The pediatric health-care system is large and complex, and things can easily go wrong.
A Fatal Error
After a harrowing ordeal, the worst seemed over for 6-year-old Michael Colombini.
Earlier that week, doctors had discovered that Michael had a brain tumor. It was a startling diagnosis, fortuitously detected when he'd been brought to the emergency room with a nasty bump he'd gotten from a fall at the playground. The child was operated on two days later, and his prognosis seemed promising.
"Everything went well with the surgery," recalls his father, John Colombini, of Croton-on-Hudson, New York. "Michael was alert and functioning by the next day. Amazingly, he was fine."
Before the child could go home, however, doctors needed to do a final MRI-a magnetic resonance imaging test of his brain-to confirm that the entire tumor was gone.
On July 27, 2001, Michael was placed inside the tubelike confines of an MRI machine, which uses a ten-ton magnet to generate images of the body's cells and tissues. John and his wife, Barbra, sat in the reception area outside the room, waiting to see their little boy.
"Suddenly, we heard a lot of commotion from inside the testing room," John recalls. "We knew something was wrong." The parents later learned that a metal oxygen container had been inadvertently left in the MRI room when the machine was turned on. Attracted by the giant magnet, the container shot through the air to the core of the machine, striking the child on his head and fracturing his skull. Michael was taken to intensive care, but two days later, he died from massive injuries to his brain.
Medical errors as horrific as this one are quite rare. But the fact is that doctors, hospitals, pharmacies, and other health-care facilities make mistakes far more often than most people realize--and many of those mistakes involve children. No one knows the exact number of kids who are victims of medical mistakes. A 1999 report from the Institute of Medicine, a research group, found that an astonishing 3 to 4 percent of hospitalized adult Americans are harmed in some way by their treatment. According to the IOM, medical errors kill an estimated 44,000 to 98,000 people in the United States each year.
In the aftermath of the IOM report, the American Academy of Pediatrics (AAP) began digging for data on kids. Researchers encountered a worrisome lack of information, with no ongoing national reporting system to track medical mistakes. "A lot of what happens with children is simply unknown," says Carole Lannon, M.D., director of the steering committee on quality improvement and management for the AAP.
But there's evidence to suggest that the youngest patients may be even more vulnerable to medical mistakes than adults are. In a study published in 2001 in the Journal of the American Medical Association, researchers who pored through more than 10,000 drug orders for children at two Boston teaching hospitals found 616 medication errors-about six mistakes for every 100 kids. Just as alarming, near misses--such as faulty prescriptions caught and corrected before the medicine was given to a patient--occurred about three times more often among children than among adults.
How It Happens
The sheer complexity of the health-care system is the underlying cause of most medical mistakes, experts say. When you bring a child to a hospital or clinic, you never deal with just one doctor. Instead, medical care is administered by an ad hoc team that can include a primary-care physician, specialists, nurses, receptionists, pharmacists, and others. Every time information and instructions pass from one caregiver to the next, there is an opportunity for miscommunication and misinterpretation.
And there is no cohesive system for overseeing the entire process. "Most errors are sins of omission, not intentional wrongdoing on anyone's part," says James E. Fox, a malpractice attorney in Sherman Oaks, California. Sadly, medical procedures--from performing operations to providing recovery care-allow little room for error.
happened to Mareena Tomei, a 14-month-old from Traverse City, Michigan. After the child had surgery to correct a kidney condition she was born with, doctors ordered that she be hooked up to a monitor and supplied with oxygen through a tube in her nose. But when she was wheeled from the recovery ward to her room, the tube was disconnected from the oxygen supply, presumably to make transport easier. With Mareena settled in a crib, her mother, Brenda, asked a nurse if the tube should be reconnected.
According to Brenda, the nurse-apparently unaware of the doctors' instructions-said doing so was unnecessary. But she promised to stay in the room to keep an eye on the child while her parents got something to eat. The nurse did leave the room, however, and while she was gone, Mareena stopped breathing. Those few minutes without oxygen cost the child most of her brain function. Mareena lost her sight, never learned to walk or talk, and now at age 5 requires round-the-clock care.
Not Enough Oversight
To a certain extent, errors are inevitable. After all, health-care professionals are only human and everyone makes mistakes. "No system as complicated as health care can operate without the potential for something going wrong," says Eric Knox, M.D., director of patient safety at Children's Hospitals and Clinics in Minneapolis and St. Paul. But compounding the problem is the fact that medical mistakes are often swept under the rug. "Our health-care system does a terrible job of acknowledging errors, compared with industries like aviation or nuclear power," says Martin Hatlie, president of the Partnership for Patient Safety, a Chicago organization that advocates for improved safety procedures in health-care facilities.
This culture of silence can discourage caregivers from speaking openly when they mess up. "In the medical field, errors are accompanied by shame and blame. Nobody wants to talk about what happened, and this limits the discussion about what could be done to correct the situation," says Julie Morath, R.N., a board member at the National Patient Safety Foundation, an industry group founded by the American Medical Association.
Advocates say that the health-care industry is slowly becoming more candid about its flaws and faults. But in the meantime, parents of kids who see doctors or are hospitalized need to stay closely involved in every step of the process. Here's how to play a greater role in promoting your child's safety and well-being.
Trust your gut. Patient advocates say parents should question and even challenge doctors if something about a child's care seems wrong. "A medical degree doesn't automatically make a doctor the best person to decide what's right for your child," says Melissa VanPopering, an attorney with Women's Legal Referral Service, in Chicago. "As a parent, sometimes you can be the real expert."
Ilene Corina, of Nassau County, Long Island, has followed that advice ever since her 3-year-old son, Michael, died in 1990 when poor follow-up care after a routine tonsillectomy led to a fatal blood infection. Several years ago, when another son, then 6, developed a severe rash and a high fever, she didn't accept her pediatrician's diagnosis of eczema. "I'd never seen anything like it, and I knew something else was going on," she says. She went through two dermatologists and an allergist before getting the correct diagnosis of impetigo, a bacterial skin infection that requires antibiotics. "You need to have a certain amount of trust, but you also have to question," says Corina, who runs a support group for victims of medical errors.
Be selective about doctors. If your pediatrician or specialist isn't receptive to your questions or concerns, find someone else. "I often hear people say, 'I have a great doctor, but he has a lousy bedside manner,' " Corina says. "But if you're not comfortable talking with your doctor, you should think about switching practices."
Bear in mind that if your doctor is autocratic with you, he's likely to be that way with other people on your child's medical team. Some hospitals are actively working to change the doctor-as-God culture. In the Twin Cities, Children's Hospitals and Clinics has a policy that anyone in the chain of command can at any point challenge decisions about a child's care if she feels the patient's safety is at risk-and parents are pointedly made a link in the chain.
Stay vigilant at times of transition. Whenever care is being transferred from one place to another (say, from the E.R. to an operating room, or from there to the recovery room), watch for mix-ups. Ask that a nurse from the first department accompany your child to the next-to confirm his identity, brief the new caregivers on his condition and history, and review plans for his care. It's also worth getting your own copy of your child's medical records and carrying them with you so you don't have to rely on memory while providing your child's history.
Always get a second opinion. Even doctors can find medical advice baffling. When anesthesiologist Tammy Euliano, M.D., of Gainesville, Florida, learned that ventricles in her 18-month-old daughter's brain were abnormally large, a neurosurgeon initially advised putting the child through a dangerous operation that had potential for ongoing complications. But other doctors suggested that she wait, and the surgery proved unnecessary. "You should get as many opinions as possible," Dr. Euliano advises.
While most doctors are doing the best they can in a rapidly changing field, the better part of vigilance is assuming that a mistake can occur. "Miracles are performed every day with new technologies, knowledge, and drugs, but each new advance in medicine also carries new risks," says Morath. "Safety issues are changing all the time, and the task of dealing with them is never done."
Errors involving prescriptions are the most common type of medical mistake, and children are especially vulnerable. Here's what parents can do to avoid problems.
- Make sure you can read what your doctor wrote on the prescription pad. If you can't, the pharmacist may not be able to, either. Check the legibility before leaving the doctor's office.
- Repeat the dosage back to your doctor to make sure she wrote what she meant. Don't accept "as directed" for a written instruction, even if the doctor has told you how to administer it.
- Request that your doctor provide written-not oral-instructions to the assistant who phones the order in to the pharmacy. Busy office staffers may forget exact instructions, and errors may result.
- When you pick up your medicine at the drugstore, double-check that the drug is what your doctor prescribed. Many pharmaceutical names sound alike-for example, Zomic, an antimigraine drug, and Zoloft, an antidepressant. Talk to the pharmacist to be sure you've gotten the right drug.
Copyright © 2003 Richard Laliberte. Reprinted with permission from the February 2003 issue of Parents magazine.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.