Carmageddon and Statistics

OVERVIEW

The number of people killed every year by medical mistakes in America appears to be simply too large for people to take in; the very scope of the problem may be the biggest obstacle to its resolution.

Originally published July 28, 2014

Room 253 in the Russell Building is crowded, bustling, lit for TV. Senate aides dart back and forth, sliding into seats behind their bosses as photographers hastily crouch. A crescendo of paper shuffling and throat clearing is cut short when the clock ticks 10 am. Taking the measure of her microphone, Senator Claire McCaskell of Missouri looks out over the room and says, “All right. This meeting will come to order.”

Looking equal parts Mrs. Doubtfire and Howell Heflin, the former Jackson County prosecutor is in high dudgeon this morning. McCaskill chairs the Senate Subcommittee on Consumer Protection, Product Safety and Insurance, and she is about to lead nine of her colleagues in what is likely the single most enjoyable public ritual in which Washington lawmakers engage: Browbeating another public figure who has been brought low through a scandal with which they themselves are in no way connected.

In the dock this day is General Motors Corporation C.E.O. Mary Barra, and it is her third go-round, because the sins to be expiated are grievous indeed.

The story has been churning the news cycle on and off for months, the press howling about the fact that for ten years, beginning in 2001, General Motors had been selling Chevrolet Cobalts and Saturn Ions with faulty ignition switches that sometimes turned the car off while being driven, or kept airbags from deploying in a crash. But what really fuels the moral indignation of the assembled senators is that “Engineers at General Motors found a way to stop ignition switches from shutting off nine years ago, but made a ‘business decision’ not to order the partial fix to a problem that has now been linked to a dozen [actually 13] deaths, NBC News has learned.”

“Today, we revisit the tragic management failures at GM that killed people,” McCaskill tells the crowd, the cameras, the microphones, the scribblers. Those killed were victims of “stunning failures” by “outrageously incompetent management” which is guilty of “gross negligence” and “a massive failure of responsibility.” She repeats: General Motors “killed innocent customers.”

And so it goes, each senator in their turn, calling for corporate heads to roll, more investigations, more compensation for the victims.

The New York Times describes how “senator after senator offered more bruising criticism of G.M.,” noting Senator Barbara Boxer’s charge of a “cover-up,” and the Times editorial page asserts that “new laws deterring such cover-ups and increasing accountability are badly needed.” USA Today and ABC News duly record Senator Richard Blumenthal’s charges of “cover-up, concealment, deceit and even fraud.”

Blumenthal, along with Senator Bob Casey, managed to raise the stakes and steal a march on the rest of the panel by introducing legislation the day before calling for jail time for corporate officers who conceal safety risks from consumers. Roll Call quoted Blumenthal as saying “five years in prison for each violation,” ought to do the trick. (Blumenthal, perhaps caught up in the moment, issued a McCarthyesque declaration that he has a “a list that we could give you of corporate cover-ups and other kinds of defects that have not been disclosed.”)

Thirteen deaths over 10 years. Hoi polloi up in arms. Lawmakers calling for reform, regulation, prison terms. Columnists and editorial writers crying out for justice, transparency and accountability.


Meanwhile, across the street, on the same day, in Room 430 of the Dirksen Senate Office Building, 10 am has come and gone, but Vermont Senator Bernie Sanders, Chairman of the Subcommittee on Primary Health and Aging, waits a few more minutes.

His panel of witnesses is ready.

The news release the subcommittee sent to the Senate Press Gallery and all the wire services and the rest of the media had a pretty catchy headline, but not catchy enough, apparently.

More Than 1,000 Preventable Deaths a Day Is Too Many”

And it’s true. More than a thousand people die every day in this country from preventable medical mistakes. In the photograph above, the witness seated to the far left is John T. James. The mild-mannered gentleman from Houston recently retired as Head Toxicologist for NASA. He was in charge of providing breathable air for space travelers.

The reason he has been summoned to testify before a congressional committee is because he authored a study published last fall which reported that more than a thousand people a day are killed by going to the hospital. Actually, “the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm,” James reported.

The conservative, low end of James’s calculations is 210,000 preventable deaths per year in American hospitals with more than 2 million people suffering life altering injuries.

It’s in a peer reviewed journal.

He’s got the numbers to back it up.

A modest, plain spoken man, James puts it this way in the abstract for his article, “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care,” published in the Journal of Patient Safety:

Based on 1984 data developed from reviews of medical records of patients treated in New York hospitals, the Institute of Medicine estimated that up to 98,000 Americans die each year from medical errors. The basis of this estimate is nearly 3 decades old; herein, an updated estimate is developed from modern studies published from 2008 to 2011.

Dr. James (Ph.D. in pathology from the University of Maryland School of Medicine) holds a triple bachelor’s degree in physics, mathematics, and astronomy from the University of Kansas and a master’s in astronomy from the University of Virginia. He knows a lot about outer space.

I was at conference with him once and asked what exactly do scientists mean when they say “the universe.” I mean, how do they know? He took out a ball point pen and started drawing circles and arrows on a dinner napkin, looked at my furrowed brow and said “You know what? I wouldn’t worry too much about it,” which I took as good advice.

That it took someone with degrees in math, physics and astronomy — someone used to thinking really, really big — to even conceive of calculating the annual death toll of hospitalization in America, should tell us something.

The black holes of American medicine caught James’s attention after the entirely preventable death of Alexander James, his 19-year-old son. John wrote a book about his son’s death, A Sea of Broken Hearts. He started Patient Safety America, dedicating the organization to his son, “who died as a result of uninformed, careless, and unethical care by cardiologists at a hospital in central Texas in the late summer of 2002.”

His efforts, in turn, caught the attention of the woman to the far right in the picture, Lisa McGiffert of the Consumers Union Safe Patient Project. Another Texan, McGiffert heads what is probably the most effective patient safety effort in the country, which is why she was called to testify.

When James’s Journal of Patient Safety article came out last fall, McGiffert’s team at Consumers Union produced a graphic to help drive the point home. The number of preventable deaths is such a staggering, almost incomprehensible statistic that it’s hard to grasp, and CU wanted to provide a way for people to relate. They chose the airline crash metaphor because, well, what else is there? It works — usually.

Despite (or maybe because of) the numbers, despite the pamphlets and press releases and post cards pointing out that the preventable hospital death toll in this country is more than the equivalent of having two jumbo jets crashing every day, the witnesses called to testify at Bernie Sanders’ hearing outnumbered the senators. Senators Sheldon Whitehouse from Rhode Island and Elizabeth Warren of Massachusetts were there, and Senator Chris Murphy from Connecticut stopped in.

There certainly was no electricity in the air. Nor could one could one say that the press came out in force. The witnesses called for creation a National Patient Safety Board, much like the National Transportation Safety Board, which investigates airline crashes. They also asked for a congressional committee on patient safety and enactment of a Patient’s Bill of Rights. But without public pressure, it is unlikely that these things will happen.

Perhaps the hearing lacked the adversarial drama of a powerful CEO being called on the carpet. Rosemary Gibson, author of The Treatment Trap and Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans asked in her Huffington Post column why no hospital CEOs were on the hot seat. You would think that those clamoring for Mary Barra to be modeling an orange jumpsuit in the exercise yard because of 13 deaths over ten years would be calling for the chief of the Cleveland Clinic to be drawn and quartered on the National Mall. But despite the disparate numbers, the General Motors hearings corralled much of the national media that morning.

In an ironic twist, much of the next day’s headlines were devoted to another event that happened on the same day of the hearings in Washington: A Malaysia Airlines jet crashed in eastern Ukraine. Two hundred ninety eight people were killed.

Maybe it’s like what Stalin is supposed to have said to Truman: “When one man dies it is a tragedy, when thousands die it’s statistics.”

And it is all statistics — until it’s you.