Betsy Lehman

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My Father, Your Mother/Child/Cousin? Medical Mistakes Affect Millions Nationwide

Betsy Lehman, a former Boston Globe health columnist, died as a result of a massive chemotherapy overdose. (Courtesy of the Lehman family)

Betsy Lehman, a Boston Globe health columnist, died 20 years ago as a result of a massive chemotherapy overdose given in error. (Courtesy of the Lehman family)

By Richard Knox

Some years back, my 78-year-old father suddenly collapsed with kidney and liver failure. He had no prior kidney or liver disease. Several doctors told us what happened.

The catastrophe was caused by his use of a medication called Pyridium for several months. It was prescribed to relieve bladder pain caused by radiotherapy treatments for Dad’s prostate cancer, which was localized and thought to be curable.

Albert L. Knox, late father of journalist Richard Knox, relaxing in New Hampshire in the mid-1980s. (Courtesy of Richard Knox)

Albert L. Knox, late father of journalist Richard Knox, relaxing in New Hampshire in the mid-1980s. (Courtesy of Richard Knox)

The package insert for Pyridium warns it shouldn’t be taken for longer than two days and elderly patients taking it should be monitored carefully for signs of liver and kidney failure. In Dad’s case, the prescription was renewed three times over a two-month period by two different doctors — who did not order any kidney or liver function tests.

It was a clearly avoidable error. “This has been an eye-opener to me,” one of his doctors told me during a conversation in the intensive care unit where Dad lay dying.

That was in 1989. Five years later, Boston Globe health columnist Betsy Lehman died of a chemotherapy overdose at Dana-Farber Cancer Institute — a medical error I documented extensively for the Globe. That tragedy, perhaps the nation’s iconic medical mistake, is credited with launching a national movement to prevent medical errors.

I’d like to think these kinds of preventable mistakes are a thing of the past. But new data from the Harvard School of Public Health, released this week, shows that’s not the case. The Harvard survey indicates that one in every four Massachusetts adults has experienced a medical mistake in the past five years, or is close to someone who has. Half of these have caused serious harm. That translates to hundreds of thousands of medical injuries in a state that prides itself on having the very best medical care.

“We do a staggering amount of harm every day.”

– Dr. Ashish Jha, Harvard

But there was also more promising medical-error news this week. Federal health officials reported a recent 17 percent reduction in “hospital-acquired conditions” such as infections, falls, trauma and bedsores. That’s 1.3 million fewer injuries and 50,000 fewer deaths since 2010, says Health and Human Services Secretary Sylvia Burwell.

Hospitals Are Killing Tens of Thousands Fewer People” was how the Washington Post billed it – a headline that managed to sound both cheerful and not-so-reassuring.

These are big numbers, on both sides of the ledger. So what’s the upshot? Do they mean American patients are safer than they were when Betsy Lehman died? Or at greater peril?

One thing’s clear: Whatever the exact numbers, they reflect a big problem that profoundly affects millions of American families.

Something like 1,000 Americans die of medical errors every day, according to one credible recent estimate. “We do a staggering amount of harm every day,” Dr. Ashish Jha of the Harvard School of Public Health testified last July at a U.S. Senate subcommittee hearing. John James of Patient Safety America, an advocacy group, recently estimated that 440,000 Americans die every year from such tragic mistakes. Nonfatal errors are 10 to 20 times more common, James says, which would mean something like 8 to 10 million medical mistakes a year.

That makes medical errors the nation’s third-leading cause of death, after heart disease and cancer, Vermont Sen. Bernie Sanders noted at last summer’s hearing.

“When you talk to people, it seems everyone has a story — everyone, whether it’s themselves, a family member, a friend,” says Barbara Fain, director of the Betsy Lehman Center for Patient Safety and Medical Error Reduction, a Massachusetts state agency whose name memorializes my Globe colleague.

Twenty years after her death, many are now asking if that movement has worked. The new federal numbers signal substantial progress toward safer care. But the new Harvard study — and a number of other recent studies — suggest that Americans are just as likely to suffer from medical errors as they were when Al Knox and Betsy Lehman died.

Which picture is right? Continue reading