990912; Sunday

Sunday Times, Knight Ridder Newspapers

September 12, 1999

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High Cost of Medical Mistakes

Part 1 of a four-part series

U.S. yearly death rate of 120,000, which makes jet crash fears seem like "a joke," is mirrored at Pennsylvania hospital

By Andrea Gerlin
KNIGHT RIDDER NEWSPAPERS

The Medical College of Pennsylvania Hospital is a typical teaching hospital. It is known for cutting-edge research programs, for training medical students and newly graduated doctors, and for providing advanced medical care.

It is also representative of modern American hospitals in another respect. In the last decade alone, records show, hundreds of its patients have been seriously injured, and at least 66 have died after medical mistakes.

The hospital's internal records cite 598 incidents reported by medical professionals to the hospital administration in the last decade. In some of those cases, patients or survivors were never told that the injuries were caused by medical errors. None of me doctors involved in the incidents was subjected to disciplinary action.

Serious injury and death caused by medical errors are well-known facts of life in the medical community. But they are rarely reported to the public.

Medical College of Pennsylvania Hospital's records came to light only because of bankruptcy proceedings last year, when its new owner publicly filed a detailed account of the 598 incidents reported at the facility from January 1989 through June 1998.

Those numbers mirror what is happening across the country. Lucian Leape, a Harvard University professor has conducted the most comprehensive study of medical errors in the United States. He has estimated that 1 million patients nationwide are injured by errors during hospital treatment each year and that 120,000 die as a result.

That number of deaths is the equivalent of what would occur if a jumbo jet crashed every day; it is three times the 43,000 people killed each year in U.S. automobile accidents.

"It's by far the No. 1 problem" in health care, said Leape, an adjunct professor of health policy at the Harvard School of Public Health.

In their study, Leape and his colleagues examined patient records at hospitals throughout the state of New York. Their 1991 report found that one of every 200 patients admitted to a hospital died as a result of a hospital error.

Researchers such as Leape say errors reported to hospital authorities represent roughly 5 percent to 10 percent of the number of actual medical mistakes at a typical hospital.

"The bottom line is we have a system that is terribly out of control," said Robert Brook, a UCLA professor of medicine. "It's really a joke to worry about the occasional plane that goes down when we have thousands of people who are killed in hospitals every year."

Account of errors

In bankruptcy proceedings last year, Tenet Healthcare Corp. -- which bought eight Philadelphia-area hospitals, including Medical College, from the bankrupt Allegheny health system -- publicly filed an account of medical errors reported at Medical College from 1989 through 1998. Such documents, which are maintained by hospitals for legal and insurance reasons, are routinely kept confidential.

The Inquirer sent written requests seeking similar information from 34 other large hospitals in Philadelphia. Of 25 that responded, all declined to provide similar insurance reports, citing patient confidentiality. Tenet declined to provide comparable data for Medical College of Pennsylvania Hospital since it took ownership.

Medical College records provide an unprecedented glimpse into the extent and nature of medical mistakes.

The cases run the gamut from benign to fatal, and involve patients whose health status ranged from young and vital to old and infirm. They include:

Four patients who died after they received too much medication, the wrong medication, or no medication.

Surgical "misadventures" during which patients' organs were punctured or blood vessels were pierced.

An epilepsy patient who died and another who was left paralyzed on one side after suffering brain hemorrhages during surgery by inexperienced and inadequately supervised residents. In those two cases, four doctors later signed a letter to a hospital administrator saying that mistakes by unsupervised surgical residents "resulted in the unfortunate death of one of our patients."

Two middle-age patients who died following cardiac emergencies -- men who according to hospital records did not receive proper or timely treatment from emergency room residents. One man sat in the emergency room with dangerously elevated blood pressure for more than seven hours before dying of a heart attack.

An 18-year-old man who received the wrong type of blood in a transfusion after an automobile accident, and died after an apparent hemolytic reaction to the blood.

Eight surgical patients who required second operations to retrieve sponges, cotton or metal instruments left inside their bodies.

Inadequate intensive-care monitoring, which delayed response to a woman who had stopped breathing She was 1eft permenantly brain- damaged.

Monitoring quality of care

The Allegheny Health, Education and Research Foundation, which owned the hospital until November, declined to comment. Tenet declined to discuss specific cases and events at the hospital preceding its ownership.

A Tenet executive said the company is aggressive and systematic in monitoring the quality of care at its 130 hospitals across the country. He said Tenet takes steps including conducting audits of hospitals to make sure they comply with laws and standard clinical practices, surveying its hospitals' performance, and reviewing adverse events on a case-by-case basis to determine whether to take action.

As of June 30, 1998, the date of the Medical College report, the hos- pital's insurers had paid roughly $30 million -- excluding legal costs -- in settlements or jury awards in 76 of the 266 cases that resulted in lawsuits. The figures include five cases settled for more than $1 million each.

Lawyers for the 400-bed hospital in East Falls near Philadelphia have consistently denied the facility's liability in lawsuits arising from errors. Medical-error experts nationwide to whom The Philadelphia Inquirer provided the report characterized the type and frequency of medical errors at the hospital as typical of modern hospitals.

"I find nothing in there that's beyond the average," said Donald Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, a nonprofit organization based in Boston.

In addition, Philadelphia's medical malpractice lawyers, who devote their days to finding hospital mistakes, do not consider Medical College out of the ordinary. "I've never heard anyone say, 'Don't let your relatives go to MCP,"' said Gerald A. McHugh Jr., who was president of the Philadelphia Trial Lawyers Association until June.

The hospital's doctors who treated patients included in the report had a wide range of expertise. Some were first-year doctors-in-training, or residents, working under the supervision of attending doctors. Others were veteran faculty who had graduated at the top of their medical school classes and are regarded by their colleagues as among the most competent in their specialties.

None of the 40 doctors involved in some of the most serious mistakes at the hospital was subjected to disciplinary action by the state Bureau of Professional and Occupational Affairs, according to an agency spokeswoman.

"Most people in health care really try hard, but they're human and they make mistakes. Physicians are not infallible," said Harvard's Leape, a co-author of the Harvard Medical Practice Study.

Leape added: "No nurse or doctor wants to hurt somebody and every nurse and doctor has hurt somebody. They don't want to do it again."

Because most medical mistakes do not go beyond hospital walls, experts say, only an estimated 2 percent to 10 percent of all cases involving medical error result in lawsuits.

"Because of the surveillance climate in health care, the tendency is not to report errors, but to conceal them or explain them away," said Berwick of the Institute for Healthcare Improvement.

The Inquirer also identified instances in which hospital staff did not tell patients or their relatives about errors in medical care -- errors that staff viewed as serious enough to warrant informing hospital administrators. Those instances document how medical errors are sometimes concealed from patients through evasion and deception.