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Medical Errors: Often Preventable, Seldom Litigated

In late 1999, the Institute of Medicine, a group charged by the National Academy of Sciences to examine health policy issues, issued a report called "To Err Is Human: Building a Safer Health System." Among other things, this report noted a high incidence of medical errors in the United States; it was discussed widely in the popular media and led to President Clinton's call for increased attention to this matter. The report drew heavily from a study of adverse events and negligent care in Utah and Colorado; that study now has been published in Medical Care.

Researchers examined 14,700 medical records, randomly selected from hospitalizations occurring in Utah and Colorado in 1992. They estimated that an adverse event -- an injury caused by medical management that resulted in a prolonged hospital stay or disability -- occurred in 2.9 percent of the hospitalizations. About 30 percent of these events were attributed to negligence. Operations and drugs were the most common causes of the adverse events (45 percent and 19 percent, respectively). In another analysis, published in BMJ, investigators used the same records to examine the relation between patient age and adverse events. The incidence of adverse events was estimated to be significantly higher in patients aged 65 and older than in younger patients (5.3 percent vs. 2.8 percent).

What are the implications for malpractice? The researchers linked malpractice claims data from these states with their data on adverse events. They found that 97 percent of patients suffering negligent injury did not sue. Conversely, 18 of the 14,700 patients did file malpractice claims, but there was no evidence of negligence in 14 of those cases.

Comment: The 2.9 percent incidence of adverse events reported here is slightly lower than the 3.7 percent incidence reported from New York State in 1984, in a study that used similar methodology (see N Engl J Med 1991; 324:370). Because nearly a third of adverse events were thought to result from negligent care, many were presumably preventable. One of the striking findings in this latest study is the marked dissociation between negligence and lawsuits: Victims of negligent care are unlikely to sue, and most claims are filed in cases without demonstrable negligence.

The Institute of Medicine report included a series of recommendations designed to reduce medical errors and to increase patient safety. (For the complete report, see http://books.nap.edu/books/0309068371/html/1.html.) It will be interesting to see whether they are implemented, and if so, whether they will have an effect on reducing medical errors in the U.S.

— AS Brett

Published in Journal Watch General Medicine March 31, 2000

Citation(s):

Thomas EJ et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000 Mar 38 261-271.

• Medline abstract (Free)

Studdert DM et al. Negligent care and malpractice claiming behavior in Utah and Colorado. Med Care 2000 Mar 38 250-260.

• Medline abstract (Free)

Thomas EJ and Brennan TA. Incidence and types of preventable adverse events in elderly patients: Population based review of medical records. BMJ 2000 Mar 18 320 741-744.

• Original article (Subscription may be required)
• Medline abstract (Free)