Fatal errors push hospitals to make big changes

Willie King went into a hospital and came out with the wrong leg amputated. Teenager Jesica Santillan died after she received a heart-lung transplant of the wrong blood type. Betsy Lehman, a medical reporter and mother of two, accidentally received fatal doses of chemotherapy four times what was intended. Ramon Vasquez died after he took the wrong heart medication when a pharmacist misinterpreted his doctor's handwritten prescription. Later, only a third of 158 doctors who were shown the prescription could identify the correct drug.

In the past decade, news of these and other medical errors has put human faces on what for many years was an invisible problem: deaths and serious injuries caused by medical mistreatment. As many as 98,000 deaths are caused by medical mistakes in hospitals each year. Now, a reform movement has begun to address these problems and is pushing radical changes in the way medicine is practiced in the United States.

Some are simple procedural reforms, from remembering to wash hands before touching patients to marking the correct site on the body for surgery. Others will require revolutionary and sometimes expensive changes in the medical culture.

Paradoxically, as more and more treatment options become available to patients in the 21st-century hospital, safety is becoming harder - not easier - to maintain. The number of drug choices, for example, has exploded in recent years, increasing the risk of mistakes. Hospitals have become hives of busy, sometimes exhausted, workers and complex systems in which a breakdown at myriad points can lead to tragedy.

How tragic began to come clear five years ago, when the respected and influential Institute of Medicine (IOM), part of the National Academy of Sciences, released a report called "To Err Is Human." It showed that about 1 of every 200 patients admitted to a hospital died because of a treatment mistake - as many as 98,000 fatalities a year. That was more, the report noted, than died in 1998 from highway accidents (43,458), breast cancer (42,297), or AIDS (16,516). While some critics later attacked the number as merely a loosely supported estimate, others contended that because of widespread undercounting, the number was almost certainly far too low.

"There's something about that report that struck pay dirt in the American psyche and the health-profession psyche," says Robert Wachter, a professor of medicine at the University of California at San Francisco and coauthor with Kaveh Shojania of the book "Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes," published earlier this year. "We discovered the epidemic of medical mistakes with the IOM report."

The IOM report also called for a review in five years "to assess progress in making the health system safer," a deadline that is now only months away. That grade is likely to be an "incomplete," reformers say.

"You can practically taste [the reforms] they're so close, yet we don't seem to be able to make them happen," says Lucian Leape, a professor at the Harvard School of Public Health who is considered by many to be the leading expert on medical errors.

Among the successes are changes in procedures, like requiring nurses or pharmacists to read medication orders back to physicians when doctors order by phone. "Before [the IOM report] there were few meaningful regulations on safety, and those that existed weren't enforced very effectively. I think that has changed," Dr. Wachter says. But this amounts to only a few things that are "relatively easy and don't gore that many sacred cows and don't cost that much money."

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