The American Iatrogenic Association is devoted to the study and reporting of medical errors that lead to disease and death.

In 2000 , a presidential task force labelled medical errors a "national problem of epidemic proportions." Members estimated that the "cost associated with these errors in lost income, disability, and health care costs is as much as $29 billion annually ." That same year the Institute of Medicine released an historic report, "To err is human: building a safer health system." The report's authors concluded that 44,000 to 98,000 people die each year as a result of errors during hospitalization. They noted that "even when using the lower estimate, deaths due to medical errors exceed the number attributable to the 8th-leading cause of death ." The addition of non-hospital errors may drive the numbers of errors and deaths much higher. As the authors note, the hospital data "offer only a very modest estimate of the magnitude of the problem since hospital patients represent only a small proportion of the total population at risk, and direct hospital costs are only a fraction of total costs."

There is much disagreement as to what constitutes iatrogenic illness. For decades, peptic ulcers were said to be caused by an emotional disorder which prevented afflicted people from managing "stress." Physicians instructed many people with ulcers to change their lifestyles and, in some cases, to take anti-anxiety medications. In recent years researchers determined that most peptic ulcers were caused by a bacteria treatable with antibiotics. Were the adverse emotional and treatment consequences of misdiagnosing ulcers as a psychiatric illness iatrogenic? Similarly, for many years epilepsy was said by medical experts to be evidence of pathological criminality. Epileptics were imprisoned in "colonies," to isolate them from the general population. Were the obviously damaging effects of this "treatment" iatrogenic? Are the present large-scale drugging of children (mostly boys) diagnosed with "Attention Deficit Hyperactive Disorder," and the former "treatment" of homosexuals with electroconvulsive therapy (shock treatment), insulin coma, and lobotomy examples of iatrogenic disease? Most physicians would say they are not, yet the harm resulting from these erroneous diagnoses and severe "treatments" are no less damaging for the people who suffered them.
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   The HealthGrades study shows that the IOM report may have underestimated the number of deaths due to medical errors, and, moreover, that there is little evidence that patient safety has improved in the last five years, said Dr. Samantha Collier, HealthGrades vice president of medical affairs. The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S.
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    Study Highlights
Among the findings in the HealthGrades Patient Safety in American Hospitals study are as follows:
About 1.14 million patient-safety incidents occurred among the 37 million hospitalizations in the Medicare population over the years 2000-2002.
Of the total 323,993 deaths among Medicare patients in those years who developed one or more patient-safety incidents, 263,864, or 81 percent, of these deaths were directly attributable to the incident(s).
One in every four Medicare patients who were hospitalized from 2000 to 2002 and experienced a patient-safety incident died.
The 16 patient-safety incidents accounted for $8.54 billion in excess in-patient costs to the Medicare system over the three years studied. Extrapolated to the entire U.S., an extra $19 billion was spent and more than 575,000 preventable deaths occurred from 2000 to 2002.
Patient-safety incidents with the highest rates per 1,000 hospitalizations were failure to rescue, decubitus ulcer and postoperative sepsis, which accounted for almost 60 percent of all patient-safety incidents that occurred.
Overall, the best performing hospitals (hospitals that had the lowest overall patient safety incident rates of all hospitals studied, defined as the top 7.5 percent of all hospitals studied) had five fewer deaths per 1000 hospitalizations compared to the bottom 10th percentile of hospitals. This significant mortality difference is attributable to fewer patient-safety incidents at the best performing hospitals.
Fewer patient safety incidents in the best performing hospitals resulted in a lower cost of $740,337 per 1,000 hospitalizations as compared to the bottom 10th percentile of hospitals.
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   If the Center for Disease Controls annual list of leading causes of death included medical errors, it would show up as number six , ahead of diabetes, pneumonia, Alzheimers disease and renal disease, continued Dr. Collier. Hospitals need to act on this, and consumers need to arm themselves with enough information to make quality-oriented health care choices when selecting a hospital.
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   Distinguished Hospital Awards and Findings
In addition to its findings on patient safety, HealthGrades today honored 88 hospitals in 23 states with the Distinguished Hospital Award for Patient Safety, the first national hospital award to focus purely on hospital patient safety. The award was designed to highlight hospitals with the best records of patient safety in the nation and to encourage consumers to research their local hospitals before undergoing a procedure.

HealthGrades based the awards on a detailed study of patient safety events in hospitals nationwide from 2000 to 2002, using the list of patient-safety incidents developed by AHRQ. Best hospitals were identified as the top 7.5 percent of the hospitals studied and had significantly different patient-safety incident rates and costs compared to hospitals that were average or in the bottom 10th percentile. Among the best hospitals, the lower number of avoidable deaths and in-patient hospital costs were directly related to their lower overall patient-safety incident rates.

If all the Medicare patients who were admitted to the bottom 10th percentile of hospitals from 2000 to 2002 were instead admitted to the best hospitals, approximately 4,000 lives and $580 million would have been saved , said Dr. Collier.
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    Each year, some 300,000 people are injured and nearly 100,000 are killed in hospitals because of medical errors, studies show. Dangerous drug interactions and prescribing errors are a major cause of these problems.

But fewer than 10 percent of physicians actually read drug labels, which provide the most complete information about a drug's dangers and uses, the studies show. And when they do read drug labels, doctors learn little, the studies show.

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    A right to know'

The public has a right to know what is going on,'' said Dr. Lucian Leape, a patient-safety expert at the Harvard School of Public Health and co-author of the 1999 study. He said

California and most other states don't do enough to publicize error rates.

It's not surprising to see there's resistance,'' he said, citing concerns about negative publicity and lawsuits. But he continued, It's only by reporting that we can learn from each other's mistakes.''

California law requires hospitals to inform the Department of Health Services of any unusual occurrence'' -- which a department spokeswoman said would include any negligence or error that causes harm to a patient. Investigators look into such reports, as well as complaints from the public, and then file a ``statement of deficiency'' if they conclude the hospital did not meet regulations or other standards of care.

Those citations carry no financial penalties, although hospitals must submit a plan of correction'' that state officials must approve. Paper copies of each hospital's deficiency statements and corrective plans are kept in a public file at the state health department's district offices.

But no one compiles or disseminates the information. In contrast, consumer advocates point to Minnesota, which publishes an annual report that lists errors or adverse events'' reported at each hospital in the state.

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    Parents Want to Know About Every Pediatrician Error


MONDAY, Dec. 5 (HealthDay News) -- American parents want to know about medical errors involving their children, no matter how harmless or severe the mistake, new research suggests.

Parents also claim to be less likely to sue if they are told openly and honestly about an error, according to a study appearing in the December issue of Pediatrics.

"This is a very important study. Things aren't necessarily as well-studied in children as in adults, and our natural tendency is to assume that everything from adults applies to children, and that's not always true," said Dr. Marlene R. Miller, director of Quality and Safety Initiatives and an associate professor of pediatrics at Johns Hopkins Children's Center. "Among adults, we want more disclosure with more severe things. But parents of a small, vulnerable child want to know everything, regardless of the severity. That's a very key difference."

Medical errors have been a focus of attention lately, with a recent Institute of Medicine report estimating they are responsible for 100,000 deaths a year in the United States. According to the authors of this study, 42 percent of Americans say they have been affected by a medical error either personally or through a friend or relative.

Most of the information, however, applies to adults. Studies have shown that adults' desire to be informed of a medical error increases with the error's severity. It's been unclear whether parents felt the same way about errors affecting their children.

In this latest study, 499 parents of children presenting at a hospital emergency room answered a questionnaire outlining several different error scenarios. Participants were asked to rate the severity of the mistake, express preferences for disclosure and reporting, and to state how they expected to respond with or without that disclosure.

Virtually all (99 percent) of the parents wanted to be told of a mistake, while 39 percent wanted the error reported to a disciplinary body and 36 percent said they were less likely to pursue legal action if the error was disclosed by the doctor.

The finding that people were less likely to see legal recourse if the error was disclosed echoes previous studies in adults. "It's not so much the error that people get upset about --it's the anger at not being told," Miller said. "People can understand that medicine isn't black and white, that it's an art."
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