Photo: Nigel Parry
In September 2000, Richard Flagg, a rugged Vietnam vet, checked into Meadowlands Hospital in Secaucus, New Jersey, to have a small benign tumor removed from his left lung. His surgery was the first on the schedule the morning after the Labor Day holiday, and the staff seemed rushed and running behind. But Flagg was optimistic; a CAT scan had indicated only a small portion of the lung would have to be removed, and in a few weeks the 60-year-old could return to his physically demanding job as a barge captain and a fully active life.
In the operating room, the table and instruments were set up for left-side surgery, the anesthesia was administered, and Flagg drifted into unconsciousness.
The next day when he regained clarity, he was stunned at the sight of tubes extending from the right side of his body. There must be some mistake, Flagg told the surgeon. But the doctor explained he had found a hemorrhaging tumor in the right lung and thus had saved his life.
Over the next several months, however, Flagg's health deteriorated. He never returned to work, had trouble walking, and was eventually tethered to an oxygen tank 24 hours a day. Still believing what the surgeon had told him about his right lung, Flagg happened to receive a copy of his medical records when his primary group of doctors filed for bankruptcy. After reviewing the records, he called his girlfriend, sobbing. On top of the stack was the pathologist's report that showed no evidence of a tumor in his right lung.
Flagg hired an attorney and sued. Desperate to regain his health, he consulted a cancer specialist, who delivered more bad news: His diseased left lung could no longer be operated on. Flagg didn't have enough lung capacity and wouldn't survive the surgery, the doctor said.
In September 2003, the tumor in his left lung ruptured and Flagg died.
Richard Flagg's story is horrific and difficult to fathom but hardly an isolated case. Incredible as it sounds, wrong-site surgeries account for an estimated one in every 15,000 operations. Meadowlands Hospital settled Flagg's case last May for more than $1 million (a spokesperson called the incident "regrettable" and says they have since upgraded their safety standards). As to what happened, it appears that a string of medical errors led to the devastating outcome, with something surprisingly simple leading the list. Flagg's attorney, Charles Rock, believes "the surgeon simply misread the CAT scan film by flipping it around, so that left became right." When the doctor entered the operating room, the incision site had not been marked on Flagg's chest, and no one on the surgical team verified with one another, or with Flagg, the procedure to be performed. So the surgeon ordered his patient repositioned and proceeded to cut out a portion of his healthy right lung.
Newspapers are full of stories about other terrible medical mistakes. In 2003, at Duke University Medical Center, 17-year-old Jesica Santillan died after the heart and lungs from a donor with the wrong blood type were implanted in her chest. In January 2004, sedation complications were to blame in the death of best-selling novelist Olivia Goldsmith (The First Wives Club), who died while undergoing routine cosmetic surgery at the prestigious Manhattan Eye, Ear & Throat Hospital. Not long after, at the same hospital a second woman was killed by an excessive dose of lidocaine, a common local anesthetic.
Without disclosing the hospital or patient names, in 2002, Robert Wachter, MD, chief of the medical service at the University of California, San Francisco Medical Center, reported an astonishing patient-mix-up case in the journal Annals of Internal Medicine. At a "teaching hospital," a 67-year-old woman identified as Joan Morris was recuperating in her room after a brain aneurysm procedure when nurses wheeled her into the catheterization lab. Mistaking her for "Jane Morrison," a 77-year-old patient who was scheduled to have an invasive cardiac test, doctors proceeded to stop and start Joan Morris's heart several times, only to discover their blunder an hour later. Luckily for Morris, she emerged from the ordeal undamaged.
Each year more than 33 million Americans walk into the forbidding and unfamiliar world of a hospital and put their lives in the hands of doctors, nurses, technicians, and administrators. And each year, according to a 1999 landmark report issued by the Institute of Medicine (IOM), an independent organization that advises the government on health policy, these medical professionals kill as many as 100,000 patients because of mistakes, most of which are clearly preventable. That's more deaths than from breast cancer or AIDS or even automobile accidents. Doctors operate on the wrong patients, amputate the wrong limbs, take out organs from the wrong side of the body, fail to monitor life-threatening conditions, misdiagnose, and administer fatal drug overdoses. The startling IOM report, titled To Err Is Human, was a wake-up call on the deadly extent of medical errors; it also noted that they cause serious and permanent injuries for thousands more patients. In a system designed to protect people, with the specific mandate to do them no harm, how have things gone so wrong?
"The short answer is, over the past 50 years, medicine has become increasingly complex, and this progress has created far more opportunities for error," explains Wachter, coauthor, with Kaveh Shojania, MD, of the 2004 book Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes. The once simple fee-for-service doctor-patient relationship has been eroded by burdensome paperwork, managed-care hassles, advances in complicated technology, more handoffs of patients from one set of doctors to another, and the long-standing problem of fatigue among residents and interns. A large number of unnecessary deaths-more than 7,000-are due to medication errors, mostly from illegible handwritten notes and prescriptions, confusion over drugs with similar names, and doctors' lack of knowledge about the appropriate use of a drug.
Above: Elizabeth Grimball, 15, is paralyzed because doctors dismissed her complaints as "psychological."