Why Hospitals Are Still Killing Us: “Invisibility, Inertia, and Income.”

That somewhat provocative title is not really mine. It comes from an article written by Michael Millenson in the journal “Health Affairs.” He was writing to an audience that included members of the hospital industry and chose the title: “Why We Still Kill Patients: Invisibility, inertia, and Income.” His outrage at the industry was ignited by a study led by a Dr. Landrigan and being published in “The New England Journal of Medicine.” The study results were presented in a NY Times article.



Before we get to Millenson’s comments let’s summarize the findings from that article.


The study was a follow up to a famous study reported on in 1999 which concluded that:

“....medical mistakes caused as many as 98,000 deaths and more than one million injuries a year in the United States.”

That effort was intended to focus more attention on the problem and lead to better procedures and fewer injuries and deaths. The latest study concludes:

“....harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.”

“Dr. Landrigan’s team focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety.”

“But instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found.”

“The researchers found.... 25.1 injuries per 100 admissions.”

“Not all the problems were serious. Most were temporary and treatable, like a bout with severe low blood sugar from receiving too much insulin or a urinary infection caused by a catheter. But 42.7 percent of them required extra time in the hospital for treatment of problems like an infected surgical incision.”

“In 2.9 percent of the cases, patients suffered a permanent injury — brain damage from a stroke that could have been prevented after an operation, for example. A little more than 8 percent of the problems were life-threatening, like severe bleeding during surgery. And 2.4 percent of them caused or contributed to a patient’s death — like bleeding and organ failure after surgery.”

Lest one think these results might be an anomaly, the article also presents results of a similar study of Medicare patients.

“A recent government report found similar results, saying that in October 2008, 13.5 percent of Medicare beneficiaries — 134,000 patients — experienced ‘adverse events’ during hospital stays. The report said the extra treatment required as a result of the injuries could cost Medicare several billion dollars a year. And in 1.5 percent of the patients — 15,000 in the month studied — medical mistakes contributed to their deaths. That report, issued this month by the inspector general of the Department of Health and Human Services, was based on a sample of Medicare records from patients discharged from hospitals.”

Now, on to Millenson and his outrage.


Millenson points out that these figures and the need to improve procedures began appearing in the literature in the 1950s, and he himself published a figure of 120,000 preventable deaths annually from medical mistakes after a 1978 study.

“It means that 2.5 million men, women, and children died preventable deaths in U.S. hospitals during the 21 years between 1978 and 1999. A staggering seven to 17 million suffered preventable injuries.”

He castigates the profession for allowing this to continue to take place. “Invisibility” is attributed to the setting.

“....medical error kills a few people at a time in private, spread out among thousands of hospitals. Moreover, most deaths occur among those who are already very sick, and only a small proportion represent negligence. This is inadvertent harm; there are no villains here.”

He goes on to state that medical people view these “inadvertent” deaths as inevitable collateral damage.


While I respect Millenson’s outrage, I think he falls a bit short here. What is the difference between a doctor who infects and kills someone because he was too lazy to wash his hands properly, and an inebriated driver who kills a person with his vehicle? I see no difference other than legal precedent.


Millenson regains his stride with a few examples of trivial things that should become standard procedure but somehow do not through “inertia.” Here is my favorite.

“...the Centers for Disease Control and Prevention published its first hand-washing guidelines in 1975. Yet nearly 35 years later, when the Joint Commission launched an improving hand hygiene project, the eight hospitals that volunteered had a baseline hand hygiene rate typical of hospitals nationwide: 48 percent. That’s worse than the worst rate at the worst big public men’s room in the United States according to one recent survey. But rather than giving providers an ultimatum, we launch campaigns to ask patients to ask doctors to please wash up.”

If your blood pressure has not elevated a bit by now, stay tuned, Millenson has the sharpest arrow yet in his quiver: ‘income.”

“But there is another elephant in the room that makes providers squirm even more. Put bluntly, many hospital executives believe they make money from complications. (Not from deaths, of course, because those shorten length of stay). Frustrated clinicians have told me this many times over the years, and as recently as a few weeks ago. The evidence has even made its way into the medical literature.”

It is interesting that this charge is being leveled in a major trade magazine (December, 2010) and it did not become front page news. At least I did not notice it if it did. Can we assume then that his accusation was not news within the community and was met with a yawn? This is pretty scary stuff.


So, we are left to be treated by lazy bums, and we have to pay our bills (if we survive) to a bunch of greedy bastards.


Y’all out there have a nice day—and let’s hope that none of us gets sick.