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Medical Errors and the Cult of Expertise in the Age of Covid | Mises Wire

Posted by M. C. on January 6, 2021

In 2020, however, look for the final tally to show that counting medical errors has been swept aside in the mortality documentation in favor of attributing more deaths to covid-19.

After all, it is now common practice to count any death in which covid-19 was a contributing factor as a death due to covid. That is, anyone who dies “with covid” is reported to be a death caused by covid.

A nurse gave a covid patient the wrong medication, which led to a severe adverse reaction? That’s a covid death. A doctor mixed up two covid patients and administered inappropriate treatment to both? That’s two covid deaths right there.

In other words, unless steps are taken to ensure accurate recording somewhere, if covid deaths are being overreported, we can expect medical-error deaths to be underreported.

https://mises.org/wire/medical-errors-and-cult-expertise-age-covid

Ryan McMaken

Ever since the covid panic began in February of this year, medical personnel such as doctors and nurses have been treated to a level of hero worship generally reserved for the government’s soldiers and cops. We were told they were heroically slaving away to treat covid victims. And although many of these nurses were apparently spending their time choreographing TikTok videos and dancing in hospital hallways, we were assured by government officials and their obedient allies in the media that medical staffers are the new model for self-sacrifice and civic virtue. 

Yet in the two decades leading up to 2020, researchers were repeatedly alarmed by the extent to which medical errors were a persistent problem in American clinics and hospitals. Beginning at least as early as 1999, an increasing number of studies suggested that perhaps nearly a hundred thousand patients per year were dying due to medical errors.

Numerous articles appeared in mass media outlets suggesting that medical training was insufficient, that systems devised by hospitals were error prone, and that malpractice was not as rare as doctors would have us believe. 

Not surprisingly, politics also intervened. Many outlets took the apparent prevalence of medical errors to prove that more government regulation and government funding were necessary. Others noted problems in how government agencies count deaths. 

But then the covid panic happened. Not surprisingly, concerns over medical competence have receded into the background, and medical personnel have instead been treated to a status of near apotheosis, with the opinion of every run-of-the-mill nurse or physician on everything from racism to “essential businesses” being of the utmost gravity. 

Moreover, with a focus on the maximization of counting covid deaths, it is likely we’ll see fewer deaths due to medical errors in official counts. And lobbying groups devoted to representing doctors and nurses are likely to use the current political situation to their own advantage. As has long been the case with police and soldiers, the medical profession is pressing the “never question us, we’re experts” line. The actual record, however, suggests the level of “expertise” ought to receive more scrutiny. 

How Many Deaths Are Caused by Medical Errors? 

After years of growing discussion on the topic, Johns Hopkins University in 2016 released a study concluding that “medical errors” were the third leading cause of death:

Analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error in the U.S. Their figure, published May 3 in The BMJ, surpasses the U.S. Centers for Disease Control and Prevention’s (CDC’s) third leading cause of death — respiratory disease, which kills close to 150,000 people per year.

A death caused by a medical error is defined as a death caused by poorly skilled staff, errors in judgment, a preventable adverse effect, or systemic problems such as computer malfunctions or mix-ups over medication.

The Hopkins study concluded that the methods of reporting deaths in the United States are inadequate to account for the full role of medical errors. 

The Hopkins statistic was widely reported in the media, such as in this 2018 article at MSNBC. MSNBC even notes that other studies have reported medical errors as the cause of over four hundred thousand deaths per year. 

Closer to 100,000 per Year?

Since then, some researchers have expressed dismay and disbelief over the notion that deaths caused by medical errors could be so numerous. For example, researcher and medical doctor David Gorski insists that many who believe the Hopkins number of 250,000 are no better than “quacks.”

Gorski suggests that only fifty-two hundred deaths per year result from medical errors. But in this Gorski relies on a very narrow definition of medical errors as the overwhelming and obvious cause of death. He nonetheless admits that more than 108,000 deaths per year are cases in which “adverse effects of medical treatment” (i.e., medical errors) are “contributory.”

Gorski’s number of fifty-two hundred is likely little more than wishful thinking. While 250,000 may be on the high end, it’s unlikely medical errors are nearly as rare as Gorski hopes.

In this study published in 2020 at the National Institutes of Health, for example, the authors take for granted that “[m]edical errors in hospitals and clinics result in approximately 100,000 people dying each year.”

And it is also widely assumed, as noted in this study by the Washington Medical Commission that “Medical errors remain vastly underreported.” After all, medical personnel are often reluctant to report errors so as to avoid potential legal problems or sanctions from supervisors.

But while some doctors insist they’re being unfairly targeted, others have been sounding the alarm for years. Today, a commonly accepted number is between one hundred thousand and two hundred thousand deaths per year.1

These are not small numbers. A total of one hundred thousand medical-error deaths makes medical errors among the top cause of deaths. If the current covid-19 pandemic plays out like previous pandemics, the total number of deaths will be much lower in 2021 than 2020’s official total of approximately 350,000. But deaths due to medical errors will continue to number around a hundred thousand year after year after year. 

Covid and Medical Errors

Gorski slams the practice in which cases where medical errors were only contributing factors in deaths are potentially counted as deaths due to medical errors. The debate has long been over how much medical errors must contribute to death before they are reasonably counted as the cause of death.

In 2020, however, look for the final tally to show that counting medical errors has been swept aside in the mortality documentation in favor of attributing more deaths to covid-19.

After all, it is now common practice to count any death in which covid-19 was a contributing factor as a death due to covid. That is, anyone who dies “with covid” is reported to be a death caused by covid.

A nurse gave a covid patient the wrong medication, which led to a severe adverse reaction? That’s a covid death. A doctor mixed up two covid patients and administered inappropriate treatment to both? That’s two covid deaths right there.

In other words, unless steps are taken to ensure accurate recording somewhere, if covid deaths are being overreported, we can expect medical-error deaths to be underreported.

Seizing a Political Advantage

Meanwhile, trying to take advantage of the current goodwill showered on medical personnel, many medical professionals are seeking additional legal protections from malpractice suits. Reuters reports:

State chapters of the powerful American Medical Association and other groups representing healthcare providers have been pressing governors for legal cover….More than half a dozen emergency room doctors and nurses told Reuters they are concerned about liability as they anticipate rationing care or performing unfamiliar jobs due to staff and equipment shortages caused by the outbreak.

Yet, there is no reason to assume covid treatments will make doctors and nurses easy targets. States already have standards in place which require plaintiffs to show that medical personnel “negligently deviated from the reasonable standard of care.” The fact that a doctor made a mistake is not enough to make a malpractice lawsuit successful.

Thus, some attorneys who represent victims of medical error and negligence worry that covid will be used as an excuse to further shield healthcare workers from legitimate lawsuits:

Joe Belluck, a New York lawyer who brings medical malpractice cases, said he’s concerned the coronavirus crisis could be used to enact a wish list of changes sought by doctors, hospitals and the medical industry to curb unrelated lawsuits.

Given the way that medical personnel have been treated by media and government personnel in the age of covid-19, it’s not hard to see how this current state of hero worship could be employed to ram through legislation favored by longtime rent-seeking special interest groups like the AMA.

  • 1. See HHS.gov: “However, preventable medical errors potentially take 200,000 or more American lives each year and cost the United States about $19.5 billion in additional medical costs and lost productivity from missed work.” (Strategic Goal 1)

Author:

Contact Ryan McMaken

Ryan McMaken (@ryanmcmaken) is a senior editor at the Mises Institute. Send him your article submissions for the Mises Wire and The Austrian, but read article guidelines first. Ryan has degrees in economics and political science from the University of Colorado and was a housing economist for the State of Colorado. He is the author of Commie Cowboys: The Bourgeoisie and the Nation-State in the Western Genre.

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Medical errors third-leading cause of death in America

Posted by M. C. on May 15, 2020

Medical error: also known as a “Fauci”

https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html

Ray Sipherd, special to CNBC.com

“My little angel” is how Christopher Jerry describes his daughter Emily.

At just a year and a half, Emily was diagnosed with a massive abdominal tumor and endured numerous surgeries and rigorous chemotherapy before finally being declared cancer-free. But just to be sure, doctors encouraged Chris and his wife to continue with Emily’s last scheduled chemotherapy session, a three-day treatment that would begin on her second birthday.

On the morning of her final day of treatment, a pharmacy technician prepared the intravenous bag, filling it with more than 20 times the recommended dose of sodium chloride. Within hours Emily was on life support and declared brain dead.

Three days later she was gone.

Sadly, Emily’s case is not unique. According to a recent study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer.

Other studies report much higher figures, claiming the number of deaths from medical error to be as high as 440,000. The reason for the discrepancy is that physicians, funeral directors, coroners and medical examiners rarely note on death certificates the human errors and system failures involved. Yet death certificates are what the Centers for Disease Control and Prevention rely on to post statistics for deaths nationwide.

The authors of the Johns Hopkins study, led by Dr. Martin Makary of the Johns Hopkins University School of Medicine, have appealed to the CDC to change the way in which it collects data from death certificates. To date, no changes have been made, Makary said.

‘The system is to blame’

Makary defines a death due to medical error as one that is caused by inadequately skilled staff, error in judgment or care, a system defect or a preventable adverse effect. This includes computer breakdowns, mix-ups with the doses or types of medications administered to patients and surgical complications that go undiagnosed.

“Currently the CDC uses a deaths collection system that only tallies causes of death occurring from diseases, morbid conditions, and injuries,” Makary stated in a letter urging the CDC to change the way it collects the nation’s vital health statistics.

“It’s the system more than the individuals that is to blame,” Makary said. The U.S. patient-care study, which was released in 2016, explored death-rate data for eight consecutive years. The researchers discovered that based on a total of 35,416,020 hospitalizations, there was a pooled incidence rate of 251,454 deaths per year — or about 9.5 percent of all deaths — that stemmed from medical error.

Now, two years later, Makary said he hasn’t seen the needle move much.

“Medical-care workers are dedicated, caring people,” said Chris Jerry, “but they’re human. And human beings make mistakes.” According to him, the day Emily was given her fatal dose, the hospital pharmacy was short-staffed, the pharmacy computer was not properly working, and there was a backlog of physician orders.

Afterward Chris said he discovered that pharmacy technicians, rather than well-trained and educated pharmacists, are compounding nearly all of the IV medications for patients. And many states have no requirements, or proof of competency, for these pharmacy technicians.

VIDEO00:34
Medical errors, one of the leading causes of death

To seek greater safeguards for patients, Chris founded the Emily Jerry Foundation in 2008. EJF focuses primarily on medication safety and better training for pharmacy technicians, as well as backup procedures that will improve the health-care system. Last year he unveiled the Emily Jerry Foundation’s National Pharmacy Technician Initiative, an interactive scorecard to make the public aware of unsafe pharmacy practices in the United States. He also travels throughout the country, speaking out about key patient safety-related issues and best practices proven to minimize the “human error” component of medicine.

Any new tools ‘will be a game changer’

Pascal Metrics, based in Washington, D.C., designs ways to increase patient safety and improve clinical reliability at health organizations.

Pascal’s chief medical information officer, Dr. David Classen, is also associate professor of medicine at the University of Utah and an active consultant in infectious diseases at the University of Utah School of Medicine in Salt Lake City. He admits there are problems: “The system of care is fragmented,” he said. “Any tools that enable patients to manage their health-care needs will be a game changer.”

To improve the safety of medication use, Classen developed and implemented a computerized physician order-entry program at LDS Hospital in Salt Lake City. “Harnessing health information technology through the use of electronic health records of hospitalized and ambulatory patients is essential,” he said.

Many hospitals, for their part, are seeking to keep pace with increasingly available technology to improve patient safety. Kim Lanyon, a senior ICU nurse at Danbury Hospital in Connecticut, said all electronic records there are double-checked, and fail-safe devices are in place.”

At Mount Sinai Hospital in New York City, Dr. Vicki LoPatchin oversees a Good Catch Award, given to medical personnel who identify potential or existing errors related to their patients’ care. Similarly, most physicians’ offices now keep records electronically, as well as recording conversations among doctors, nurses and their patients in order to make certain there is clarity and that no mistakes result.

Even so, Makary said ordinary complications can occur, especially from unneeded medical care. According to him, “Twenty percent of all medical procedures may be unnecessary.” He faults also the overprescription of medication following surgery, particularly opioids.

Doctors, he said, have been encouraged by drug companies, sometimes through cash payments, to “promote” their products, as revealed by the website Dollars for Docs.

What patients can do to protect themselves

According to Dr. John James, a patient-safety advocate and author of A Sea of Broken Hearts: Patient Rights in a Dangerous, Profit-Driven Health Care System, patients need to take charge. “There needs to be a balance between the provider community and the patients. It is not an even relationship at all.”

In 2002 James lost his 19-year-old son after he collapsed while running. He had been diagnosed with a heart arrhythmia by a cardiologist a few weeks prior and was released from the hospital with instructions not to drive for 24 hours.

“His death certificate said he died of a heart arrhythmia,” he said, but my son really died as a result of “uninformed, careless, and unethical care by cardiologists.” He explained: “If you have a patient with heart arrhythmias of a certain level and low potassium, you need to replace the potassium, and they did not. And they didn’t tell him he shouldn’t go back to running.” Communication errors, he said, are “unfortunately very common.”

In 2014 James retired early to devote his life to improving patient safety. His mission: to teach people how to be empowered patients. He has created a patient bill of rights, which he’s been pushing to become federal law. Yet so far he said his letters to the Centers for Medicare & Medicaid Services have gone unanswered.

“Makary has a lot of courage,” James said. “A lot of the retired doctors will tell you it’s a mess and it’s terrible. But for a young physician to come out and say what he did, that’s pretty bold. Makary is a brave guy.”

James’ site, Patient Safety America, lists the three levels in which patients can protect themselves. These include being a wise consumer of health care by demanding quality, cost-effective care for yourself and those you love; by participating in patient-safety leadership through boards, panels and commissions that implement policy and laws; and by pushing for laws that favor safer care, transparency and accountability.

Too often, the health-care system silences people around a problem.
Dr. Martin Makary
surgical oncologist and chief of the Johns Hopkins Islet Transplant Center

Here are some other ways patients can be vigilant right now:

Ask questions. Gain as much insight as you can from your health-care provider. Ask about the benefits, side effects and disadvantages of a recommended medication or procedure. Use social media to learn more about the patient’s own condition, as well as those medications and procedures for which they were prescribed.

Seek a second opinion. If the situation warrants or if uncertainties exist, get a second opinion from another doctor: A good doctor will welcome confirmation of his diagnosis and resist any efforts to discourage the patient from learning more — or what Makary calls, “attempts to gag the patient.”

“Too often,” he said, “the health-care system silences people around a problem.” Why? Many doctors are reluctant to speculate, but some admit the answers range from simple ego to losing a patient to another doctor they trust more.

Bring along an advocate. Sometimes it’s hard to process all the information by yourself. Bring a family member or a friend to your appointment — someone who can understand the information and suggestions given and ask questions.

Ilene Corina, president and founder of the Pulse Center for Patient Safety Education & Advocacy, based in Wantagh, New York, urges both the patient and their advocate to be “respectful but assertive” in seeking answers to the questions they may have. In some cases, she recommends a “designated medication manager” to be a safety check on the advice the care provider gives.

Download an app. By having your medical information literally in the palm of your hand, you can work as a team with your doctor to cut your risk for medical errors. Health-care apps can be simple or complex, and depending on your age and condition, you can manage your well-being, medications and more.

More from Modern Medicine:
Disturbing YouTube content reveals tech’s dark side on young minds
Scientific breakthrough may finally lead to an effective anti-obesity drug
New treatment aims to prevent hair loss in cancer patients

Correction: The story has been updated to revise Dr. Martin Makary’s first name.

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