Why Don’t Patients Report the Harm Caused by Medical Errors?

According to ProPublica, the nonprofit investigative journalism organization, "A review of medical records by the U.S. Health and Human Services Department's inspector general found that in a single month 1 in 7 Medicare patients was harmed in the hospital, or roughly 134,000 people. … An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths ... which projects to 15,000 patients in a single month."

So why, then, are patients so reluctant to report medical errors? In reviewing nearly 200 stories ProPublica has collected via its Patient Harm Questionnaire, the writer learned that many of the contributors—people who have suffered harm while undergoing medical care—don’t file formal complaints with regulators. The reasons range from being traumatized, disabled, unclear about the bureaucratic process of complaint and, remarkably, unaware that they’ve been a victim of a medical error.

That’s not good for them or anybody who has or will avail themselves of the U.S. health-care system—in other words, it’s bad for everybody.

When harmed people don’t complain, as ProPublica notes, there is no independent investigation, no outside accountability for providers who may have made mistakes, no public inspection report that documents the problems and, one hopes, prompts solutions and avoids repeated mistakes.

Of course, the latter point assumes that an agency receiving a complaint and pursuing it makes its report public. That isn’t always the case.

There’s no central system to tally and track adverse medical events. “There’s no way to know,” according to ProPublica, “when and where patients are being harmed or to tell if the problem is worse in one place than another.”

What’s taking so long? At the turn of this century the Institute of Medicine’s landmark “To Err Is Human” report recommended a national system to record cases of serious harm to patients or death to provide accountability, expand the body of medical knowledge and to save lives.

Even though in many states hospitals are required to file reports when patients suffer unexpected harm—called “sentinel” or “adverse” events—federal officials say such state efforts are lacking. In July, the Department of Health and Human Services found that only 12 in 100 harmful events identified by its inspector general’s office even met state requirements for reporting them. Hospitals reported only 1 in 100 harmful events.

As we reported last month, when hospitals accept responsibility for harming patients, good things happen in terms of reducing costs and improving care.

The bleak scenario of under-reporting might be redrawn in the not too distant future.

The federal Agency for Healthcare Research and Quality (AHRQ) is inviting the public to submit comments about a proposed program to encourage consumers to complain about harm suffered while undergoing medical care.

By collecting information in a common format, the agency hopes to develop ways to gather information by phone and via the Internet and to follow up with a questionnaire for medical providers. Patients will be asked what happened, who was involved and for permission to contact their medical providers involved in the event. Official public comment is due Nov. 9; you can also submit comments directly to Doris Lefkowitz, the AHRQ reports clearance officer, at doris.lefkowitz@AHRQ.hhs.gov.

One member of ProPublica’s Patient Harm Facebook group explained why so few of the people like her pursue complaints about their care. She said emotional trauma, physical disability, feeling intimidated by providers and social pressure not to complain conspire against airing grievances. She said that a passive questionnaire is unlikely to elicit responses and suggested instead that patient harm information be gathered like the national survey given to recently discharged hospital patients. Its results are publicly reported on Hospital Compare, a site composed of data collected by HHS from all Medicare-certified hospitals that’s intended to help medical consumers find hospitals and compare their quality of care.

Other ways you can report harm while undergoing medical treatment include:

  • Contact a state professional licensing agency that monitors doctors or nurses. Find your state’s agencies here.
  • Contact the Joint Commission, which accredits hospitals.
  • Contact a Medicare Quality Improvement Organization. These agencies work with consumers, physicians, hospitals and other caregivers to make sure patients get the right care at the right time, particularly among underserved populations.