No Outrage, No Story In Dead Patients

Dec 22, 2010

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A good story involves drama and conflict. A federal judge with Republican ties nixing a Democratic president's signature achievement in ensuring access to care for all is a great story. One, two, even three reports about hospitals avoidably (if inadvertently) killing tens of thousands of Americans annually once they have the insurance that ensures them access to care apparently has little, if any, drama at all.

Back in November 1999, the Institute of Medicine issued a landmark report saying that 44,000 to 98,000 Americans were being killed every year by preventable medical errors in hospitals. "To Err Is Human" was a political bombshell, which created an uproar. Its impact continues to reverberate.

But those reverberations can feel rather faint when you consider today's political landscape. Two new reports this November showed that the nation's death toll related to medical errors has barely budged in 11 years, and a third report released in August said pretty much the same. That inertia represents the equivalent of the entire population of Washington, D.C., being wiped out during this period. For the most part, though, no one paid any attention to this story. Truth be told, it was boring.

A compelling story has good guys and bad guys -- an over-reaching federal government or evil corporations. It also must have visible victims. When Arizona stopped funding organ transplants due to its fiscal emergency, real people with photogenic families were on hand to plead their case – making it a powerful story.

The storyline also should be easy to follow. So, for instance, Newt Gingrich's brilliant slogan "Paper Kills" transformed concern over medical errors into a straightforward technical fix. Faster diffusion of health information technology was good for patients, for the earnings of the industry that prodded politicians and the press to jump on the bandwagon, and for Gingrich's for-profit Center for Health Transformation.

By contrast, a Nov. 15 Health and Human Services estimate that hospitals inflict preventable harm on roughly 60,000 old people every month -- and kill a significant proportion of them -- was just a number. It didn't have enough political pizzazz for The Washington Post, except for an opinion piece that appeared earlier this week. Meanwhile, The New York Times secreted the story in the business section, presumably because the price tag of preventable harm was $44 billion. By that logic, the war in Afghanistan should be next to the stock tables.

Just before Thanksgiving, the Times did place on the front page a New England Journal of Medicine study concluding that the death rate from medical injury had not declined since 1999. Worth noting was were the vague explanations by health care leaders as to why progress has been so slow. Additionally, the story did not even mention the HHS report, which was based on a seemingly better methodology and more recent data. Perhaps the medical editors don't read the business pages.

Completely ignored by all was a careful study released in August by the Society of Actuaries that used claims data from private insurers. Even in this younger and presumably healthier population, errors in 2008 caused more than 2,500 avoidable deaths -- not to mention more than "10 million lost days of work." (I presume this figure refers to the effect of injured workers, not dead ones.)

You can't really blame the press and politicians. They take their cues from the stakeholders, and the patient advocacy groups too often seem to be yawning, not yelling. The AARP magazine ran a cover story this past summer on the crusade against medical errors by actor Dennis Quaid. However, if AARP issued a press release after any of the three reports I've cited -- HHS, for example, said a stunning one of every seven hospitalized Medicare beneficiaries suffers harm as a result of care -- I can't find it.

Infections play a major role in treatment-caused harm. However, the Committee to Reduce Infection Deaths, run by Republican activist Betsy McCaughey, was silent. McCaughey did find time earlier this year to denounce comparative effectiveness research (supported by the Democrats) as "death panels." I also could find no mention of these reports by the National Patient Safety Foundation or Consumers Advancing Patient Safety.

There was some information hiding under "Consumers Union News Releases" on that organization's Safe Patient Site. Meanwhile, the politically powerful American Cancer Society, American Heart Association and American Diabetes Association seem energized by searching for cures, not safe care.

There are other reasons the new studies were treated as old news. Easy villains have disappeared. The original 1999 IOM report was issued during a slow news period and shocked the general public by using several examples of real patients who'd been harmed. In its wake, patient safety efforts were launched, including the latest HHS report, which was mandated by Congress.

In the time since, 27 states and the District of Columbia have adopted public reporting of infections or other errors, in part because of a concerted campaign by Consumers Union. In addition, hospitals, physician groups, insurers and other stakeholders are enthusiastic participants in a variety of efforts dedicated to care improvement.

Still, those explanations don't entirely excuse the outrage outage. If groups whose purpose is to advocate for consumers can't get excited anymore about dead and injured patients -- if they can't find names to go with the numbers and can't create a narrative about the human toll of a clear and documented failure of hospitals to adopt proven strategies for avoiding harm -– if the so-called consumer groups don't care enough to cry out in outrage, then why should anyone else? And so they haven't.