The possibility of medical error in at least four suspicious deaths at Cook County Hospital is under investigation by the Illinois Department of Public Health and the Cook County medical examiner`s office, officials said Thursday.
The four patients, all seriously ill, died within the last two months under unusual circumstances that may have involved improper medical procedures or inappropriate medication. Three of the deaths are under investigation by the medical examiner`s office, and one has been ruled accidental but is still under study.
”We want to find out the circumstances under which these people died and whether medical errors or accidents contributed to the deaths,” said a spokesman for the medical examiner`s office.
The suspicious deaths at County Hospital follow several recent and widely reported cases involving medical mistakes. In one case, a retired Miami Herald photographer died after a toxic substance was accidentally injected into his spinal column. In another, a pregnant woman from Albany, N.Y., became permanently paralyzed after a similar mistake.
The reports have focused increased attention on medical errors and incompetent physicians, problems that have become urgent concerns of the federal government and organized medicine.
”This is a serious problem,” said Dr. Robert Derbyshire of Santa Fe, a past president of the Federation of State Medical Boards of the United States. ”I don`t know how many of these medical errors occur, but unfortunately they are not uncommon.”
A number of factors contribute to these errors, including sloppiness, tired staff members, haste, honest mistakes, inadequate controls, misjudgments and incompetent doctors, he said.
The death of Sylvester Hester, 64, at County Hospital on Feb. 17 was ruled accidental. An autopsy at the hospital showed that the patient, who suffered from chronic kidney failure, died after a nurse accidentally punctured a major vein in his chest with a needle, causing excessive bleeding, said the spokesman for the medical examiner`s office.
The first case that came to the attention of authorities was that of Herman Ferguson, 73, who died Jan. 30, apparently after he was given an inappropriate dose of potassium chloride, a heart drug.
A doctor and two nurses who allegedly tried to alter records to cover up the error have been suspended and are facing dismissal proceedings, said Terence Hansen, acting hospital director.
The third case involved John Jones, 79, who died March 16 in the hospital`s intensive-care unit. Jones was suffering from chronic lung disease and gastrointestinal bleeding.
The spokesman for the medical examiner`s office said a fellow patient in the unit complained that doctors and nurses were delayed in responding to an alarm indicating that Jones` heart had stopped beating. More than three minutes elapsed before a nurse arrived, though the other patient had tried to get help for Jones, he said.
The fourth case was that of Sarah Bush, 58, who died Monday after a respiratory tube aiding her breathing accidentally slipped out, the spokesman said.
The respirator tube was quickly replaced, but Bush, who was suffering from lung cancer and pneumonia, died 23 minutes later, the spokesman said. Her body had been taken to a funeral home when the medical examiner`s office retrieved it for an autopsy, he said.
The state Public Health Department, which licenses hospitals, will send a team of investigators to County Hospital next week to determine whether any licensing regulations have been violated, said Mary Huck, a department spokeswoman. She said the department`s investigation was prompted by complaints from hospital personnel.
”If we find violations, our first course of action will be to work with the hospital to correct them and then to conduct routine reinspections to make sure that they remain corrected,” she said. ”Only in an extreme case would we revoke a license.”
Susan Stanger, County Hospital spokeswoman, said, ”We will cooperate fully with these investigations and will take any actions deemed necessary.” The growing awareness of medical mistakes has been sparked by the malpractice crisis and efforts to curb out-of-control health-care costs, said Dr. Richard Wilbur, president of the Council of Medical Specialty Societies, Lake Forest.
”There are lousy doctors out there who shouldn`t be practicing, and there are a lot of preventable mistakes,” he said. ”Patient injury prevention has become our major thrust.
”Something is going to go wrong once in a while no matter what you do,” Wilbur said. ”What we are doing is going into every specialty to identify problems that can be avoided and develop ways to prevent them.”
Patient injury appears to be common, he said. A study reported several years ago in the New England Journal of Medicine showed that of 2,500 patients admitted to major teaching hospitals, 36 percent experienced an avoidable error related to a surgical procedure, he said.
Another study of 21,000 randomly selected hospital records conducted by the California Medical Association and the California Hospital Association revealed that 4.65 percent of the patients had been injured and nearly 1 percent had sustained injuries that were considered legally negligent.
Based on those figures, as many as 280,000 of the 35 million hospital patients admitted in 1981 may have been subjected to medical negligence for which they probably would have won malpractice lawsuits, Wilbur said.
Yet, fewer than 30,000 medical malpractice lawsuits were filed that year, indicating that most cases of negligence are either not discovered or not reported, he said.
Dr. James Sammons, executive vice president of the American Medical Association, said organized medicine must clean its own house if it expects to win malpractice reform.
The crushing increase in medical malpractice lawsuits, awards and insurance rates is forcing some doctors out of business and greatly adding to the cost of the nation`s health-care bill, he said.
Doctors should police their colleagues by reporting incompetent physicians to hospital review boards and notifying state licensing boards of doctors who are flagrantly negligent, said an AMA task force on professional liability and insurance.
Of the $356 billion spent on health care in 1983, 30 percent was related to laboratory tests and other procedures and treatments ordered by physicians as a defense against possible malpractice lawsuits, the task force said.
The malpractice crisis is primarily due to the unrealistic expectations of patients and the nation`s costly, slow and inefficient legal system, Sammons said.
”Medicine is a complex, rapidly changing, inexact science, and patients` needs, histories and responses to treatments vary greatly,” he said. ”Many claims involve no negligence at all–only unfulfilled expectations.”
A major part of the problem is that the federal and state governments, organized medicine, hospitals and doctors have paid little attention to the problems of medical mistakes and bad doctors, Derbyshire said.
State licensing boards rarely suspend or revoke a doctor`s license, and when they do, the offending physician can move to another state to set up practice, he said.
