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The Institute of Medicine
The Institute of Medicine (“IOM”) was established in 1970 to examine policy matters pertaining to the health of the public and to advise the federal government. The IOM’s to Err is Human: Building a Safer Healthcare System was published in 1999. In that text, the IOM studied the literature on the frequency and cost of health care-related errors and the factors that contributed to their occurrence. Errors were defined as “the failure of a planned action to be completed as intended” or “the use of wrong plan to achieve an aim.” The errors fell into several diverse categories and types, as follows:
Error or delay in diagnosis
Failure to service indicated tests
Use of outdated tests or therapy
Failure to act on results of monitoring or testing
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or routine of using, a drug
Avoidable delay in treatment or in responding to an abnormal test
Failure to provide preventative treatment
Inadequate monitoring or follow-up of treatment
Failure of communication
Other system failure
IOM’s studied conclusion was that preventable medical errors in this country are killing at least 44,000 and maybe as many as 98,000 people every year. The vast majority of these deadly errors resulted from systemic failures not just personal or individual families.
More recently, the Journal of Patient Safety published an effort to update the “nearly 3 decades-old” basis of the estimates found in IOM’s to Err is Human.In A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care, John James, a NASA toxicologist and patient safety advocate, reviewed several studies that attempted to evaluate the incidence of adverse events. As was the case in the studies relied upon by the IOM in 1999, a physician was required to determine that an adverse event occurred and was required to classify the severity of the harm. Using a weighted average of the studies, Dr. James concluded that a minimum of 210,000 deaths a year occur from preventable medical errors in hospitals. Dr. James noted, however, that each of the studies was limited by the failure of providers to chart of omission and by the failure of providers to chart known errors of commission within the record. Accounting for those limitations, Dr. James concluded that up to 440,000 deaths occur each year from care in hospitals. This would put medical negligence third behind only heart disease and cancer as the most common cause of death in this country.
Evidently, medical malpractice is widespread in America. To put the crisis in perspective, the number of people killed by medical errors in 2012 was roughly 10 times the number of people killed in car accidents. Similarly disturbing is the estimate that “severe harm,” from preventable medical errors is “10- to 20- fold more common than fatal harm.” The scope of this crisis suggests that it is not merely the result of a few doctors and nurses making mistakes, but instead reflects a systemic problem, where error and the potential for error lies deep within the core of our health care institutions. The data suggests that this is true in every area of the hospital, including the labor and delivery unit.