UNMET NEED HIGHLIGHTED IN THE POST: Medical error is the third leading cause of death in the country. A recent documentary, Bleed Out, blames errors on a lack of transparency within care teams. Limited provider accountability post hoc is also spotlighted as a cause.
I saw a most disturbing HBO movie a couple weeks ago, Bleed Out. The film, by Steve Burrows, follows the story of how his mother’s hip surgery led to permanent brain damage. Mrs. Burrows’ brain damage from a coma following surgery occurred in the ICU where a doctor monitored her by video camera from a location miles from the hospital. (Does this really go on???) There were no live doctors in the ICU, only nurses, and Mr. Burrows contends the camera was not always on. Mrs. Burrows lost all her money, her home, many of her cognitive and physical abilities, and is now living in a skilled nursing facility with Medicaid paying the cost.
Ten years of hell for Mrs. Burrows and son followed this hip surgery gone wrong. I’m not even going to get into the possible errors committed by the surgeon, anesthesiologist, and ICU nurse. To add to his mom’s medical woes, Steve Burrows got eyeballs deep into the financial side of this tragedy, fruitlessly arguing with the insurance company and hospital over an unrelenting torrent of large charges, as well as pursuing a lawsuit that his superstar attorney said he had long odds of winning. Unfortunately, the attorney was right. And then there was the added burden of Burrows having to travel twice a month from his home in LA to his mother’s home in Wisconsin to navigate this shit storm.
The viewer of this documentary fully feels the sense of helplessness that overtakes Burrows. No power to the patient here, folks. Even Burrows’ uncle, a retired physician who originally advised Burrows to file the lawsuit, abandons his nephew and his mom (the uncle’s sister). You watch Bleed Out thinking that someone is going to throw Burrows a lifeline and it never happens. He’s happy he got to make this movie but how many other patients and their caregivers will have the wherewithal to make a movie that captures the misdeeds of their tormentors? And not to be too harsh but having the opportunity to make an HBO documentary is a pyrrhic victory given all the tsuris mother and son had to endure.
Medical errors galore
There’s so much to unpack here that I can fill ten blog posts with all the systemic problems that this horror movie highlights so I’m going to focus on the source of the horrors, medical error. According to a 2016 Johns Hopkins study, more than 250,000 people in the United States die from medical error every year, making it the third leading cause of death in the country. And yet the CDC does not include medical errors on its list of the top causes of death in this country.
As cancer surgeon and lead author of the Hopkins study Marty Makary points out, cause of death counts affect how research dollars are allocated. So medical error is left holding the short end of the research funding stick. Makary delves deeply into the disturbingly large number of fatal medical errors in his book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care.
Transparency wanted
Makary points to one reason why healthcare isn’t transparent: physicians’ code of omertá, which restrains them from blowing the whistle on incompetent colleagues. Even Burrows’ uncle, the retired doctor, won’t testify at the malpractice trial and denies he recommended filing the suit even though he’s A) retired and B) the brother of the plaintiff. “Off record”, though, there is finger-pointing by an MD in Bleed Out. Burrows secretly records a meeting at Panera with his mom’s surgeon who, when asked what he would do if he were in Burrows’ shoes, responds: “I’d like an accounting, just like you, for why in the hell no doctor was there [in the ICU]. Their intensive care unit, where this problem occurred, we still don’t know what happened. We don’t have accountability.”
The end of the movie spotlights Mayo Clinic as a paragon of transparency. According to a 2014 article in Mayo Clinic Proceedings: “Mayo physicians are keenly aware that their clinical inputs to a patient’s medical record will be read by the others on the patient’s medical team. As one Mayo physician shared with us: ‘It is peer pressure. It is the fishbowl effect. I want to do things right because everyone I respect and trust is going to be able to see what quality of doctor I am.’”
Mayo’s transparent fishbowl reminds me of a quote I once heard from a totally unrelated field, corporate environmental sustainability. Corporate sustainability guru Joel Makower once said, “If you are going to be naked, you better be buff.” Makower argues that green activists shining a big, bright light on corporations’ environmental activities have led companies to clean up their acts. Much of the practice of medicine, on the other hand, still operates in a shroud of mystery and the patient is left to hope that what she’s picked behind Door #3 is the right choice. (My apologies to younger readers who don’t remember Monte Hall and Let’s Make a Deal).
The buck doesn’t stop here
You have to have at least a little faith in your doctors but patients and their caregivers should question every diagnosis and recommended treatment that don’t make sense. Unfortunately in an emergency situation, though, we don’t always have time to question the physician or to get second opinions. And who in their wildest dreams would have thought their mom’s hip surgery would lead her to slip into a coma in an e-ICU, totally ignored by medical staff? The patient and her caregiver can only do so much if there’s no accountability. In Bleed Out, one of Burrows’ targets is Wisconsin’s torts laws that make it exceedingly difficult for medical plaintiffs to win. (That’s not to say, though, that frivolous lawsuits should be allowed to waste the courts’ time and money). And where were hospital accrediting organizations like NCQA and JCAHO in this sordid saga? How about Wisconsin’s Department of Safety and Professional Services, the body that licenses doctors in the Badger State? What about Wisconsin’s insurance commission? We don’t know the full story, only Burrows’ account of it, but it appears that these institutional safety nets were all MIA. What a shame.
