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Squandering Billions - Health Care in Canada

Thoughts About Health Care Spending

We are as interested in our visitors' opinions as we are our own. Please send your comments about health care spending to dnixdorf@allstream.net

Adverse Events:
- excerpts from the book Squandering Billions

"A hospital is like a war. You should try your best to stay out of it. And if you get into it you should take along as many allies as possible and get out as soon as you can. For the amount of money the average hospital stay costs, you could spend an equal length of time at just about any resort in the world, transportation included. And unless your condition required emergency treatment, your health might be better off if you spent the time and money at the resort, too. For the hospital is the Temple of the Church of Modern Medicine, and thus one of the most dangerous places on earth."
- Robert Mendelsohn, M.D.

Serious traffic accidents, particularly if there is an injury or loss of life, can paralyze whole freeways for several hours. Thousands of cars and commercial vehicles sit and wait, spewing carbon monoxide. People miss appointments, airline flights and delay-caused business losses accumulate. Hospital, patient, and doctor schedules fly asunder. Everyone must wait while police, emergency crews, and expert accident investigators gather the evidence they need to determine the who, what, why, where, when, and how of the tragic event. Accuracy is thought to be far more important than either the cost or inconvenience caused to thousands of other citizens. It is important to be precise in the assignment of responsibility and, if facts dictate, blame. In order to do that, the investigation must take place right away, before evidence disappears.

In Canada each year, about 3,000 people lose their lives in highway accidents. Unfortunately, this great toll is a minor statistic compared to the tragic mistakes made within the health care system of the country. The "adverse events" study released in May, 2004, by the Canadian Institutes of Health Research (CIHR) and the Canadian Institute for Health Information (CIHI) reported that as many as 23,750 deaths occur each year in Canadian acute care hospitals due to error, clearly preventable mistakes, most often due to surgery, infection, and drug reactions.

A truly alarming aspect of these numbers is that all of the data came from medical charts, and not from any independent assessment of the circumstances. In other words, those who committed the mistakes and their associates were the only sources of evidence. A similar American study stated bluntly, "Only 5-20 percent of iatrogenic events (medically caused) are ever reported." If all this is not sufficiently chilling, the Canadian study analyzed only a representative sample of acute care hospitals, and based its findings on 2.5 million admissions each year. Of these, 7.5 percent (185,000 admissions) suffered an adverse event, which extended their stay in hospital or resulted in death. In addition to the human carnage, the financial waste is staggering.

Acute care hospitals represent only one slice of the total health business. Procedures performed in clinics, diagnostic centres, physicians’ offices, nursing homes, psychiatric institutions, and an array of other health centres, were not included in the study, and represent a far bigger area of concern. No one has the slightest idea how many iatrogenic errors might be uncovered if the entire field of medicine were to be studied, particularly if the same forensic intensity were applied that is accorded highway accidents and crime scenes. A controversial American paper entitled Death by Medicine (Null et al.) assembled all of the data from respected research agencies covering the full gamut of health care, including senior citizens' homes. The paper concluded that adverse events currently cause 783,000 deaths per year. All official U.S. sources admit to 100,000 deaths per year as a result of medical mistakes and over 100,000 as a result of drug interactions.

What is most shocking is that this epidemic surprises no one who works within the health system. Managers of the best long-term care facilities now routinely perform thorough examinations of their residents before they go to acute care hospitals. It is standard practice to count any bruises, wounds, or abrasions before they depart. One executive of a multiprovincial long-term care corporation said in an interview that patients invariably have “more wounds on their body” after a hospital visit than before they went. Regular complaints seem to do little to improve the situation. These minor cuts and bruises may be the result of careless handling in hospitals or even self-injury as a result of insufficient monitoring. But they do demonstrate indifference and a system that too often regards patients as merchandise, something to process and accommodate.

Following the May release of the Canadian report, media scrambled to interview doctors and hospital administrators across the country. The interviewees made all the right noises about it being a "wake up call," and the "need to be more vigilant," and so on, but there was not the slightest sense of surprise, shame, or embarrassment. The indifference was overwhelming: "Germs go with the territory," some said. "It's because government doesn't provide sufficient funding," was heard in some quarters.

It is not unreasonable to estimate that mistakes within the entire Canadian health system may be inadvertently or negligently killing 50,000 people a year or more, rivaling heart disease and cancer as the greatest threats to life. No one knows the exact number, because the formal adverse events investigation focused only on a narrow slice of total medical-pharmacological care in the country. If documented American numbers can be used as a guide, 50,000 may be conservative. This compares to 3,000 deaths due to car accidents and about 500 as a result of crime. Yet, despite this high fatality rate, iatrogenic errors receive the least investigative attention of any other cause death. The reason for this is that the evidence and motivation required for a thorough investigation must come from the same culture as the one that made the errors in the first place.

Only in the relatively rare instances of formal inquests or malpractice actions is there any independent investigation of cause, and then only a considerable time after the event. In these instances, the investigators are dependent upon the formal records maintained by those who, in all likelihood, were party to the misadventure.

THEY JUST DON'T GET IT - Gary Bannerman suggests that none of the American Presidential candidates have the slightest comprehension about what is necessary to achieve universal health care MORE

AMERICAN THINK TANK SLAMS HEALTH SYSTEMS of U.S. and CANADA - A survey of more than 6,000 doctors in seven countries gave Canada poor marks on several aspects of patient care, including wait times for tests, use of electronic medical records, doctors available after hours, multi-discipline teams to treat chronic illness and financial incentives for improving quality of care. The survey suggested Canada has a long way to go on many fronts to catch up with the other countries, which included the United Kingdom, Netherlands, New Zealand, Australia and Germany. MORE

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