HOSPITAL ERRORS: Rule, Not Exception, Warns Philadelphia Inquirer Series
"The chance of errors occurring during [hospital] treatment may be far greater than you had imagined," warns the Philadelphia Inquirer in a four-part examination of inpatient medical mistakes that ran this week. The paper's investigation was spurred by the unusual publication in Bankruptcy Court of internal records from the Medical College of Pennsylvania Hospital, in a report filed by Tenet Healthcare Corp. after it purchased MCP from the Allegheny system last year. Unable to get similar information from any of 34 other large hospitals in the Philadelphia area, the Inquirer's first installment focuses exclusively on MCP, printing detailed summaries of several of the 598 incidents reported by medical staff from 1989 to 1998. The paper also reports that "none of the 40 doctors involved in some of the most serious mistakes at MCP was ever subjected to disciplinary action by the state Bureau of Professional and Occupational Affairs," and notes "expert" estimations that only 2% to 10% of medical error cases result in lawsuits because of a tendency to conceal errors from patients and their families.
A National Issue
Though it is MCP that is dragged through the wringer in the first installment, the Inquirer cautions repeatedly that "the type and frequency of medical errors at MCP [are] typical of modern hospitals" (Gerlin, 9/12). The remaining three parts of the series aim to confirm that, focusing on the problem of medical errors nationwide. Relying on the 1991 "Harvard Medical Practice Study," a year-long examination of errors at 51 New York hospitals published in the New England Journal of Medicine, the Inquirer reports that one of every 200 patients admitted to a hospital died from a medical mistake. Extrapolated nationally, those numbers add up to one million injuries-and 120,000 resulting deaths-every year. Physicians interviewed by the Inquirer at several leading academic institutions attribute the problem largely to the "culture of medicine," which "discourages acknowledging mistakes, asking for assistance, exhibiting any weakness or challenging a supervisor" (Gerlin, 9/13). Relative to other large industries -- particularly those required to uphold similar quality standards such as commercial aviation -- health care has not developed sweeping standards to promote honesty and increase safety, despite 1997 estimates that hospital mistakes cost Americans nearly $51 billion per year. These costs are paid by health insurers who then pass the tab along to employers and patients, but employers have yet to leverage their negotiating power to pressure providers to crack down on errors ( (Gerlin, 9/15).
Patients in the Dark
Though mistakes are common, "medical professionals routinely do not tell patients or their families about the errors." Citing a 1991 Journal of the American Medical Association study conducted by UCSF researchers, the Inquirer reports that only 54% of residents discussed mistakes with their attending physicians, while an even smaller number -- 24% -- told patients or families. Although the AMA and other professional associations say unequivocally that physicians have an ethical responsibility to inform patients when errors happen, concerns about legal liability and professional appearance mean physicians routinely ignore such guidelines. "Welcome to the real world," remarked Dr. Frank Davidoff, editor of the Annals of Emergency Medicine ( (Gerlin, 9/14).
Culture of Denial?
In an industry characterized by a "flawed culture built around denial," which forces providers to hide or rationalize failures for fear of sabotaging their careers, self-reporting of errors doesn't often happen. A Joint Commission for the Accreditation of Healthcare Organizations policy requiring hospitals to notify JCAHO of errors has yielded only 500 incident reports since 1995 -- far lower than would be expected -- and state efforts in Pennsylvania and New York have yielded similarly poor results. But organized efforts to improve quality may not be so effective either, notes the Inquirer, citing critics who, led by a federal report issued in July, argue JCAHO's "cozy relationship with the hospitals it accredits" inhibits the commission's ability to "aggressively monitor substandard care and incompetent doctors" (9/15).