Congress Holds Hearing on Medical Errors
February 3, 2000
On December 13, 1999, the Senate Appropriations Subcommittee
on Labor, Health and Human Services held a public hearing
to discuss the issue of medical errors in the United
IOM Report on Medical Errors
The Congressional hearing was prompted by the release
of a study titled To Err Is Human: Building a Safer
Health Care System, published by the Institute of
Medicine (IOM), the medical arm of the National Academy
The report estimates that at least 44,000 Americans
die each year as a result of medical errors and it points
out that the figure may be as high as 98,000 deaths
per year from adverse medical events.
The IOM report notes that "More people die in a given
year as a result of medical errors than from motor vehicle
accidents (43,458), breast cancer (42,297), or AIDS
(16,516)." Medical mistakes are estimated to cost between
$17 billion and $29 billion per year.
Congress Hears from Industry and Patients
The subcommittee invited ten people to testify about medical
errors, including patients and their representatives,
medical and nursing professionals, and government officials.
The witnesses testified that there are serious problems
with medical errors and called for more federal money
to fix the problems.
However, one of the patient witnesses offered an important-and
rarely discussed-perspective regarding the perverse
economic incentives involved in the health care industry.
Does Medicine Profit From Mistakes?
Diana Artemis of Falls Church, Virginia told the subcommittee
that, following hospitalization for routine hip surgery,
she ended up requiring additional surgeries due to hospital
negligence and medical misdiagnosis. She was also placed
in a nursing home for six weeks following one of the surgeries.
"Were I not young, fit and healthy, I believe I would
have died," she testified.
Artemis told the subcommittee that she believes the
medical industry profits from their mistakes. Following
is an excerpt from Artemis' sworn testimony before Congress:
"The cost of a routine hip replacement with implant?
About $12,000. The total cost to my insurance company
of these multiple surgeries, rehabilitations and outpatient
treatments? Nearly $200,000. Did the surgeon or hospital
administrator responsible for training and hiring staff
have any incentive to do it right the first time? No,
apart from the personal integrity and competence a patient
would hope they would have, both doctor and hospital
profited from every mistake which required repeated
surgeries, [hospital] stays, drugs, equipment, x-rays,
and therapies. This was not HMO insurance or government-regulated
health care; it was private, fee-for-service care."
She continued, "Did my insurance company have an incentive
to contest the charges? No, they claimed that contesting
the charges would be more expensive than simply paying
whatever was billed," Artemis said. [It is worth noting
that the IOM report acknowledges that "Most third party
payment systems provide little incentive for a health
care organization to improve safety, nor do they recognize
and reward safety or quality."]
Who is Accountable for Medical Mistakes?
Artemis went on to point out the lack of accountability
for medical mistakes. "So, to whom is a doctor or hospital
administrator accountable? To you, to me, to the government,
to other doctors?" she asked. "No one really, I found.
On paper they may be accountable to a State Medical Board
or the Joint Commission on the Accreditation of Healthcare
Organizations (JCAHO), but these Boards and the JCAHO
are merely doctors and administrators `policing their
own.' JCAHO inspections are announced several months in
advance and well prepared for by a hospital's staff. In
the case of a Medical Board investigation of a patient
complaint, unless there is evidence of drunkenness or
egregious social misconduct, a doctor or administrator
will usually be vindicated by his peers," stressed Artemis.
Can Patients Find Information on Doctors' Quality
During the hearing, she also noted that patients have
a hard time finding information about the quality of doctors'
care. "Can an individual gain access to complaints lodged
with the Medical Board or State Insurance Corporation
to judge for him/herself whether to take a chance on a
particular doctor or hospital?" asked Artemis. "Not on
your life! Had I been able to review patient comments
about my surgeon, I never would have chosen him. Although
technically competent with superb credentials, his history
of incompetent aftercare made him a poor choice. It is
remarkable to me that I can find out more about a plumber
by contacting the Better Business Bureau and viewing its
open file of consumer comments, than I can about a doctor
who is going to cut open my body. . ."
She continued, "As the shocking statistic of 100,000
plus deaths per year (and several hundred thousand more
injured by negligence or inadequate staff training)
show, it is time the medical `industry' opens its books
to public scrutiny of its patient-handling protocols,
safety records and training requirements. Additionally,
any citizen ought to be able to obtain a copy of any
complaints filed against a doctor or hospital. Let the
consumer have the `right to know' and judge for him/herself.
After all, our lives are often in their hands and our
salaries and insurance costs pay their bills," she said.
Getting Beyond "Us" vs. "Them"
One of the important points Artemis made is that the medical
industry [including hospitals, doctors, nurses, ancillary
staff, etc.] must admit and acknowledge mistakes in order
to correct them. "I would respectfully add that we've
got to get beyond an `us versus them' mentality with doctors
and hospitals covering up their mistakes and refusing
to acknowledge them," she said. ". . .Unless doctors and
hospital officials are willing and able to admit their
mistakes, learn from them, and promptly correct them,
we will widen the chasm of distrust between `them' and
`us' and watch a percentage of our Gross Domestic Product
(GDP) spent on medical care skyrocket." She further recommended
the creation of objective data that would allow consumers
to compare the quality of care between doctors. "The consumer
would benefit by being able to make an informed and objective
choice," she said.
An executive summary of the Institute of Medicine's
report titled To Err is Human: Building a Safer
Health System is available online at www.nap.edu.
A complete volume is available for sale from the National
Academy Press (800) 624-6242 or (202) 334-3313.
This article was originally published in the January/February
2000 issue of Health
More people die in a given year as a result of medical
errors than from motor vehicle accidents.