British Medical Journal - Medical errors kill almost 100000 Americans a year

[Guest guest]

British Medical Journal

 

1999;319:1519 ( 11 December )

 

Medical errors kill almost 100000 Americans a year

 

Fred Charatan , Florida

 

An expert panel from the Institute of Medicine, part of the National Academy of

Sciences, found that medical errors kill from 44000 to 98000 Americans each

year.

 

The chairman of the 19 member panel, William C Robinson, president of the W K

Kellogg Foundation in Battle Creek, Michigan, a private, grant making body,

said, " These stunningly high rates of medical errors resulting in deaths,

permanent disability, and unnecessary suffering are simply unacceptable in a

medical system that promises first to `do no harm.' "

 

The panel's report, which was released in November, recommended that a new

federal centre for patient safety should be set up in the Public Health Service

and should have a budget of about $100m (£63m) a year, which is equivalent to

just over 1%of the $8.8bn a year in costs estimated to be attributable to

preventable medical injuries.

 

Healthcare providers would be required to inform state governments of any

medical errors leading to serious harm; currently only 20 states have such

reporting requirements. Doctors and nurses would also be re-examined

periodically by state licensing boards to evaluate their competence and their

knowledge of safety practices.

 

The report condemned the current fragmented system of handling medical mistakes,

which relies on a combination of peer review, federal and state regulation,

malpractice lawsuits, and evaluations by private accreditation bodies.

 

Nancy Dickey, a past president of the American Medical Association, which

supports the panel's recommendations, was concerned about mandatory reporting

and public disclosure of serious medical errors.

 

Dr Dickey said: " On the surface it appears to be a relatively straightforward

step but actually it engenders all sorts of problems with confidentiality and

liability. Doctors find themselves in a real bind. "

 

However, the panel said that a crucial strategy in reducing errors was to shift

the focus " from blaming individuals for past errors to a focus on preventing

future errors by designing safety in the system. "

 

Apart from citing surgical horror stories like that of Willie King, who had part

of the wrong leg amputated at University Community Hospital in Tampa, Florida,

in 1995 the panel found that more than 7000 Americans died each year as a result

of " medication errors, " which included the prescribing or dispensing of the

wrong drugs. For example, the panel said, pharmacists often had difficulty

deciphering the illegible handwriting of doctors who prescribe drugs (4

December, p 1456).

 

Karen M Ignagni, president of the American Association of Health Plans, which

represents health maintenance organisations, said, " Health plans will rise to

this challenge and will work with doctors, hospitals, and public officials to

address these issues. "

 

In an article in last week's New York Sunday Times, entitled " Do No Harm

Breaking Down Medicine's Culture of Silence, " Dr Lucian Leape, a professor of

health policy at Harvard, and a member of the expert Institute of Medicine

panel, discussed the problems surrounding the task of addressing medical

mistakes. He said: " Physicians are taught that it's your job not to make a

mistake. It's like a sin. The whole concept of error as sin, as a moral failing,

is deeply ingrained in medicine, and it is very destructive. It means people

cannot talk about it, because it is too painful. "

 

As the BMJ went to press, President Clinton announced that he accepted the

institute's recommendations and would instruct federal agencies providing or

financing health care to adopt all feasible techniques for reducing medical

errors.

 

The BMJ will be publishing a theme issue on error in medicine on 18 March and

holding a one day conference on 21 March.

 

 

 

 

Docvite wrote:Journal American Medical Association July 26,

2000;284(4):483-5