Appendix 73b - Malpractice

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

Malpractice Makes Perfect

Reviewing stroke, pneumonia, and heart attack deaths from 12 hospitals, one study found that over a quarter of the deaths might have been prevented.[882] A study in JAMA found that one in seven heart attacks occurring in a hospital were actually caused by the physician.[883]

The first major malpractice expose was published in the New England Journal of Medicine in 1981:

[Researchers found that over a third] of 815 consecutive patients on a general medical service of a university hospital had an iatrogenic [doctor-caused] illness. In 9 percent of all persons admitted, the incident was considered major in that it threatened life or produced considerable disability. In 2% of the 815 patients, the iatrogenic illness was believed to contribute to the death of the patient.[884]

Then in 1990, rocking the medical community, the Harvard Medical Practice Study. Conducted by the university's prestigious school of public health, it is considered one of the most comprehensive and objective empirical studies of malpractice ever performed. Based on the review of over 30,000 randomly selected patient records, researchers estimated that 27,179 injuries, including 6895 deaths and 877 cases of permanent and total disability, resulted from physician negligence in New York state alone in one year.[885]

Not surprisingly the adverse events suffered by uninsured patients were twice as likely to be caused by negligence than for those with private insurance.[886] My mom wants me to tattoo, "I have health insurance" on my chest just in case I ever arrive at a hospital unconscious.

The art of medicine, like that of war, is murderous and conjectural - Voltaire

Extrapolating this data to the national level, medical malpractice is the leading cause of accidental death in the United States. According to an article in JAMA, doctor's negligence causes the equivalent of a jumbo jet crash every three days.[887]

A Harvard law professor who co-authored the study calculated the annual national number of dead to be 150,000, with 234,000 injuries - and this estimate only included injuries and deaths caused by doctors in hospitals. By comparison, in 1992, 42,000 persons were killed in highway crashes; 27,000 died as victims of a crime; 23,000 died of AIDS.[888] As one consumer group press release reads, "Negligent doctors kill more than twice the number of people killed by firearms and twice the number of people killed by auto accidents...."[889]

What did the director of the AMA's office of professional liability have to say to these accusations? "The Harvard study showed 99 percent of hospital patients are safe." Mern Horan, the spokesperson of Ralph Nader's Public Citizen organization, replies. "The fact that 'only' 1 percent of all hospital patients are injured or killed by medical negligence... is hardly as reassuring as the AMA... finds it."[890]

Poor Compensation

Researchers went back and studied all the cases of negligence reported in the Harvard Medical Practice Study. In only 2% of cases in which doctors were found negligent were malpractice claims ever filed. And contrary to a myth popular among physicians, the poor and uninsured were significantly less likely to sue for malpractice, a finding verified by the General Accounting Office.[891] The researchers conclude, "Medical-malpractice legislation infrequently compensates patients injured by medical negligence and rarely identifies, and holds providers accountable for, substandard care."

Hypocritic Oath

The American Medical Association has fought bitterly to limit the ability of patients to sue for damages. In spite of this policy, the AMA, after listening to Hillary Clinton expound on the Administration's healthcare plan, consulted its lawyers and announced that if the plan restricted a doctor's ability to earn professional fees, the AMA would sue. The Georgia Civil Justice Foundation:

It is remarkable that... these special interests [like the AMA] at one time or another have sought to restrict or eliminate consumers' access to the courts. Yet for the protection of their own rights - when they perceive they are being threatened - they turn to our civil justice system.... They are wrong when they work to limit the right of ordinary, less powerful, far less well positioned citizens to do the very same thing.[892]

Testimony before Congress: "The advantage of the tort system* is that it provides a continual, ongoing system of 'regulation by incentives.' And it does not rely on enforcement by the medical profession which, like any other profession, is notoriously reluctant to police its own members."[893] From the journal Hospital Practice:

It is sad but true that many physicians practice more carefully than they did in the past because they have one eye on the potential litigant.... If the courts and insurance companies and the fear of malpractice become the most important disciplinary weapon in medicine - distasteful as the idea may be to physicians - so be it.[894]

* The tort system refers to the ability to take civil action against wrongful acts - the ability to sue for malpractice.



[882] Dubois, RW and RH Brook. "Preventable Deaths." Annals of Internal Medicine 1 October 1988:582-589.

[883] Bedell, SE, et al."Incidence and Characteristics of Preventable Iatrogenic Cardiac Arrests." Journal of the American Medical Association 265(1991):2815-2820.

[884] Steel, K, et al. "Iatrogenic Illness on a General Medical Service at a University Hospital." New England Journal of Medicine 304(1981):638-642.

[885] Brennan, TA. "Incidence of Adverse Events and Negligence in Hospitalized Patients." New England Journal of Medicine 324(1991):370-376.

[886] Localio, AR, et al. "Relation Between Malpractice Claims and Adverse Events Due to Negligence." New England Journal of Medicine 325(1991):245-251.

[887] Leape, LL. "Error in Medicine." Journal of the American Medical Association 272(1994):1851-1857.

[888] Medical Negligence

[889] Consumers Union [publishers of Consumer's Reports] Press Release. May 16, 1994.

[890] Rice, B. "Do Doctors Kill 80,000 Patients a year?" Medical Economics 71(1994):46.

[891] GAO/HRD-93-126, August, 1993.

[892] Quick Facts on Medical Malpractice Georgia Civil Justice Foundation.

[893] Testimony of Patricia M. Danzon, presented to the Committee on Labor and Human Resources, U.S. Senate, July 10, 1984.

[894] Robert SD. "Malpractice, Medical Discipline and the Public," Hospital Practice. 19(1984)209, 216.



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