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It appears that human lives are cheaper and medical mistakes more common now than EVER before, according to a recent study by Public Citizen. This reality stands in contrast to politicians assertations that medical malpractice lawsuits represent part of the reason for rising medical costs. Clearly, the exact opposite is true. Increased accountability- in the form of increased liability for careless mistakes, would lower costs, not raise them.

"The cost of the medical malpractice liability system- all malpractice insurance premiums - fell to less than 0.6 percent of the $2.1 trillion in total national health care costs in 2006, the most recent year for which the necessary data to make such comparisons are available."

"The cost of actual malpractice payments fell to 0.18 percent - one-fifth of 1 percent - of all health care costs in 2006. Annual malpractice payments subsequently fell from $3.9 billion in 2006 to $3.6 billion in 2008, but comparative data on total health care costs are not available." (Clearly, they are rising rapidly, not falling)

The facts speak for themselves.

Medical errors are responsible for an immense burden of patient injury, suffering and death. Errors in the provision of health services, whether they result in injury or expose the patient to the risk of injury, are events that everyone agrees just shouldn't happen. Errors are readily understandable to the American public. There is a sizable body of knowledge and very successful experiences in other industries to draw upon in tackling the safety problems of the health care industry. The health care delivery system is rapidly evolving and undergoing substantial redesign, which may introduce improvements, but also is clearly exposing Americans to new hazards.

Myths dispelled by the recent report are many. For example, the whole purpose of so called "tort reform" is based on the assertation that malpractice lawsuits are on the rise (WRONG) and without merit (also VERY wrong). It also assers that awards are excessive (Profoundly wrong because only the most injured typically receive them, and more than the number who do sue, never sue, because the system is set up to make it impossible, this lack of accountability makes doctors, hospitals and insurance companies unaccountable and likely to become even more careless, not less.)

"The relatively small amount paid out for medical malpractice generally goes to patients with the most serious injuries. More than 80 percent of the money paid out for medical malpractice in 2008 was for cases involving "significant permanent injuries"; "major permanent injuries"; injuries resulting in quadriplegia, brain damage or the need for permanent care; or death, according to NPDB reporting.

Despite the hysteria surrounding debates over medical malpractice litigation, experts have repeatedly concluded that several times as many patients suffer avoidable injuries as those who sue. The best known such finding was included in the Institute of Medicine's (IOM) seminal 1999 study, "To Err Is Human," which concluded that between 44,000 and 98,000 Americans die every year because of avoidable medical errors. Fewer than 15,000 people (including those with non-fatal outcomes) received compensation for medical malpractice that year, and in 2008, the number receiving compensation fell to just over 11,000.

There is no evidence that errors are any less rampant today. Most of the IOM's safety recommendations have been ignored. Meanwhile, various safety indicators continue to raise alarms. For example, the Joint Commission, which accredits hospitals, learned about 116 occasions in which surgeons operated on the wrong part of a patient's body in 2008 and 71 times in which foreign objects were left inside patients' bodies. Health experts call these "never events" meaning that they simply should not happen at all."

Originally posted to Andiamo on Mon Mar 01, 2010 at 04:23 PM PST.


How Should Our Health Care System Deal With Medical Mistakes?

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Comment Preferences

  •  Tip Jar (7+ / 0-)

    Hey I have an idea! Single payer healthcare for ALL, It actually works! No compromises! Saves HALF! Eliminates the 50% waste. Saves millions of lives!

    by Andiamo on Mon Mar 01, 2010 at 05:12:01 PM PST

  •  Very good, very important diary. Many thanks. (2+ / 0-)
    Recommended by:
    Nailbanger, AguyinMI

    Stonewall was a RIOT!

    by ExStr8 on Mon Mar 01, 2010 at 05:45:52 PM PST

  •  I think doctors etc are too much in a hurry. (3+ / 0-)
    Recommended by:
    ExStr8, lakehillsliberal, marykk

    I understand their time is valuable but it's like the all rush around doing everything and they are so much in a hurry that they screw up.

    I had a buddy lose his good leg when they were operating on his bad one. My wife had an ovary removed because the doctor accidentally cut into it during surgery and then on a second surgery with the same doctor he accidentally cut her bladder open. Both times the surgeon was leaving after the surgery for vacation and left my wife to be fu'd on in the hosp by an md she didn't even know. I can't help but think that his anticipation of leaving town may have played a part.

    In my wifes case and my pals neither sued. I've known a lot of people messed up by doctors that never sued.

    What I think is sort of wrong like I can order a pair of shoes from REI and read 35 customer reviews on that pair of shoes. Yet there is no place on the net or elsewhere where you can rate your doctor and have other people see it.

  •  How about another choice? (1+ / 0-)
    Recommended by:

    How about an aggressive, top to bottom re-making of how we practice medicine (and provide health care) to make errors much less common?

    You suggest that witch-hunts ("accountability" and "disincentivizing") will miraculously reduce error, save lives, and bring us world peace. There is little if any evidence in support of this proposition. To the contrary, aggressive efforts to punish and assign blame tend to drive error underground, making genuine reform much harder to achieve. The FAA learned long ago that encouraging a culture of open reporting of error, rather than ruthless punishment and prosecution that drives error underground, was far more effective.

    Contrary to what the diarist implies, there are many of us in the medical community doing everything we can to reduce the dreadful toll of preventable medical error. There are many very promising avenues for improvement, from electronic health records and decision support tools that permit ongoing quality assessment and error correction to "systems design" in hospitals and office practices that make it far more difficult for errors to occur and perpetuate.

    Don't get me wrong; I'm not suggesting a free pass for incompetent docs who commit serial malpractice. But the notion that it's "just a few bad apples" and ruthless punishment is the solution is simply incorrect. Yes, some doctors commit a disproportionate share of mistakes. But the great preponderance of preventable medical errors are committed by competent, committed, capable docs who are horrified when they make a mistake. Trust me on this.

    Personally, I'd favor a combination of root-and-branch rebuilding of how we practice medicine to 'error-proof' the process, together with far more aggressive "hands-on" regulatory supervision by State agencies, and a no-fault system that promptly and efficiently compensates patients injured by medical events.

    Note that this means patients injured by completely unavoidable complications would be compensated by this system; currently only patients who can prove negligence are compensated. And the policing/regulating function would be far more appropriately performed by professional State regulators, rather than by the incredibly inefficient, expensive, capricious legal system. As you undoubtedly know, studies have shown that the majority of patients injured by medical error do not in fact bring legal action...and the majority of patients who attempt to bring legal action have not been injured by negligence. The current system is essentially the worst of all possible worlds.

    •  How about many improvements? (1+ / 0-)
      Recommended by:

      I strongly support an aggressive, exhaustive re-making
      of how we educate medical personnel and how and by
      whom medicine is practiced. I have done so for
      several decades. And, as a pilot, I support much of
      the FAA model.

      Investigating, "policing" and punishment are very
      much part of the FAA system. If you over-fly your
      destination by 45 minutes in a scheduled, commercial
      operation without a compelling reason, your right to
      fly aircraft commercially is terminated fairly quickly.
      This is not a "witch hunt"--this is enforcement.

      Yes, the FAA has made reporting a centerpiece of its
      effectiveness, but reporting leads to systemic
      improvements and enforcement where appropriate. And
      enforcement is generally quite swift--suspension of
      licenses can be immediate, and revocation is not rare.

      If, as happenes in mediciine, the airline industry
      had 100,000 "accidental" fatalities in one year,
      the FAA would have long since shut down the airlines

      I have had intimate, active association with various
      medical communities, primarily academic, for over
      forty years, and I would be hard-pressed to say that
      "many" are doing every thing they can to "reduce
      the dreadful toll of preventable medical error."
      Some, yes... many, not so sure.

      In my responsibility of supervising the care of an
      elderly parent, I have encountered many errors,
      some with the potential for serious adverse
      consequenses, in clinic and hospital, and we
      are "known entities"--a relative in high places.
      And when I point out these mistakes, I'm usually
      greeted with a shrugged apology--not horror. You
      can trust me on this.

      Very importantly, NO "State" agencies! The "F" in
      FAA stands for Federal, and for good reasons. State
      medical societies are too much like cults... nuff

      I do agree that the current system in medicine
      is close to the worst of all possible worlds, and I
      am confident that doctors are not capable of
      sufficient self-correction--quite the contrary, they
      run the cabals which primarily serve to enrich

      The worst loss of life in commercial avaiation
      resulted from the horrible collision of two 747's
      at Tenerife in 1977. We now know that an
      arrogant, "prima donna" airline captain was the
      direct cause of that disaster, although there were
      many contributing factors. I've witnessed too much
      arrogance in the medical "profession" to escape the

      I wish I had time to continue this discussion, as I
      appreciate your contribition, but it is a vast
      subject and my day must end soon. I hope that all
      our comments will spur others to think and act on
      these vital matters.

      Stonewall was a RIOT!

      by ExStr8 on Mon Mar 01, 2010 at 08:03:28 PM PST

      [ Parent ]

      •  I have to agree...I have seen many (1+ / 0-)
        Recommended by:

        medical errors in my time and I have only been a patient or the relative of a patient.  Doctors are too dam busy for their own good and that of their patients.  Medicine is one of those professions that should not be practiced as piecework or with a high profit motive in mind.  You do not get the best results that way.  

        "When fascism comes to America, it'll be wrapped in a flag and carrying a cross." Sinclair Lewis

        by lakehillsliberal on Mon Mar 01, 2010 at 08:42:42 PM PST

        [ Parent ]

        •  Americans care is so bad by international (1+ / 0-)
          Recommended by:
          standards that doctors in other countries don't believe it. They just don't believe it.

          How could doctors say this, without having done that, etc.

          The overriding pressure to not spend money is killing a lot of people. Tests aren't getting done. Don't let them tell you tests are not necessary, they really are.

          The right ones, which often they don't know about, either.

          They are lazy and don't want to spend the time learning that they need to.

          Hey I have an idea! Single payer healthcare for ALL, It actually works! No compromises! Saves HALF! Eliminates the 50% waste. Saves millions of lives!

          by Andiamo on Tue Mar 02, 2010 at 05:34:25 AM PST

          [ Parent ]

          •  Gotta disagree there. (1+ / 0-)
            Recommended by:

            One of the most pernicious trends in medicine today is actually too many tests. We do far, far too many CT scans and MRI scans. It's far easier for me to get a scan or an expensive panel of blood tests than to spend the extra 30 minutes with the patient required to really dig into the history, past records, and clinical exam to get a handle on what's going on. The reimbursement system brutally penalizes taking the time required to do it right, and rewards ordering more expensive tests.

            The unnecessary and potentially lethal cumulative exposure to radiation from repeated CT scans is a critical issue that is attracting far too little attention.

            •  In all the mistakes I have witnessed it is the (0+ / 0-)

              time issue that caused them.  Because of their tight schedules, the not knowing the patient and the medical history is what caused them to make the mistake.

              "When fascism comes to America, it'll be wrapped in a flag and carrying a cross." Sinclair Lewis

              by lakehillsliberal on Tue Mar 02, 2010 at 08:48:31 AM PST

              [ Parent ]

      •  State medical society? NO. State licencing board. (1+ / 0-)
        Recommended by:

        I'm not suggesting for an instant that State medical societies be permitted to police their own members. Really, I completely agree that this is absurd.

        In NY, the State is commendably aggressive about policing physicians through the Office of Professional Medical Conduct. They have the authority to immediately terminate a physician's license to practice. The most dreaded words in the English language? "There's someone from OPMC here to talk to you, doctor.".

        As a practicing physician, I believe strongly that this is a good thing. My family members are patients too. I absolutely want an aggressive State regulatory body supervising physicians and immediately removing the dangerously inept or dishonest.

  •  I'd like to see your support for this (1+ / 0-)
    Recommended by:

    the majority of patients who attempt to bring legal action have not been injured by negligence.

    Now they may not all recover, for a host of reasons, but that's hardly dispositive of the issue.

    If you think you're too small to be effective, you've never been in the dark with a mosquito.

    by marykk on Mon Mar 01, 2010 at 06:06:45 PM PST

    •  What should people do when they catch one? (0+ / 0-)
      When they have proof?

      Not as serious as some, but a fraud nonetheless.

      Hey I have an idea! Single payer healthcare for ALL, It actually works! No compromises! Saves HALF! Eliminates the 50% waste. Saves millions of lives!

      by Andiamo on Tue Mar 02, 2010 at 05:17:08 AM PST

      [ Parent ]

      •  You can't bring a case unless you are SERIOUSLY (1+ / 0-)
        Recommended by:
        injured. I mean, seriously. If you are an adult, that means "almost dead" in most states. It definitely means not able to work. And then you may get $60-70k, your lawyer takes a third, and then, in many cases, your old insurance company takes the rest, off the top, (to repay them for the care they spent, that didn't prevent the accident) and you remain uninsurable, even if you could buy insurance, you couldn't afford it, because you are and unable to get a job.

        Thats what we have come to.

        Its like the politicians are saying F** Y** to any American who tries to survive.

        Hey I have an idea! Single payer healthcare for ALL, It actually works! No compromises! Saves HALF! Eliminates the 50% waste. Saves millions of lives!

        by Andiamo on Tue Mar 02, 2010 at 05:21:46 AM PST

        [ Parent ]

  •  My wife's malpractice insurance premium (0+ / 0-)

    is down about 25% since four years ago.

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