Carnage in the Hospitals

Health care needs revamped regulation to lower the toll of death and maiming

(Panchenko Vladimir/Shutterstock)

Commentary

Health care, the most error-prone, deadliest industry in the world, may also be among the most poorly regulated. To lower the toll, health care’s self-serving regulatory system needs to be scrapped in favor of transparency that exposes harms, eschews coverups, and puts patients first.

Although the public is largely unaware of the scale of harm that stems from poor regulation—as many as 400,000 patients per year at U.S. hospitals alone are estimated to be needlessly losing their lives—the health care industry has known of the problem for more than four decades. In the 1980s, the extent of medical error was documented by the Harvard Medical Practices Study, in the 1990s by the Institute of Medicine, in the 2000s by the U.S. Inspector General, and in the past decade by the Johns Hopkins University School of Medicine.

The precise hospital toll is unknown because medical errors that result in death aren’t recorded. The estimates from these and other authoritative sources instead rely on reviews of the patients’ documented health records to determine how often “communication breakdowns, diagnostic errors, poor judgment, and inadequate skill” led directly to a patient’s death. As one example of an unidentified medical error, the Johns Hopkins study cited the case history of a young woman who died days after undergoing what appeared to be a successful transplant operation.

“An autopsy revealed that the needle inserted during the pericardiocentesis grazed the liver, causing a pseudoaneurysm that resulted in subsequent rupture and death. The death certificate listed the cause of death as cardiovascular,” the study reads.

The estimates of unnecessary hospital deaths could be just the tip of the iceberg, because they don’t count the needless deaths at outpatient care such as ambulatory surgical centers, in nursing homes, at medical clinics, or at home. Neither do they count what doubtless would be many millions of people whose preventable medical injuries stopped short of death. By way of comparison, the U.S. construction industry, which the National Safety Council of the Bureau of Labor Statistics lists as the United States’ most accident-prone industry, logs a mere 1,000 deaths per year.

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And yet, despite the government’s many regulatory layers over virtually all aspects of the health care industry, the failure of regulation has largely been ignored. Unlike other risky sectors such as automobiles and coal mines, where regulation has led to immense progress, “research has suggested that the amount of error in healthcare may not have changed,” according to an analysis in BMJ Quality and Safety.

Health care regulation focused on reducing medical errors would have meticulously tracked the number, type, and location of errors that occurred each year to identify lax standards, the need for better training, and counter-productive medical procedures. Yet in the existing system that allegedly informs public awareness and national research priorities each year, the annual list of the most common causes of death, “medical error is not included on death certificates or in rankings of cause of death,” according to the analysis by Johns Hopkins.

Medical errors claim more lives than suicides, motor vehicle accidents, and firearms—more than all causes other than heart disease and cancer, making them the third leading cause of death in the United States. Yet, they’re largely invisible.

“Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums, such as a hospital’s internal root cause analysis committee or a department’s morbidity and mortality conference,” the researchers wrote. “These forums review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department.”

To eliminate the culture of behind-closed-door discussions, which is inculcated by the current system of “self-regulation” within state medical boards, physicians should instead be regulated by systems that are transparent to the public and have the incentive to expose poor practices and incompetence. It makes no more sense to have physicians regulate themselves and expect them to freely admit to failings that would affect their reputations and their medical malpractice insurance premiums than it would to have the automobile industry regulated by a committee appointed by Ford and General Motors.

As a first step to making the health care system accountable, death certificates must include the category of “medical error” as a cause of death to allow researchers to hone in on why errors occurred and how to minimize occurrences in the future. To discourage false reporting on death certificates, an adverse events reporting system should be established to enable those familiar with the deceased to report possible wrongful deaths.

The administration of the death certificate process should be under the auspices of coroner’s offices, which typically are required to investigate all homicides, suicides, and other sudden or unexpected deaths, including deaths at construction sites. Coroners now investigate at their discretion deaths related to medical procedures, but with medical-error deaths dwarfing the mandatory categories, coroners, as a default, should investigate medical errors when so requested by a family member, putting on coroners the onus of demonstrating why a potential medical error shouldn’t be investigated.

The coroner’s mandate should further be expanded to commissioning studies to identify where false reporting of deaths has occurred and whether fines or criminal prosecution should be pursued. To complement such coroner’s studies, which would be based on random samples of deaths reported to be free of medical errors, family members who order a private autopsy—they typically cost between $2,500 and $5,000—should be reimbursed should the autopsy reveal grounds to suspect a medical error.

Given the large number of wrongful deaths, once the system has become transparent and the wrongful deaths become known, numerous claims for damages will result, leading to a sea change in medical procedures. Physicians and hospitals who have a shoddy record will face exorbitant medical malpractice insurance premiums, while those who consistently make the right call will see their fees decline. Most of all, the medical culture will begin to change, from one that looks the other way when someone meets a premature end to one that’s vigilant in enforcing and enhancing high standards.

Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.