Intended for healthcare professionals


Medical errors kill almost 100000 Americans a year

BMJ 1999; 319 doi: (Published 11 December 1999) Cite this as: BMJ 1999;319:1519
  1. Fred Charatan
  1. Florida

    An expert panel from the Institute of Medicine, part of the National Academy of Sciences, found that medical errors kill from 44000 to 98000 Americans each year.

    The chairman of the 19 member panel, William C Robinson, president of the W K Kellogg Foundation in Battle Creek, Michigan, a private, grant making body, said, “These stunningly high rates of medical errors—resulting in deaths, permanent disability, and unnecessary suffering—are simply unacceptable in a medical system that promises first to ‘do no harm.’”

    The panel's report, which was released in November, recommended that a new federal centre for patient safety should be set up in the Public Health Service and should have a budget of about $100m (£63m) a year, which is equivalent to just over 1% of the $8.8bn a year in costs estimated to be attributable to preventable medical injuries.

    Healthcare providers would be required to inform state governments of any medical errors leading to serious harm; currently only 20 states have such reporting requirements. Doctors and nurses would also be re-examined periodically by state licensing boards to evaluate their competence and their knowledge of safety practices.

    The report condemned the current fragmented system of handling medical mistakes, which relies on a combination of peer review, federal and state regulation, malpractice lawsuits, and evaluations by private accreditation bodies.

    Nancy Dickey, a past president of the American Medical Association, which supports the panel's recommendations, was concerned about mandatory reporting and public disclosure of serious medical errors.

    Dr Dickey said: “On the surface it appears to be a relatively straightforward step but actually it engenders all sorts of problems with confidentiality and liability. Doctors find themselves in a real bind.”

    However, the panel said that a crucial strategy in reducing errors was to shift the focus “from blaming individuals for past errors to a focus on preventing future errors by designing safety in the system.”

    Apart from citing surgical horror stories—like that of Willie King, who had part of the wrong leg amputated at University Community Hospital in Tampa, Florida, in 1995—the panel found that more than 7000 Americans died each year as a result of “medication errors,” which included the prescribing or dispensing of the wrong drugs. For example, the panel said, pharmacists often had difficulty deciphering the illegible handwriting of doctors who prescribe drugs (4 December, p 1456).

    Karen M Ignagni, president of the American Association of Health Plans, which represents health maintenance organisations, said, “Health plans will rise to this challenge and will work with doctors, hospitals, and public officials to address these issues.”

    In an article in last week's New York Sunday Times, entitled “Do No Harm—Breaking Down Medicine's Culture of Silence,” Dr Lucian Leape, a professor of health policy at Harvard, and a member of the expert Institute of Medicine panel, discussed the problems surrounding the task of addressing medical mistakes. He said: “Physicians are taught that it's your job not to make a mistake. It's like a sin. The whole concept of error as sin, as a moral failing, is deeply ingrained in medicine, and it is very destructive. It means people cannot talk about it, because it is too painful.”

    • As the BMJ went to press, President Clinton announced that he accepted the institute's recommendations and would instruct federal agencies providing or financing health care to adopt all feasible techniques for reducing medical errors.

    The BMJ will be publishing a theme issue on error in medicine on 18 March and holding a one day conference on 21 March.

    Embedded Image

    Willie King, who had the wrong foot amputated before having the correct one removed, appears at a rally to highlight negligence


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