Costly Health Care Mistakes

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Most of us feel pretty vulnerable when we enter a hospital. We’re probably sick or injured, unfamiliar with the lingo being bandied about by the lab coated crowd, and have little means to comparison shop for therapists or knowledgably evaluate proposed treatments. Here’s another reason to feel vulnerable: medical malpractice that many of us won’t recognize as such — or be able to prove.

A new study by William E. Encinosa and Fred J. Hellinger of the federal Agency for Healthcare Research and Quality calculates that medical errors associated with surgeries in the <!—->United States cost nearly $1.5 billion a year. True, insurance companies typically pick up the tab — initially. Eventually, we all pay through higher insurance premiums. And, of course, there’s seldom compensation, let alone consolation, for the pain and suffering that these errors may have triggered.

My husband can attest to this. He had back problems for which he consulted plenty of surgeons and others. In the end, he decided to opt for a surgical solution, looked up reviews of local doctors on the web, compared proposed surgical options, and then nearly went crazy second-guessing his choices.

Shortly after the surgery, which the doctor said went smoothly and without complications, my husband realized he had become chronically short of breath. It didn’t get better as the months wore on. Eventually, he saw a pulmonologist who diagnosed him as having lost the use of half of his diaphragm. Was his surgery to blame? The timing certainly suggested that. So did the fact that the doctor entered his spine adjacent to where nerves controlling the diaphragm reside. And then there’s a question of whether the doc might have been jet lagged. He had just returned two days or so before the surgery from a long trip to Africa.

The doctor? He argued that nothing he did during the surgery could possibly have caused my husband’s continuing shortness of breath.

One of husband’s doctor cousins — a pulmonologist himself — pointed out during a subsequent visit to town that it that was a tough call to diagnose the source of a diaphragm’s partial paralysis. The good news, he offered: The problem usually self-corrects or the body adapts. But three years later, my husband still has trouble ascending steep stairs without becoming winded. That’s a big change for someone who had been quite athletic. Indeed, it has curtailed many of his former athletic pursuits — itself an unhealthy side effect.

Of course, many people suffer far worse. Ten percent of people who died within three months of surgery succumbed to effects of a preventable error, according to Encinosa and Hellinger’s paper in the July 28 Health Services Research. Ouch!

And as in my husband’s case, the problems may not emerge until after a patient leaves the hospital. Indeed, 20 percent of medical costs incurred by medical malpractice (my term, not the authors’) occurred once a patient had been discharged from the hospital.

There’s no way to eliminate mistakes. People aren’t perfect, and doctors are people. In fact, the Institute of Medicine titled its 2000 report on health care quality “To Err Is Human.” That report estimated that medical errors were claiming up to 98,000 lives each year and costing the nation between $17 billion and $29 billion annually.

Tackling the topic of building a safer health care system, the IOM’s report challenged that system to cut its medical-error rates by 50 percent over the next five years. Actual error rates — termed “adverse events” — in fact dropped by only 1 percent during that period, Encinosa and Hellinger note.

Their new study looked at data from 161,000 hospital admissions for surgery between early 2001 and late 2002. Its analysis focused on 14 potentially preventable errors, such as complications associated with anesthesia, accidental punctures or cuts, leaving a foreign body in the patient, treatment-associated infections, hemorrhage or wound-healing problems, reactions to blood transfusions, and events that should have been avoided by good nursing care.

In all, more than 4,000 of the admitted patients — 2.6 percent — suffered from at least one of the potentially preventable medical errors. Of these patients, 5.6 percent experienced problems associated with more than one such error. Patients affected by medical malpractice had a 6.3 chance of dying over the 90 days following surgery versus just 0.6 percent if no known errors occurred.

Potentially more telling: Surgeries that had involved errors typically cost almost $67,000 on average, compared to just $18,000 for those with no known errors. Hospital stays also tended to be longer for patients affected by malpractice: 21.5 days on average, versus just 5.1 for ostensibly errorfree care.

Hospitals have a vested self interest in curbing medical errors, Encinosa and Hellinger point out, since Medicare will cease reimbursing hospitals for the extra costs of eight classes of medical errors beginning in October.

As big as the $1.5 billion annual price tag for surgical errors is, the new paper’s tally accounts for only 14 categories of them. “Thus,” the authors acknowledge, “there may be many more preventable safety events (as well as near misses) that occurred but that were not included in our analyses, such as medication errors. In fact, we do not consider drug-related errors, diagnostic errors, and errors in choice of therapy.”

What an argument for preventive medicine. Downed any whole grains or today’s recommended five servings of fruits and veggies yet?