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About Street roots. (Portland, OR) 1998-current | View Entire Issue (March 16, 2012)
Street roots 8 March 16, 2012 T ilfr ' 'i - il 1 ■ T T o l i Ô P H O T O BY JO N W IL L IA M S BY ROSETTE ROYALE C O N T R IB U T IN G W R IT E R ’ve got a friend, I’ll call him George, who, for several months, experienced an intense pain on his side. Turned out to be a kidney stone. George had dealt with them before and passed each one, with varying degrees of discomfort. But this time, no such luck. Doctors determined that due to the kidney stone’s size - 9 millimeters by 7 millimeters, roughly the size of a raisin — it was too large to pass through his ureter, into his bladder and out his urethra. So they scheduled George for a lithotripsy, a procedure that would use acoustic shock waves to “blast” the stone to bits, the easier for it to pass. It was supposed to be an easy procedure. It wasn’t. Somehow, during the process, a tear developed in George’s kidney. Could it have been the result of stone fragmentation during the procedure? No one knows. But as a result, George lost two quarts of blood. Doctors worried about complications. George had to wear special “socks” to massage his calves, to prevent blood clots. He wondered if something else would go wrong. Luckily, it didn’t. And after spending several days in the hospital, he went home, where, for a couple weeks, he battled through waves of pain. A follow-up visit with a new doctor revealed that his urologist had prescribed an improper dosage of pain medication. His new doctor tweaked his medication. Finally, after a month, George seems to be on the mend. Did my friend George experience a medical error? Maybe. It’s impossible to know. But the whole time I spoke with William Charney, I couldn’t stop thinking about George. With 30 years experience as a health and safety officer in the health care industry, including five years as the safety coordinator for the Washington Hospital Association, Charney has become a vocal activist for health care reform. Recently, his attention has been drawn to medical errors, those events that occur in health care settings that impact patients’ health. By Charney’s reckoning, some of those impacts have deadly consequences. Through research I Epidemic of Medical Errors and Hospital- Acquired Infections: Systemic and Social Causes by William Charney (CRC Press) he’s gathered, he believes that medical errors lead to more than 788,000 deaths a year, making them the leading cause of death in the United States. For proof, he points to a new book he edited, “Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social Causes” (CRC Press, $99.95). A collection of 19 essays written by Charney and a group of doctors, nurses and health care professionals, the book relates sobering stories from a nurse on the frontlines, how medical errors affect marginalized populations and how hospitals can be breeding grounds for infections. It’s enough to make you feel ill. But if he and his colleagues are right that medical errors kill more people than anything else, then why don’t we know about it? Charney has a few ideas. And, while sitting over a lunch at the Salmon Bay Café in Ballard, Wash., he spoke about what causes medical errors, who suffers because of them and what people - meaning all of us who seek out medical care — can do to stop them. R osette Royale: What does the term medical error mean? W illiam Charney: We define it as a combination of medical errors where the doctors, nurses or health care workers make mistakes: health care acquired infections, misdiagnoses, medication errors, surgical errors that produce either fatality or some form of morbidity, blood clots, hospital-acquired diarrheas that they can’t control. A lot of studies, like in the Institute of Medicine (the nonprofit health-focused branch of the Academy of Sciences), they come out every once and a while (and report) we have 100,000 medical errors. But people get misled by that number. These are means, these are scientists picking out the middle value. So, picking the middle value, you still get 788,558. If you look at the CDC data of people who died in 2009, it’s 2.4 million who died of all causes. A third of people who are dying are dying because they’ve had some kind of relationship with their health care delivery system. I mean, it’s an epidemic of grotesque proportions. It’s an earthquake. R.R.: Sometimes when there’s an earthquake, there’s an indication the earthquake is coming. So, has there been an indication this was coming? W.C.: There has been. Five years ago, various institutions, especially the American Hospital Association, started the 100,000 Lives Campaign because they started to get embarrassed by the numbers of medical errors. There was a good national effort to see if they could reduce the damage, reduce the amount of harm. And they came up with some ideas. But if you look at the data, they’re mostly going after low-hanging fruit, which is my criticism. They’re not taking on the strategic or the systemic causes. That would mean they would have to change health care, and the way we deliver it. They have some nice ideas, and they’re kind of warm and fuzzy: computerized medical records, IT solutions, team medicine, computerizing pharmaceutical interventions. But I call the systemic causes the real causes of this epidemic. R.R.: A nd what are they? W.C.: Your list starts with for-profit medicine. When you are in business to make a profit, certain things get left behind. And the data shows that a for-profit hospital has up to two to four times the rates of medical errors as not-for-profit hospitals. Which doesn’t mean the not-for-profit hospitals don’t have high rates, but the for-profit hospitals, they’re trying to save money in medicine and have a negative patient effect. The second cause is patient-to-staff ratio. Now when they are higher than 1:5 nurse to patients, your mortality rate goes up. When they get to be about 1:8, you have 31 percent higher potential for mortality on any given day than you would have if you had a 1:4 ratio. It’s also housekeeping. We don’t know how to clean hospitals in this country, and we cut back on housekeepers. They clean the stretchers, they clean the beds, they clean the rooms. Because we don’t have See EPIDEM IC page 9
