The death Monday of Rep. John Murtha (D-Pa.) after complications from gallbladder surgery raises questions about whether the lawmaker was among the nearly 100,000 people who die in U.S. hospitals annually due to preventable medical errors.
With the ongoing debate in Washington about the nature of health care reform, Murtha's passing shines light on one area that hasn't had enough scrutiny, how to make our health care system safer. As the American health care system has been labeled by some as the most advanced in the world, others are critical of the fact that so many people die in hospitals annually due to preventable medical errors.
It's not just about the cost to the health care system to deal with the errors, but the needless number of lives lost. This system-wide failure was highlighted over a decade ago in the Institute of Medicine (IOM) report "To Err Is Human: Building a Safer Health System."
Questions about circumstances surrounding the death of Murtha, the longtime Defense Appropriations chairman and confidante to House Speaker Nancy Pelosi - viewed from afar without specific knowledge of his medical condition - are likely to heighten a long-running debate among medical practitioners and others.
According to the Washington Post, Murtha had elective laparoscopic gallbladder surgery performed at the Bethesda Naval Hospital and fell ill shortly afterwards from an infection related to the procedure. Murtha was hospitalized to Virginia Hospital Center in Arlington, Va., to treat the post-operative infection. His care was being monitored in the intensive care unit (ICU), a sign that suggests that not only was the infection becoming widespread but also that vital organ systems were shutting down.
Was his death preventable or simply unavoidable? A 2009 study by the University of Maryland Medical Center notes that when gallbladder surgery is performed electively "the mortality rates are very low. (Even in the elderly, mortality rates are only 0.7 - 2%.)"
Perhaps Murtha, 77, was one of the unlucky 2 out of 100 to have died from this elective surgery. It is also equally likely that he died of a medical error or omission.
As Dr. Atul Gawande notes in his newest book, "The Checklist Manifesto," in his experience a simple list has helped prevent less-than-optimal surgical outcomes. One item on the list was whether or not IV antibiotics were given at the time the surgeon began the opening incision. You would think this would be obvious, as in the operating room there is a surgical team that as a group is responsible for the patient's care. Do they work as a highly functioning team? Are there clear lines of communications between the surgeon, anesthesiologist, nurses, and surgical techs?
Sadly, communications are not as clear as they need to be. As Gawande notes, a simple two minute checklist not only forced communications (something as basic as an introduction to the surgical team – "Hi, I'm Dr. Gawande general surgeon") but also verified that critical tasks were completed. As a result, the checklist decreased the complication rates by 36 percent and death rate by half. Disappointingly only 20 percent of American hospitals have adopted these types of checklists.
Bethesda Naval Hospital, as a government institution, is not included in surveys by the respected Leapfrog Group, an organization that works to reduce preventable medical mistakes and rates hospitals on their processes to keep patients safe. (Leapfrog Group was founded by large employers, who purchase health insurance, to evaluate the care their employees receive from hospitals).
Virginia Hospital Center, where Murtha was hospitalized, didn't submit any information either even though it is listed in the Leapfrog Group database. Specifically, Virginia Hospital Center declined to respond to the survey on how they are doing to keep medical errors from occurring. Questions include whether there is adequate ICU staffing, processes to reduce ICU infections, and steps to prevent harm. Gawande notes in his earlier New Yorker piece that even intensive care units errors of omission and missed opportunities happen that can be avoided with checklists.
Even now, as Gawande points out, getting doctors and hospitals to improve patient safety with something as basic as a checklist has been extraordinarily difficult. And it's symptomatic of a broader problem in our health care system, unforced errors that can be fatal.
Davis Liu, M.D., is a practicing board-certified family physician in Roseville, Calif., and author of "Stay Healthy, Live Longer, Spend Wisely – Making Intelligent Choices in America's Healthcare System."