Hospital Errors’ High Cost
The National Academy of Sciences released a report last week detailing how medical mistakes--from drug mix-ups during surgery to overdoses of chemotherapy--injure as many as 1 million Americans each year and kill from 44,000 to 98,000. That makes medical errors a leading cause of preventable death, killing more people each year than breast cancer or motor vehicle accidents.
Medical researchers have long known that the United States’ $1.5-trillion health care industry lags other businesses in implementing quality controls to ensure basic safety. The NAS report is the best illustration to date of how simple controls like computerized double checks of lab tests could reduce the number of deaths from medical mistakes by half within five years and cut the $17 billion to $29 billion lost annually in income, disability and added health care costs because of preventable medical errors. The report calls for the distribution of “best practice” medical standards so hospitals can emulate the success of hospitals like California’s Loma Linda University Medical Center, which can do safe and effective coronary artery bypass surgery for an average of $8,000 per case, compared to the national average of $18,000.
The report’s dramatic warnings, however, are in serious danger of being brushed aside by hospitals, doctors and others less than eager to see medical errors exposed. Attempts to bring better quality control to health care have been beaten back in the past; in the early 1980s, officials of the federal Department of Health and Human Services devised report cards to rate hospitals on how well they were guarding against hospital-acquired infections, which were rising precipitously at the time. After fierce lobbying in Washington by hospitals, the plan was scrapped.
The national academy recommends that Congress create a Center for Patient Safety that would “develop knowledge and understanding of errors in health care by developing a research agenda.” Rather than waiting for Congress to study whether to create a center to study safety, President Clinton should ask the Department of Health and Human Services to require hospitals to report the most serious medical errors that occur under their care or risk losing their federal Medicare and Medicaid funds. Washington has huge leverage; nearly half of all the money that hospitals get each year is federal money. Hospitals should also comply with the best medical practice standards that the nonpartisan National Coalition on Health Care plans to release next spring. The national Agency for Health Care Policy should be beefed up to administer and monitor reforms.
The states can help improve health care quality now by requiring hospitals, pending a family’s approval, to conduct autopsies on patients who die of uncertain causes. The proportion of autopsies performed in the United States each year has slumped from 42% of hospital deaths in 1965 to less than 5%, according to a study recently published in the Archives of Pathology and Laboratory Medicine. In part, that’s because physicians rarely request an autopsy for fear it might uncover a misdiagnosis and trigger a malpractice claim.
Some medical mistakes may be inevitable, but there’s no excuse for failing to learn from them. As the NAS report put it, “To err is human, but errors can be prevented.”
