Medical malpractice is the third leading cause of death? Really?

Heard this claim from one of the local ambulance chasers on one of their ads (Morgan & Morgan). A Google search reveals over 50,000 hits.

So what’s the straight dope here? Can that many deaths be blamed on doctors and hospitals? If that figure is correct, then a substantial number of deaths can be pinned on them, at least partly.

My hunch is that someone pulled the number in question completely out of their ass, but wanted to drop it in here and let you all at it.

The number comes from a 2000 study published in the Journal of the American Medical Association. While the number is not entirely rectally derived, “medical malpractice” is not an accurate term for it, nor one that the study’s authors used. Rather, the authors were looking at “the combined effect of errors and adverse effects that occur because of iatrogenic damage not associated with recognizable error…” (“Iatrogenic” means caused by medical examination or treatment.)

So these are not (all) malpractice, per se. But they are considered preventable deaths, if we change what we’re doing. Even infections in hospitals are considered, by nurses and doctors, a failure of something we’re doing, although realistically we may not be able to prevent every single infection.

The numbers quoted in the study break down to deaths per year due to:

12,000 – unnecessary surgery
7,000 – medication errors in hospitals
20,000 – other errors in hospitals
80,000 – infections in hospitals
106,000 – non-error, negative effects of drugs

These numbers were gathered from the following sources:

Leape L. Unnecessary surgery. Annu Rev Public Health. 1992;13:363-383.
Phillips D, Christenfeld N, Glynn L. Increase in US medication-error deaths between
1983 and 1993. Lancet. 1998;351:643-644.
Lazarou J, Pomeranz B, Corey P. Incidence of adverse drug reactions in hospitalized
patients. JAMA. 1998;279:1200-1205

Errors are not always malpractice. Malpractice is “Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional.”

Furthermore, to be considered malpractice, four criteria must be met.

(1) a duty of care was owed by the physician - that is, if a doctor offers you advice at a dinner party, but is not your doctor, there is no duty of care, so there can be no malpractice

(2) the physician violated the applicable standard of care - that is, they did not do something that is accepted as standard of care, or they did do something that is not considered standard of care. So if I follow all the current guidelines for wound care of your pressure ulcer and it becomes infected anyway, that’s not malpractice. That’s just life sucking (for both of us.)

** (3) the person suffered a compensable injury -** close calls don’t count. Death, clearly, does.

(4) the injury was caused in fact and proximately caused by the substandard conduct. - This is where things get murky in the real world, because people are complicated and often many factors contribute to a bad outcome. But it’s up to the plaintiff to prove - if I’m using old wound care guidelines and at the same time you’re not changing the dressing every day like I told you to, it’s up to you to prove that my not following the standard of care caused the problem, and not your failure to follow instructions.

So some of those deaths in that huge number are malpractice, and some are not. Some are errors without being malpractice. And the largest portion of them aren’t errors *or *malpractice, but adverse drug events.

Medical malpractice is a legal distinction, and is only established after a trial or settlement. Just because the result of medical treatment was less than ideal and with 20/20 hindsight the doctor could have, or even should have done something differently, does not mean it was necessarily medical malpractice.

Top Ten Causes of Death in the USA (from 2013):
#1. Heart disease: 611,105
#2. Cancer: 584,881
#3. Chronic lower respiratory diseases: 149,205
#4. Accidents (unintentional injuries): 130,557
#5. Stroke (cerebrovascular diseases): 128,978
#6. Alzheimer’s disease: 84,767
#7. Diabetes: 75,578
#8. Influenza and Pneumonia: 56,979
#9. Nephritis, nephrotic syndrome, and nephrosis: 47,112
#10. Suicide: 41,149

It appears that most Google hits are citing this 2013 study which asserts between 210,000 to 400,000 deaths per year “associated with preventable harm in hospitals.”

An earlier (1999) study by the Institute of Medicine came up with the estimate of 44,000-98,000 preventable deaths. Nearly an order of magnitude lower, but still in the Top Ten even at the lower bound.

On preview: Like WhyNot and kaltkalt said, these articles are playing very fast and loose with the term “malpractice”. Just because your routine bunion surgery gets infected and you die doesn’t necessarily mean the doctors did anything legally wrong.

Pulling unnaturally large numbers out of one’s ass without adequate lubrication is also a common cause of fatal injuries.

It seems to me that medical malpractice can be considered the third leading cause of preventable death if you fudge the numbers a little bit:

It wasn’t that long ago that doctors refused to wash their hands before operating on patients - said that the idea of a little tiny creature [microbe] being able to take down a large human was ludicrous!

Also at that time (1870), MOST patients who went to hospitals died.

Why yes, medicine is practically unchanged from 146 years ago.

Third leading cause of death?

There is a pretty obvious solution–don’t call the doctor go to the hospital for anything less deadly than heart disease (#1) or cancer (#2).

All listings of “causes of death” in order are problematic, because they depend on how you group them. Is “respiratory disease” one single major cause of death, or do you break it down into various kinds of lung cancer, asthma, emphysema, pneumonia, and so on? You can put anything you want at the top of the list, as long as you slice everything else even finer.

Plus, of course, causes of death are very often intertwined. For instance, suppose a fellow comes down with prostate cancer. The cancer metastasizes, and causes some other internal organ to fail (say, the liver). The liver failure causes toxins to accumulate in the bloodstream, causing damage to various other organs, including the heart. Eventually, the damage to the heart is so great that it stops pumping, and as a result, the brain doesn’t get any oxygenated blood, and so shuts down, that being death. Is that death blamed on the prostate, the liver, the heart, the blood, or the brain?


The leading cause of death is life.

If this is true, then why wasn’t it bigger news? Even if we go with the lower number of 210k, that is still the equivalent of the 9/11 attacks happening at least once a week.

You call this living?

I think we need to consider that when a person seeks medical attention, typically they’re already sick. So if they die of this sickness, I’m not so sure we should blame the doctors automatically. Yes, a surprisingly large percentage of people die in hospitals, and this does put upward pressure on the dividend payments made to shareholders … but it’s a stretch to make the cause and effect case … people are going to die, if there’s profit to be had in such an activity, I see no reason to blame the hospitals for just simply capitalizing on the inevitable.

I read an article many years ago written by a lawyer. This was at a time when Cesarean sections were far far far safer than forceps deliveries, but we still some “old school” doctors who insisted on using the forceps. The medical community was powerless to stop them so the lawyer argued that suing the living shit out of them was the only way to force them to stop using forceps.

Can we trust doctors to police themselves? Do we allow them the time to even review these cases? Humans make mistakes, but if humans don’t know they made a mistake, they’ll just keep making the same mistake over and over and over … with deadly results.

My wife phoned a lawyer when her mother died. She was in pretty serious condition, they tried to intubate her, punctured a lung, she deteriorated and never recovered. The lawyer said their defense is that the intubation took place according to all recognized medical standards, and sometimes a lung gets punctured despite all reasonable care by a competent professional practitioner. No case.

Still, that would fall into the category of a death caused by “something the hospital did to her”.

Interesting that all the articles leave out one important number: the total number of hospitalizations.

That’s 136 million.

Whether the resulting number of deaths is high or not is a different issue, but you need that number for any discussion.

It isn’t malpractice that causes death. medicine done by the book can kill you too. A surgery can have complications, you can get an infection, a drug that is prescribed properly can have adverse side effects.

The idea that if we got rid of malpractice and the deaths would drop isn’t true. Some would, but a lot is just an unpleasant side effect of the fact that medicine isn’t perfect even when done right.

But yes, medicine (both done properly and improperly) is the third leading cause of death in the US despite the fact that it is never reported as such.

My girlfriend had a lung removed because of a large tumor. After 3 negative biopsies and me giving them detailed reasons why I felt it was a piece of food lodged in her lung they decided to do the surgery anyway. It took over 4 years to get the pathology report back, it turned out to be mummified food like I told them. they never came back after surgery and told her she did not have cancer, they simply said they got it all. The evidence I gave them indicating it was food was very clear and obvious yet they chose to ignore it. her life will likely be shortened and her quality of life greatly reduced.