Lieber - Killer care: how medical error became Americas third largest cause of death, and what can be done about it

L ike most Americans, I love and fear health care. With age, this fear increases. In fact, it increases reasonably. The oldI am 66and the very young are more likely than other patients to suffer medical errors, including fatal ones.

I have a rare condition caused by a genetic mutation that puts me at risk of blood clots and stroke. A few years ago, when I was highly symptomatic, in great pain, and walking with difficulty, a doctor diagnosed this malady, which soon was confirmed by a blood test. I started taking a maintenance dose of oral chemotherapy, put aside my cane, and returned to a normal pain-free life with mobility.

A month before the accurate diagnosis, I had gone to an emergency room because of a gangrenous blackness on my foot and fear of a clot. The emergency physician wanted to admit me, and bring in a vascular surgeon to assess severing my toes. At this point, my family physician and a close friend appeared. With his backing I exercised the patients essential right to say no, left the hospital, and saw a series of specialists, one of whom finally got it right.

Had my toes been amputated, I would have joined the ranks of those who have received wrong site, wrong limb, wrong organ, and other unnecessary surgeries known as never events, because the medical profession admits that they never should have happened. Error specialists, and there are many, might say that I had a near miss, something health care is just beginning to study and learn from following the example of the aviation industry.

I was fortunate, but others among my family and friends have not been so lucky. In her twenties, my future wife underwent an unneeded colonoscopy on a distressed and inflamed gut. The probe perforated her colon. This led to emergency surgery to save her life, a temporary colostomy, and subsequent surgeries to repair her intestine and remove the colostomy. She recovered fully, but went through a year of health-care hell. She endured an overtreatment error from an unnecessary procedure. As Sanjay Gupta, the neurosurgeon and chief medical correspondent for CNN, recently put it, More treatment, more mistakes.

My fathers later years were marred by a hospital-acquired infection (HAI) that he apparently contracted during a minor knee-draining procedure. My mother endured a hand-off error following surgery for a nonmalignant brain tumor. Because physicians failed to order anti-seizure medication, she convulsed and entered a coma for three weeks, from which she emerged a hemiplegic with limited speech. My close friend, the family practitioner who helped me avoid unnecessary foot surgery, saw his elderly mother enter but not leave the excellent teaching hospital where he serves on the staff. During routine cataract surgery, she suffered an anesthesia error, aspirated vomit, and died. My professional mentor, Byrd Brown, Pittsburghs preeminent civil rights attorney, had a lung transplant at age 70. During the post-surgical hand-off, his attending physician ordered a necessary but highly toxic anti-rejection drug. A misplaced decimal point meant that my very sick colleague received ten times the intended dose. It killed him. A lethal prescription is regarded as a medication error.

Two of those situations led to medical malpractice claims that yielded settlements: one low and one moderate. I cannot say more because as in most civil tort claims, the eventual settlement and release documents contained clauses forever binding those involved to secrecy, which helps to resolve these grief-driven contests and soothes some of the suffering and loss with compensation, As controversial as they are common, such gag orders stop the public, patients, and health providers from learning as much as they might about medical accidents, and hopefully preventing them in the future.

Over four decades, I have pursued dual careers in law and writing. As an attorney I have concentrated on civil rights, employment, and business cases. Early on I was involved in a support role in a single medical malpractice case. A young couple sought genetic counseling at a world-renowned academic medical center in the South. Their first child had been stillborn and severely deformed. They wondered if they should attempt another pregnancy. They had excellent government insurance that covered this type of service because the husband was an active-duty soldier.

The geneticist who read the x-ray photomicrography of their chromosomes called a karyotype said that they were normal, healthy, and not at any greater risk than others. They conceived again, but this time the child was born alive, with major developmental defects that would require a lifetime of expensive care. It turned out that the geneticist misread their chromosomes. Prior to this he had analyzed only karyotypes of drosophila (fruit flies), not humans. Victims like these cannot be made whole in court and only rarely is their suffering fairly compensated, but this jury returned a large measure of damages to pay for the childs care. Again, I cannot say more because the case was resolved in such a way that the hospital decided not to appeal, and the family and its lawyers promised confidentiality. Nevertheless, everyone in and around this case learned a profound lesson about medical errors that has been vindicated by data: experience matters. Whether you are a patient in need of a lung transplant or merely seeking to have an x-ray read accurately, it makes total sense to pick a provider who has completed the task successfully many times before.