Caution: Hospitals May Be Hazardous to Your Health
by author David Crowe

Many lives are saved by treatment at modern hospitals, but hospitals can also be dangerous places causing a staggering number of health problems and even deaths. Minor side-effects from treatment of a serious condition can be tolerated, but disability, worsening illness, or death after treatment for a minor condition is not acceptable.

A 1998 Journal of the American Medical Association (JAMA) University of Toronto study showed how big the problem is in the US. The study estimated that 6.7% of hospitalized patients suffered a serious, unexpected adverse drug reaction in hospital - that’s about two million drug reactions every year. Of these, 106,000 patients died each year. The study assessed all drug-related errors including the administration of the wrong drug or incorrect dosage, which are other significant but lesser sources of injury and death.

The 1991 Harvard Medical Practice Study found that 3.7 percent of 30,000 randomly selected patients had “disabling injury caused by medical treatment”. About half of these were the result of an operation and included wound infection or technical complications, such as difficulty controlling bleeding. Drugs were responsible for 19 per cent of the adverse events. When extrapolated to the entire US population, it is estimated that 180,000 deaths are due to medical treatment in hospitals every year. Some studies suggest the total may be even higher.

Canadian and American hospitals are similar enough that these statistics can be extrapolated. With a population about nine times smaller, this would imply that about 25,000 Canadians die every year from medical treatment in hospitals. However, based on Ontario reports of drug reactions in hospitals, only about 1,800 fatal drug events occur annually. The flaw in this reasoning is that only a tiny fraction of adverse events are reported, about one per cent based on Canadian research from 1976. However, since these reports were limited to drug events and were considered to be dramatically under-reported, the total number of deaths could be even higher than 25,000.

A recent Canadian study reported in the Canadian Medical Association Journal provides some support for the larger figure. This study found that almost one-quarter of a group of elderly patients, (average age 71), experienced at least one adverse event after discharge from hospital. A significant majority of the adverse events were due to prescription drugs. Three percent of the events resulted in permanent disability and three percent in death.

While it may not always be possible to stay out of hospital, it is important to limit admission unless it is really necessary. While in hospital, keep stays as short as possible. Insist on being made aware of all treatment options. It is your right to be fully informed of all treatments, and to refuse treatments that do not seem justified. Monitor any treatment and be prepared to demand your rights, as they may not be freely offered. It is particularly important to carefully monitor the use of any drugs, ensuring that only those that are essential are taken and that they have been correctly dispensed.

The importance of close monitoring of treatment was shown by a 2003 JAMA study of patients who were isolated due to a penicillin-resistant infection. These patients were found to experience more than double the risk of adverse events compared to a matched group of non-isolated patients. Even when physical contact is limited, patients’ family and friends can still keep in touch with the patient and their medical staff by phone, fax, or e-mail. This communication must be maintained to ensure that symptoms and side-effects are taken seriously, and that medical treatment is appropriate.

It is important for patients to realize that hospital personnel are not necessarily all-knowing. Guidelines for treatment are revised regularly, and sometimes drug regimens are even discarded. During the SARS crisis it was common to prescribe Ribavirin; after the crisis doctors admitted that this drug caused toxicity in the majority of patients. A recent Canadian study of antibiotic therapy for urinary tract infection showed that three days of antibiotics were more effective than the seven days recommended by many doctors. Hospitals function best when procedures are followed, but these procedures are not always scientifically justifiable and they often ignore true health and individual variation.

The biggest risk is to the elderly. They are, on average, the recipient of more drugs than younger people, and may be less equipped physically and emotionally to question the treatment they are receiving. It may be necessary for friends or relatives to closely monitor their care, particularly the drugs they are taking, to ensure that they don’t become just another statistic.

A 2000 JAMA commentary categorized the estimated unnecessary hospital deaths in the US as follows:

• 12,000 deaths from unnecessary surgery
• 7,000 from medication errors in hospitals
• 20,000 from other errors in hospitals 
• 80,000 from hospital-acquired infections
• 106,000 from non-error adverse effects of medications

David Crowe is a Calgary-based environmentalist and analyst of modern medical science. He has an HBSc in Biology and Mathematics. References can be obtained from him at David.Crowe@aras.ab.ca.

Source: alive #259, May 2004