Lieff Cabraser Civil Justice Blog

How Anesthesiologists Reduced Medical Errors by Learning from Malpractice Suits and Adopting New Technology

How Anesthesiologists Reduced Medical Errors

Medical errors are the third leading cause of death in the U.S., after heart disease and cancer. As many as 440,000 people die each year as a result of preventable medical errors, often due to a doctor’s negligence. (Journal of Patient Safety).

In addition to deaths and injuries, medical errors also cost our nation billions of dollars. A 2011 study put the figure at $20 billion a year. According to a 2012 report in the Journal of Health Care Finance, counting indirect costs like lost productivity due to missed work days, medical errors may cost over $750 billion each year.

Focusing on the Wrong Approach: So-Called “Tort Reform”

How should this epidemic of patient harm in hospitals be addressed? Some refuse to acknowledge the prevalence of patient harm in medical facilities. Instead, they seek to bar injured persons from filing lawsuits for medical malpractice and call this restriction “Tort Reform.” Such authorities further assert that because of malpractice lawsuits, doctors must engage in “defensive medicine” by ordering excessive tests and other procedures designed to avoid possible later litigation.

There is no evidence to support that defensive medicine is actually driving healthcare costs. The most recent formal study on the subject — The Cost of Defensive Medicine on 3 Hospital Medicine Services — found that tort reform would lead to an “insignificant reduction in healthcare spending.”

The Right Approach: Improving Technology and Learning From Past Mistakes

A sounder approach for the medical profession is to combine the important lessons learned from already-resolved liability cases with the introduction of new technologies and practices to improve patient safety and reduce wasteful healthcare spending.

Safety initiatives in the field of anesthesia over the past three decades demonstrate the dramatic advantages of this course of action.

Forty years ago, anesthesiology was considered to be the riskiest specialty to insure and consequently had among the highest malpractice premiums. Today, anesthesiologists pay one of the lowest medical-malpractice rates in the field, as the number of fatalities and brain damage due to errors by anesthesiologists have declined over time.

What happened? There was a dramatic decrease in patient deaths due to anesthesia, dropping from one death per 1,500 anesthesia procedures in the 1970s to less than one for every 200,000 anesthesia cases today, according to the American Society of Anesthesiologists (ASA).

How did this occur? “Rather than pushing for laws that would protect them against patient lawsuits, anesthesiologists began to focus on improving patient safety. Their theory,” the Wall Street Journal reported in 2005, “less harm to patients would mean fewer lawsuits.”

The theory proved true: Claims against anesthesiologists constituted 7.9% of medical-malpractice claims in 1972. By early 2000, the number of malpractice claims against anesthesiologists had declined to 3.8%, a drop of 50%. As a result, the average annual premium for medical liability insurance rates, according to the American Society of Anesthesiologists, fell from $39,303 in 1985 to $19,594 in 2013.

Work Done by Anesthesiologists to Improve Patient Safety

Prior to 1985 when medical-malpractice rates for anesthesiologists were high, anesthesia patients in the U.S. were put in a medically-induced unconscious state with the use of ether or other flammable gasses. According to Dr. Richard Novak, the Deputy Chief of Anesthesia at Stanford University Hospital, a lack of oxygen to the patient’s heart or brain was primarily responsible for so many anesthesia malpractice death and brain damage claims. However, the anesthesia practice began to progress with the establishment of the Anesthesia Patient Safety Foundation in 1985. The foundation’s main mission was to improve anesthesia patient safety and aid in avoiding preventable adverse clinical outcomes.

With a newfound goal, the ASA began conducting research, analyzing malpractice claims, and investigating how patients were injured or killed during surgery. The ASA found a repeated pattern of anesthesiologists mistakenly inserting the patient’s breathing tube down the esophagus, rather than the trachea. This error in judgment led to patients undergoing cardiac arrest, contributing to medical-malpractice suits.

New technologies, such as pulse oximetry (a device clipped to the patient’s finger that measures blood flow and oxygen saturation) and capnography (via a device that monitors carbon dioxide levels and determines if a patient is breathing properly) that arose in the late 1980s and early 1990s resulted in fewer occurrences of these kinds of errors. Over time, more changes to the standards of anesthesia care have taken place to improve patient safety and the anesthesia specialty as a whole.

The history of anesthesiology and its advancement through its focus on patient safety and learning from liability cases provides a good model for reducing medical errors in our society.