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Medical Malpractice News
Preventable Errors Still Causing Deaths Five Years Later
Researcher finds that medical errors are still high five years
after Institute of Medicine's landmark report showing as many as 98,000
deaths are due to preventable errors each year.
Five years after the Institute of Medicine (IOM) released its seminal
report, To Err is Human, which concluded
up to 98,000 Americans died each year from medical errors, the medical
community has made little progress in reducing the risk to patients
who use the healthcare system. An article by Lucian Leape, Adjunct
Professor of Health Policy at the Harvard School of Public Health,
in the Journal of the American Medical Association concedes that "the
proven measured fruits of the IOM report so far are few."
Shift in the Focus of the Premium Crisis
One year after the IOM released its report, doctors began to report
a surge in the cost of medical malpractice premiums. To many observers,
this perceived crisis shifted the medical community's attention from
saving patients to saving money. Leape believes that this crisis "has
deflected interest of lawmakers from error prevention to an effort
to put caps on malpractice settlements." The focus is now on
how to minimize malpractice payouts rather than correct the errors
that cause malpractice lawsuits in the first place.
Culture of Medicine is to Blame for Lack of Improvement
Leape outlines ways in which the structure of the healthcare system
impedes the pathway to reduced medical error. They include:
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Physicians reluctant to admit error—Physicians fear that
admitting error is an admission of guilt and an easy avenue to
a malpractice lawsuit. Thus, they are unwilling to embrace a new
system that they feel would increase liability.
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Lack of leadership at the hospital and health plan level—Efforts
to implement safety measures have been met with stiff resistance
from the boards of hospitals and health plans.
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An insurance system that rewards error—The current reimbursement
system actually rewards error by allowing physicians to bill for
procedures necessitated by injuries they inflicted on patients
through their mistakes.
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The complexity of the healthcare system—With over 50 medical
specialties and rising numbers of health-related professions,
the risk that there will be a failure of communication within
the system is increasing.
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Perceived threat to authority and autonomy—Incorporating
a system of safety measures requires physicians to relinquish
independent judgment and authority for a system that requires
interaction with others.
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Lack of measures of improvement—There are few systems that
comprehensively measure improvements, making it difficult to gauge
how much progress has been made.
195,000 Preventable Deaths Every Year
In its report, the IOM estimated that 98,000 people die each year
due to preventable medical errors, at a cost of $29 billion. Subsequent
studies claim the number may be even higher. In 2004, HealthGrades
released a report which found that the IOM severely underestimated
the number of deaths caused by medical errors each year. Its data
suggest that the true number was closer to 195,000 deaths annually,
nearly twice the number reported by the IOM.
Funds for Safety Research Diverted
In 2001, in response to the IOM report, the federal government earmarked
$50 million annually for patient safety research to be administered
by the Agency for Healthcare Research and Quality (AHRQ). However,
by 2004, most of this money had been shifted to fund studies of information
technology. This suggests that the agencies in charge of developing
and administering safety improvements do not understand the core of
the problem.
Known Improvements are Not Implemented
The National Quality Forum (NQF), which has taken an active role in
developing quality of care and standard of reporting measures, developed
a set of practices to improve patient safety. By 2003, the Joint Commission
on Accreditation of Healthcare Organizations (JCAHO) had mandated
that hospitals implement only 11 of the 30 safety practices ready
for use, or only slightly more than one-third of ready improvements.
Footnotes
- Leape, Lucian L. & Berwick, Donald M., "Five
Years after To Err is Human: What Have We Learned?" Journal
of the American Medical Association (JAMA), 2005.
- Leape & Berwick
- Leape & Berwick
- HealthGrades
Quality Study: Patient Safety in American Hospitals, HealthGrades,
July 2004.
- Leape & Berwick
- Leape & Berwick
June 2005
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