The Dark Side of Patient Care

No patient walks through the doors of a hospital expecting to be injured or made worse off than when he or she arrived.

Between 200,000 and 400,000 patients in the U.S. die each year from preventable medical errors, while far more suffer serious injuries like infection, organ loss, and paralysis.

Patients expect that doctors and care providers will make them better, not worse.  Medical institutions should provide consistent, appropriate levels of care in order to diagnose and treat their patients.  In some cases, however, the standard of care provided falls painfully short of our expectations.

Several recent high-quality studies have revealed that a shocking number of patients die each year as a result of poor medical practices.  A recent review of several high-quality studies published in The Journal of Patient Safety proved that between 200,000 and 400,000 patients in the U.S. die each year from preventable medical errors.  Far more patients suffer serious harms, such as infection, organ loss, and paralysis, because of medical errors.  Estimates in the medical field place the number of serious harms at 10 to 20 times the number of annual deaths.  Given that range, it is estimated that between 2 million and 8 million patients suffer serious harms as a result of medical errors each year.

These figures are consistent with the results of prior studies. Investigators of a study published in 2008 reported that 1.5% of all deaths of Medicare patients hospitalized each month are the result of preventable medical errors.  A similar 2010 study showed that 1.4% of deaths of Medicare patients are the result of medical errors.  A study published in Heath Affairs in 2011 reported that a medical error contributed to the deaths of 1.1% of all patients.  The average age of the patients in that study was 59 years old.

In May 2016 the British Medical Journal revealed that medical errors should be considered the third leading cause of death in the United States. The currently reported third leading cause of death is chronic lower respiratory disease.  The study found that medical errors surpassed this cause by more than 100,000 annually.  The investigators determined that greater than 250,000 deaths each year are caused by medical errors, but the actual number is likely much higher.  There are limitations in identifying the true number of deaths caused by medical errors because of the way deaths are reported.  Causes of death on death certificates are often tied to insurance billing codes.  Of course, there is no code that labels medical error as the cause of death.

Researchers have classified the types of errors into five different categories:

Errors of Commission

These types of errors involve mistaken action on the part of the medical provider either because it was the wrong action or because the action was performed improperly.

Errors of Omission

These types of errors involve failing to do something that needed to be done in light of the patient’s medical history or diagnosis.  Common examples of acts of omission include:

• A failure to do some act such as not ordering a MRI for a patient or not mandating that the MRI be read immediately on a stat basis;

• A failure to follow guidelines for the treatment of a specific condition; and

• A failure to provide needed medication.

Communication Errors

Communication errors can occur between patient and medical provider, or between multiple medical providers. For example, a patient may be hospitalized because he has passed out for no apparent reason and passing out is a sign of a heart condition.  Suppose that the cardiologist understands that the patient should not resume much physical activity but does not clearly communicate that expectation to the patient.  The patient goes on a long run weeks later while the physician is awaiting test results. The patient collapses and dies. This is an example of a communication error.

Contextual Errors

Contextual errors occur when a given treatment plan or other measure may be correct if considered in isolation, but is not correct for a specific patient. An example would be a care plan requiring a patient to remember to perform regular activities but the patient cannot consistently remember to do these activities because of cognitive disabilities.

Diagnostic Errors

Diagnostic errors occur when a patient gets the wrong treatment or ineffective treatment because the wrong diagnosis has been made.

Factors that Contribute to Poor Outcomes

There are many factors that contribute to these poor outcomes.  The most common factors that contribute to death and serious harm from medical errors in the hospital setting are:

• Poor technology for patient care;

• Poor infrastructure for good patient handoffs between shifts and between inpatient and outpatient transfers;

• Guidelines, policies, and protocols not routinely being followed; and

• Cost driven problems, including:

• Increasing production demands without increasing resources;

• Understaffing the facility by hiring too few workers to meet the patient demands or having undertrained or incompetent staff members.

Deaths from preventable errors are not limited to hospitals and doctors’ offices.  Deaths and serious injuries commonly occur in skilled nursing facilities, post-hospital rehabilitation facilities, nursing homes, and assisted living facilities.

The Department of Health and Human Services found that 29% of patients—about 1 in every 3—who entered a rehab facility suffered further medical errors.  About half of these errors were likely or completely preventable.  The injuries ranged from bedsores and infections to permanent disabilities and death.  Dr. David Classen, an infectious disease specialist at the University of Utah School of Medicine, stated that “If the first rule of health care is to ‘Do no harm,’ then we’re failing.’ ”

Nursing homes and assisted living facilities are an integral part of the healthcare system.  Seniors across the country require assistance with daily activities and health care services.  Each day family members make the difficult decision to move their parents and other loved ones into these facilities because they lack the ability to care for them at home.  According to the Centers for Disease Control and Prevention (CDC) more than 1.4 million people, aged 65 and older, live in nursing homes and assisted living facilities.  There are 15,600 nursing homes across the country.

Falling is a serious risk for seniors in nursing homes and assisted living facilities.   1 out of every 5 falls causes a fracture or head injury. The most common fractures from falls are of the hip, femur, and pelvis followed by the humerus, forearm, bones within the hand, and ankle bones.

Falls can be fatal, even if the initial fracture is treated. Falls reduce the quality of life, including decreasing functional behavior and increasing feelings of isolation, depression and helplessness.  According to the Mayo Clinic, broken bones, and particularly a broken hip and femur, result in serious complications and shortened life. Immobile seniors are at risk for deep vein thrombosis, bedsores, urinary tract infections, loss of muscle mass, infections like pneumonia, and death.

Falls are all too common in nursing homes.  Nearly 1,800 seniors living in nursing homes die each year because of fall-related injuries.

There are many errors that contribute to falls in the elderly.  These include:

• Understaffing or poor training of staff concerning the number of people needed to transfer a patient, when to transfer a patient, or how to transfer a patient;

• Not toileting patients as frequently as needed resulting in patients attempting to get out of bed unassisted;

• Overly medicating patients with sedatives and other mood altering substances;

• Modifications to a patient’s environment, including a new or different room, changes in the height of a bed, or removal of objects that were previously used for stability;

• Inappropriate treatment of underlying conditions;

• Slippery surfaces;

• Poor lighting; and

• Unstable furniture.

Preventable errors in rehabilitation centers, nursing homes, and assisted living facilities frequently result in serious injuries and deaths.

Michael A. Hill is an accomplished trial lawyer focusing on representing individuals who have suffered life changing injuries, including traumatic brain injuries, birth injuries, spinal injuries, chronic pain syndromes, and death.   Michael practices in state and federal courts around the country and has argued cases in front of numerous appellate courts, including the Ohio Supreme Court.  Michael has recorded several seven figure verdicts and settlements.  Michael is a regular speaker for lawyers concerning litigation and trial practice.  Michael is a member of The National Trial Lawyers Top 40 under 40, Top 10 Nursing Homes Lawyers, Top 25 Medical Malpractice Lawyers, Super Lawyers: Rising Star, and Multi-Million Dollar Advocates Forum.

Michael is from Flint, Michigan and received his undergraduate degree from Oberlin College in Oberlin, Ohio, where he was introduced to his wife, Hilary.  Michael received his law degree from Case Western Reserve University School of Law where he graduated Magna Cum Laude.  Michael and Hilary live in Lakewood, Ohio.