Up to 440,000 Patients May Die Each Year in US

Check out this article.  Please!!! It’s from Propublica and is entitled “ How Many Die from Medical Mistakes in U.S. Hospitals?” by Marshall Allen.  What Allen tells us is that way more people are dying from medical mistakes that we thought.  The 1999 IOM report To Err is Human estimated there were 98,000 deaths a year from preventable medical errors.  In 2010, another study by the Department of Health and Human Services (DSS) estimated that 180,000 Medicare enrollees were dying from medical mistakes. That was only Medicare recipients mind you.  Now we have another study that tells us the number of preventable deaths may be even higher than 180,000.  So between 1999 and 2013, we have made only statistical progress in registering how many more deaths we have than we estimated fourteen years ago.

The fact that so many people are dying in US hospitals comes as no surprise to me.  As I travel from state to state and hospital to hospital, I hear some great stories and some really terrifying ones. Sometimes I think it’s a miracle that more people aren’t dying and being injured. I have written about a number of the latter problems on my blog.  Safety models like those developed in aviation are not being utilized nearly enough. Not enough people are working on  genuine teams and get little to no team training.  When hospitals do take advantage of excellent programs like TeamSTEPPS, the training may be a one time only event and not recurrent, or implemented in a way that does not integrate team lessons into actual practice.  Doctors are still reaming out, blowing off, or otherwise discouraging nurses who try to point out patient safety errors.  I have gone to many patient safety meetings over the past  years, and few physicians are present, with nurses making up most of the audience. But RNs may also be as much part of the problem as the solution.  Many RNs are in a discipline and punish mode.  Nurses don’t listen to aides and do not include those lower on the health care ladder — those referred to as “nurse extenders” (like MDs refer to RNs as “physician extenders”) on what passes for a team.

Then there is fatigue and workload. Everyone who works in healthcare seems to be exhausted most of the time.  This is not true only of physicians-in-training, whose work week has not been reduced far enough.  Nurses are working 12- plus hour days. Physicians who are in practice, not training, are working 15- hour days or more.  NPs in a hospital which I recently visited were workig  15 to 16 hour shifts routinely. Only one state, California has any nurse staffing ratios.  And there are no regulations about the number of patients physicians can see in a day. Ditto for the workload of others in healthcare.

Or what about accessories.  As Michael Gardam and I have written in our Boston Globe article “Medical Staff Need to Lose Their Ties and Rings,” walk down the corridors of US hospitals and ties wave in the breeze even though we know that they are carriers of bacteria.  Nurses, doctors and other staff where rings, watches and bracelets when god knows what kind of bacteria is lurking beneath.  In many hospitals there may not be unambiguous protocols for making sure reusable medical equipment really isn’t being reused.  (See post “Is It Dirty or Is It Clean?)As for reporting systems, hospital management seems to either seesaw between tolerating reckless, dangerous practitioners (or as in the cases of Charles Cullen and Jayent Patel passing them on to other institutions) or to continue disciplining staff who make mistakes that were not due to recklessness at all.  Some are even firing staff for such mistakes.  In some cases, like Julie Thao in Wisconsin, some have been charged with a felony for an inadvertent error. In Texas RNs who tried to report serious medical mistakeswere charged with a felony for their patient advocacy. To state what should be obvious, this does not serve the cause of patient safety.

These are only some of the Swiss Cheese layers that have not been systematically addressed and that contribute to patient deaths and injuries. In my experience hospitals and other health care institutions race around dealing with one layer in the Swiss Cheese  and then another, implementing one flavor of the month initiative after another, without making sure anything is permanently fixed and without constantly revisiting patient safety issues.  Until these and many more layers are systematically dealt with, patients will continue dying and being injured.



Showing 6 comments
  • Patrick Mendenhall

    Amazing stuff – well said!

  • Dr. Ira Williams

    Find The Black Box (my 3rd book on HC) describes what has always been missing in the efforts to improve the quality of health care and patient safety, and offers a logical and doable process to begin to finally create an organizational structure for that “system”. To Err Is Human recognized the absence of an organizational structure, but they, and all others since, have failed to recognize the harmful effects of its absence. Dr. Marty Makary’s book title UNACCOUNATBLE says it all in one word. There is not, and never has been, sufficient means for accountability when things go wrong in patient care, and they must on a regular basis.
    Find The Black Box is a well-intended challenge to the quality of health care army of experts. Medicine is a scientific endeavor and all true scientific endeavors are, or should be, based upon unbiased consideration of new and different considerations. I offer Find The Black Box for such consideration.

    • Suzanne

      Will definitely check it out. Thanks for the heads up. i agree with you about accountability and love Marty Makary’s book, but patients can’t be expected to protect themselves. The definition of being a patient is that there are many times when we simply can’t protect ourselves. When we’re sickest we’re also the most out of it and the most vulnerable. Someone has to be held accountable — not to punish but to learn about safety and put it into practice.
      Thank you for the comment.

    • Bobbie Jenke

      Thank you Marshall Allen for your committed work to patient safety!!! And thank you Joel of Patient-Safety for your tireless work. I believe this article above addresses some of the serious problems ethical providers face for “whistle-blowing” in our current medical industry. But, does this account for why I cannot get any evaluations for help by any local physicians/specialists in my Sonoma County community/UCSF/CA Pacific Med. Center and more after my barbaric Thoracic Outlet Surgery I had in 2004 that is now really killing me at age 56 after 9 years of unmitigated pain and agony following it. Even our CA Medical Board stated TOS surgery carried GREAT risks–but, my surgeon lied and said they didn’t on a document we both signed. The Medical Board had that document, but NEVER disciplined the surgeon, Avery of CA Pacific Med. Cntr for lying about such risks to me, or for his lack of skills or reason in performing such a barbaric surgery on me. please see
      my website tossurgerynightmare dot com
      I have little functional time left. And I do blame Kaiser Permanente for the cause much of the predicament I am in today. Since my injury in 1998 by a Sonoma County Rolfer–Kaiser fought me on all my requests for help and/or to go out of plan for help–so they financially drained me, and I Iost all trust in this HMO. Shame ofn Kaiser and this entire medical industry! Patients need enforceable LAWS regarding this license to KILL industry. Instead of “thriving financially” from our demise. That’s all of us!!

  • joel

    You are saying the same thing that has been being said ceaselessly for at least 160 years, at least since Semmelweis if not before. Your thinking is based on the same paradigm as all of the previous people who asked these same questions and made these same statements. It’s the wrong paradigm. It’s the wrong questions and the wrong statements. The false assumptions on which they are based get passed on generation after generation. They are assumptions that benefit health care professionals at the expense of the well-being of patients. As long as we operate on those assumptions, there always will be problems like neckties flopping around despite the problems for patients with that. Passing a law against neckties misses the point. We cannot micromanage our way out of this. We have been trying to do that for 160 years and in that much time we haven’t even managed to get health care professionals to sterilize their hands well enough. We have to change the paradigm so that health care professionals will work out these problems for themselves. That is a paradigm health care professionals will get laws passed to prevent, but you can read about it at this link if you want: http://www.patient-safety.com

    • Suzanne

      Sorry that you seem to think I do not understand the issues. Looked on your blog and agree with much of what you say which I have also written about here and elsewhere. I do not argue here for micro management. but yes I think doctors and nurses and other staff shouldn’t wear rings and ties, and bracelets etc, and yes I think team training should be mandatory. Obviously changing culture involves a great deal, but it also involves passing and enforcing regulations that are the healthcare equivalent of not allowing drivers to run red lights when they’re in a hurry. Check out my writing and don’t jump to conclusions.

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