Street roots
8
March 16, 2012
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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