1. Fewer than
one-half of 1% of the nation’s doctors face
any serious state sanctions each year. 2,696 total serious
disciplinary actions a year, the number state medical boards
took in 1999,
is a pittance compared to the volume of injury and death of
patients caused by negligence of doctors. A recent study
by the Institute
of Medicine of the National Academy of Sciences estimated that
as many as 98,000 patients may be killed each year in hospitals
alone as a result of medical errors.Earlier studies also found
that this was a serious national problem.
2. Harvard researchers
found that 1% of a representative sample of patients treated
in New York state hospitals in 1984 were
injured, and one-quarter of those died, because of medical
negligence.Nationwide, that would have translated into 234,000
injuries and 80,000 deaths
in 1988 from negligence in American hospitals. Most of this
involves physicians. There is no clear evidence that there
has been significant
improvement since then.
3. A similar study conducted in California
in 1974 found that 0.8% of hospital patients had either been
injured by negligence
in the hospital or had been hospitalized because of negligent
care. Extrapolation of those findings would have yielded
an estimate of 249,000 injuries and deaths from negligent medical
practice
in 1988.
4. In 1976 the HEW Malpractice Commission estimated
similarly that one-half of 1% of all patients entering hospitals
are
injured there due to negligence. That estimate would have
indicated 156,000
injuries and deaths resulting from doctor negligence in
1988.
5. Expanding these estimates to include general medical
practice outside of a hospital, the potential abuse by
physicians
is even greater. An in-depth interview with 53 family physicians
revealed
that 47% of the doctors recalled a case in which the patient
died due to physician error. Only four of the total reported
errors led to malpractice suits, and none of these errors
resulted
in an action by a peer review organization.
6. Medical students
at SUNY-Buffalo were asked to recall incidents during their
clinical training that raised ethical
concerns.
More than 200 students responded (40% of total sample);
the majority of instances they reported (60%) did not
in the
researchers’ opinions
threaten the patient’s life, health or welfare.
This, however, implies that potentially 40% did.
7. It
is not unreasonable to estimate that at least 1
percent of doctors in this country deserve some serious
disciplinary
action each year. This would amount to 7,703 physicians
being disciplined each year, a number that, unfortunately
far exceeds
the actual number of physicians disciplined.
8. Sexual
abuse of or sexual misconduct with a patient is also a serious
issue. Six to ten percent of psychiatrists
surveyed
confessed to having engaged in sexual contact with
a patient and in a longitudinal study.
9. Two studies surveyed
residents to determine the incidence of substance use. Recent
alcohol use was
extremely high
in both groups (87% within the last year for emergency
medicine
residents;
74% within the past 30 days for surgery residents).Additional
findings proved extremely disturbing; although the
emergency medicine program directors accurately determined
the
incidence of alcohol use amongst residents, they
dramatically underestimated
the percent who were actually impaired by the substance
as indicated by diagnostic tests (1% estimate impaired
vs. 13%
diagnosed.)
10. This does not bode well for creating
a medical system that prevents mishaps before they occur.
And although
the surgery
residents reported negligible recent cocaine use,
when employed, the drug was typically obtained
from the
hospital supply,
indicating a greater ease of access than for the
general population.
11. residents excessive work
hours Their longest period without sleep during their first
year of
residency was an average
of 37.6 hours (standard deviation (SD) 9.9).
· During a typical work week, they worked an average of 56.9 total
hours (SD 30.19) in on-call shifts (as distinguished from the
total average number of hours they worked per week). An on-call
shift is a continuous shift at the hospital allowing for little
to no sleep; two on-call shifts are typically scheduled per
week.
· 25% reported being on-call in the hospital a total of over 80
hours per week. Surgeons reported the highest average hours
of on-call time per week (72.5).
·
On a scale of 0 (never) to 4 (almost daily), residents most
frequently gave a response of 3 for the amount of sleep deprivation
experienced
during the first year. Over 10% of residents
indicated sleep deprivation was an “almost daily” occurrence.
12. Just 5.1 percent of doctors account for 54.2 percent of the
malpractice payouts, according
to data from
the National Practitioner
Data Bank. Of the 35,000 doctors who have had
two or more malpractice
payouts since 1990, only 7.6 percent of them
have been disciplined. And only 13 percent of
doctors
with five
medical malpractice
payouts have been disciplined.
13. Between 44,000
and 98,000 people die in hospitals annually each year due
to preventable medical
errors, the Institute
of Medicine found. A survey of doctors and
other adults released in December in the New England
Journal of
Medicine found
that more than a third of the doctors said
they or their family
members
had experienced medical errors, most leading
to serious health consequences. The cost to
society in terms
of disability and health care costs, lost income,
lost
household production
and
the personal costs of care are estimated to
be between $17
billion and $29 billion. In contrast, the medical
liability system costs
$6.7 billion annually, about what is spent
on dog
food each year.
14. There is no growth in the
number of new medical malpractice claims. According to the
National
Association of Insurance
Commissioners, the number of new medical
malpractice claims declined by about
four percent between 1995 and 2000. There
were 90,212 claims filed in 1995; 84,741 in 1996;
85,613 in 1997;
86,211 in
1998; 89,311 in 1999; and 86,480 in 2000.
While medical costs have increased by 113
percent since 1987, the amount spent on medical
malpractice
insurance
has increased
by just 52 percent over that time.
Insurance companies are raising rates because
of poor returns on their investments, not
because of increased
litigation
or jury awards, according to J. Robert Hunter,
director of insurance
for the Consumer Federation of America. Recent
premiums were artificially low.
Malpractice insurance costs amount to only
3.2 percent of the average physician’s revenues.
Few medical errors ever result in legal claims.
Only one malpractice claim is made for every
7.6 hospital
injuries,
according to
a Harvard study. Further, plaintiffs drop
10 times more claims than they pursue, according
to Physician
Insurer
Association
of America data.
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