The state of hospital care: worse today than during World War II

Humanist, Nov-Dec, 2004 by Ralph R. Reiland

A 1999 study by the Institute of Medicine, "To Err Is Human;' reports that 98,000 Americans die annually due to in-hospital medical errors. But according to a new study from Colorado-based Healthgrades Inc., a company that specializes in tracking patient outcomes and rewarding hospitals that it assesses as performing the best, the Institute of Medicine's estimate of preventable in-hospital deaths was short by half.

Researching data on nearly half of all hospital admissions from 2000 through 2002 in all fifty states and the District of Columbia, Healthgrades puts the number of annual deaths from medication errors and other in-hospital mistakes at 195,000. That equates to more than three times the total number of Americans who were killed in Vietnam in over a decade of war.

Healthgrades' report, "Patient Safety in American Hospitals," includes the deaths of low-risk patients from infections, as well as the mistakes made in attempts to rescue dying patients--both of which were missing from the Institute of Medicine report. "If the Centers for Disease Control and Preventions annual list of leading causes of death included medical errors," says Dr. Samantha Collier, vice president of medical affairs at Healthgrades, "it would show up as number six, ahead of deaths from diabetes, pneumonia, Alzheimer's disease, and renal disease."

And frighteningly, the figure 195,000 may be too low. "We're relying on data that hospitals submit," explains Collier, "and that might be a reason to under-document" the actual number of mistakes and resulting in-hospital deaths. "And we were only looking at in-hospital errors" says Collier, suggesting that medical errors made in outpatient settings would take the death toll to even higher levels.

Imagine how Americans would react as a nation if a U.S. passenger jet were crashing every day, or if terrorists were successful in bringing down a fully-loaded U.S. passenger plane that often. The 195,000 figure, explains Collier, is "the equivalent of 390 jumbo jets full of people dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S."

In total, the United States had 292,000 combat deaths during all of World War II. In U.S. hospitals, according to the Healthgrades report, that many people die due to medical errors every eighteen months.

In the face of this massive death toll, the Bush administration is seeking to put a $250,000 cap on recoveries for noneconomic damages due to medical errors, place time restraints on a patient's right to sue, limit the level of punitive damages that can be sought, and block lawsuits filed by patients seeking compensation from manufacturers for harm caused by medical devices or drugs.

On the point of preventing people from suing the manufacturers of defective medical products, the administration is arguing that patients lose the right to sue once a product has been approved by the Food and Drug Administration. "The FDA is not infallible," countered the New York Times in a recent editorial. "It seems poor policy to assume that once the agency has judged a product safe enough to use, the manufacturer should be insulated forever from lawsuits that could force improvements. Simple justice suggests that victims harmed by a product should be able to seek compensation."

Referring to "a culture of lawsuits in America, a litigation culture," George W. Bush stated in a speech earlier this year to a group of health care professionals in Little Rock, Arkansas, that the U.S. health care system "looks like a giant lottery" and "somehow, the trial lawyers always hold the winning ticket." In fact, what looks more like a lottery is people taking a chance entering a hospital and hoping to come out alive.

"Lawsuits don't heal patients--that's a fact;' said Bush in his Little Rock address. "We can have balance in our society when it comes to a good legal system and a good medical system. It's not that way today. The pendulum has swung way, way too far,"

Looking at the numbers, one has to wonder if the pendulum has swung far enough. Most studies show that only a very small percentage of negligently injured patients ever file a lawsuit. And with the equivalent of a World War II occurring in America's hospitals every eighteen months, one also has to ask why Bush is saying that the way to reduce bad performance is through a reduction in the penalties for bad performance.

Ralph R. Reiland is the B. Kenneth Simon professor of free enterprise at Robert Morris University and a columnist at the Pittsburgh Tribune-Review.