Wednesday, February 10, 2010

From Daily Kos

Medical Error, Liability, and Murtha

An element of healthcare reform, one in which Democrats have acquiesced to Republican demands, is brought into sharper focus this week. The death of Rep. John Murtha, from complication from gallbladder surgery highlights a complex issue that Republicans have framed in terms of "junk lawsuits," but reformers think of it in terms of preventable medical errors.

Dr. Davis Liu, M.D., a practicing board-certified family physician and author of “Stay Healthy, Live Longer, Spend Wisely – Making Intelligent Choices in America's Healthcare System," writes about the short-shrift the issue has gotten in the larger reform debate.
...As the American health care system has been labeled by some as the most advanced in the world, others are critical of the fact that so many people die in hospitals annually due to preventable medical errors.
It's not just about the cost to the health care system to deal with the errors, but the needless number of lives lost. This system-wide failure was highlighted over a decade ago in the Institute of Medicine (IOM) report “To Err Is Human: Building a Safer Health System.”
According to the Washington Post, Murtha had elective laparoscopic gallbladder surgery performed at the Bethesda Naval Hospital and fell ill shortly afterwards from an infection related to the procedure. Murtha was hospitalized to Virginia Hospital Center in Arlington, Va., to treat the post-operative infection. His care was being monitored in the intensive care unit (ICU), a sign that suggests that not only was the infection becoming widespread but also that vital organ systems were shutting down.
Was his death preventable or simply unavoidable? A 2009 study by the University of Maryland Medical Center notes that when gallbladder surgery is performed electively “the mortality rates are very low. (Even in the elderly, mortality rates are only 0.7 - 2%.)”
Bethesda Naval Hospital, as a government institution, is not included in surveys by the respected Leapfrog Group, an organization that works to reduce preventable medical mistakes and rates hospitals on their processes to keep patients safe. (Leapfrog Group was founded by large employers, who purchase health insurance, to evaluate the care their employees receive from hospitals).
Virginia Hospital Center, where Murtha was hospitalized, didn't submit any information either even though it is listed in the Leapfrog Group database. Specifically, Virginia Hospital Center declined to respond to the survey on how they are doing to keep medical errors from occurring. Questions include whether there is adequate ICU staffing, processes to reduce ICU infections, and steps to prevent harm.
What the tort reformers won't tell you is the extent to which medical liability has improved patient safety, including the establishment of organizations like Leapfrog Group. You'll hear all about the complaints of doctors complaining of having to perform "defensive medicine," and often justifiably so. There are additional costs to the system when doctors end up ordering unnecessary tests and procedures. But there are other means of addressing those issues, including a greater reliance on evidence-based care. Removing medical liability--already a minor contributor to out-of-control system costs--would likely come at a high cost for patient safety.

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