Rate of Medical Mistakes Prompts New Safeguards

AMERICAN hospitals may be the most trusted in the world, but doctors say the health-care industry deserves a good head-to-toe examination to maintain that trust.

The past few years have given glimpses of a system under stress. Patients have received the wrong medicines and surgical procedures at some of the nation's top hospitals, sometimes with fatal results. Some families are spurning civil courts to file criminal charges, including homicide, against doctors for botched treatments.

But a recent landmark study of two leading institutions concludes that all doctors, and not just the ones making egregious errors, need new ways to double-check their work. The stakes are high for an industry that is under pressure to cut costs. Experts say hospitals must police themselves better or face more regulation from outside.

''The problem is this: We assume that high talent [in doctors] and respect is enough,'' says Clement McDonald, a medical ethicist at Indiana University's Regenstrief Institute in Indianapolis. ''But it doesn't matter how smart you are,'' even the best make mistakes.

Americans put more faith in hospitals than they do in airlines and other high-risk industries, he adds. ''In the airline industry, they doublecheck this and triplecheck that. Given that humans are who they are, you have to have a system that is suited for them.''

One in 15 patients admitted to two top-teaching hospitals in 1993 received drugs that caused injuries, according to the study by Harvard Medical School in Cambridge, Mass., published in the July issue of the Journal of the American Medical Association. None of the incidents at the hospitals, Massachusetts General Hospital and Brigham and Women's Hospital in Boston, was deemed the result of negligence or malpractice.

The study's authors say they had expected a much higher error rate. But for many Americans who have come to expect perfection, anything less may come as a shock.

''We believe the only way to improve the system is to be open and honest about the problem,'' says George Thibault, chief medical officer at Brigham and Women's Hospital. ''The old way was to find the bad apples [among the hospital personnel.] But most of the problems were a systems failure.''

The system at both Brigham and Women's and Mass General was simple, but flawed. Doctors prescribed medicines, often on hastily scribbled notes, nurses transcribed the notes, and then an intern administered the prescription. Human error could enter into the process at any point, becoming known only if a patient reacted differently from what was expected.

Increasingly, medical missteps are making headlines, and are prompting criminal charges:

* Boston Globe health writer Betsey Lehman received a fatal overdose of a drug last December, while undergoing treatment at Boston's Dana-Farber Cancer Institute. No charges have been filed, and Dana-Farber is reexamining its method for ordering treatments.

* Two Milwaukee women died early this year after a laboratory misread test results. The district attorney has filed reckless homicide charges against the lab, a lab technician, and a doctor.

* A nursing-home patient died after she mistakenly received intravenous food through the wrong tube. The doctor who made the error is serving 52 weekends in jail for the mistake and for waiting 10 hours before sending the woman to a hospital.

As a result of the study, Brigham and Women's is testing a $1.5 million computerized medication-order system where a doctor can doublecheck the correct drug and dosage, depending on the patient and the conditions. Costs are not yet available for the ''personnel intervention'' program being tested at Mass General, where pharmacists are accompanying doctors on some of their rounds and making suggestions for prescriptions. Harvard is monitoring each form of safeguard to see what works best.

The Harvard study will have a strong impact on other hospitals, says Paul Schyve, senior vice president of the Joint Commission on the Accredition of Hospitals, an independent agency that accredits 80 percent of the nation's hospitals.

''Unfortunately, changes have an up-front cost,'' he says. ''But in the long term, hospitals end up saving money.''

But many hospitals may put off buying computerized systems or hiring new personnel, says Arthur Caplan, a medical ethicist at the University of Pennsylvania in Philadelphia. ''It will take some major scandal for hospitals to make changes,'' he says.