www.digitaljournal.com/article

Medical malpractice brings more deaths annually than the total number of Army soldiers who lost their lives during Vietnam. Many factors seem to provide the perfect medium for deadly errors; errors that rarely find justice.
No matter how you slice it, the medical malpractice pie never ends up evenly serving those who caused problems for their patients or providing substantial justice for the injured or dead. Statistics have shown that in the United States alone, there are around 98,000 reported cases of malpractice death annually as revealed by the Institute of Medicine’s (IOM) 1999 report entitled To Err is Human. That is close to the same number of Army soldiers alone who lost their life in Vietnam during the entire 16-year conflict or almost 20 times the number of American soldiers killed in Iraq since 2003.

It doesn't take a mathematician or statistician to understand that medical malpractice, or simply defined as a mistake, is a serious problem.

The reasons cited for mistakes are enumerable, from patient failure to disclose pre-existing conditions, arrogance on the physician’s behalf to simple documentation mistakes or adverse drug effects. However, those mistakes continue to kill many innocent men, women and children in a peacetime effort on our own soil without a single handgun or automatic weapon being used. Although around half of the overall mistakes were made by surgeons, another one-third were made by everyday medical practitioners whose only weapon was a high-end degree and a clipboard of sorts. It is its own epidemic, one with a treatable outcome and yet continues to be of grave concern.

Humans make errors and physicians are humans bound by overstuffed patient waiting rooms and rigid insurance guidelines, all of which can serve as a field for errors. And although a few turn out to be willfully negligent or downright dangerous, individual practice or clinic processes and hospital procedures often provide the perfect breeding ground for accidents. It is a carefully interwoven network of information that can have fatal results if not executed to the "T."

So where do these mistakes occur?

Typically, a medical error is made in one of three ways when it comes to patients. False positives, or handing out a diagnosis when a disease is not present can create their own brand of misery not only for a patient, but also for a system that is already costly and overworked. A false negative, or failure to properly diagnose when a patient seeks medical attention, can have devastating consequences that need not be explained in detail. And finally, not making any decision or calling a diagnosis “inconclusive” could lead a patient on a costly and deadly goose chase in search of an explanation of symptoms. Taking those particular mistakes into account, a quality review document in the IOM’s report explains that mistakes happen in one of four primary areas, most all of which are human based:

Diagnostic
Error or delay in diagnosis
Failure to employ indicated tests
Use of outmoded tests or therapy
Failure to act on results of monitoring or testing
Treatment
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatment or in responding to an abnormal test Inappropriate (not indicated) care
Preventive
Failure to provide prophylactic treatment
Inadequate monitoring or follow-up of treatment
Other
Failure of communication
Equipment failure
Other system failure


With the system as a whole showing responsibility for making these mistakes as much as individual negligence, it is necessary to not only hold accountable the offending provider but to also look at these overall systems that “lead people to make mistakes or fail to prevent them.”

One example of a failed system would be drug labeling in hospitals that cause confusion and can lead to fatalities during hectic or overworked times, as was the case of Dennis Quaid’s newborn twins that were given lethal doses, or “vials containing 10,000 units per millilitre of heparin instead of vials with a concentration of 10 units per milliliter.” A few months later, a hospital in Corpus Christi, Texas dosed as many as 17 newborns with lethal adult doses of the same drug. That was not before three infants died in an Indiana hospital from the same dosing mistake of six newborns in 2006. Taken as a whole, these three media-sensationalized adverse events or mistakes show the layperson that there is a problem. Come to find out, the heparin vials were coloured only shades of blue apart so lighting or a plethora of factors could have caused one to grab the wrong dose. The problem isn't just heparin:

medical researchers reported in the journal Pediatrics that about one in 15 hospitalized children is harmed by a drug mix-up.
That's 7 percent of all hospitalized children, or about 540,000



Unfortunately, some mistakes are not quite this obvious. For some patients who are handed the expertise of either a dismissal of symptoms or an inconclusive diagnosis without follow up or finding of cause, the end result can parallel that of the heparin mistake.

For instance, patients who go through general blood tests often don’t realize that those tests don’t necessarily show markers for certain health problems. Auto-immune problems may require an entirely separate blood workup and a visit to a specialist in order to rule out or confirm certain diseases and disorders. What is worse, some physicians may minimize a “weakly positive” result on blood test, claiming that its nothing to worry about without further ruling out that tad bit of self-proclaimed “logic.” If an ANA, or antinuclear antibody test used in the detection of Lupus, shows a weakly positive result, there is a small percentage of the healthy population who will show up with this result. However, what about the other 95 percent? According to a recent conversation with a specialist in the area of certain auto-immune disorders, ANAs are found in all of our bodies but its the number ratio and pattern that help in the diagnosis of certain problems. In fact, ANAs can be found in:

patients with infections, cancer, lung diseases, gastrointestinal diseases, hormonal diseases, blood diseases, skin diseases, and in elderly people or people with a family history of rheumatic disease


A "weakly positive" result does not indicate a definitive diagnosis, nor does it dismiss one either.

And if the deadly mistakes weren’t enough, consider the secondary or tertiary outcomes that extend beyond the mishap or costs associated with increased healthcare and rising premiums. Mistakes, especially when they create injury or prolonged health issues, can cause a severe decline in the health web itself. Patients no longer trust physicians; overall satisfaction diminishes; psychological well being crumbles, possibly leading to further medications and health issues; physicians suffer a decrease in patients impacting the practice; overall community wellness deteriorates. Mistakes impact everyone involved from the patient, their family and loved ones, to the treating physician and his or her network, down to the billing office and the insurance, all of which as an impact on the overall operations of society. Of course, the monetary costs that run upwards of $30 million each year for the mistakes made seem to get significant play as do the effects those costs have on lives, jobs and families.

Since an “accurate” medical diagnosis is the core of all other healthcare decisions surrounding an individual, it is fairly safe to say that even the slightest error in judgment could result in a downpour of negative problems not only for the patient, but for the family and the provider as well. Blunt force trauma to the head that is overlooked could create major financial burdens down the road as symptoms continue to worsen. Sure, the initial injury might seem small or the symptoms associated might mimic that of a panic attack and in a crowded emergency room, it would be easy for a new physician to dismiss a patient who presents with a certain grouping of symptoms as a depressed or anxious individual. However, given the environment, many patients would be temporarily anxious while waiting in the E.R. listening to near death experiences, homeless vagrants high on cocaine suffering a heart attack and trying to get a meal in the process or police officers guarding the rooms of criminals who just killed innocent bystanders in a drive by.

Following the reality of such a high rate of misdiagnosis and mistakes made, many uninvolved individuals use the "S" word to explain potential recourse. "You should sue" or "I would sue their pants off" are really just people blowing off hot air, when in reality, less than 1 in every 10 misdiagnosis cases actually go legal.

Further research into medical misdiagnosis and getting compensated for the pain and suffering caused by a medical mistake also shows some interesting trends as far as recovery. With only around 8 percent of those who suffer injury from a medical error filing suit, the number of claims each year is upwards of around 20,000 in the United States. Of those claims, it is believed that just under one-third actually end in a payout and 95 percent of those were settled out of court. A study of a handful of states showed that of the claims paid out, the higher claims paid were typically a result of court litigation, around two and a half times more than if settled.

In the case of the heparin babies who died in Indiana, the parents of two of those killed from the lethal mistake filed suit as reported in September of 2008. The parents of the other infant who died were said to plan on filing suit.

In summary, 98,000 mistakes are made each year that result in death but only 20,000 claims are filed each year for both death cases and injury cases. And extrapolating from the claims study (linked above), less than 33 percent of those cases actually result in a payout. Those who did payout, over 95 percent settled before going to trial which resulted in a lesser payout. And if a rapid result is what is being sought, well, stats show that the average time to file suit is over a year after the injury and payout comes over two and a half years after the litigation begins, with an overall process of about 4 years. Its a sad state of operations that seems to have a higher rate of incidence in certain Urban counties where the Bureau of Justice shows that half of the malpractice lawsuits occur in the "75 largest counties in the country" and from a specific population of the medical community, as over half of all malpractice cases are linked to 5 percent of doctors.

Although advice is plenty, some sound advice may be to get copies of all medical tests, know your results and ranges, ask questions and don't be afraid to seek another's opinion. Don't trust just because you are not a doctor but rather, use that as a tool to question and ensure circles are completed that involve your health, your family, your life. If your family physician is offended, then he or she wasn't looking out for your well being or your family after all.

A 98,000 annual death rate caused by medical mistakes is enough to warrant a raised eyebrow, don't you think?

Information and commentary on the Harvard Medical Practice Study, a benchmarking and reproducible account of medical mistakes.