To Sue or Not to Sue? Tis Nobler …

A few years ago, the National Academy of Sciences' Institute of Medicine released a report showing that between 44,000 and 98,000 people die each year because of mistakes by medical professionals.

Those who delight in ascribing evil motives to the legal profession, also fail to inform their acolytes that in fact more people die each year in the United States from medical errors than from highway accidents, breast cancer or AIDS.

That's an awful lot of Americans, grievously injured or killed due to medical errors. And the legal system is for many, their only salvation. However the Republican controlled Congress, has made it a high priority and a centerpiece of Mr. Bush's bogus healthcare reform agenda to impose federal limits on tort litigation, particularly medical malpractice.

A new study released published in the Annals of Internal Medicine reviewed 307 closed medical malpractice claims, 181 of which allegedly involved diagnostic errors that ended up harming patients. A large majority of those cases involved various types of cancer.

This report is significant because it reviews basic errors made by doctors, including tests ordered too late or not at all and failure to create follow-up plans which played a role in nearly 60 percent of cases in which patients were allegedly hurt by missed or delayed diagnoses, the study found.

Errors are common in medicine and are a focus of efforts to improve health care quality. Very little of the recent attention on medical errors has focused on those that occur around diagnosis. It is not uncommon for persons to discover that they have a condition that their doctor missed. Although each person with a missed diagnosis knows his or her individual story, the reasons for missed diagnoses from the perspective of the health care system have rarely been studied.

I have a close friend, a young woman of 37 with three children. About a year ago, she went to Kaiser Permanente in California complaining of a lump in her breast. She was given a cursory examination and sent home. She was told to return in four months. She did as instructed. Four months later when she went back to kaiser, she was belatedly diagnosed with stage four breast cancer. She underwent radiation treatment, a radical mastectomy then chemotherapy followed by additional radiation.

If this had been me, I would have been furious. By failing to order an immediate diagnostic test, a simple and routine mammogram, Kaiser played fast and loose with the life of this young mother

While researchers acknowledged that most claims involved several factors, they said major ones included mistakes by doctors: failure to order appropriate diagnostic tests (100 cases); failure to create a proper follow-up plan (81); failure to obtain an adequate history or perform an adequate physical examination (76); and incorrect interpretation of tests (67).

Doctors not involved with the study said the findings highlight the fact that physicians -- and patients_ need to err on the side of caution when it comes to ordering diagnostic tests, keeping detailed records and doing follow-up.


My friend happened to be a young immigrant who thought she could trust our healthcare system to protect her. I'm sure no one told her that at every level, the system was irretrievably damaged. The system betrayed her and her trust. She was neither "compulsive" nor "diligent" thinking that was the responsibility of her doctors.

"It seemed like the bottom line was that the problems were problems that would occur less if a person was just very compulsive or very diligent," said Dr. Steven Sorscher, an oncologist at Washington University Medical School in St. Louis. "It highlights the fact that the causes of serious errors are often preventable."

Was my friend seriously harmed by the Kaiser incompetence? Might she have avoided such disfiguring surgery had she received the proper tests when she initially saw her doctor--the jury is out. She had a particularly agressive and fast growing cancer which is not uncommon in younger women.

The study looked at random samples of claims from four malpractice insurance companies throughout the U.S. The reviewers were instructed to ignore the outcomes of the claims, all of which closed between 1984 and 2004; nearly 60 percent of the cases resulted in serious harm and 30 percent resulted in death. All involved missed or delayed diagnoses in office settings.

Most of the errors occurred in doctor's offices and primary care physicians were those most frequently involved. More than half of the missed diagnoses involved cancer, primarily breast and colorectal cancer, and biopsies were the test most frequently at issue.

So the next time you hear someone malign a lawyer and spew nonsense that tort reform is the absurd cure-all for our broken healthcare system, remind them of the facts. Fact number one: the costs of malpractice premiums are only about 1 percent of total U.S. healthcare costs. Then remind these folks that a recent study in the International Journal of Health Services found that in 2003, administration costs in the US health care system ate up about $400 billion or about 25% of total health care spending.

By comparison, publically funded national health care systems incur administrative costs of a few percent of total health expenditures. According to a New England Journal of Medicine study Canada's national health insurance system spends just 1.3% on overhead, and the US's Medicare and Medicaid programs have administrative costs of between 2-5%.

The facts are our friends. The truth will set you free.

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Posted at 8:22 PM, Oct 08, 2006 in Civil Justice | Health Care | Hypocrites of Tort "Reform" | Medical Errors | Medical Malpractice | Right to Access the Courts
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