Could Rep. John Murtha Have Died from a Medical Error or Omission?

While the news reports that Representative John Murtha of Pennsylvania died after complications from gallbladder surgery, the question no one is asking is whether his death was a preventable one or simply an unfortunate outcome. According to the Washington Post, Murtha had elective laproscopic gallbladder surgery performed at the Bethesda Naval Hospital and fell ill shortly afterwards from an infection related to his surgery.

He was hospitalized to Virginia Hospital Center in Arlington, Virginia, to treat the post-operative infection. His care was being monitored in the intensive care unit (ICU), a sign which 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? One reference notes that when gallbladder surgery is performed electively that "the mortality rates are very low. (Even in the elderly, mortality rates are only 0.7 - 2%.)" Perhaps Murtha 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 - a simple list helped prevent less than optimal surgical outcomes. One item on the list is whether or not IV antibiotics were given at the time the surgeon begins the opening incision. You would think this would be obvious, yet in the operating room, there is a surgical team which 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.

The Leapfrog Group rates hospitals on their processes to keep patients safe. Bethesda Naval Hospital being a government institution isn't listed and is not part of the survey. (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 which can be avoided with checklists.

In other words due to lack of transparent information, both hospitals are black boxes - Bethesda Naval Center because it is a government run hospital and Virginia Hospital Center because it didn't submit any data. There is a good chance that Murtha's death was possibly avoidable. This doesn't mean that doctors aren't working hard or trying to do their best. I believe that getting medical care must be as safe as it is humanly possible. Having witnessing near misses in medical care with my family and understanding what it takes to make patient safety as routine as other highly reliable organizations, I recognize that there is still much to do.

In the mean time, what does this mean for you? Surgery is never routine. If you need to have an operation, check out the hospital and how it rates to keep you safe at The Leapfrog Group. Not listed there? See if you can get surgery at a hospital that is recognized by Leapfrog.

Healthcare Reform Needs IT support

In 2006, the New England Journal of Medicine published a study that found regardless of an individual's socioeconomic, demographics, and health care insurance status that uniformly Americans only received the recommended medical care just a little more than half the time. Slightly better than a coin flip. Perhaps more concerning is what was not said, - our nation does not have the desire or the plan to overhaul and implement the "large-scale, system-wide changes" to our dysfunctional health care system needed to provide quality health care to all.

Two-thirds of Americans currently rate the health care system as fair or poor. Fewer employers are offering health care insurance to their workers and retirees due to unstoppable increases in premiums. Instead of improving the system, the federal government and health care insurers major focus is the active promotion of health savings accounts and consumer driven health plans with high deductibles. By not insulating patients from the actual costs of care, it is hoped that market forces will slow costs and improve quality as patients also become consumers.

But gains in health care quality will not be driven by an informed public. Unlike other goods and services consumers compare routinely, evaluating medical care is not easy. In a system requiring more patient responsibility, a survey found two-thirds of Americans would still simply follow the advice of their physicians rather than researching the options. Yet the vast majority of patients get their care by physicians who need to rely on and sort through paper charts trying desperately to find the information they need to give the right intervention and do so only 55% of the time. Annually it is estimated that 83,000 Americans died simply because they did not receive the recommended care.

The good news is that there already are a few health care organizations and medical groups that consistently provide their patients the recommended care. Organizations like the National Committee of Quality Assurance and the Leapfrog Group continue to identify providers, health plans, and hospitals that perform at this high level. Unfortunately these groups are more the exception than the rule.

One of these high performers is the Veterans Administration. In a study published two years ago, the VA performed as well and at times better than the best commercial health plans in diabetes care. This was not always the case. The VA's recent success was due a leadership change that focused relentlessly on delivering quality care and provided its physicians the information technology infrastructure and tools to not only collect, evaluate, and improve their patient care, but to do that repeatedly and routinely across all VA medical centers.

It is clear then that the path to improve health care quality is not shifting more costs to the patients, nor is it going to be solved by requiring employers and the government to spend more money on a health care system that cannot deliver on its potential.

Unless the public and our leaders demand a complete system overhaul, the rapid implementation information technology support systems to help all providers focus on health care quality, our current and future generations cannot and should not expect to live healthier and longer than their predecessors. This is not a prediction. As it stands, this is our legacy to our children. This is their destiny.