The American Medical Establishment Is On the Wrong Track in
Its Efforts to Reduce Medical Errors
This is a commentary about health care. It tells why we are losing the battle to prevent over
100,000 unnecessary deaths in America's hospitals each year
West Palm Beach, Florida, September 05, 2012 -- This is a commentary about health care. It
tells why we are losing the battle to prevent over 100,000 unnecessary deaths in America's
hospitals each year. My opinion is that physicians are primarily responsible for the deaths.
A recent poll of Swedish doctors showed that a sizable minority felt that physicians were
the source of most patient mishaps. That doesn't prove anything, of course. But I will stand
by the facts in the body of my commentary below.
I’m a retired neurosurgeon who served as a chief of staff and governing board member of
two separate 400 bed community hospitals over a five year period. I learned where most of
the skeletons were hidden. I was a reformer who tried to remove doctors who repeatedly
hurt their patients. There were several of them at each hospital. Their sins included
refusing to show up in an emergency, lying to patients and other doctors, missing
diagnoses, getting poor operative results, doing unnecessary surgeries and extracting
sexual favors from patients. My efforts were opposed by my colleagues, the hospital
administrators and the hospital lawyers. I sensed that protecting bad doctors was a
significant cause of the unnecessary loss of 98,000 lives a year from harmful adverse
events. To Err is Human, a book by the Institute of Medicine revealed that stark figure to a
shocked public in 2000.
I had to do some lifting and probing before I could turn my intuition into arguments. My
research into why my experience was nearly universal led me to someone who mined the
National Practitioner Data Bank, Dr. Robert Oshel, who worked for the data bank before he
retired. That repository was established by Congress in 1986 and put into effect at the end
of 1990. It lists for the public, by a number only, those physicians who have been sued
successfully or have lost their license to practice. Here’s what he found over a period of 20
1. There is a hard core of 2% of the physicians whose misdeeds result in half of the
money paid out in malpractice cases.
2. The average hospital drops only one doctor from its staff every twenty years.
3. About 250 doctors lose their licenses each year, or 0.04% of the total. At that rate it
would take 50 years to remove the hard core 2% from practice.
There is an insidious cause of undue leniency to doctors who repeatedly hurt patients in To
Err is Human itself. The authors had turned the interpretation of the original data of their
own published findings, the Harvard Medical Practice Studies, their primary source, on its
head based on theoretical, not empirical grounds. No new studies were done so that no
new data were gathered to contradict the original. The original numbers showed that at
least 61% of adverse events in hospitals were the result of blunders by individual
physicians and that systems errors were responsible for only 6%. I questioned the chief
author of both studies, Dr. Lucian Leape of Harvard, in a series of e-mails, and found his
explanations for his monumental reversal inadequate and unscientific.
To Err Is Human had famously blamed bad health care delivery systems, not bad doctors.
It emphasized “creating safety systems inside health care organizations through the
implementation of safe practices at the delivery level. This level is the ultimate target of all
the recommendations.” As a result, all of the efforts to save the lives of the 98,000 per year
have been systems based. The licensing boards of all the states, the main bulwarks against
bad doctors, have bought into this and made a joint statement to that effect in 2008. They
said, “Systemic sources of risk significantly eclipse professional incompetence as the
dominant cause of harm to patients.” The evidence from the Harvard Medical Practice
Studies was otherwise.
Documentation that the systems correction approach was not working came in two
devastating reports that came out in November, 2010, one from the Inspector General of
HHS, based on data gathered on Medicare patients and the other from Harvard Medical
School based on outcomes in several North Carolina hospitals. That state was chosen
because its hospitals had the reputation of rigorously following systems error prevention
methods. Both reports said that in the first decade of this century, the period following the
publication of To Err is Human, the number of deaths from adverse events was unchanged
from the 15 years preceding, perhaps greater, and had stalled at 120,000 per year.
According to the facts, we are getting almost nowhere in our efforts to reduce hospital
It boils down to this: The most reasonable interpretation of the Harvard Medical Practice
Studies is that the greatest share of responsibility for harmful errors falls on individual
physicians, not bad systems. The systems approach, while it was a huge and rapid success
in preventing airline mishaps and poorly manufactured cars, has made only a small dent in
the number of unnecessary deaths in American hospitals. That tiny inroad came in avoiding
three to six thousand deaths a year from infected intravenous lines, thanks to Dr. Peter
Pronovost of Hopkins, an accomplishment which got swallowed up by the number of
deaths from other sources. Over a million will die in the next decade. We have no time to
lose. We must rid the profession of repeatedly erring doctors on a much larger scale than
the minute fraction that we remove now.
Philip Levitt, M.D., F.A.C.S.,
Diplomate Ameerican Board of Neurological Surgery
Past Chief of Staff, St. Mary’s Hospital,
West Palm Beach, Florida
JFK Memorial Hospital,
10 Shannon Circle, West Palm Beach,