It looked like a crime scene.
As I walked down the hospital corridor to visit an ailing friend, I was struck by the number of rooms with closed doors covered in yellow ‘caution – keep out’ tape. These were rooms housing a patient with a deadly and highly contagious hospital-acquired infection, like MRSA (Methicillin Resistant Staphlococcus Aureous) or C Diff (C Difficile). Both are caused by easily corrected hospital practices that endanger patients, including a lack of hand washing, contaminated instruments, and unsanitary procedures.
It was a crime scene.
Infections are among the most prevalent and preventable sources of harm to hospital patients, but they are far from alone in the danger they pose.
The Institute of Medicine (IOM) first brought widespread attention to the simmering problem of an indifferent and deadly health care system in 1999 with their gently-titled report: To Err is Human: Building a Safer Health System. Extrapolating from the handy Medicare database, they estimated 98,000 deaths a year due to infections, medication errors, unnecessary surgeries and other types of hospital and doctor malfeasance. The analysis was based on data from 1984 and is now nearly 30 years old.
Although the authors of the IOM report clearly hoped that the medical-pharmaceutical establishment would use the facts to become less deadly, that has not happened.
Updated information suggests that the actual number of people killed in hospitals might be as high as 440,000 a year, which would make in-hospital care the third leading cause of death in the U.S.
These numbers reflect only deaths among the hospitalized. They don’t include those who are damaged in the hospital but die elsewhere. Nor do they include those who survive their hospital stay but live with injury or disability, which is estimated to be three times the number of deaths.
Further, the estimate fails to reflect the massive amount of under-reporting by hospitals and physicians. An independent investigation of patient records by the Health and Human Services Administration in 2012 identified overwhelming numbers of unreported events. It concluded:
… more than 130,000 Medicare beneficiaries experienced one or more adverse events in hospitals in a single month. …. Hospitals report only about 1 in 7 incidents of patient harm.
An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths,” the [HHS] found, “which projects to 15,000 patients in a single month.”
How does the American Hospital Association defend its constituents? According to their spokesman:
… the last decade of unprecedented cost-cutting and financial instability has impacted all areas of hospital care.
It’s had an effect on infection control and it’s had an effect on [hospitals] ability to recruit and retain workers. It’s had an effect on our ability to invest in new and updated equipment as much as we would like to,” said Rick Wade, spokesman for the AHA.
‘It’s also a question in front of society: How much do you want to invest in high-quality, safe medical care?”
There you have it. You didn’t expect a ‘we’re sorry and we’ll do better’ defense, did you? Don’t expect hospitals to be safe and healthy, they say, if you don’t pay us more and then we’ll give it a shot.
The federal government is waking up to the massive financial cost of doctor and hospital malpractice and doing something about it: It’s docking reimbursement for readmissions to fix reasonably preventable harm, including Never Events, things that should never happen and which are not considered for any type of compensation, including:
Transfusing the wrong type of blood – a Never Event
Secondary operations as a result of leaving equipment inside of a patient during the first procedure — a Never Event
Air embolism – a Never Event
Post operative infections
All other infections linked to hospital procedures, such as catheters
Medication errors including harm to diabetic patients
Pressure ulcers (bed sores)
Dislocations, fractures or head injuries caused by falls
Burns and electric shocks to patients
Private health insurers are now adopting federal reimbursement guidelines.
Hospitals may have been happy to ignore malpracrice within their doors as long as they were getting paid to fix the problems they caused, but withdrawing even minimal payment for repairing their damage was simply too much to ask. Lawyers and hospital administrators have taken up the cause, offering advice on how to get around the rules and continue to be fully reimbursed for misconduct. The most popular recommendation is to manipulate records to make it look as though the hospital wasn’t responsible for the damages they caused.
If you’re not a hospitalist, you may not be happy to be asked to change your documentation so that the hospital can get paid more …
Hospitals … will continue to closely oversee physician documentation on Medicare patients.
According to the Journal of Patient Safety, medical and pharmaceutical harm outside of hospitals doesn’t get “tucked into an easily analyzed data base like Medicare.” Total harm, it concludes, is likely to be much more prevalent and severe than scientific studies can substantiate.
It is … probable that medical practice … is actually the number one cause of death and disability in the US.
Consumers Reports analyzed data from hospitals in almost every state and gave composite grades for patient safety for each one. Distressingly, no hospital earned a grade higher than a mediocre 72 out of a possible 100, and most failed convincingly.
Far too many of the most well known hospitals, including Massachusetts General Hospital, UCLA Medical Center, Cleveland Clinic, New York-Presbyterian, and Mount Sinai Medical Center had grades so low that they should probably be closed to safeguard the public.
A number of hospitals throughout the country, including Johns Hopkins in Baltimore and Emory University Hospital in Atlanta, could not be analyzed because they refused to submit the necessary information.
Did you know that the death rate drops when surgeons go on strike?
It is clear that once we are admitted to the hospital, our life is in our own hands. But we are not without resources. Here are some survival tips:
1. Never go to a hospital for a condition that is not an emergency. For scheduled surgery, remember that outpatient surgical centers can do a much better job of controlling their environment and maintaining accountability than hospitals where responsibility for patient care is diffused.
2. Keep track of medications your doctor says you should be taking and what hospital staff wants to give you. Know the dosages and take notes. Medication errors are a serious source of patient injury and death.
3. Try to wean yourself from all pharmaceuticals, which, as their ads are legally obligated to note, are extremely dangerous. Get used to the idea that all drugs are unnatural chemical additions to the human body and, in varying degrees, are all poisons. Herbals, spices, vitamins, and botanicals, as well as your own mind, can be excellent substitutes that can heal you without endangering your life. Do a little internet research, some experimentation, and improve your chances for staying alive and healthy.
4. Make sure that no one touches you who is not sterile. If the nurse puts on surgical gloves and then picks up the remote that you dropped, s/he is no longer sterile and must not touch you until s/he is.
5. Stay as far from medical radiation and other questionable procedures as possible. Make sure you know the reason for x-rays and other measures and how they will affect your treatment. If their only purpose is to satisfy the doctor’s curiosity and will have no effect on your prognosis or treatment, politely decline.
6. Ask questions. Your survival may depend on how much of a pain in the butt you are. Do it with a smile and expect the best.
The only solution to our deadly medical care system is you the patient. According to the Journal of Patient Safety:
The epidemic of patient harm in hospitals must be taken more seriously if it is to be curtailed. Fully engaging patients and their advocates during hospital care and systematically seeking the patients’ voice in identifying harms….
from the archives: