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Johns Hopkins ‘medical error’ study delivers false conclusion

The authors of a paper from Johns Hopkins University School of Medicine wrote: “If medical error was a disease, it would rank as the third leading cause of death in the U.S.” The lay press covered the article extensively.

Hospitals and doctors report cases of death by medical error to medical examiners and coroners. I’ve investigated several doozies: One patient bled to death during an endoscopic procedure when a misdirected instrument punctured his aorta. More than 20 people, two of whom died, contracted hepatitis because biopsy instruments weren’t adequately sterilized between cases.

But I haven’t seen errors in numbers that come even close to the third leading cause of death. There’s something wrong with this paper’s conclusions.

I doubt that thousands of error-related deaths are being covered up. I’ve seen only one such case – a fatal overdose administered in the operating room. The hospital CEO found out after a couple of days. His first call was to my office; his second to the Joint Commission on Accreditation of Healthcare Organizations. He probably saved his hospital from the loss of its accreditation because a lot of people knew, and somebody surely would have squealed eventually.

One problem with the Johns Hopkins paper is that the authors looked at years-old studies that documented a relatively small number of error-related deaths in a few institutions, extrapolated and came up with a huge number of deaths nationwide.

In his 1883 memoir, Life on the Mississippi, Mark Twain ridiculed extrapolation: “In ... 176 years, the Lower Mississippi has shortened itself ... an average of a trifle over one mile and a third per year. Therefore ... any person can see that 742 years from now the Lower Mississippi will be only a mile and three-quarters long, and Cairo and New Orleans will have joined their streets together ... There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment of fact.”

I suspect a bigger problem than extrapolation is the definition of “medical error.” The paper says: “Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome.” The italics are mine.

It would be nice if all actions achieved their intended outcomes, but they don’t. For many people, death without medical intervention is likely or certain. Interventions that might help aren’t guaranteed to do so. If you operate on enough people’s brains, some will die. If you insert catheters into enough people’s coronary arteries, some will die. If you give appropriate amounts of potentially dangerous but also potentially life-saving drugs to enough people, some will die.

Bad outcomes like these occur when every person and every system does their job as best they can. I don’t think such deaths qualify as errors.

When bad outcomes are reported (and it’s likely a good many aren’t), medical examiners typically consider them to be complications of the diseases being treated and call them “natural.”

I agree with the authors that a better job of reporting and measuring true medical errors – and bad outcomes – would increase the likelihood of “mitigating (their) frequency, visibility and consequences.” Changes in reporting requirements and modifications to death certificates could help further that goal.

But my experience doesn’t support the contention that more people die from “medical error” than from emphysema, strokes or accidents. I think the paper’s conclusion is inaccurate, inflammatory and unhelpful.

Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003 to 2012. She now lives in Florida and Maryland. Email her at chuser@durangoherald.com.

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