February 2004 Bulletin

From our readers

Write to The Editor, AAOS Bulletin, 6300 North River Road, Rosemont, Ill. 60018-4262

Hospital Errors

Your short article in the October 2003 edition of Bulletin entitled “Hospital Errors have Devastating Impact on Health Care System” was very disturbing. It states that, “Almost 32,600 deaths, 9.3 billion dollars in excess charges and 2.4 million extra hospital days are caused each year by medical injuries during hospitalization.” Further in the article it mentions a study analysis of 18 complications as sometimes caused by medical errors.

The article seems to use the words “error,” “injury” and “complication” as though they are synonymous. In my own subspecialty of spine surgery, a wound infection is perhaps one of the more common complications that results in increased hospital days, charges, and occasionally death. However, I do not consider a postoperative wound infection to be an “error” or a “medical injury.” It is clearly a recognized complication and is often seen in people with underlying medical conditions such as diabetes or immunosuppression.

To bundle complications with errors is very misleading, particularly to the public. The article states that, “the reopening of surgical incisions was the second most serious event, causing an estimated 405 deaths annually.” The reopening of surgical incisions is done for a good reason, and these reasons are often complications such as infections or hematomas. Again, this is not a medical error but a recognized complication that has been discussed in advance with the patient.

I think it is important to clearly define the terms used in such reports and to distinguish between a true medical error, which in my opinion occurs with far less frequency than recognized but unavoidable medical complications.

Robert G. Johnson, MD
San Antonio, Tex.


Specialty Hospitals

I am amazed about the perception of the public and many physicians about all of the drives to develop specialty hospitals (October 2003 Bulletin). Dr. Holms, in a prior letter to the Bulletin (December 2003), outlined the cost-shifting part of the drive to develop specialty hospitals. He forgot another extremely important reason why physicians are willing to take the risk and do the work necessary to develop a treatment facility outside of the pre-existing large hospitals in which they currently work. That is hospital administrators who have diminished, and in many cases removed, the physician voice from development plans with their organizations. Apparently, the current hospital MBA mantra that is being embraced is that we physicians represent only replaceable economic units and that our job is to work. We are not supposed to have any say in the development of treatment protocols, staff or programs for patient care. The lack of a collaborative relationship with the medical staff has led many physicians to conclude that they must take control in any arena where they can find control available to take.

Specialty hospitals would not exist if the current hospital administrations were doing a good job of taking care of the their primary customers, the physicians.

James E. Stoll, MD
Milwaukee


Diversity

Affirmative action is a euphemism bestowed upon us by the federal government. It sounds so innocuous until we realize what it means. It means racial quotas. You must look at the results and how it is interpreted not the words. Like with people we look at what they do, not what they say. I did not know and am dismayed that that the leadership of the AAOS would support such misguided foolishness. I doubt it would pass a popular vote of the members.

Affirmative action is very much an unfunded government mandate. We are in effect saying that we took unfair advantage of a minority and now our children will have to make up the difference. They are the victims in this sociological quota system.

I am relieved to know that even though it was partially upheld in one of the two recent Michigan cases before the Supreme Court, four of the nine justices voted against it. I don't know if I was relieved or not to know that the "swing vote" of the Supreme Court (Sandra D. O'Connor) thinks that we will only need this doctrine for 25 more years. Maybe she could give me some help on the Super Bowl next year.

Michael X. Rohan, MD
Panama City, Fla.


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