Journalism in the Public Interest

How Many Die From Medical Mistakes in U.S. Hospitals?

An updated estimate says it could be at least 210,000 patients a year – more than twice the number in the Institute of Medicine’s frequently quoted report, “To Err is Human.”

An updated estimate says at least 210,000 patients die from medical mistakes in U.S. hospitals a year. (File, Scott Olson/Getty Images)

It seems that every time researchers estimate how often a medical mistake contributes to a hospital patient’s death, the numbers come out worse.

In 1999, the Institute of Medicine published the famous “To Err Is Human” report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media.

In 2010, the Office of Inspector General for Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.

Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says.

That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second.

The new estimates were developed by John T. James, a toxicologist at NASA’s space center in Houston who runs an advocacy organization called Patient Safety America. James has also written a book about the death of his 19-year-old son after what James maintains was negligent hospital care.

Asked about the higher estimates, a spokesman for the American Hospital Association said the group has more confidence in the IOM’s estimate of 98,000 deaths. ProPublica asked three prominent patient safety researchers to review James’ study, however, and all said his methods and findings were credible.

What’s the right number? Nobody knows for sure. There’s never been an actual count of how many patients experience preventable harm. So we’re left with approximations, which are imperfect in part because of inaccuracies in medical records and the reluctance of some providers to report mistakes.

Patient safety experts say measuring the problem is nonetheless important because estimates bring awareness and research dollars to a major public health problem that persists despite decades of improvement efforts.

“We need to get a sense of the magnitude of this,” James said in an interview.

James based his estimates on the findings of four recent studies that identified preventable harm suffered by patients – known as “adverse events” in the medical vernacular – using use a screening method called the Global Trigger Tool, which guides reviewers through medical records, searching for signs of infection, injury or error. Medical records flagged during the initial screening are reviewed by a doctor, who determines the extent of the harm.

In the four studies, which examined records of more than 4,200 patients hospitalized between 2002 and 2008, researchers found serious adverse events in as many as 21 percent of cases reviewed and rates of lethal adverse events as high as 1.4 percent of cases.

By combining the findings and extrapolating across 34 million hospitalizations in 2007, James concluded that preventable errors contribute to the deaths of 210,000 hospital patients annually.

That is the baseline. The actual number more than doubles, James reasoned, because the trigger tool doesn’t catch errors in which treatment should have been provided but wasn’t, because it’s known that medical records are missing some evidence of harm, and because diagnostic errors aren’t captured.

An estimate of 440,000 deaths from care in hospitals “is roughly one-sixth of all deaths that occur in the United States each year,” James wrote in his study. He also cited other research that’s shown hospital reporting systems and peer-review capture only a fraction of patient harm or negligent care.

“Perhaps it is time for a national patient bill of rights for hospitalized patients,” James wrote. “All evidence points to the need for much more patient involvement in identifying harmful events and participating in rigorous follow-up investigations to identify root causes.”

Dr. Lucian Leape, a Harvard pediatrician who is referred to the “father of patient safety,” was on the committee that wrote the “To Err Is Human” report. He told ProPublica that he has confidence in the four studies and the estimate by James.

Members of the Institute of Medicine committee knew at the time that their estimate of medical errors was low, he said. “It was based on a rather crude method compared to what we do now,” Leape said. Plus, medicine has become much more complex in recent decades, which leads to more mistakes, he said.

Dr. David Classen, one of the leading developers of the Global Trigger Tool, said the James study is a sound use of the tool and a “great contribution.” He said it’s important to update the numbers from the “To Err Is Human” report because in addition to the obvious suffering, preventable harm leads to enormous financial costs.

Dr. Marty Makary, a surgeon at The Johns Hopkins Hospital whose book “Unaccountable” calls for greater transparency in health care, said the James estimate shows that eliminating medical errors must become a national priority. He said it’s also important to increase the awareness of the potential of unintended consequences when doctors perform procedure and tests. The risk of harm needs to be factored into conversations with patients, he said.

Leape, Classen and Makary all said it’s time to stop citing the 98,000 number.

Still, hospital association spokesman Akin Demehin said the group is sticking with the Institute of Medicine’s estimate. Demehin said the IOM figure is based on a larger sampling of medical charts and that there’s no consensus the Global Trigger Tool can be used to make a nationwide estimate. He said the tool is better suited for use in individual hospitals.

The AHA is not attempting to come up with its own estimate, Demehin said.

Dr. David Mayer, the vice president of quality and safety at Maryland-based MedStar Health, said people can make arguments about how many patient deaths are hastened by poor hospital care, but that’s not really the point. All the estimates, even on the low end, expose a crisis, he said.

“Way too many people are being harmed by unintentional medical error,” Mayer said, “and it needs to be corrected.”

See how you can help ProPublica investigate patient safety and join our Facebook group on the topic.

Errors are constantly being reviewed and corrected. You simply can not
avoid human errors.

How many are harmed by all the incorrect information published by the

Working toward perfection is an honorable goal, but we will have to
settle for excellence.

Hospitals in some states are required to report defined medical errors however the regulators sweep the errors under the carpet and rarely do they fully investigate these errors.  As for healthcare-associated infections, if the investigator knows nothing about how these infections occur they can not properly investigate them.

Excellent update on Dr. Leape’s report.

Like most negligent homicides and manslaughter suspects, we rely on doctors to self-report when their performance unnecessarily cripples or kills a patients.  For this reason, doctors are as likely to report preventable errors and complications as drunk drivers will self-report their intoxication.  Medical peers don’t report for the same reason that family members won’t report familial drunk drivers.

And unlike other industries whose products kill or injure consumers, preventable errors, complications and “adverse drug reactions” (ADRs) actually generate profits for hospitals.  So while patients define “good doctors” as those who keep us healthy, hospital administrators and academics define “good doctors” as those who generate profits.

Paradoxically, “tort reform” (something I once supported) dissuades patients and their survivors from filing claims against doctors, hospitals and the makers of vaccines and generic drugs, which dissuades hospitals from changing medical environments and services that threaten and injure patients.

For these reasons, I suspect that preventable errors, complications and adverse drug reactions are much higher than the estimated “third leading cause of death in the US.”  Until the US tort system is fully restored and an INDEPENDENT (not influenced by the healthcare, pharmaceutical or HHS) “black box” reporting system is established, preventable errors, complications and ADRs will remain what I suspect is the #1 leading cause of preventable death in the US.

Bruce J Fernandes

Sep. 19, 2013, 1:22 p.m.

And think about how many visitors to loved ones leave and subsequently get a hospital-borne infection.  I was one of them and there was no doubt on my doctor’s part that is the only place I could have gotten such an infection; it didn’t take a genius inasmuch as my wife got it and gave it to me.

There are no statistics accumulating that information either.  There should because there is a cost to visitors who get these infections too.

States are so understaffed they can barely carry out their inspection duties now and they have become more responsive in the aftermath rather than a precursor with a reporting function designed to pre-empt and prevent future outbreaks.

I joked last FEB when I went in for an elective procedure that maybe they should triage all of us out in an attached building outside the hospital before we enter.  Do all the disinfectant and related and then wheel us in through a corridor between buildings to dedicated elevators to operating rooms.

George Bernick

Sep. 19, 2013, 1:24 p.m.

How does this compare with medical delivery systems in Canada and the United Kingdom?

I do not know Clark Baker. but his perspective is “dead on” in my opinion.

Martha Deed, PhD

Sep. 19, 2013, 1:41 p.m.

John James’ analysis is a real contribution to understanding the reach of death by medical error.  Marshall, you have performed a valuatble service here by asking other experts to evaluate James’ methods and to lay out James’ findings in lucid lay terms.  Thank you very much!

The hospital association now acccepts the 1999 figure of 98,000 preventable deaths a year. That’s 11 dead patients a DAY, almost one every two hours. Initially, of course, the association dismissed the 1999 study - just as it now ridicules the new findings.

98,000 per year is 11 per hour, not 11 per day. *shock*

Suzan Shinazy

Sep. 19, 2013, 4:26 p.m.

Thank you John James! Yes, it is time for a national bill of patient’s rights. It is time the hospitals prove they can keep patients safe. It is time they show more math, numbers that prove your nurse and hospitalists really do have time for you;  time to keep you safe and time to give the excellent care that will return you to the best possible health.
BS7SDEN; do you really believe what you wrote? Are you the smoke blower or recipient?

but wait, there’s more.  a few years ago Don Berwick’s group said it had implemented reform that had eliminated approximately 100,000 deaths/year, which also sorta challenged the IOM numbers inasmuch as the Berwick group was much smaller.  In any event, there are a lot of avoidable deaths occurring in hospitals, which is a good reason for staying away from them whenever possible.  whether they’d rather clean up their act or dispute the numbers is an open question.  latter’s a lot easier.

Just another example of how the FDA and AMA are not protecting the public like they say they are. There would be dramatically less deaths in medicine if this was the case.

You have dietary herbs / supplements that kill a couple people and they get yanked from the market in no time.

Meanwhile, Tylenol kills over 4000 annually, and it’s still on the market. “Modern” medicine is the 3rd leading cause of death in the US. These are conservative numbers in the article, too.

Medical doctors push pills and do many needless surgeries. Visit the white coat at your own risk. They are educated by pharmaceutical companies. Total conflict of interest and the patient suffers.

So funny how the AMA used to smear alternative medicine to silence competition. They function like the mafia in every sense of the word. They were even found guilty in a federal court of conspiring to contain and eliminate safe and natural therapies.

Now, the public is slowly realizing that it’s better to go conservative first, rather that just going to an MD that pushes dangerous drugs.

There are real people behind these deaths. Hospital negligence killed my mother. When the surgeon couldn’t figure out why she wasn’t getting better, he told her it was her own fault and she should try harder. An autopsy showed the cause of death was a hospital error. The surgeon and hospital had no incentive at all to learn from her death. They were paid huge amounts of money anyway.

Thanks to Marshall Allen for this article, and to John T. James for his book.

Martha Deed, PhD

Sep. 19, 2013, 6:47 p.m.

Karen, you are so right.  My daughter died much the same way, and her autopsy also showed a missed diagnosis (spinal infection) that could have been treated if doctors had found it.  Far too many of us can tell similar stories, but somehow, we aren’t able to make either our leaders or society-at-large motivated enough to do anything about it.

Byron Winchell

Sep. 19, 2013, 6:54 p.m.

Wow, an order of magnitude greater than gun deaths.  Nothing to see here, folks.  Move along, doing something might jeopardize a source of serious campaign money.

Robert C. Bowman, M.D.

Sep. 19, 2013, 9:04 p.m.

This week 40,000 to 210,000 Americans using various measures “died” due to deficits in nutrition, missing health insurance, health access barriers, social deprivation, disparities, mistakes, or various inequities.

Big data makes it easy to get big attention focused on whatever variables that the researcher chooses to load and compare.  Get ready for much more.

Improvements are about local and personal, not national number crunches. Most commonly physicians or hospitals get too much credit and too much blame.

Why would we think that the 0.6% of the time in the hospital or in a health care encounter would have so much impact compared to the 99.4% of the rest of the person’s life, or the enormous impact of family, neighborhood, and parent factors?

frank Jersawitz

Sep. 19, 2013, 10:15 p.m.

Doctors always bury their mistakes.

So this is why the Republicans are trying to destroy the Affordable Care Act?

So that America’s poor…scratch that.

So the Republicans are trying to destroy the Affordable Care Act so that America’s poor and those Americans who are employed by the stunning number of American businesses who see providing health care to their employees as an unpalatable hit to “shareholder value”/the CEO’s pay/the proprietor’s profits will avoid the even more stunning possibility that they will be killed by “the best medical system in the world” by dying for want of access to that medical system?

Heck…and here I had thought that the reason was the Republicans are the face - the hands - of evil in this world.

If you enter the medical system today you are automatically in jeopardy. Most patients enter a machine who’s gear drag you into a labrynth of medical lingo, procedures & drugs. On the machine end is an army of technicians including doctors, nurses, aides, orderlies, managers & administrators. Each individual fears the other as dozens of pages of reports are written for each patient so all behinds are covered. The patients overall well being is the last thing they consider as each patient becomes a mere number. The only way to be somewhat protected is to have an active advocate who puts in plenty face time, asks questions & most importantly is willing to be aggressive at times demonstrating that the patient is not alone and everyone is being watched. Otherwise you’re on your own and the results can be fatal. The statistics above prove this out conservatively 210,000 times a year.

Propublica investigators should do a series about patients injured because orthopedic surgeons did not heed the warnings about the use of bone morphogenic protein 2 (BMP 2) used fuse spinal vertebrae.  From 10-50% of patients who have had spinal surgery using this synthetic protein have suffered complications.  I am one of them.  The problem is no one knows how to treat the inflammatory complications,
I would like to hear from anyone who has had BMP 2 placed in their spine and who has suffered any type of complication, especially an untreatable inflammatory complication.
Thanks to those who are making the public aware of medical adverse events.

That’s 24 deaths / Hr. 24/07. How many are saved / Hr. What is the ratio ?. Dr Ron Grassi. Boca Raton, Fl.

Dayton Smith, Jr.

Sep. 20, 2013, 12:50 p.m.

There is no real study that can accurately report deaths by “avoidable medical error”. Every number reported starting with the 1999 study of 98,000 people dying from “avoidable medical error” to this study of 440,000 is vastly understated. In the April, 2013 publication “A Day in Health” they estimate that the 1999 study by the Institute of Medicine reporting 98,000 deaths a year is way understated and reports a 2011 study published by a “Day in Health” claiming current reporting methods miss 90% of serious adverse events. This puts the real number of people being killed each year by the medical industry at well over 1,000,000. It further makes death by “avoidable medical error” the number one cause of death in the US.
What people fail to recognize is the devastation this causes the families of these plus 1,000,000 people being killed a year. Most of this trauma imposed on the families is caused by the doctor who killed their loved one refusing to take any responsibility for his / her actions. This goes as far as altering a patient’s medical records after they have been eliminated and then supporting these altered records with deceit and lies. So after a loved one is killed the family is then required to face the biggest enemy they will ever confront or today’s US Medical Industry and the state and federal regulatory agencies they control.
Anyone who wants to understand what has really happened to the US Medical Industry and why needs to link to our website Medical Malpractice Awareness and read some of the documents along with some of the Victim Posts.  In addition, they should read our national mission statement which includes how this terribly broken system could be fixed while saving billions in the process.
What makes this issue far worse is we have no one to address it as congress; the senate and president have sold us out in favor of power, politics and greed along with their back pockets. Anyone who may questions this must ask why the medical industry posts seven plus lobbyists to each member of congress and the senate, out spends all other lobbyists by a ratio of 4:1 and in the past few years have dumped 5.6 Billion Dollars into the hands of congress.
It is the medical industry who is responsible for all this needless pain, suffering and death but it is your congressman and senators who are 100% the cause.
Proper regulation, standards and transparency and accountability of all medical professionals would solve 80% of these grave problems and save hundreds of thousands of lives but the only people who have the authority to implement these regulations are the congress and senate but they are owned by this 2.8 Trillion Dollar business.
Dayton Smith, Jr.
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Suzan Shinazy RN

Sep. 20, 2013, 12:54 p.m.

The number of deaths are significant enough that you would think all healthcare workers would want major improvements in the system. When I see any health care professional write a statement that defends the status quo, I am sickened. I am doubtful any healthcare professional with eyes that wide shut, would be able to give total, unbiased care.

Many patients lives are saved in healthcare, but that should never be used as an argument to over look the lives lost.

What about the patients living with disabilities from medical error?  What happens when the ratio becomes 50/50? Will it be said, ‘Well we save every other one.’

It would be very wise of the medical community to give respect to every life; to reach out to the patient advocates that are asking for change. The advocates are the ones that can make the system better, and therefore every healthcare workers job will be better, and the healthcare worker will live with less stress/fear of injuring someone due to our fast paced, failing system. That would be a win - win solution.

If this were the airline industry there would be a national revolt. Something has to be done. However, I don’t think there is any healthcare workers gathering before their shifts saying “All right gang let’s see how many we can kill today”.

Many of the people who were “killed” by medical errors were circling the drain to begin with and would have likely died with no errors being committed. 

And a “medical error” is also defined as accidentally giving two Tylenol 500mg instead of one.  Unless you’re allergic to Acetaminophen 1000mg of Tylenol isn’t fatal, but for the purpose of this article such an error is included in the stats.

Conclusion?  An agitprop piece purposed to whip up popular support for Obamacare.

I cannot decide whether I like better:

Dr Ron Grass’s “The number of people we save justifies the number of people we kill.” (as somebody peripherally noted, there are no other industries where successful outcomes justify the waste of human life)


Citizenfitz’ “The fact that humans died due to medical errors should be accepted as proof that they would have died anyway - and besides, both the number of terminated human lives and the importance of those wasted lives is exaggerated by the definition of ‘medical error’.”

Martha Deed, PhD

Sep. 20, 2013, 4:15 p.m.

“circling the drain”?

I truly hope that you are not a healthcare provider.

Scary attitude.

bssteve, stop putting words into people’s mouths.

“I truly hope that you are not a healthcare provider.”

It’s common ER terminology.  I did a write up on this at my site.  Come on over!

Dr Dave: “On the machine end is an army of technicians including doctors, nurses, aides, orderlies, managers & administrators. Each individual fears the other as dozens of pages of reports are written for each patient so all behinds are covered. The patients overall well being is the last thing they consider as each patient becomes a mere number.”

“Doctor” in Home Economics?

Dr Ron Grassi

Sep. 20, 2013, 4:40 p.m.

Let’s be Scientific and Objective here. No room for emotion. Simple question. Does anyone out there know the ratio. Focus; How many lives are saved per minute vs/ how many are lost to Gross Medical Neglegence. Not Medical Malpractice. Just like they say “Air travel is still the safest form of travel” when a plane crashes usually 99.99% of those people die. But the bigger picture is most planes do not crash. So 1 death in 100’s of thousands of miles traveled is not statically significant and acceptable in that industry. We need to compare this to that just so we can wrap our brains around It. Pretty simple. At the current rate of deaths per day due to Med. Neg. (not med malpractice) is currently equivalent to 2 Jumbo Jet Crashes / day. If 2 jets crashed / day the News on TV would be overwhelming. They would shut down the airports. My Question is what’s the difference in the question of concern and public awareness. Why is it not OK for 2 jets to crash every day but it’s OK for the same amount of people to die every day from Gross Medical Neglegence. Again. We are not talking about Mal Practice.

Suzan Shinazy RN

Sep. 20, 2013, 5:43 p.m.

Dr. Ron Grassi, I do not have that ratio answer for you. Do you know?

Imagine if we started to save that 440,000 lives a year because the errors were not made. We all need to stand up to the current system of pushing healthcare workers so fast that errors occur. We can do that. We can save many more lives. Why wouldn’t we want that?

Citizenfitz, I have heard and used the phrase ‘circling the drain’ a few times (I never liked it), but I think the difference is, when I said it, it was to alert everyone that my patient was in rapid physiological decline and I needed everyone in the room stat, the physician on the phone and on the way to the ICU, etc. It is more appropriately called a rapid response now. The purpose is to do what we can to keep our patient from declining all the way to ‘code blue.’

Using the term ‘circling the drain’ to blame the patient and excuse the medical errors is unjustifiable. It can take just one mistake to push the patient over the edge. Some patients die when everything is done correctly to the best of our knowledge at this time. As our knowledge increases, we will see more of these patients live; unless the healthcare worker excuses bad medicine and says, ‘The patient was circling the drain anyway.’

If you are a healthcare worker, be the best you can be. If you do not know something, speak up and find someone that does. And, do not give power to the fact others may put you down for asking. Share knowledge; seek knowledge; it is all about doing the best for every patient. If our patient is safe, we are safe.

Dr Ron Grassi

Sep. 20, 2013, 6:30 p.m.

@ Suzan, RN. Once again. It is not my intention to be critical or become emotionally involved. I suggest we need more data. I am a Clinician & Research Doc. Trained to think pragmatically. How would an Epidemiologist handle this issue. Why do most not step up to the plate and face the music. I’ll tell you “Too Chicken” and I get that. Don’t throw rocks in glass houses. Don’t S—t in your own backyard. Etc. Wait till you see how many people fall of this conversation. Because they are scared they may rock the boat or ruffle the wrong feathers. The fact remains. We are still killing between 3-6 patients / minute in the USA. If we are saving 300 to 600 per minute than that # is acceptable. Human error is between 1-3%. I testify in Court as an Expert Witness. Do you know what ” Whithin a reasonable degree of Medical probability, certainty ” is ?.....51%. In contrast to Scientific certainty. 1-3%.

re:  We are still killing between 3-6 patients / minute in the USA. If we are saving 300 to 600 per minute th[e]n that # is acceptable.

While I would naturally dispute that conclusion (I both don’t believe that human life is the equivalent of widgets rolling off an assembly line and am aware that many an assembly line worker demonstrates a higher morality than some members of the medical community), I would posit that the general acceptance of that kind of medical morality would call for automatic levying of medical malfeasance or, perhaps more appropriately, murder charges should a doctor’s or medical facility’s record demonstrate a negative correlation between wealth/insurance-possessed and patient mortality.

Don’t want the American people to start thinking that the medical community is attempting to add your lifespan to your ability to divert wealth to yourself from the American economy/the American people on the list of things that wealth possessed currently limits.

More bluntly, seeing somebody with gray hair shouldn’t automatically trigger the thought “They must be rich.” in an American’s mind.

Kerry O'Connell

Sep. 20, 2013, 7:28 p.m.

Dr Grassi
By your logic it would be perfectly acceptable to train medical students by letting them operate on other medical students, If we only lose 1 to 3% of all future docs no harm done, cost of doing buisness.

Curious as to how to you draw the line between Gross Medical Negligence and mere Medical malpractice?

@Kerry O’Connell:  I don’t know what makes me think the difference will reside in who is on the receiving end of the accusation.

Or if the accused is a partner in a particular medical practice…

Or, perhaps, if the accused is also a customer of a particular insurance company and so may drive the effectively shared cost of that company’s malpractice premiums…

I.e. monetary drivers…percentages.

Suzan Shinazy RN

Sep. 20, 2013, 9:59 p.m.

Dr. Grassi, compassion and emotions are a part of healthcare clinicians must be able to deal with. Patients need to be treated as a whole person.

As an expert witness, you must know that all hospitals are not created equally and some have far higher rates of REPEATED medical errors.  Meaning, they have fallen out of even your acceptable range, and they stay there. Acceptable?

Human error is real. That is why we have back up safety systems in place, ie, when a physician orders the wrong dose, the pharmacist should catch it. The RN must know it is a correct dose before giving it. Computers are set to flag errors. With all these double checks in place, that would be 3 people and a computer, does that improve the human error of 1-3% that you stated?

I am not afraid of ruffling the wrong feathers.  I am, however, interested in bridging the gap between patients and the healthcare system. Guess what? Patients have something to add to improve healthcare besides their wallets. And it is ok! We can all be safe.

Medical “errors” kill 98,000 Americans a year…no, 180,000 Americans a year…no, between 210,000 and 440,000 Americans a year…

You know what those numbers make me wonder? 

Why hasn’t the National Rifle Association jumped at the opportunity to dwarf the 8,583 homicides by firearms in 2011 with those awe- (or fear-, or disgust-, or grief-, or anger-, or all of the aforementioned…as the case may be) inspiring examples of death-by-medical-practitioner?

The IOM report may have been accurate in 1999, however, as a nurse working in this health care system for the last 30 years, I can tell you that we have a very different health care system now than we did in 1999. Thus those numbers do not remotely reflect the danger today that faces any person at the mercy of the current system. The corporate takeover of healthcare has made hospitals very dangerous places indeed, just from the perspective of nursing care alone- unsafe nurse staffing levels contribute greatly to the number of adverse events and are a continuous threat to patient safety.

Add in the growing number of for profit nursing schools who deliver substandard education and training for nurses and the risk to patients increases even further. This is another area where more research is needed. Many of these schools cater only to the bottom line and do not provide nursing students with the knowledge and skills necessary to be safe practitioners at the bedside.

Remind me to never use an American hospital. And to think our treasonous, unelected govt in the UK are trying to force this on us.

I do have to take issue with comments I have read that suggest that patients become ‘just a number’ whan they enter hospital. Is this how things are in US hospitals? Because it isn’t in the hospital I work in. The vast majority of hands-on healthcare workers that I have worked alongside are caring, professional and very human.

One final thing; I think it should be pointed out that these figures will include patients who have died earlier than would be expected, but who’s condition was already such that their life expectancy had been shortened to some extent. It doesn’t reduce the seriousness of this, but it should be remembered that these are not all patients who walked into hospital with an ingrowing toenail and came out in a box. Not like those who walk into college bright as a pin and get shot stone dead.

As a current nursing student who will be graduating in Dec and entering the profession, I have to say Joannie Pope’s comments swere spot on. I feel I have been rushed through classes and labs, receiving skills training in labs and textbook knowledge in a subpar, formulaic, assembly line atmosphere, meant to crank out nurses to fill “demand.” Many of my classmates and I share the same concern, that we are incredibly under-prepared and lacking in the knowledge needed to be competent, let alone good healing, nurses. And the reaction we get from our instructors and the medical community in our clinicals isn’t reassuring. “Oh, it’s ok, it’s when you start working that you really learn everything and how to be a nurse.” So we learn to nurse by learning the same bad habits?

However, I must add I do believe there are good intentions within the system. They push critical thinking, holistic well-being of the patient, and independent judgement of patient safety more than anything, leaving skill sets as the stuff we will ” mostly learn in the hospitals.” I guess they figure if they can instill these foundational or core values up front, we will acquire skills that are built on them and not the observed bad habits.

Still, I do have to say, it all makes me think that people are human and make mistakes, no matter how much training and judgement they have. And patient care is such a multi-faceted approach…it’s not so much the procedures and meds but the miscommunication or lack of that leads to errors. Will being more conscientious have the adverse effect of limiting treatment? Will doctors be too afraid of making mistakes and hold back on giving aggressive treatment? Do we just give up on trying? I do not say this with the intentions of diminishing the tragedy oflosing a loved one to medical errors. It is just a thought that I think many might have.

The real point of this ramble is to say as a future nurse who wants to be a compassionate, caring, and above all safe care-giver, I am a little frightened and hesitant in going forth in the current medical climate, and unsure how to navigate it. Any advice is welcomed!

3,000 people killed ten years ago on 9/11 = freak out. Spend hundreds of billions of dollars. Trillions actually, including the wars.
100,000 people killed every year = who cares? No money it and no opportunity or excuse for a turn key police state.

First, to the a spokesman for the American Hospital Association who said that their group has more confidence in the IOM’s estimate of 98,000 deaths, keep in mind that the CDC has said that more patients than that die from hospital acquired infections alone.

Second, most care takes place outside of hospitals. For instance, consider C Diff, which is just one type of infection. 75% of those cases are contracted in health care settings other than hospitals. If that percentage is consistent for other infections caught in hospitals, then infections alone may be killing 400,000 patients annually across all care settings. And there are lots of other iatrogenic causes of patient death.

Third, as can be heard in the other comments to this article, referring to all the causes of patient harm as “errors” or “mistakes” is inaccurate and misleading. It makes it so easy for the care giving community to dismiss the problems harming patients since there always are going to be errors. To use the wrong term is to misunderstand the problems and so do the wrong things to protect patients. What about policies that save money even though they allow a certain number of patients to die as a result? What about incompetent practitioners who are allowed to keep practicing for political reasons? What about the inaccurate records that are created to cover up nearly everything that goes wrong in medicine? None of those can be called errors.

That is just the beginning of the list of non-errors harming patients but being dismissed as innocent mistakes. Search on the word “nequamitis” for better terms for the ills in medicine harming patients.

Dina J. Padilla

Sep. 21, 2013, 3:55 p.m.

Joel, you are 100% correct and the only reason for “nequamitis”, is profit,  only for a few.

Dr Ron Grassi

Sep. 21, 2013, 4:51 p.m.

We have all acknowledged that we have a problem here.

Any Solutions.

Martha Deed, PhD

Sep. 21, 2013, 5:09 p.m.

Great question, Dr. Grassi.  Don’t we have to start with finding out exactly how large the problem is and where the problems lie?  Would take a sea change maybe, but a starting point would be for patients and their families to be included in all root cause analyses discussions and for hospitals to post their CMS compliance surveys online and to make them publicly available at their reception area desks. 

Public inspection reports are done with nursing home inspections in NYS and it is of great value to families.  Patients and the public should not have to jump through FOIA hoops to find out what is happening with their hospitals.

Also, I think we need to understand that patients and front-line staff often have common interests re staffing levels, infection control, proper equipment (lifts, for example)—and that these shared difficulties could be starting points.  Thanks for the question.

Dr Ron Grassi

Sep. 21, 2013, 5:34 p.m.

@ Dr Martha:  The problem is epidemic, pandemic. Here in the USA we publish it. We have no idea how ramped on a global scale this actually is. As Larry David , the producer of Seinfeld would say, pretty, pretty scary. JAMA published this original data over 10 years ago. I speak to Doc’s all the time . Give them this fact and their response is “Your kidding me. Where did you ever hear of that”  It’s amazing that they are hearing it from little old me for the first time. Notwithstanding the patients. Come on. 2 Patient Loads of Jumbo Jet Crashes / Day in the USA due to Gross Medical Negligence. Recall, their is a difference between that and malpractice. We have acknowledged the animal exists. Now identify it. Isolate it. Contain it. Pretty, pretty simple.

Dr. Grassi and others,

Just submitted proposal to Knight Foundation to address the problem of preventable deaths at our healthcare institutions. See proposal here..

How Safe is Your Hospital?

As a physician I have seen how organizations can make a difference when it comes to patient safety…

Will be happy to discuss further and surely can use help….

Brief intro to proposal:
How Safe is Your Hospital? Saving lives by eradicating medical errors

How Safe is Your Hospital? is a project that utilizes actionable information to test the hypothesis that informed citizens, interacting with healthcare stakeholders, will eradicate preventable medical errors in Philadelphia area hospitals.

How Safe is Your Hospital?  is motivated by the belief that all healthcare institutions must be top performers when it comes to patient safety. Additionally it is guided by the recognition that in order to achieve excellent healthcare outcomes, patients and citizens must work together with healthcare providers and hospitals toward that goal. When we become patients, requiring emergency medical care, it’s often too late to address hospital safety and quality concerns. Even if we are motivated to investigate the quality and safety record of the hospitals in our community, we are helpless facing the currently available complex information that is publically available on government, hospital and commercial websites and billboards. We believe that by providing relevant user friendly information that leads to individual action plan, we can 1. prevent medical errors for our selves and 2. by holding relevant stakeholders accountable for patient safety outcomes, we can achieve improved health outcomes for all patients.

Being an active health issue blogger, I LOVE this news. Can’t wait to see how the medical industry shills explain this one.

@Abinico: Thank GOD you have your ear to the ground. This may be bigger than Enron.

This article is part of an ongoing investigation:
Patient Safety

Patient Safety: Exploring Quality of Care in the U.S.

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