How Hospitals Can Kill You – Part I

           This is the first in a series of three articles on how hospitals can and do kill patients. Hospital admissions are the third leading cause of death in the United States. These articles, taken together, will shock you and make you think twice before going into a hospital or putting a loved one there for almost any reason.

You're Taking A Chance When You go to a Hospital as a Patient

          First, it is important to say that hospital results are thankfully more often good than bad. Hospitals and the many skilled doctors who try their best, as well as the many well-intentioned nurses and staff, and the state-of-the-art equipment and appliances will normally send you home cured and happy.

            However, the facts that follow highlight problems that happen all too often, and they may occur even more frequently than what’s reported here.

Superviruses, Negligence and Infections, oh my!

          With so many antibiotic-resistant superviruses and other infectious agents populating hospitals these days, checking in for treatment can be dangerous. Many adverse incidents are caused by hospital staff errors, doctors’ negligence, the treatment, the equipment, virulent infections, and the very air itself.

           Any of these could prematurely end a hospital stay or extend it almost indefinitely.

To Prepare You for What Follows, Here are Some Facts:

Healthcare-associated infections: (HAIs) kill more people in the United States than AIDS, breast cancer and auto accidents combined. Healthcare Facilities Today
Methicillin-resistant staphylococcus aureus (MRSA):  a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus (staph) because it's resistant to some commonly used antibiotics.
Norovirus: a very contagious virus that causes vomiting and diarrhea. You can get norovirus from having direct contact with an infected person or consuming contaminated food or water.
C. Diff: You take antibiotics to knock out a bacterial infection. But for some people, these drugs can trigger a potentially life-threatening infection caused by a type of bacteria called clostridium difficile, or it can cause colitis, a serious inflammation of the colon.
Staph: It can often be found living harmlessly on human skin. But occasionally, staph will wander into a hair follicle or slip into a crack in your skin causing a great many common infections ranging from boils, to sties, to rashes. Red sores and pus are typical of affected areas. About 18,700 people die in this country each year from drug-resistant staph infections, according to a recent federal study - more deaths than the United States sees from AIDS annually. (Chron)

750,000 HAI Cases in 2011

           Although significant progress has been made in preventing some healthcare-associated infection types, there is much more work to be done. On any given day, about one in 31 hospital patients has at least one healthcare-associated infection - this is down from 1 in 25 in 2015. CDC, U.S. News March, 2015.

          Hospital acquired infections (HAIs) range between $28 billion and $45 billion in annual direct hospital costs in the US alone.

          In 2011 alone, there were roughly 722,000 cases of HAIs in U.S. hospitals, and about 75,000 of those patients died during their hospitalization. If that doesn’t sound serious enough, consider the fact that more than half of those HAIs occurred outside of the intensive care unit (ICU). Lifehacker.

1,700,000 HAI cases annually?

          Roughly 1.7 million hospital-associated infections occur annually in acute-care hospitals which result in tens of thousands of patient deaths and billions of dollars in costs to the healthcare system. $35.7 to $45 billion per year is spent on treating these infections.

          The total direct, indirect, and nonmedical social costs of HAIs are estimated at around $96 billion to $147 billion annually, including loss of work, legal costs, and other patient factors. Becker’s Hospital Review How HAIs lead to direct, indirect and unintended hospital costs.  May 26, 2015

40,000 Errors Daily

          Each day, more than 40,000 harmful and/or lethal medical errors occur, placing patients in worse situations than they came in with. According to a 2013 study, preventable medical errors kill around 440,000 patients each year. That’s 10 times the number of deaths caused by motor vehicle crashes. Mercola, April 06, 2016

Five to Ten Percent of Patients Have HAI

          When people go to the hospital, they should not contract a preventable healthcare-associated infection (HAI). Unfortunately, HAIs affect 5 to 10 percent of hospitalized patients in the U.S. per year. Approximately 1.7 million HAIs occur in U.S. hospitals each year, resulting in 99,000 deaths and an estimated $20 billion in healthcare costs.

          The CDC estimates two million people in the United States are infected annually by hospital-acquired infections, resulting in 20,000 deaths. The most common infections are those of the urinary tract, the surgical site and from various pneumonias at a cost of $20,000 to $25,000 per patient.

HAI reduction in 2018

            Remedial action to fix the HAI problem began and the number of infections declined in 2018. “The Centers for Disease Control and Prevention (CDC) estimates that, on any one day, as many as one in 25 hospital patients suffer from a hospital-acquired infection (HAI).

           While the latest data shows a significant decrease in infection rates of both MRSA and C. diff in acute care settings and inpatient rehabilitation facilities — 7% and 8%, respectively — HAIs continue to trouble patients and providers alike. Oct 23 2018, Lippincott Solutions

“Never” Events

           Studies of wrong site, wrong surgery, and wrong patient procedures show that “never events” are happening at an alarming rate of up to 40 times per week in U.S. hospitals.  (Archives of Surgery)

           “Never events” are improbable errors like operating on the wrong patient, giving a patient treatment or medication meant for another, and operating on the wrong body part or the right one for the wrong disorder - anything involving mistaken identities.

Are You Afraid Yet?  There’s More, Much More

           As many as 1.2 million U.S. hospital patients may be infected each year with a virulent staph infection that's resistant to antibiotics - a rate almost 10 times greater than previous estimates, a new study finds. (HealthDay News)

           The research, conducted by the Association for Professionals in Infection Control and Epidemiology, also found that as many as 119,000 hospital patients each year may die from the tough-to-treat strain of bacterium, called methicillin-resistant Staphylococcus aureus (MRSA). The germ is spread by touch and can lead to dangerous skin infections, blood infections, and pneumonia.

          “This is a wakeup call that hospital administrators should understand the importance of this problem," said report author Dr. William Jarvis, an epidemiologist and president of the consulting firm, Jason and Jarvis Associates.

          "The rate of MRSA was higher than had previously been estimated, Jarvis said. "Not only did we find MRSA in all states in all facilities, but 66 percent of it was on the medical service, which runs counter to previous beliefs that most MRSA was in intensive care units," he added.

           One expert agreed that more needs to be done to fight this looming threat. "In the early years of the 21st century, we are seeing the value of antibiotics decline as more and more germs become resistant to them," said Dr. David Katz, the director of the Prevention Research Center at Yale University School of Medicine. "Methicillin resistant Staph aureus is one important example of this trend.”

Dr. Barbara Starfeld

          The iconic Dr. Starfeld, head of the Department of Health Policy and Management at Johns Hopkins School of Hygiene and Public Health in Baltimore, Maryland, did a comprehensive study of American healthcare. She wrote an eye-opening article published in JAMA (the Journal of the American Medical Association) on July 26, 2000, entitled “Is U.S. Health Really the Best in the World?” Her conclusions were shocking. 

          She first outlined the statistically low ranking of the U.S. in world health, longevity, and infant mortality and the highest in obesity, which were consistent with the statistics outlined in Chapters 1 and 2. Then she went on to detail the number of deaths that can be attributed to our healthcare system itself:

          The healthcare system also may contribute to poor health through its adverse effects. 

  • 12,000 deaths/year from unnecessary surgery
  • 7,000 deaths/year from medication errors in hospitals
  • 20,000 deaths/year from other errors in hospitals
  • 80,000 deaths/year from nosocomial hospital-acquired infections in hospitals
  • 106,000 deaths/year from non-error, adverse effects of medications

          These total to 225,000 deaths per year from iatrogenic causes (illnesses caused by physicians, other healthcare providers, or their medications or treatments).

          Three caveats should be noted:

First, most of the data are derived from studies in hospitalized patients.
Second, these estimates are for deaths only and do not include adverse effects that are associated with disability or discomfort.
Third, the estimates of death due to error are lower than those in the IOM (Institute of Medicine) report (referred to later in this chapter and footnoted below). 

          If the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000. In any case, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. 

          Note that Dr. Starfeld’s statistics do not include illnesses or deaths occurring outside hospitals in nursing homes, doctors’ private offices, or patients’ homes.

Study Shows What Originally Set the Stage for this Problem 

           Vanessa McMains, writing for the prestigious Johns Hopkins Hospital HUB, published an article on May 3, 2016, entitled “Johns Hopkins study suggests medical errors are third-leading cause of death in U.S. Physicians advocate for changes in how deaths are reported.” In summary, the article revealed that in 1949, billing codes were established to tally causes of death.

          The coding system was designed to maximize billing for physician services, not to collect national health statistics. Heart disease and cancer got top billing and funding, and medical errors were not even counted. 

          The original purpose of billing codes was, therefore, to maximize payment to doctors, not to highlight or bring attention to their errors. Because malpractice and other errors are not revealed by payments under the codes, such errors may never come to light.

         While the casualties among these innocent, sick people have been suppressed, doctors and hospitals have continued their usual billing practices with the errors hidden behind this wall of codification. 

Is it Really the Third Leading Cause of Death or the First?

          As brought to light by Dr. Starfeld, medical errors cause 9.5% of all U.S. deaths each year, amounting to the third highest cause of death in the U.S.  But it is suggested, upon considering these cited articles from Dr. Starfeld and Ms. Mcmains, that if all of the pertinent facts and evidence were gathered, we might well conclude that hospitals would be found to be the largest healthcare-related killer in the country.

How could this happen?

         It’s simple, financial incentives to correct the situation aren’t present. Most hospitals get paid for all the work they do, regardless of whether it helped or harmed the patient.

          The more they do, the more they make. The hospital is a business entity, run by humans under the banner of a healthcare operation. For many hospital administrators and CEOs the primary reason for hospitals is to be an oasis of care and cure, for others, it is for profit first.

Affordable Care Act Exacerbated the Problem

        The Affordable Care Act gave more patients access to free healthcare (in other words, paid for by government), which gave the hospitals a free hand to provide more and more services to more and more patients regardless of cost or consequences.

Food for Thought

          If we are the reputed “gold standard” of healthcare in America, why are we ranked 37th in healthcare by the World Health Organization, 26th in longevity and 29th in infant mortality? And this is in spite of the fact that we spend $3.2 trillion a year on it (in 2018 elevated to $3.4 trillion). Do medical errors play a part in this horror show?

Want to read on? View part II here and part III here. 

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 Dr. Mike Carberry, D.C.