Johns Hopkins Medicine researchers say medical errors should officially rank as the No. 3 cause of death in the United States. It reportedly claims more than 250,000 American lives annually, just behind heart disease and cancer, which each kill roughly 600,000 people a year.
And yet, respiratory disease, which causes approximately 150,000 deaths per year has claimed the third spot ranking. The researchers sent a letter to the CDC to tack on medical mistakes to its yearly list of death causes. Researchers also called on local agencies to change the way medical error cases are listed on death certificates. That way, the government could more easily keep track of the issue.
Medical mistakes run the gamut. They could be complications during surgery that aren’t recognized. They could be incorrect doses of medication. They could be overlooked doses of medication or the wrong medication. It could be an obvious diagnosis that a doctor simply failed to see.
But getting an exact count of these incidents is tough because the CDC (Centers for Disease Control and Prevention) coding system that tabulates death certificate information doesn’t account for things like, “poor judgment,” “diagnostic errors” or “communication breakdowns.”
One of the lead authors of the Johns Hopkins study, surgeon Dr. Marty Makary, said there is an overestimation for conditions like heart disease, and yet not enough of an examination of medical error issues as a cause of death. And of course, not all hospitals and health care providers are eager to concede an error contributed to death, as that would prove to be significant ammunition in a medical malpractice lawsuit.
The study was published in The BMJ (which used to be called the British Medical Journal).
As of this writing, the CDC only counts conditions as the underlying cause of death on death certificates. That very definition excludes medical errors. What Johns Hopkins researchers say is that if medical errors were documented accurately, they would rank above diabetes, suicide and Alzheimer’s disease as a cause of death.
As of 2014, the most common causes of death were:
- Heart Disease
- Chronic Lower Respiratory Diseases
- Accidents/ Unintentional Injury
- Alzheimer’s Disease
- Influenza/ Pneumonia
- Kidney Disease
In an interview with journalism non-profit ProPublica, a representative of the CDC argued against the contention that the agency is grappling with any type of coding issue. Medical mistakes are cited on death certificates, he said, and there are codes that capture them. However, the CDC only counts the “underlying cause of death.” That means whatever it was that led the person to seek treatment in the first place is what is considered the “cause of death.” So even if a doctor clearly indicates a medical mistake on a a person’s certificate of death (which isn’t always guaranteed), it’s not going to be published in the totals.
This approach, the CDC spokesman said, is in line with guidelines that are followed internationally. But what that means is that “heart disease” might be listed as a “cause of death” in the CDC figures, even when it was in fact a medical error that led to the patient actually dying.
Researchers have proposed adding a question to death certificates that specifically inquire as to whether a preventable care complication contributed to the decedent’s cause of death.
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Study Urges CDC to Revise Count of Deaths from Medical Error, May 3, 2016, By Marshall Allen and Olga Pierce, ProPublica
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Pitt-Hart v. Sanford USD Med. Ctr. – Medical Malpractice or General Negligence, April 25, 2016, West Palm Beach Medical Malpractice Attorney Blog