IOM made own medical error: Patient death count

A hot and shrill’ report draws blistering retort

McDonald CJ, Weiner M, Hui SL. Deaths due to medical errors are exaggerated in Institute of Medicine Report. JAMA 2000; 284:93-94.

In a wicked counter-punch to the recent Institute of Medicine (IOM) report on patient safety, the authors charge that the number of deaths due to medical errors were exaggerated in a "hot and shrill" report that "shouts about death and disability in U.S. hospitals."

"The IOM uses elaborate controls to ensure a careful balance of interests in the parties on the committees that produce reports and it uses extensive review to avoid errors in its reports," the authors conclude. "However, the reliance on studies without controls to make headline claims about huge numbers of preventable deaths was one error that it did not catch."

The IOM report estimated that medical errors cause between 44,000 and 98,000 deaths a year. "The unstated corollary — reinforced by the death rate from motor vehicle collisions juxtaposed with the death rate from adverse events — is that eliminating preventable adverse events also will eliminate the deaths," the authors state. "Motor vehicle occupants do survive their ride if collisions are avoided. Unlike most people who step into motor vehicles, most patients admitted to hospitals have high disease burdens and high death risks even before they enter the hospital. Although some hospital deaths are preventable, most will occur no matter how many accidents’ we avoid."

Of course, medical errors are never excusable, but the baseline death risk has to be known and factored out before drawing conclusions about the real effect of adverse reactions on death rates, preventable or otherwise, they continue. The so-called Harvard study, on which the IOM report was based in part, included caveats such as "lead to death" and "died at least in part as a result of adverse event." The other study cited — the Colorado-Utah report — cited a proportion of patients who died in the adverse reaction group, but said nothing about the cause of these deaths.

"The IOM did not mention any of these limitations in its report," the authors charge. "Given these facts, using available data and some reasonable assumptions, we believe that the increment in the published death rate due to adverse events above the baseline death rate could be very small. We also assert that the available data do not support IOM’s claim of large numbers of deaths caused by adverse events (preventable or otherwise). . . . Clearly, more study with careful attention to risk levels is needed to determine the true impact of adverse events on death rates among hospitalized patients. Until those results are available, the design of regulatory solutions is premature."