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HOW MEDICAL ERROR BECAME AMERICA'S THIRD LARGEST CAUSE OF DEATH, AND WHAT CAN BE DONE ABOUT IT
“A succinct, disturbing report on the prevalence of malpractice in modern medicine. ….An imperative analysis that begs for discussion by industry watchdogs and consumers alike.” —Kirkus Reviews
“Brilliant...scholarly. A reading of Killer Care makes an immediate personal investment in our own safer patient-centered care logical and worthwhile. ...Killer Care is strongly advised.”
—T. Michael White, M.D., former VP and clinical professor of medicine,
University of Pittsburgh Medical Center; author, Unsafe to Safe
“In Killer Care, James Lieber uncovers systemic failures and lack of safeguards in patient safety. His wake-up call not only informs, but provides specific and actionable recommendations for patients and their families. His analysis also points to system fixes that will make being a patient safer for all of us.”
—Barbara Mittleman, M.D.; former director, Program on Private-Public Partnerships,
Office of Science Policy, National institutes of Health (2006-2012)
Print + E-book: $26/£21
Each year in the U.S., a quarter of a million deaths are attributable to medical error. If the number shocks, on some level you already knew it was so. Everyone knows someone—perhaps it was yourself—who has suffered miserable treatment in American hospitals, part of the most elaborate, most extensive and expensive health care system in the world. But it is perhaps the most inefficient.
Misdiagnoses, wrong prescriptions, operating on the wrong patient, even operating on the wrong limb (and amputating it): these are the consequences of rampant carelessness, overwork, ignorance, and hospitals trying to get the most out of their caregivers and the most money out of their patients.
What are we to do? Killer Care lays out the very real danger each of us faces whenever we enter a hospital. But more than that, it spells out what we can do to mitigate that risk. The book is also the story of the remarkable heroes fighting this plague of medical errors—patients and their families, but also doctors and nurses. Starting about twenty years ago, a number of victims and even some perpetrators of these errors began a social movement that offers us vital protections when we are most vulnerable: they have begun a cultural shift that is transforming every facet of health care.
Publication December 10, 2015 • 286 pages
Paperback ISBN 978-1-682190-10-4 • E-book 978-0-984295-09-8
James B. Lieber is the author of Rats in the Grain: The Dirty Tricks and Trials of Archer Daniels Midland and Friendly Takeover: How an Employee Buyout Saved a Steel Town (nominated for the Pulitzer Prize). He has written for a variety of publications, The New York Times, The Atlantic Monthly, and The Nation among them. His article on the financial crisis for The Village Voice became that publication’s most widely read article for the year. He is a Pittsburgh-based lawyer, dividing his practice between civil rights law and commercial litigation.
An excerpt from Killer Care
….Lehman was a respected journalist, admired and well-liked by her peers. They jumped on the story involving the famous hospital. As in the Zion case, they asked why an inexperienced junior physician was writing lethal orders, and highlighted the lack of the oversight and quality control that should have caught the error in Lehman’s and Bateman’s treatments. How could a reputable institution such as Farber lack a computerized ordering system that would have prevented lethal overdoses of a dangerous drug? Was medical arrogance involved? There were no good answers. Incidentally, during a treatment at Farber the previous May, Lehman had written to a fellow reporter that her doctor was “cold and rotten.”
It began to dawn on media outlets, including local papers in Massachusetts, that the error problem was bigger than Betsy Lehman, and in fact pervasive. In conjunction with her story, they covered cases then breaking around the country: a four-year-old who bled out and died following a tonsillectomy, a diabetic in Tampa who had the wrong leg amputated, a 77-year-old who asphyxiated in the same hospital when his respirator mistakenly was disconnected by a technician, a woman in Grand Rapids whose surgeon removed the wrong breast.
Following the Lehman and Bateman debacles, Dana-Farber became one of the safest hospitals in the country. A study from 1997-2003 showed no medication errors that caused death or permanent injury. For over 800,000 doses of chemotherapy, there were twenty-eight mistakes that required monitoring, including a burn that resulted in a skin graft, and an extra dose causing an additional hospitalization.
The wrongly amputated leg in Tampa that received wide coverage during the Lehman tragedy belonged to 51-year-old Willie King, a retired operator of earthmovers at Florida construction sites. A diabetic with circulatory disease, King had his left leg removed below the knee on February 20, 1995 at University Community Hospital. Willie King, however, consented in writing to the amputation of his diseased right leg.
As experienced surgeon Dr. Rolando R. Sanchez sawed through King’s left leg, a nurse in the operating room took a final glimpse at the patient’s record and started to shake and sob. The surgical suite blackboard listed left leg surgery, as did the operating room schedule, and the hospital computer system. When Sanchez entered the OR, he viewed the anesthetized King with his left leg draped, sterilized, and marked for surgery. Most of the sheets and forms in King’s file that the nurse flipped through also indicated the left leg, except two: Willie King’s signed and initialed consent form specified his diseased right leg, as did the patient’s initial medical history notes.
The surgeon could and should have reviewed King’s medical history before cutting. These documents would have shown that all the wrongheaded, repetitive scheduling materials emanated from a clerk’s botched keystroke. Despite the nurse’s plea, Sanchez had gone too far to stop, and as he tearfully testified later to the Florida Agency for Health Care Administration, “I tried to recover from the sinking feeling I had.” At a press conference two months later, Willie King remembered that: “When I came to and discovered I lost my good one, it was a shock, a real shock. I told him, ‘Doctor, that’s the wrong leg.’”