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Patients Killed by Hospital Errors

Conservative Estimates: 5-25 Deaths
Weekly in Massachusetts

By John Breneman
February 2001

When Boston Globe health columnist Betsy Lehman was killed by a chemotherapy overdose at the world-renowned Dana Farber Cancer Institute in the early 1990s, it was portrayed as a rare occurrence. It was an embarrassing blow to the state’s reputation for quality health care.

The establishment has attempted to turn that lemon into lemonade by naming a crusade to reduce medical errors after Lehman. But medical errors are hardly as rare as the Massachusetts health care establishment would have you believe.

230-461 Injuries Per Week
If the national figures on medical mistakes are extrapolated for Massachusetts, this would mean that 230-461 hospital patients are seriously injured by mistakes each week. Because Massachusetts has a higher than average concentration of hospitals, the rates could be higher. However, the state Department of Public Health statistics show on average that there were only 9 medical mistakes per week during 1999 and an anticipated 11 per week in 2000. The number nationwide is one million patients per year injured by mistakes.

If the 4 percent medical error rate found in New York hospitals for 1997 is applied to Massachusetts hospitals, there were 587 medical errors each week in Bay State hospitals that year.

If the number of people who are killed are extrapolated from national figures, this would show that somewhere between 24 and 50 people are killed each week by medical errors in Bay State hospitals. The DPH refuses to say how many deaths result from medical error. The nationwide number is 44,000 to 98,000 deaths per year.

The national numbers come from a respected report on medical errors by the Institute of Medicine in Boston. Its report uses the extrapolation method based on medical records in other states, including New York. Even if we use their lower number which shows 44,000 annual deaths, this would make medical errors one of the leading causes of death in America behind illnesses like cancer, heart disease, diabetes, etc. The American College of Physicians decided not to challenge the report, even though it believed the medical mistake death toll was lower, somewhere between 10,000 to 20,000 nationally. But even if the lower of those figures is extrapolated for Massachusetts, it translates to five medical error deaths each week.

The Massachusetts Department of Public Health operates the oldest death registry in the country, but unlike almost every other type of death, DPH does not keep figures on the medical mistakes death rate. State public health officials say the national figures extrapolated for the Bay State are too high. But they claim they don’t know what the real figure is. If the figure of 24–50 deaths per week is correct, this would make medical errors one of the leading causes of death here and a grade A public health crisis. But with the state refusing public accountability on the issue, the true rate remains a mystery.

One of the experts who compiled the national figures, Dr. Lucian Leape of the Harvard School of Public Health, would answer only a few questions. But he said he stands by the figures. “It’s just an estimate, but it’s in the correct ballpark,” he said. “It’s based on good information.” In his reluctance to comment on the problem of medical errors, Dr. Leape was typical of the Boston medical establishment studying the problem. One of the difficulties in understanding the true picture on medical mistakes is what one observer characterized as a “code of silence” among the hospital and academic communities.

On one hand, the Department of Public Health claims it has no idea how many medical error deaths there are in Massachusetts hospitals because it relies on the hospitals to govern themselves. Hospitals are obligated by law to report any serious incident, but it is well known in the industry that there are many ways an “adverse situation” can be written up in a medical report. On the other hand, DPH claims it is working very hard to reduce medical errors because “even one is too many.” But how can it solve a problem without knowing the extent of it? There is no central registry of medical error deaths in Massachusetts.

Nancy Ridley, the DPH assistant commissioner, oversees medical errors. “We really don’t care what the number is – it’s too high,” she said. “We don’t care if it is five or ten, any [medical error] death is unacceptable.”

Dirty Little Secret
“The dirty little secret of medicine is there’s a lot of errors,” said Arthur Levin, a New York health care consumer and advocate. He claims hospitals never took medical errors seriously until the problem grew to proportions where it was difficult to hide anymore. Levin believes the solution to the problem begins with “honest reporting” by state and hospital officials.

“For most hospital administrators, coming clean with medical mistakes is almost unheard of,” said Martha Slade, attorney for the Veterans Hospital at Lexington, Kentucky, which began a revolutionary procedure in hospitals by admitting to patients that a medical error had occurred – including informing the families of patients who had died. The family of one woman who died at the Lexington V.A. Hospital said they were shocked when they were told their mother died from a medical error. “If they’d tried to stonewall, I would have wanted their head on a platter,” said Denise Harberson, the daughter. “But when they admitted they made a mistake, it defused the situation.” The family made a reasonable settlement with the hospital.

Legal damages went down at the Lexington hospital after it adopted the “come clean” approach to medical mistakes. Patients could understand human error, but they were offended when hospitals tried to cover up or insult their intelligence. It is this element of arrogance and obfuscation from hospitals and doctors that often provokes lawsuits.

Massachusetts is routinely called the “mecca” of American medicine by state health care leaders and the state media. One of the many ironies of the medical error epidemic is the fact that virtually all the patients who die of medical mistakes have health insurance. Massachusetts, in its zealous quest to get health insurance for every citizen of the state, pretends that health care is equivalent to eternal salvation. The subtext of the message is that if you have health care, you will be healed and never die. The truth is 26,000 people die in Massachusetts hospitals every year – under the umbrella of some form of health insurance. How many of them die from medical errors will remain a question until Massachusetts legislators demand accountability from state officials.