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Physicians divided: Report of medical-error deaths on target or exaggerated?


July 5, 2000
Web posted at: 9:18 a.m. EDT (1318 GMT)

In this story:

Dispute over methodology

'Shocking figures'


ATLANTA (CNN) -- The Journal of the American Medical Association this week contains conflicting evaluations of a widely noted report that as many as 98,000 people die each year from medical errors in American hospitals.

The Institute of Medicine (IOM) last November claimed more people die in American hospitals from medical mistakes than die nationwide from better known causes including highway accidents, breast cancer or AIDS.

The report prompted U.S. President Bill Clinton to order a study of preventable deaths in federal health care facilities. Congressional hearings were initiated.

  • Read the two evaluations in JAMA

    But this week, Dr. Clement McDonald and two colleagues, all of the Indiana University Center for Aging Research, argued that the reported number of deaths in the IOM study was exaggerated.

    In a defense of the IOM report, Dr. Lucian Leape of the Harvard School of Public Health disputed that charge, saying the death figures were more likely underestimated. Leape is a coauthor of the challenged study.

    Dispute over methodology

    The Institute of Medicine report said mistakes in administering medicines and other errors by doctors and nurses cause between 44,000 and 98,000 deaths in hospitals each year.

    The national figures came from statistical extrapolations of studies in New York, Colorado and Utah. Death rates attributed to medical errors in those studies were applied to a much larger number of patients admitted to hospitals throughout the country.

    McDonald criticized the manner of selecting patients whose records were included in the studies by Leape and others. The selected patients, he argued, were already very sick, and the lack of any comparison group made the study flawed.

    "Most patients admitted to hospitals have high disease burdens and high death risks even before they enter the hospital," wrote McDonald. "Although some hospital deaths are preventable, most will occur no matter how many 'accidents' we avoid."

    He added that medical errors "are never excusable, but the baseline death risk has be to be known and factored out before drawing conclusions about the real effect of adverse reactions on death rates, preventable or otherwise."

    In his rebuttal, however, Leape said most patients in the study probably would not have died if an error had not been committed.

    To identify patients whose deaths in hospitals appeared related only to mistakes by doctors and nurses, Leape said, terminally ill and severely ill patients and those with complicated health problems were excluded.

    "All patients who had major surgery, acute myocardial infarction (loss of some heart-muscle use), pneumonia or stroke who had an uncomplicated course … were excluded," he said. The goal was to study relatively low-risk patients who would almost certainly have left their hospitals alive but who died.

    'Shocking figures'

    Leape went on to say that the death figures, though "shocking," were probably too low, because some factors were not considered.

    The studies did not include deaths from medical errors that occured outside a hospital setting, such as in outaptient surgical centers, nor could they take into account medical errors that were not recognized or not reported, he wrote.

    Clinton administration officials are working toward establishing a confidential means for hospital staff members and others to report serious medical errors to a central office -- without regard to any individual’s culpability.

    Leape applauded the effort. Most errors, he wrote, are due to "defects in the design and conditions of medical work," not personal carelessness.

    "Rather than attempting to assuage guilt or outrage about errors by punishing, discounting or self-flagellation, physicians need to look to preventing recurrence of errors."

    The objective, set forth in the November account, is to emphasize identification of common mistakes, then to educate doctors and nurses nationwide in how to avoid them.

    McDonald argued that before any policies are implemented, a more thorough study of the death rates caused by medical errors needs to be done, to determine the true extent of the problem.

    Reuters contributed to this report.

    AMA votes to support tracking of medical errors
    June 15, 2000
    Medical groups release new safety recommendations, questionnaires
    May 19, 2000
    Medical mistakes: A legal and ethical dilemma for doctors and patients
    April 28, 2000
    Hospital association opposes mandatory reporting of medical errors
    February 22, 2000
    Medical errors kill tens of thousands annually, panel says
    Nov. 30, 1999
    Clinton orders task force to seek reduction in medical errors
    December 7, 1999
    Study: Drug reactions kill an estimated 100,000 a year
    April 14, 1998
    Report: Deaths from medication errors on increase
    February 28, 1998

    AMA - American Medical Association Home Page
    Institute of Medicine
    American Hospital Association
    Institute for Safe Medication Practices
    National Patient Safety Foundation

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