Medical Research Fraud

Doctors' basic errors are killing 1,000 patients a month

The Independent 13 July 2012

Almost 12,000 patients are dying needlessly in NHS hospitals every year because of basic errors by medical staff, according to the largest and most detailed study into hospital deaths ever performed in the UK.

The researchers from the London School of Hygiene and Tropical Medicine and colleagues found something went wrong with the care of 13 per cent of the patients who died in hospitals. An error only caused death in 5.2 per cent of these – equivalent to 11,859 preventable deaths in hospitals in England.

Helen Hogan, who led the study, said: "We found medical staff were not doing the basics well enough – monitoring blood pressure and kidney function, for example. They were also not assessing patients holistically early enough in their admission so they didn't miss any underlying condition. And they were not checking side-effects... before prescribing drugs."

In one case a middle-aged man who had a cyst on his neck removed developed an infection. He was treated with antibiotics but medical staff did not realise he was not responding until it was too late and he died.

In another case, a 40-year-old obese woman was in hospital for three weeks while doctors investigated symptoms including vomiting and weight loss before discovering she had ovarian cancer. She was never given preventive treatment for blood clots – a risk of prolonged bed rest – and died of a clot on the lung.

The study was based on analysis of 1,000 deaths at 10 NHS trusts during 2009. Previous estimates have suggested up to 40,000 deaths a year are caused by errors in care but these have been based on international studies and have not directly linked the errors with the cause of death.

Dr Hogan added: "Hospitals must learn from careful analysis of preventable deaths and make every effort to avoid [them]."

Most of the patients who died were elderly and frail and suffering from multiple conditions. But some were in their 40s and 30s. More supervision by senior consultants was required to ensure junior doctors carried out proper assessment on admission and liaised with GPs and social services.

International evidence suggests one in 10 hospital patients suffers harm as a result of errors in their care, ranging from short-term effects from a wrong prescription to severe harm resulting from an operation on the wrong limb.

But the new study, published online in BMJ Quality and Safety, found errors of omission were more frequent than active mistakes.

Dr Hogan said: "The NHS in the future is going to have to look after very frail elderly patients as their numbers increase. Our systems are not robust enough to ensure we avoid harming them."

The authors say the quality of hospital care should be assessed on the basis of harm caused by errors, rather than on deaths. "If 95 per cent of deaths in hospital are not due to preventable poor care, the scope for hospitals to demonstrate reduction in their mortality rate is limited," they say.

A Department of Health spokesperson said it was an important study which revealed a picture of preventable deaths.

"Patients have a right to expect the very best care from the NHS. Any preventable death in hospital is unacceptable and we expect the NHS to ensure patients receive high-quality, safe and effective care. We know that data like this can help hospitals to improve services," said the spokesperson.

Man who died of dehydration was killed by hospital neglect

Neglect by medical staff led to a man dying of dehydration in a hospital bed, a coroner has ruled. Medical staff at St George's Hospital in Tooting, south London, did not give Kane Gorny vital medication to help him retain fluids. The 22-year-old, who was a keen sportsman, even phoned police from his hospital bed as he was so desperate for a glass of water, the inquest heard. Deputy Coroner Dr Shirley Radcliffe told the hearing: "A cascade of individual failures has led to an incredibly tragic outcome."

She recorded a narrative verdict at Westminster Coroner's Court and said Mr Gorny had died from dehydration contributed to by neglect. Dr Radcliffe said: "Kane was undoubtedly let down by incompetence of staff, poor communication [and] lack of leadership, both medical and nursing."

James Stevenson, the solicitor for Mr Gorny's family, said they were "devastated by the number of missed opportunities" to prevent his death.

Kerala plants encyclopedia

Minu Ittiype in Outlook India

One would be forgiven for mistaking Hortus Malabaricus to be a treatise on exotic plants from the Garden of Eden instead of the Garden of Malabar. For author Hendrik Adriaan van Rheede tot Drakenstein’s (then governor of Dutch Malabar, 1670-77) prose on his many journeys into the dense forests of Malabar (in present day Kerala) is almost as lush as the vegetation. Indeed, in one section he describes that he saw such a marvellous variety of flora that it was difficult to find two trees of the same kind in the same forest.

In a flourish of similes, he likens a tree adorned with green creepers to a magnificent palace. (Hardly the stuff one expects in a preface to a plant encyclopedia.) What astonished him no less was how the natives would pick up a few leaves, crush them to use as a balm or eat them to relieve themselves of some ailment.

The secrets of the leaves, roots, berries etc and their effects on the human body were common knowledge in Malabar in the 17th century, passed down orally from one generation to the next. Rheede was intent on documenting this vast trove of traditional knowledge for his fellow Europeans and proceeded to oversee the scientific description and paintings of the medicinal uses of 742 species of flora of Malabar. It was a herculean task which took him 30 years to complete. As governor, he employed 25 experts for the project, including physicians, botanists, painters, engravers, translators and a legion of 200 supporting staff to gather the plants. The Raja of Cochin and the Zamorin of Calicut readily lent their support. The period was not without political intrigue and in between Rheede found himself posted to Batavia in the middle of the project. But he remained ardently faithful to it. The 12 volumes of Hortus were published in Amsterdam between 1678 and 1693.

For over 300 years the Hortus volumes remained in relative obscurity due to a linguistic barrier: it was written in Old Latin and there was none well versed both in Old Latin and the plant kingdom to decipher it. In 1968, K.S. Manilal, a botany scholar and taxonomist, finally undertook the arduous task of studying Latin for 12 years, collected over 400 species of the mentioned plants and decoded Hortus. The project took 35 years of his life, but an English translation was published in 2003 (published by Kerala University) with a Malayalam edition coming out in 2008.

A comprehensive analysis of the Hortus also throws up some uncomfortable questions, some of which have already got the state’s intelligentsia talking. Like the case of the Hortus’s main contributor, a hereditary Ezhava vaidyan (physician) named Itty Achuthan, who was at the time forbidden from using the official written form of Malayalam, vattezhuthu, because he was not from the upper caste. His certificate in kolezhuthu, published in the Hortus, is a testament to this though, ironically, he was the chief protagonist in the documentation. So Hortus, besides documenting the flora, is also a subverted commentary on the culture, linguistics and social structure of the period. The record shows that initially three Saraswat Brahmins—Ranga Bhatt, Vinayak Pandit and Appu Bhatt—gymnosophists well versed in the classic medical texts, were initially employed to assist in identifying the plants. But when Van Rheede found that the Brahmins relied on their servants for physical verification of the plants he found Itty Achuthan far more invaluable. (In a sense, through the encyclopaedia he created, for the first time, an unimaginable inter-caste collaboration.) Achuthan, a descendant of Kollatt vaidyans, had inherited certain ancient palm leaf manuscripts which set out in detail the medicinal use of various plants. During his time, he was considered the most knowledgeable man in the field.

Commemorating the 333rd year of the Hortus, historians now believe it is the only authentic source of the ancient ethno-medical knowledge of Kerala, pre-dating even Ayurveda. As Dr B. Ekbal, former Kerala University V-C, puts it, “It was a decentralised medical practice that was Dravidian and predated ayurveda. Almost like an internal colonisation, later Ayurvedic practitioners appropriated this knowledge.” Today’s Ayurveda doctors are not too sure about this theory, saying their system is codified and argue that the medicinal properties described in Hortus are based mostly on folklore. Dr K. Anilkumar, executive director of Kerala Ayurveda Ltd, says, “We need to study Hortus to ascertain its efficacy. Like it’s mentioned that the bark of the coconut tree can be used to cure liver diseases. We’ll need research to see if there’s any truth to it.”

Kerala’s traditional knowledge of the curative powers of plants has eroded over the years but with the translation of Hortus an intangible heritage has once again become accessible. Some of the plants mentioned have become extinct, others unidentifiable. Even the health of the forests has declined, with trees now reduced to pygmies: the biggest kokum or kodampuli tree of today would at most fill a man’s armspan today but the book has instances of a similar tree’s girth “filling the embrace of two men”. Hortus is a repository of medical treasures as well as insights: who knew the oil of the common brinjal taken with opium has the potent effect of poison?

Medical Errors - Eighth Leading Cause of Death in the US

According to the Institute of Medicine, between 690,000 and 748,000 patients are affected by medical errors in the US every year and between 44,000 and 98,000 die from them. Even this low ball estimate makes medical mistakes the eighth leading cause of death worse than breast cancer, AIDS and motor vehicles accidents. It also makes medicine far more error prone than high-risk fields. For commercial aviation to take the same toll in the US as medical errors do, a full-up 747 would have to crash every three days, killing everyone on board.

More troubling is the medical profession's traditional response to these disturbing statistics, which has largely involved evasion, obfuscation, minimisation, defensiveness and denial....

"Observing more senior physicians, students learn that their mentors and supervisors believe in, practice and reward the concealment of errors. They learn to talk about unanticipated outcomes until a mistake morphs into a complication. Above all they learn not to tell the patient anything."  - Nancy Berlinger in After Harm.

Extracted from Being Wrong by Kathryn Schulz