Hearst Newspapers has written an extensive article about the prevalence of medical mistakes and how they are the #1 cause of accident deaths in America. You can read the story on the Seattle Post Intellingencer’s web site.
The article states that 98,000 people die every year from medical mistakes. This is more than the number of people killed in the 9/11 terrorist attacks on the World Trade Center. Also, more than 99,000 patients succumb to hospital-acquired infections, and most of these deaths are clearly preventable.
Hearst reports that there is a prevalent “Veil of secrecy” among hospitals when it comes to reporting the mistakes and the circumstances surrounding the preventable deaths of patients. It appears that among states that are participating in healthcare safety campaigns, just 20% of the hospitals in these areas are participating. You would think that the medical mistake-death statistics would provide some incentive for most if not all of these hospitals to participate in a campaign designed to reduce mistakes and prevent unnecessary mistaks.
The case of Michael Blankenship
A 15-year old boy sought dental treatment at the dental clinic of a well-known and highly respected hospital that specializes in treating children. Michael Blankenship had autism, but he received regular treatment at this hospital.
When Michael was discharged the hospital’s chief pediatric dentist made a fatal mistake. She prescribed a Fentanyl “pain patch” because Michael’s mother informed the hospital that her son could not, or would not, ingest oral medication due to his autism. This fact had also been recorded in Michael’s chart years earlier.
The dentist prescribed Fentanyl, a very potent narcotic that is designed to treat chronic pain patients. According to the drug’s warning label, Fentanyl should never be prescribed to an opiate-naive patient like a young 15-year-old boy who had no history of using narcotic medication over a long period of time. And the drug should never be used to treat acute pain, or pain following surgery on an as needed basis.
But Michael’s dentist prescribed the highest dose available, and instructed mom to apply the patch later that evening. Even the hospital’s head pharmacist failed to detect the mistake, and also told mom again that the prescription was accurate and the dose safe.
Michael’s mother did as instructed. The next morning Michael was found dead in his room. The Fentanyl patch delivered so much of the narcotic to Michael’s system that it caused respiratory arrest and this caused his death. As you can imagine, Michael’s mother is devastated.
The whole family is now suffering over what was a very preventable mistake. It never should have happened had there been appropriate safeguards in place by the hospital.
A dentist decided to prescribe a lethal dose of a narcotic that never should have been prescribed in the first place. The dentist merely had to consult the Physician Desk Reference (a reference book that most physicians have in their office) to discover that there were at least 5 warning signs in Michael’s case which would have informed any reasonably competent doctor that the drug should not be used at all.
What can we do as a society to prevent medical mistakes?
The first order of business is to communicate how prevalent mistakes are in our hospitals today. Yet the doctors and the state medical association consistently spout propaganda to deflect attention of these mind-numbing statistics by arguing that doctors should be immune from mistakes so lawyers can’t sue and obtain million dollar jury verdicts.
I’ve never seen a multi-million dollar verdict against a doctor or hospital that didn’t involve a horrible injury or the needless death of a patient. When negligent physicians and hospitals maim and kill, they cause a substantial amount of suffering, pain, and usually an extensive neeed for future medical care.
Just a few years ago the Washington State Medical Association waged an aggressive campaign to limit damages recoverable in medical negligence cases. The doctors argued that physicians were having to leave the state in record numbers because of outrageous insurance premiums. The measure was soundly defeated by Washington citizens. But word is that the WSMA is planning its next attack in the coming years.
The article by Hearst has again raised awareness of a problem that no one, not the local and national governments combined, has addressed through public attention and intelligent disclosure laws. If hospitals were forced to report all incidences of negligence, then I believe more would be done to avoid the mistakes in the first place. But the healthcare industry has continued to fight against reasonable reporting and disclosure laws.