How Hospitals Can Kill You – Part III

This is the final installment of a three-part series of three articles on how hospitals can kill you. You can view part I here and part II here. Continue reading below to learn of other common medical and hospital errors that can kill or cripple you.

Other Common Medical and Hospital Errors

Injury from Falls

          Falls among hospital patients are fairly common, with up to 7 falls per 1,000 patient-days. Approximately 30% of inpatient falls result in injury, with up to 6 percent resulting in serious injury.

          These serious fall-related injuries can include fractures, subdural hematomas, excessive bleeding, and even death. Injuries due to falls also increase healthcare costs - up to 7.5% of hospital-acquired falls result serious injury.

          Using conservative estimates, there are more than 500,000 falls each year in U.S. hospitals, resulting in 150,000 injuries.  (https://www.npsf.org/page/safetyissuesprofl)

          The annual incidence of falls among the elderly is estimated to be approximately 220 per 1,000, or seven million annually. The CDC has reported that more than a third of adults over 65 fall each year.

          The total direct costs of all fall injuries in the elderly in 2000 exceeded $19 billion. Furthermore, the costs of injurious falls are projected to reach $32.4 billion by 2020. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492485/)

Pressure Ulcers (Bedsores)

           Pressure ulcers are also known as pressure sores or decubitus ulcers, all of which fall under the term “pressure injuries” (PIs). These are injuries to skin and underlying tissue resulting from prolonged pressure on the skin.

           The patients who develop PIs are usually elderly, with a condition that leaves them immobile. Bedsores can develop rapidly and can become severe unless cared for quickly.

           An easy solution? Get the patient up and moving regularly!

2.5 Million Patients a Year Develop Bedsores

          Bedsores affect 2.5 million patients per year. In 2004, according to the CDC, 159,000 nursing home residents had pressure sores, making pressure injuries the second most common hospital billing claim.

          “The national incidence rate of PIs is 2.5% in hospitals, or 60,000 deaths/year. The cost of individual patient care ranges from $20,900 to $151,700 per pressure ulcer. Medicare estimated in 2007 that each pressure ulcer added $43,180 in costs to a hospital stay.”

           PIs costs the U.S. Health System $9-11 billion per year and $70-150 thousand per patient for Stage in severe cases.” (https://aquilacorp.com/resources/pressure-sores/statistics/)

(https://www.ahrq.gov/professionals/quality-patient-safety/pfp/2015-interim.html)

Blood Clots and Deep Vein Thrombosis (DVT) 

           DVT is a condition involving the formation of a blood clot in the deep veins of the legs or pelvis. After formation, the clot can restrict blood flow in the region, causing pain and swelling (usually in the legs).

(https://www.webmd.com/dvt/blood-clots)

          Blood clots can also form when your blood doesn't flow properly. If it pools in your blood vessels or heart, the platelets are more likely to stick together. 

          DVT most commonly occurs during or after surgery or other prolonged inactivity (such as sitting for six or more hours on a plane). (https://www.webmd.com/dvt/blood-clots)

Hospital-Induced Delirium and Post-Hospital Syndrome

          Surprisingly common in the elderly, what can look like dementia may be a state of confusion brought on by a mix of meds combined with simply being in the hospital. (https://medshadow.org/features/hospital-induced-delirium)

           Hospital-Induced Delirium is estimated to cost more than $143 billion annually, mostly in longer hospital stays and follow-up care in nursing homes. (https://khn.org/news/for-many-patients-delirium-is-a-surprising-side-effect-of-being-in-the-hospital/)

           Dr. Robert Pearl, M.D, best-selling author on healthcare issues, states in his Pharma and Healthcare article “How Hospitals Can Kill Us”:

“Imagine an institution where the occupants are routinely left immobile, deprived of sleep and fed a diet that is tasteless and nutritionally marginal. Imagine further that they experience the indignity of losing any semblance of privacy, wakened at all hours and get stuck multiple times a day with needles.”

          This sounds altogether too much like life in a prison. Because of exposure to such inhospitable environments, many patients suffer acute and long-term complications.

          These conditions are most common in the elderly, and the older the patient, the more likely and more severe the problems become. They are both preventable, but still occur far too often.

Hospital-Induced Delirium

          The usual experience in most hospitals is that patients are frequently awakened during the night for testing or injections with bright lights, beeps from equipment, people shuffling around them, and other noises.

          Additionally, some hospitals do not allow exercise and require bed rest, resulting in weakened and shrinking muscles, lowered stamina, and coordination. Worst of all is the prescription of drugs that can create even more confusion. Its not unusual that a patient is given some form of opioid that can distort their reality.

“The result of all these factors is disorientation and mental confusion, with little chance to recover in an environment which is like a warzone to the already ailing frail elderly patient. The delirium may manifest itself in the hospital but symptoms may be perpetuated once the patient returns home or is required to stay in a nursing home for an indefinite period. Often, even months later, the patient is still unable to walk normally, can’t sleep, has nightmares, nervousness, and has no clue about what happened in the hospital. Young people are more resilient, but they are still susceptible."
"Over half of the elderly patients and over three-quarters of those treated in intensive care, suffer from hospital-induced delirium. Over 7 million suffer annually, and it goes unrecognized in over half of the cases. Hospital stays are prolonged for those who develop this complicated set of ailments and symptoms, accumulating a cost to Medicare of $164 billion a year.” (https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC1853193)  | (https:/khn.org/news/for-many-patients-delirium-is-a-surprising-side-effect-of-being-in-the-hospital/)Post-Hospital Syndrome  

         For days and weeks after their stay in the hospital, vulnerable and elderly patients may become ill from a variety of conditions such as intestinal ailments, pneumonia, and heart failure. The hospital experience may have been so disturbing and intense that it degrades an already weakened physical constitution and creates susceptibility to a host of other physical problems.

          According to the American Academy of Nursing, 65% of patients over 65 develop weakness in the legs within 48 hours of release. Many remain crippled. (https://khn.org/news/for-many-patients-delirium-is-a-surprising-side-effect-of-being-in-the-hospital/)

The Bottom Line for the Elderly

Often checking your elderly loved one into the hospital is putting them in a safe place. Regardless of how hearty he or she may seem to be, nobody is safe considering these facts. If you have to admit them, you must spend day and night with them to be sure of their safety.

If the conditions above are present, it would be best to check in to another hospital or facility that is quieter, less invasive, and more considerate of your loved one as a human being. Remember, hospital staff deal with sick people all the time and sometimes they can become calloused or less aware of what is really happening.

Other Errors

          The following quote is from an article by Dr. Leana Wen, MD.  Concerned about the constant problem of misdiagnosis, she wrote the book “The Doctor is Listening”. In it she says:

“In this examination of the doctor-patient relationship, Drs. Wen and Kosowsky argue that diagnosis, once the cornerstone of medicine, is fast becoming a lost art, with grave consequences. Using real-life stories of cookbook-diagnoses-gone-bad, the authors Wen and Kosowsky illustrate how active patient participation can prevent these mistakes.”

          In other words, listen to the patient and find out what is wrong. Often the diagnosis is right there. Here are some of the stories from her book.

•   Misdiagnosis: Right diagnosis is, obviously, the most important key in cure. If you don’t know what is wrong with the patient, how can he be treated?

•   Unnecessary treatment: Patty Skolnik’s son had brain surgery that left him partially paralyzed. He died, and then his mother learned that the surgery wasn’t needed.

•   Unnecessary tests and deadly procedures: Over 700 billion spent every year on unnecessary test and treatments. Always ask WHY a test is needed.

•   Medication Mistakes: Over 60% of hospitalized patients miss their regular medication while in the hospital, or worse, they’re given the wrong meds. Medication errors injure 1.5 million Americans every year at a cost of $3.5 billion.

•   “Never Events”: Operating on the wrong patient or wrong body part, food going into chest tubes instead of stomach tubes, air bubbles in IV catheters, objects left in the body after surgery. All of these are classified as “never events”.

•   Missed warning signs or signals: Nurses or doctors fail to see warning signs such as heart rate and blood pressure changes until it is too late.

The Ten Most Common Medical Errors in the U.S.

          To get to the bottom of how doctors and/or hospitals can seriously harm you, just go to a lawyer or insurance malpractice website and see what they say. Dr. Barry Bialek, M.D., senior contributing editor for CoverMD, a Medical Malpractice Insurance company, said in “The Ten Most Common Medical Errors in the U.S.”:

"Medical errors in the U.S. kill up to 100,000 people every year. In its 1999 landmark book, To Err Is Human: Building a Safer Health System, the Institute of Medicine (www.iom.edu) stated that medical errors in the U.S. kill up to 100,000 people every year. In other words, for every person killed in the U.S. by a drunk driver, two people are killed by medical errors."

           These errors, as itemized in the CoverMD article, are listed below:

  • Technical Medical error: Five-year-old had stomach pain, was rushed to the hospital, and his appendix burst. Doctor cut Billy’s renal artery and he bled to death.
  • Failure to use indicated tests: Emily had severe indigestion and she was rushed to the hospital. A doctor sent her home without doing EKG or even prescribing medication for indigestion. She died of a heart attack.
  • Avoidable delay in treatment: Michelle and husband checked in for the delivery of their baby. A nurse watched for 45 minutes while the contractions sped up and the baby’s heart rate dropped. The child survived, but because of severe cerebral palsy, he now requires round-the-clock-care.
  • Failure to take precautions: 250 lb. Marvin tried to get out of bed with nurse assistance, but he fell and broke his hip. The nurse should have called for help before moving him.
  • Failure to Act on Test results: Bright, energetic 9-year-old Sara felt sick so a doctor ordered urine and blood tests, diagnosed her as having a urinary tract infection, and sent her home without even looking at the results showing high blood sugar. Unfortunately, Sara returned in a diabetic coma, and never fully recovered.
  • Inadequate monitoring after a procedure:  12-year-old Tammy had tonsillectomy in an ambulatory surgery center. In the recovery room, she appeared to be sleeping normally, but had stopped breathing. She never regained consciousness and now lives with aid of 24-hour care.
  • Inadequate patient preparation before a procedure: Paul had a simple procedure, but nobody told him to stop taking huis blood thinner, Coumadin. The doctor biopsied his throat and because the bleeding wouldn’t stop, blood filled his lungs and he died.
  • Inadequate follow up: Jasmine had a colonoscopy and the Versed (a narcotic) she was given made her feel woozy. At home she was in pain, but doctor on call said to wait until the morning and call again. 48 hours later she was rushed to hospital where 3 feet of her colon had to be removed when it was discovered that she had a leak.
  • Avoidable delay in diagnosis: A 20-year-old college sophomore got knocked out in a bar fight. He awoke in the ER with bad headache, but the resident doctor didn’t call in a CT team. At 6:00am, his intracranial bleeding raised the pressure on his brain and he blacked out – forever.
  • Improper dosage and/or method of use of drugs: Jessie ate too much chocolate cake, and her blood sugar spiked. The doctor gave her too much insulin and it starved her brain of glucose. She died.

           Errors occur most often in a patient’s room or in the operating room. The next most common locations are the emergency room, the labor and delivery room, and the doctor’s office.

Ten Years Later

          Ray Sipherd presented a CNBC special on Feb 22, 2018 entitled: “The Third-leading Cause of Death in U.S. Most Doctors Don't Want You to Know About.” In the program he said:

“A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Other reports claim the numbers to be as high as 440,000. Medical errors are the third-leading cause of death after heart disease and cancer.”

          Advocates are fighting back, pushing greater legislation for patient safety.

          What happened that caused deaths to more than double in less than two decades? Our population didn’t grow that much.

Breaking News – an Example

           In an April 16, 2016 article by John Gregory, entitled “NC hospital reviewing 9,200 cases after lab mistakes wrongly diagnosed cancer, published in The Health Exec, he says:

“After at least 10 patients received improper diagnoses owed to pathology lab errors, Winston Salem, N.C.-based Wake Forest Baptist Medical Center has been reviewing 9,291 cases ahead of a June deadline set by CMS that could strip its Medicare certification.”

           As North Carolina Health News reports, Wake Forest Baptist’s errors were costly. Of the 10 already identified, three of them underwent unnecessary surgery and radiation treatment in 2016 and 2017, including one who received a double mastectomy despite not having breast cancer.

          A fourth patient was “underdiagnosed,” as her cancer was caught 13 months after biopsy. 

          These mistakes were attributed to a pathologist identified as “MD #7” in the CMS report, but the problems went beyond a single doctor. Failure to train workers in the lab or document whether recommended maintenance schedules were followed for lab equipment was also cited.

          Inspectors found failures to “monitor water quality, temperature and humidity levels in the lab,” as well as numerous expired supplies being found on lab shelves dating back as far as 2005.

          To list all of the medical errors and diseases a patient can fall victim to during a hospital stay would take volumes. It is a major reason why the America spends so much on healthcare, yet we rank at the bottom for quality of care.

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 Dr. Mike Carberry, D.C.