Hospitals are complex business and healthcare organizations. In large hospitals in metropolitan areas, there are teams of healthcare providers working around the clock and communicating with each other through the patient’s medical chart. The wonder is not that errors in communication occasionally lead to a preventable error, the wonder is that it does not happen more frequently than it does. In my experience, you cannot be in the hospital for three days without a preventable medical error occurring in your care. Fortunately, most preventable medical errors do not cause significant harm to the patient.
Sadly, we have very little hard data about what goes on in hospitals. For example, we don’t know how many patient deaths occur each year as a result of preventable medical errors. The most common estimates are between 44,000 and 98,000. The larger estimate is over two times the smaller one. It is astonishing that our information is so scanty that hospital deaths due to medical mistakes can be so hard to pin down. The reason our information is so scanty is that hospitals go to great lengths to keep secret what goes on inside their walls.
If you are injured while a patient in a hospital due to the fault of a doctor or a nurse, it is only on extremely rare occasions that the hospital will reveal that fact to you. In almost every case, you will have to figure out on your own why you were injured and that it was not just one of those things that happens from time to time. Since it is unlikely that you know much about medicine, it will be hard for you to figure out that you were the victim of medical malpractice.
In addition to keeping their mouths shut when they injure someone, hospitals have obtained protections from state legislatures in almost all the states that keep confidential most hospital investigations into patient injuries and most doctor or nurse discipline. This is all protected under the rubric of “peer review,” the idea being that if these investigations can be kept out of the public eye, all of the participants will feel more comfortable reporting incidents and discussing what happened. While that is the idea behind peer review, it often does not work to foster greater patient safety, but less.
It is an open secret that health care workers are reluctant to admit to having made a mistake. They are only human, after all. Who among us wants to admit to a mistake? There can be serious consequences for a health care professional who admits to a mistake, or even worse, reports a colleague’s mistake. A nurse in Tennessee who admitted that she made a mistake when withdrawing medication from a computerized drug dispenser, was prosecuted criminally when the patient to whom she administered the incorrect medication died. Doctors who report other doctors often face either outright retaliation or more subtle forms in which their treatment of patients becomes the subject of hospital investigations.
The Joint Commission is an organization that accredits hospitals. It encourages, but does not require, hospitals to report what are called sentinel events. These are unexpected events that cause death, permanent injury, or serious, temporary injury to a patient. Examples include surgery on the wrong patient or the wrong site, transfusion with the wrong blood type, overdosing a patient with radiation, and a foreign object left behind at surgery. In 2022, 1,441 sentinel events were reported to the Joint Commission. This is a ridiculously small number of the actual sentinel events during any given year. If 44,000 to 98,000 patients are dying due to medical errors each year, those are all reportable sentinel events. In addition to those unexpected events that cause death, there are many, many times more events that cause significant injury but not death. Hospitals are not reporting their sentinel events. They are sweeping them under the rug.
On those occasions when a hospital is sued and decides to settle the claim, it always insists on a confidentiality provision in the settlement agreement to keep the fact of the payment from the public.
Hiding mistakes hurts the public. Only when mistakes are faced can there be steps taken to prevent the same mistake from happening in the future. Paying lip service to improving the quality of care but taking steps that frustrate improvement does not make us safer.
Hospitals are big business, at least in most localities. Whether they call themselves non-profits or not, they are in business to make money. As a result, they most often make decisions on the basis of whether it is good for the bottom line rather than whether it is good for the majority of their patients. When the choice is bottom line or patient, the bottom line is going to win.
