Medical Error: Third Leading Cause of Death

By Lisa Freeman

p207514_l.jpgMany major news outlets have recently carried a story highlighting findings that “medical error is now the third leading cause of death in the U.S.”

According to an analysis of existing research, Martin Makary, M.D., of Johns Hopkins University, has determined that over 250,000 Americans die each year from medical errors in hospitals, ranking it behind only heart disease and cancer.  The estimate is probably understated because it does not include deaths due to medical errors that occur outside of hospitals. It also does not include those due to certain recognized causes of sentinel events (unexpected events involving death or serious injury) such as communication breakdowns, diagnostic errors or other human factors.

In fact, in 2013 John James, a retired NASA scientist whose son died as a result of medical error, had his research published in the Journal of Patient Safety.  He estimated that “440,000 Americans experience a preventable adverse event while hospitalized that contributes to their death.”

Where is the outrage? Why have we not heard more calls for transparency, immediate action, and accountability all along?

One reason might be because it is difficult to determine the actual number of deaths.  As Dr. Makary also pointed out, medical error is not listed as a cause of death on death certificates, and as a result, he has requested that the Centers for Disease Control and Prevention include it on their annual list reporting the top causes of death.

For those of us who have lost a loved one to medical harm, this is very important.  First of all, it recognizes the truth of what we have experienced.  And secondly, most of us do not want to see our experiences repeated, yet until medical error is recognized as a leading cause of death, it will not be recognized as a priority for research to be funded and solutions to be found.

Another reason might be because this is a difficult topic for many people to talk about.  When people enter the health care system, many do not want to think about what might go wrong, or even that something could.  They want to trust and believe that they will receive the best care possible; that their health care providers will be well trained and highly skilled.  They want to believe that nothing will go wrong.  Recognizing the extent of this crisis undermines the perception and trust that people want to maintain.

Perhaps the fact that these numbers cause people to question the excellence of our health care system has also perpetuated their difficulty gaining traction.  After all, they are estimates rather than hard numbers and health care is big business.  According to the Commonwealth Fund, the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care in 2013.  It might be perceived by insiders that there is a lot to be lost by a rethinking of how we are doing things.

Perhaps they are still looking for the simpler solutions.  While we are seeing a gradual change in the culture of patient safety within health care, there are islands of excellence but seas of mediocrity.

Health care must start doing things differently.  First and foremost, patients must become the true center of health care.  They must be involved in all aspects of care and at all levels of health care, from the exam room to the boardroom.

All of our health care facilities must function with complete transparency and honesty.  We can only learn from what we can identify.  Everyone must feel safe to speak up when they see or are involved in safety issues, without fear of reprisal.

At the same time, responsibility for events that involve patient harm must be identified so that learning and remediation can take place.  And with this learning, steps must be taken to identify all causes and to create safer ways to provide high quality health care to everyone.

This is a tall order, but 250,000 and 440,000 are not just numbers.  In this conversation they are real people; they are mothers and fathers, sisters and brothers, children, friends, and colleagues. They are individuals whose extended families’ lives were forever changed. They are people who died who shouldn’t have.

Lisa Freeman is the executive director of The Connecticut Center for Patient Safety, a non-profit that works in communities, within our healthcare systems, and with elected officials to improve the quality of health care and to protect the rights of injured patients through education, accountability, and advocacy.

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