wind.
    Practice in Florida where the average malpractice case settles for $8,000.

    Come on down!

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