Medical/Surgical Error and Prescription Drug Adverse Reactions: The 3rd Leading Cause of Death in the U.S.

Gary G. Kohls, MD

“2.6 million people die annually in low-and middle-income countries from medical errors, and that most of those deaths are related to misdiagnosis and administration of pharmaceutical products…Medication errors alone cost an estimated $42 billion (US dollars) annually. Unsafe surgical care procedures cause complications in up to 25% of patients resulting in 1 million deaths during or immediately after surgery annually...Four out of every ten patients are harmed during primary and ambulatory health care. The most detrimental errors are related to diagnosis, prescription and the use of medicines.” -- The World Health Organization

Below are summaries of two medical journal articles and one online article that conclude that medical errors are the third leading cause of death in the US. The first study, published in 2016 in the British Medical Journal, was authored by researchers from the Johns Hopkins University School of Medicine. The authors calculated that medical errors accounted for > 250,000 deaths every year in the US, which made iatrogenic (= physician, drug or vaccine-caused) deaths the third leading cause of death in the US, surpassed only by #1 heart disease (647,457) and #2 cancer (599,108) (2018 CDC data).  

It is important to note that medical errors and adverse effects from prescription drugs that have caused deaths or illnesses are rarely listed by physicians on death certificates or in rankings of causes of death or illnesses. The journal articles call for better reporting by physicians.  

Also be aware that the two studies – as has been the case of ALL such studies of causes of death, acute illnesses, chronic illnesses or adverse drug effects - did NOT evaluate vaccine-induced deaths or injuries, mainly because virtually every physician, in every country (where powerful, for-profit pharmaceutical/vaccine corporations control the practice of medicine, most medical school curricula and most major media outlets), consistently fails - or refuses to acknowledge - even the most obvious vaccine injuries or deaths as worthy of being reportable diseases or worthy of being listed in their differential diagnostic impressions, discharge diagnoses or death certifications.  

Here is the British Medical Journal (2016) article:  

Medical Errors are the 3rd Most Common Cause of Death in the US  

By Martin Makary, MD and Michael Daniel – May 3, 2016 (1738 words)  

(Lead author Makary is a professor in the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland)  

For full article and references, go to: http://iacld.ir/DL/elm/95/medicalerrorthethirdleadingcauseofdeathintheus.pdf  

The annual list of the most common causes of death in the United States, compiled by the Centers for Disease Control and Prevention (CDC), informs public awareness and national research priorities each year. The list is created using death certificates filled out by physicians, funeral directors, medical examiners, and coroners. However, a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death.  

As a result, causes of death not associated with an ICD code, such as human and system factors, are not captured. The science of safety has matured to describe how communication breakdowns, diagnostic errors, poor judgment, and inadequate skill can directly result in patient harm and death. We analyzed the scientific literature on medical error to identify its contribution to US deaths in relation to causes listed by the CDC.    

Death from Medical Care Itself  

Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient. Patient harm from medical error can occur at the individual or system level. The taxonomy of errors is expanding to better categorize preventable factors and events. We focus on preventable lethal events to highlight the scale of potential for improvement.  

The role of error can be complex. While many errors are non-consequential, an error can end the life of someone with a long life-expectancy or accelerate an imminent death. The case in the box shows how error can contribute to death. Moving away from a requirement that only reasons for death with an ICD code can be used on death certificates could better inform healthcare research and awareness priorities.    

How Big is the Problem and are all Iatrogenic Deaths Preventable?  

The most commonly cited estimate of annual deaths from medical error in the US—a 1999 Institute of Medicine (IOM) report—is limited and outdated. The report describes an incidence of 44,000-98,000 deaths annually. This conclusion was not based on primary research conducted by the institute but on the 1984 Harvard Medical Practice Study and the 1992 Utah and Colorado Study.  

But as early as 1993, Leape, a chief investigator in the 1984 Harvard study, published an article arguing that the study’s estimate was too low, contending that 78% rather than 51% of the 180,000 iatrogenic deaths were preventable (some argue that all iatrogenic deaths are preventable).   This higher incidence (about 140,400 deaths due to error) has been supported by subsequent studies which suggest that the 1999 IOM report underestimates the magnitude of the problem.  

A 2004 report of inpatient deaths associated with the Agency for Healthcare Quality and Research Patient Safety Indicators in the Medicare population estimated that 575.000 deaths were caused by medical error between 2000 and 2002, which is about 195,000 deaths a year.   Similarly, the US Department of Health and Human Services Office of the Inspector General examining the health records of hospital inpatients in 2008, reported 180,000 deaths due to medical error a year among Medicare beneficiaries alone.  

Using similar methods, Classen et al described a rate of 1.13%. If this rate is applied to all registered US hospital admissions in 2013, it translates to over 400,000 deaths a year, more than four times the IOM estimate. Similarly, Landrigan et al reported that 0.6% of hospital admissions in a group of North Carolina hospitals over six years (2002-07) resulted in lethal adverse events and conservatively estimated that 63% were due to medical errors.  

Extrapolated nationally, this would translate into 134,581 inpatient deaths a year from poor inpatient care. Of note, none of the studies captured deaths outside inpatient care—those resulting from errors in care at home or in nursing homes and in outpatient care such as ambulatory surgery centers.    

Case History: The Role of Medical Error in Patient Death  

A young woman recovered well after a successful transplant operation. However, she was readmitted for non-specific complaints that were evaluated with extensive tests, some of which were unnecessary, including a pericardiocentesis. She was discharged but came back to the hospital days later with intra-abdominal hemorrhage and cardiopulmonary arrest. An autopsy revealed that the needle inserted during the pericardiocentesis grazed the liver causing a pseudo-aneurysm that resulted in subsequent rupture and death. The death certificate listed the cause of death as cardiovascular.  

A literature review by James estimated preventable adverse events using a weighted analysis and described an incidence range of 210,000-400,000 deaths a year associated with medical errors among hospital patients.  

We calculated a mean rate of death from medical error of 251,454 a year using the studies reported since the 1999 IOM report and extrapolating to the total number of US hospital admissions in 2013.  

We believe this understates the true incidence of death due to medical error because the studies cited rely on errors extractable in documented health records and include only inpatient deaths.  

Although the assumptions made in extrapolating study data to the broader US population may limit the accuracy of our figure, the absence of national data highlights the need for systematic measurement of the problem.  

Comparing our estimate to CDC rankings suggests that medical error is the third most common cause of death in the US. Human error is inevitable. Although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences.  

Strategies to reduce death from medical care should include three steps:

1.     making errors more visible when they occur so their effects can be intercepted;

2.     having remedies at hand to rescue patients; and

3.     making errors less frequent by following principles that take human limitations into account. This multi-tier approach necessitates guidance from reliable data.    

Deaths Caused by Medical Errors in America are not Measured!  

Currently, deaths caused by errors are un-measured and discussions about prevention occur in limited and confidential forums, such as a hospital’s internal root cause analysis committee or a department’s morbidity and mortality conference.  

These forums review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department. There are several possible strategies to estimate accurate national statistics for death due to medical error. Instead of simply requiring cause of death, death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.  

An early experience asking physicians to comment on the potential preventability of inpatient deaths immediately after they occurred resulted in an 89% response rate.  

Another strategy would be for hospitals to carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of error. A root cause analysis approach would enable local learning while using medicolegal protections to maintain anonymity. Standardized data collection and reporting processes are needed to build up an accurate national picture of the problem.  

Measuring the consequences of medical care on patient outcomes is an important prerequisite to creating a culture of learning from our mistakes, thereby advancing the science of safety and moving us closer towards the Institute of Medicine’s goal of creating learning health systems.    

Health Priorities  

We have estimated that medical error is the third biggest cause of death in the US and therefore requires greater attention. Medical error leading to patient death is under-recognized in many other countries, including the UK and Canada.   According to WHO, 117 countries code their mortality statistics using the ICD system as the primary indicator of health status. The ICD-10 coding system has limited ability to capture most types of medical error.  

At best, there are only a few codes where the role of error can be inferred, such as the code for anti-coagulation causing adverse effects and the code for overdose events. When a medical error results in death, both the physiological cause of the death and the related problem with delivery of care should be captured.  

To achieve more reliable healthcare systems, the science of improving safety should benefit from sharing data nationally and internationally, in the same way as clinicians share research and innovation about coronary artery disease, melanoma, and influenza. Sound scientific methods, beginning with an assessment of the problem, are critical to approaching any health threat to patients.  

The problem of medical error should not be exempt from this scientific approach. More appropriate recognition of the role of medical error in patient death could heighten awareness and guide both collaborations and capital investments in research and prevention.  

    Prevalence, Severity and Nature of Preventable Patient Harm Across Medical Care Settings  

By Maria Panagioti, et al – July 17, 2019 (Excerpted article: 480 words)  

Full article, including author affiliations and references at: https://www.bmj.com/content/366/bmj.l4185  

Objective 

To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.  

Introduction

Patient harm during healthcare is a leading cause of morbidity and mortality internationally.  

The World Health Organization defines patient harm as “an incident that results in harm to a patient such as impairment of structure or function of the body and/or any deleterious effect arising therefrom or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury, and may be physical, social or psychological (eg, disease, injury, suffering, disability and death).”   

The health burden and patient experiencing healthcare-related patient harm has been reported to be comparable to chronic diseases such as multiple sclerosis and cervical cancer in developed countries, and tuberculosis and malaria in developing countries.   

Harmful patient incidents are a major financial burden for healthcare systems across the globe.  

It is estimated that 10-15% of healthcare expenditures are consumed by the direct sequelae of healthcare-related patient harm. Early detection and prevention of patient harm in healthcare is an international policy priority.    In principle, zero harm would be the ideal goal. However, this goal is not feasible because some harms cannot be avoided in clinical practice.  

For example, some adverse drug reactions which occur in the absence of any error in the prescription process and without the possibility of detection are less likely to be preventable.  

Key sources of preventable patient harm could include the actions of healthcare professionals (errors of omission or commission), healthcare system failures, or involve a combination of errors made by individuals, system failures, and patient characteristics.   

Key types of preventable harm were

1.     drug-related,

2.     diagnostic errors,

3.     medical procedure-related, and

4.     healthcare-acquired infections.  

The excess length of hospital stays attributable to medical errors is estimated to be 2.4 million hospital days, which accounts for $9.3 billion excess charges in the US.  

Another important finding is that preventable patient harm appears to be a serious concern in advanced medical specialties including intensive care and surgical units.  

Patients treated in these specialties were more likely to experience preventable patient harm compared with patients treated in general hospitals. Surgical harm is a sizeable part of the overall in-hospital harm, but our estimates are higher than anticipated.  

Conclusion

Our findings affirm that preventable patient harm is a serious problem across medical care settings. Priority areas are the mitigation of major sources of preventable patient harm (such as drug incidents) and greater focus on advanced medical specialties. It is equally imperative to build evidence across specialties such as primary care and psychiatry, vulnerable patient groups, future studies are critical for reducing patient harm in medical care settings. ______________________________________________________________________________  

Appendix Table of Annual Iatrogenic Deaths in The United States (235 words) From: https://www.ourcivilisation.com/medicine/usamed/deaths.htm   (Deaths induced inadvertently by a physician or surgeon or by medical treatments or diagnostic procedures)  

Adverse Drug Reactions 106,000 Deaths Medical Error 98,000 Deaths Bedsores 115,000 Deaths Infection 88,000 Deaths Malnutrition 108,800 Deaths Outpatient Deaths 199,000 Deaths Unnecessary Procedures 37,136 Deaths Surgery-related 32,000 Deaths  

TOTAL 783,936 Deaths  

Annual Unnecessary Medical Events  

The enumerating of unnecessary medical events is very important in our analysis. Any medical procedure that is invasive and not necessary must be considered as part of the larger iatrogenic picture.  

Unfortunately, cause and effect go unmonitored. The figures on unnecessary events represent people ("patients") who are thrust into a dangerous health care system. They are helpless victims. Each one of these 16.4 million lives is being affected in a way that could have a fatal consequence. Simply entering a hospital could result in the following (out of 16.4 million people):  

2.1% chance of a serious adverse drug reaction (186,000). 

5% to 6% chance of acquiring a nosocomial [hospital] infection (489,500). 

4% to 36% chance of having an iatrogenic injury in hospital (medical error and adverse drug reactions) (1.78 million). 

17% chance of a procedure error (1.3 million).  

All the statistics above represent a one-year time span. Imagine the numbers over a 10-year period. Working with the most conservative figures from our statistics we project the following 10-year death rates. ­­­­­­­­­­­­­_____________________________________________________________________________  

Dr Gary Kohls is a retired rural family physician from Duluth, Minnesota who has written a weekly column for the Reader Weekly, Duluth’s alternative newsweekly magazine since his retirement in 2008. His column, titled Duty to Warn is re-published around the world.  

Dr Kohls practiced holistic mental health care in Duluth for the last decade of his family practice career prior to his retirement in 2008, primarily helping patients who had become addicted to cocktails of psychiatric drugs to safely go through the complex withdrawal process.

His column often deals with various unappreciated health issues, including those caused by Big Pharma’s over-drugging, Big Vaccine’s over-vaccinating, Big Medicine’s over-screening, over-diagnosing and over-treating agendas and Big Food’s malnourishing food industry. Those four sociopathic entities can combine to even more adversely affect the physical, mental, spiritual and economic health of the recipients of the vaccines, drugs, medical treatments and the eaters of the tasty and ubiquitous “FrankenFoods” – particularly when they are consumed in combinations, doses and potencies that have never been tested for safety or long-term effectiveness.  

Dr Kohls’ Duty to Warn columns are archived at: http://duluthreader.com/search?search_term=Duty+to+Warn&p=2; http://www.globalresearch.ca/author/gary-g-kohls; http://freepress.org/geographic-scope/national; https://www.lewrockwell.com/author/gary-g-kohls/; and https://www.transcend.org/tms/search/?q=gary+kohls+articles

 

NOTE: The views expressed here are those of the author and do not necessarily represent or reflect the views of Reader Weekly.”