DEATH BY
MEDICAL ERROR
THE HIDDEN EPIDEMIC
By
William Charney
Editor of
“Epidemic of Medical Errors and
Hospital-Acquired Infections”
What does the term “Medical Error” mean?
 A combination of medical errors where doctors,
nurses or health care workers make mistakes:
 Medical errors
 Health care acquired infections
 Misdiagnoses
 Medication errors
 Surgical errors that produce fatality or morbidity
 Blood clots
 Hospital-acquired uncontrollable diarrheas
 Outpatient errors
 Nursing home errors
Medical Error
leading cause of
death to Americans…
over 788,000 per year
plus millions of
injuries
Source: Dr. Gary Null and Joe
Graedon, MS, and Teresea
Graedon, PhD, “Top Screwups
Doctors Make and How to Avoid
Them”
Medical Error
2nd leading cause of
death to Canadians…
approximately 56,517
to 63,098 deaths per
year plus 552,473
adverse events
Source: Extrapolation from
Baker Report and the Public
Health Agency of Canada
Systemic causes of medical error have
been built into the design of the systems
both in Canada and U.S.
Systemic Factors in Medical Error
Profit Motive:
 The Journal of General Internal Medicine
published a study in March 2000, titled
“Hospital Ownership and Preventable
Events”. It showed that patients in for-profit
hospitals are 2 to 4 times more likely than
patients at not-for-profit hospitals to suffer
adverse events such as post surgical
complications, delays in diagnosis, and
treatment of an ailment.
Source: Vol. 15 No. 3 Pgs. 211-219
Factory Medicine in Canada
Number of:
 Patients per day
 Procedures per day
 Operations per hour
 Patients per minute
 Beds per region
Systemic Factors in Medical Error (cont’d.)
Staffing:
 Patients in a hospital with a 1:8 nurse-topatient ratio, have a 31% greater risk of dying
than patients in hospitals with a 1:4 ratio.
 Only state with ratio
regulation is California
 No Canadian province
has ratio regulation
Source: Aiken, et al; JAMA
288 No. 16 (2002) 1987-92
Systemic Factors in Medical Error (cont’d.)
Shift Work:
 Longer shifts translate into more errors.
Physicians who are scheduled to work long
hours make 36% more errors with 5 times
as many serious diagnostic errors
Source: Found in "Epidemic of Medical Error" CRC Press,
ed. Charney, Chapter 9 authored by Pontus pp. 191
Systemic Factors in Medical Error (cont’d.)
Behavior:
 A study of 1,700 nurses, physicians, clinical
care staff and administrators found fewer than
10% address behavior by colleagues that
routinely includes trouble following directions,
poor clinical judgment or taking dangerous
shortcuts. Specifically, 84% of MDs and 62%
of RNs and other clinical care providers had
seen coworkers taking shortcuts that could be
dangerous to patients…fewer than 10% said
they directly confront their colleagues.
Systemic Factors in Medical Error (cont’d.)
Non and Under Reporting:
 There are 27 states in the U.S. with
reporting regulations
 Quebec is the only province in Canada that
has reporting regulations
 5% and no more than 20% of medical error
incidents are reported
Source: Leape, JAMA 1994, Dec. 21 272(23) 1851-7
Systemic Factors in Medical Error (cont’d.)
Working Conditions:
 Poor working conditions, such as
ergonomics, patient developmental flows,
staffing, workload, scheduling, and
autonomy contribute directly to medical
errors. In 115 studies included in a 2003
review, working conditions affect patient
safety, the rate of medication errors, and
the rate of recognition of such errors after
they occur
Source: Blum et al; Natural Science Sleep 3 pp. 47-85
Systemic Factors in Medical Error (cont’d.)
Accountability:
 Studies have shown even getting
healthcare workers to wash hands between
patients or after leaving bathrooms is not
enforced and there are low compliance
rates
 52% of doctors did not wash their hands
between patients
Source: CDC, 2003
Systemic Factors in Medical Error (cont’d.)
Cost-Benefit Analysis:
 The Society of Actuaries has stated that
medical errors are costing $20 billion a
year. Bedsores alone account for a cost of
$3.9 billion annually. The cost per patient
of medical error can be as high as $20,000
per bed (using the American Hospital
Association’s data of 1 million hospital beds
in the U.S.)
Systemic Factors in Medical Error (cont’d.)
Injury to Workers:
 Injury contributes systemically to medical
error and compromises patient safety.
 Injuring a worker leads to a downstream
negative patient effect.
Source: Charney and Schirmer, AAOHN Journal - American
Association of Occupational Health Nurses Journal)
Systemic Factors in Medical Error (cont’d.)
 Bullying:
 Nurses reported that 71% of bullying
behavior resulted in medical error of which
29% resulted in death
Source: Rosenstein, et al. Joint Commission Quality Patient
Safety 34(8) 467-71
Systemic Factors in Medical Error (cont’d.)
Technology:
 Reliance on technology is not a panacea
for solving medical errors. Human factors
still apply.
 Despite computerization of pharmaceutical
approaches, 98,000 people per year end
up in emergency rooms every year (mostly
elderly) due to medication error.
Source: New York Times, 2012
Organizations in charge of fixing medical
errors are organizations mostly responsible
for creating problems
 Patient advocacy groups and Canadian
and American labor unions should lead
the struggle to reform health care
Organizations in charge
of fixing medical errors
are organizations
mostly responsible for
creating problems
Patient advocacy groups and Canadian
and American labor unions should lead
the struggle to reform health care