Medical errors prevalent and costly, new survey of Massachusetts residents shows
In Massachusetts, a state that prides itself on its top-quality health care, 20 percent of residents have experienced a recent medical error, and most of them said they “still feel abandoned or betrayed by their doctor,’’ a new survey shows.
Researchers also calculated that errors in the state totaled 61,982 in one single year and that it cost $617 million to provide the follow-up care required by those patients as a result of the mistakes — an amount researchers called a conservative estimate.
And despite a heralded Massachusetts law that requires health care providers to disclose medical errors that cause significant harm and encourages them to apologize — similar to laws in other states — only 19 percent of residents who reported an error said a caregiver apologized afterward.
The report to be released Monday by the Betsy Lehman Center for Patient Safety, a state agency, is one of the most comprehensive statewide examinations of medical errors.
It includes two components: an analysis of Massachusetts insurance claims in 2013 to estimate the number and cost of errors that year, and a recent survey of 5,000 Massachusetts households asking whether they or a close family member had experienced a medical error in the last five years. Researchers interviewed 253 respondents in-depth to uncover the long-term impact of errors.
The prevalence of medical errors reported by Massachusetts residents closely mirrors that found in national surveys and has not improved a lot over the past 20 years, underlining what medical safety leaders said is a discouraging reality. Doctors, nurses, and other providers across the country have made some progress in discrete areas: fewer patients contract certain infections in hospitals, and bar codes have reduced medication mix-ups. But widespread improvement has been elusive.
Politicians have focused on reining in cost increases and improving access to treatment. And some hospitals and nursing homes have been reluctant to invest financially in reducing errors when results are uncertain and may not help their bottom line.
“I don’t know anybody who thinks we have made massive progress in last two decades,’’ said Dr. Ashish Jha, a professor at the Harvard School of Public Health. “There is a very large unfinished agenda.’’
The survey results are humbling in Massachusetts, which is home to many patient safety leaders and where Betsy Lehman’s death from a medical error in 1994 sparked improvements in hospital care in Boston and nationwide. Lehman died after caregivers at Dana-Farber Cancer Institute mistakenly gave the 39-year-old Boston Globe columnist, who was battling breast cancer, a fatal overdose of chemotherapy.
Dana-Farber installed an electronic system to order chemotherapy doses more accurately — as have many hospitals — and improved teamwork and supervision of doctors in training to cut medication errors.
But many other types of harmful care still persist.
“If we can’t push the envelope and do a little bit more, nobody can,’’ said Dr. Gordon Schiff, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital.
A lack of basic information about the prevalence and impact of medical errors in the state has been part of the problem, said Barbara Fain, executive director of the Lehman Center, who hopes the findings will reenergize providers to tackle the issue.
One bright spot in the survey shows that the right approach makes a positive difference for patients, she said. Of the 19 percent of residents who said a provider apologized after an error, the vast majority believed the apology was sincere. And when providers spoke honestly about mistakes, patients were less likely to feel angry, depressed, abandoned, and betrayed.
The organization’s analysis of 2013 insurance claims, which included 98 medical codes associated with preventable harm, found that the most common and costly errors involved pressure ulcers and post-surgery infections, similar to national studies. Massachusetts patients suffered 14,369 pressure ulcers — typically bedsores — and 4,625 post-operation infections that year.
The same year, patients experienced 1,511 accidental punctures or lacerations during surgery, and providers left foreign objects, such as surgical sponges, inside patients’ bodies an estimated 224 times. Yet hospitals, which are required to report when objects are left inside patients, told public health officials about just 33 instances in 2013, a number that has not changed much over time.
Errors occurred in nursing homes, doctors offices, and hospitals. The report did not identify providers by name.
The resulting cost, $617 million, was slightly more than 1 percent of the state’s total annual health care expenditures.
Those costs are due to errors like the one Richard Bunbury experienced last year. He requires intravenous antibiotics at his Roslindale home to treat the long-term effects of Lyme disease. A nurse accidentally dislodged the catheter inserted into his arm and quickly pushed it back, creating the potential for a dangerous infection, he said. The error meant Bunbury had to have a new catheter inserted at a hospital.
“It was quite painful,’’ said Bunbury, who responded to the Lehman Center survey. “And this was a procedure I wouldn’t have had to have otherwise.’’
The Lehman Center’s data have limitations because they do not capture every type of error. Not included, for example, are diagnostic errors, such as when a provider misses a cancer diagnosis, a mistake that often leads to malpractice lawsuits.
Researchers used 2013 data because it was the final year of a medical coding system that allowed comparisons to a similar national study. Some providers might argue errors have since decreased.
Experts also disagree about what exactly counts as an error. Some cite pressure ulcers, painful sores that occur when skin breaks down from staying in one position too long.
“They are not themselves a medical error, but they are a consequence of other errors in care. They’re a signal that something went wrong,’’ said Dr. Eric Schneider, senior vice president for policy and research at The Commonwealth Fund, a research organization based in New York City.
Caregivers may not have examined a patient when admitted to a hospital or nursing home, failed to change the patient’s position in bed, neglected to use the correct cushions, or all of the above.
Mark Schlesinger, a professor at the Yale School of Public Health, said not all errors are simple and obvious, as when a pharmacist fills a bottle with the wrong medication.
“The cause is often complicated and involves multiple people,’’ he said, “like a slow-motion train wreck’’ after which it’s hard to assign blame. For example, a patient gets a new medication in the emergency department. Days later the patient’s doctor, who was not alerted to the visit, prescribes another drug that causes a severe reaction when combined with the first drug.
“Was it the doctor’s error, the patient’s error, or the ER’s error?’’ Schlesinger asked.
When no single person is responsible, that can give providers an excuse to avoid patients: “You know you have an angry patient, and who wants to deal with an angry patient?’’ said Schlesinger, who helped the Lehman Center analyze the in-depth patient interviews.
More than 60 percent of patients who experienced a medical error were unhappy with how providers communicated with them afterward. Thirty-four percent said caregivers did not talk to them about the mistake at all.
Diana Mamouni, who lives in North Andover, said her 72-year-old mother’s congestive heart failure worsened because of a series of missteps at a nursing home.
“It wasn’t just one mistake. It was an attitude and series of mistakes that led to major complications from which she was unable to bounce back. My mom is not going to come back, but if they had acknowledged it, that would have been nicer,’’ she said.
Many patients who’d experienced errors reported being more alert to problems during medical care, always bringing another person to appointments or seeking second opinions as a result, Schlesinger said.
More broadly, the Lehman Center plans to create a consortium to develop a comprehensive set of steps to improve patient safety in the state and measure progress.
“Massachusetts has a record of being on the leading edge,’’ Fain said. “There is no reason why we can’t be a leader on patient safety as well.”