With a report out this week on the frequency of medical errors in Massachusetts, it's hard to pick out the numbers that are the most disturbing.
The Betsy Lehman Center for Patient Safety's study calculated 61,982 "preventable harm events" to patients in one year in Massachusetts. Those errors lead to more than $617 million in excess health insurance claims – not to mention long-term impacts on physical and emotional health of many patients and their family members.
Those excess health insurance claims amounted to about 1% of the state's health care expenditures in 2017; the study concluded its numbers underestimated the number of errors and the cost, because many common errors can't be reliably identified by analyzing health insurance claims.
The medical errors covered the gamut – infections introduced through careless use of catheters; items inadvertently left inside patients during surgery; improper punctures during procedures – all the way to actions that lead to chronic pain, paralysis or death.
Besides the economic cost, the study recorded how patients felt and reacted after medical mistakes were identified. The data found that errors frequently resulted in long-term sadness, anger, depression or anxiety among patients. Two-thirds of the people who responded expressed "reduced levels of trust in health care no matter how long ago the error occurred." Some 57% said they "sometimes or always" continue to avoid the doctor or facility where the medical mistake was made. And, the report summary says, "Of great concern is that more than one-third of all respondents report that they continue to sometimes or always avoid all medical care" after the error.
But there are positive findings as well. The report found open communication by health care providers can go a long way. Many patients reported lower levels of emotional harm when providers communicated openly about the errors. Without open communication, the study found 50% of patients continued to be angry, 78% avoided the doctor who made the error and 80% continued to stay away from the health care facility where it occurred. But with open communication, just 7% continued to be angry, 30% avoided the doctor and 21% stayed away from the facility after the medical error was made.
The report is both a snapshot of the frequency of medical errors in the state and road map for ways to improve the system. It says real progress has been made to improve patient safety in the last 20 years, but the increase in medical procedures performed outside hospitals means "risks to patient safety are an emerging concern in physician and dentists' offices, surgery centers, pharmacies, dialysis centers, patients' homes, nursing homes – anywhere patients receive care."
The death of Boston Globe reporter Betsy Lehman in 1994 from an accidental, massive overdose of a chemotherapy drug during treatment for breast cancer lead to an Institute of Medicine report in 1999, "To Err is Human," a broad analysis of medical errors nationwide and an effort to begin working on ways to prevent them. In Massachusetts that effort continued with establishment of the Lehman Center, focused on analyzing medical practices and errors. With the release of this report, the center plans to convene a Massachusetts Health Care Safety and Quality Consortium to help develop a vision and goals to improve safety in all health care settings.
The report notes Massachusetts faces the same challenges as other states, but there's reason for optimism. It concludes that with "our leadership on medical research and innovation and our achievements in the health policy arena" – coupled with a history of collaboration in health care – the Bay State can be a "model for the nation on patient safety too."
This type of continuing scrutiny and analysis should give us all hope that patient safety will remain high on the priority list of all health care providers.
To read the report: www.betsylehmancenterma.gov/assets/uploads/Cost-of-Medical-Error-Report-2019.pdf