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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 States.

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 of Sciences.

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 of Care?

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 Freedom Watch.

 
More people die in a given year as a result of medical errors than from motor vehicle accidents.