Despite having the most expensive healthcare system in the world, the United States does not top the list of country rankings when it comes to stopping preventable deaths.
Many of these untimely demises are the result of medical errors, such as the error that occurred when Lavern Wilkinson sought treatment for a cough two years ago. Although is not possible to determine conclusively that a medical error contributed to her death, the New York City woman died in March 2013 of lung cancer after what her aunt described as a missed opportunity for early diagnosis.
Lavern’s story
In late February, the New York Daily News broke the story of the 41-year-old mother of one. In 2010, Wilkinson visited the Kings County Hospital emergency room in Brooklyn, New York with a bad cough. Doctors there took x-rays of her chest, likely to check for pneumonia.
Wilkinson’s aunt, Gloria O’Connor, told theGrio that a doctor missed a nodule that was present on her right lung. The hospital then sent her home with advice to take Motrin, as the emergency room care providers who directly treated her believed she only had asthma.
Over two years later, after another visit to the same emergency room, Wilkinson was diagnosed with stage IV lung cancer. The illness had, by that time, spread to her spine, liver and brain, O’Connor said. Wilkinson died on March 10, a tragedy compounded by the fact that she leaves behind a 15-year-old daughter named Micalia. Micalia has severe autism, a need for lifelong care, and will be left parentless.
Wilkinson accepted a settlement of $625,000 offered by hospital administrators in early 2013.
Medical errors are common
“We were deeply saddened by the death of Ms. Wilkinson. We very much regret this tragedy and the profound impact it had on our patient and her family,” a representative for the New York City Health and Hospitals Corporation (HHC), which oversees Brooklyn’s King’s County Hospital, said in a statement to theGrio. “We recognize the importance of learning from this experience and have put in place additional safeguards to ensure that any abnormal radiology finding receives timely attention and appropriate follow-up. Keeping our patients safe is our first priority, and we are committed to doing all we can to prevent this situation from happening again.”
Wilkinson’s unfortunate story is hardly unique. According to recent findings published in the journal Health Affairs, a third of patients admitted into hospitals suffer from adverse events, meaning any undesirable result of the use of a medical product, including medical errors.
Medical errors such as Wilkinson’s misdiagnosis underscore the need for improvement of America’s expensive health care system. Currently, the U.S. government estimates that nearly 18 percent of America’s GDP goes toward purchasing healthcare. Americans spend more than anyone else in the world for medical expertise.
Despite this, the American system is far from the best in many areas. When it comes to preventing unnecessary deaths, for example, The Commonwealth Fund ranked the U.S. last out of four countries, compared to France, Germany, and the United Kingdom, in a 2012 report.
Medical errors don’t reflect incompetence
The misdiagnosis that may have contributed to Wilkinson’s early death could have occurred normally as part of routine — even quality — treatment.
“All medical errors, at least in my experience, are complicated,” says John D. Banja, medical ethicist and professor of rehabilitation medicine at Emory University in Atlanta. His book, Medical Errors and Medical Narcissism, dissects the human component of medical mistakes by examining the doctors who make them. “Very rarely do you find one person doing something inexplicably stupid that culminates in a disaster,” he says. “As you dig into what happened, you invariably see all kinds of factors that make it clear how the error occurred.”
In Wilkinson’s case, her aunt said a radiologist had spotted the lung nodule during her first visit to the emergency room. O’Connor also related that a different doctor, who was a first-year resident, sent Wilkinson home to take an over-the-counter pain reliever.
Her aunt said Wilkinson was never given the results of her x-ray.
“I’ve heard of cases where surgeons have amputated the wrong limb in a hospital,” Banja says. “You ask yourself, ‘how could a doctor have done that?’ Yet, I know of cases where that surgeon has walked into the operating room and the patient has already been draped and prepped on the wrong side. In virtually every case, what we know is in order for a catastrophe the size of what happened to Lavern to happen, you have to have multiple healthcare professionals making multiple mistakes that are not detected.”
Electronic health records: a solution?
The month that Wilkinson received her cancer diagnosis, President Obama signed The Patient Protection and Affordable Care Act (PPACA), better known as the Affordable Care Act or Obamacare, into law. The policy contains a series of health care reforms, set to roll out over a four-year period, to control the costs of health insurance and expand care to more Americans.
Effective as of October of last year, PPACA Section 3002 requires hospitals to begin adopting and implementing rules for the electronic exchange of health information. With electronic health records, the policy attempts to, “reduce paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improve the quality of care,” according to the U.S. Department of Health and Human Services.
This measure provides monies of up to $107,750 in Medicare and Medicaid incentive payments to providers for implementing these systems. On the flip side, hospitals that fail to adopt certified Medicare and Medicaid Electronic Health Record (EHR) systems by 2015 would have their Medicare reimbursements reduced.
“Hospitals realize the promise of health information technology to improve quality of care,” says Marie Watteau, director of media relations at the American Hospital Association, of this new measure. “The AHA supports the EHR incentive program.”
While Americans wait for the ongoing implementation of Obamacare, hospitals are researching state-of-the-art practices to eliminate mistakes.
For further info on EHR or EMR, check out a site like https://www.patientnow.com/emr/.
Hospitals test EHR systems
A third of medical errors among Medicare beneficiaries are related to drugs prescribed by doctors according to the Department of Health and Human Services. A study from the international medical community sheds light on how EHR systems might improve such outcomes.
Early this year findings were published from two hospitals in Australia whose doctors switched from handwritten prescriptions to a digital system. The electronic system was designed not only to digitize the process, but also to review patients’ existing medications and allergies, alert for proper dosing, and inform health care providers of any potential conflicts. As a result of the new system, prescription errors at the Australian hospitals were reduced by 60 percent.
In New York City, administrators of the hospital where Wilkinson was diagnosed with lung cancer are implementing similar improvements.
The HHC announced a few months before Wilkinson’s death that it is investing $302 million into a new, “state-of-the-art” electronic medical record system for all of its patient care facilities. Ross Wilson, chief medical officer at HHC, said in a statement that he expects the initiative to improve patient care.
“Patient outcomes improve when a complete medication history is available, particularly when combined with lab test results, electronic order entry systems and decision prompts also being provided through a state-of-the-art electronic medical record system,” Wilson said. “And when doctors and staff spend less time dealing with paper records, they have more time to care for patients.”
Wilson called the move a “step forward for the City’s public hospital system both in efficiency and improving patient outcomes.”
Yet, there will always be risk
Banja believes that the introduction of new policies and such innovative technologies could make hospitals safer, but there will always be risk.
“We have to recognize that hospitals are dangerous places,” he says. “They’re high-stress places, they’re places where doctors and nurses are pushed to the limits of their productivity. Where you look at the typical hospital environment, it’s easy for errors to happen and it’s harder for them to be noticed and corrected.”
Follow Donovan X. Ramsey on Twitter at @idxr