Medical Malpractice Case of the Month
October 2002

Though your physician took an
oath to do no harm, don't assume you are safe at the doctor's office.
While health reformers have been. focused on deadly errors in hospitals recently, a growing number of medical experts say patients can face equal or greater risks in doctors' offices and out patient surgery clinics-from botched anesthesia during cosmetic surgery procedures to suspcious-looking X-ray films that get filed away without follow-up. Several states are weighing legislation to regulate offices more closely, but few states require reporting of outpatient medical errors. And individual doctors' offices are even less likely than hospitals to have modern electronic medical records, equipment :and computerized prescribing devices that could help cut errors.
Though there are no reliable national statistics, data from malpractice. insurers, federal researchers and medical societies indicate the risk of outpatient medical errors is growing along with the number of visits to outpatient facilities. According to the American Hospital Association, outpatient visits jumped to 521 million in 2000 from 202 million in
1980, while total inpatient admissions fell to 33 million from more than 36 million. By 2005, the American Society of. Anesthesiologists estimates, .10 million
procedures will be performed annually in doctors' offices-twice the number of office-based surgeries in 1995.
monitoring of patients in the recovery and postoperative period, the group said, could have prevented a larger number of office-based claims.
The. Outpatient-error issue has divided medical groups, particularly in the cosmetic-surgery field where there was a rash of bad publicity from deaths during liposuction procedures in the late 1990$. Princeton's Ms. Armstrong cited data from 1994 to .1998 In Health Affairs showing the death rate from liposuction performed by board-certified aesthetic plastic surgeons at 19.1 per 100,000-higher than the death rate in the country from car accidents or homicides, with 78% of the deaths in outpatient offices.
But an American Society of Aesthetic Plastic Surgery spokeswoman says those figures are outdated and misleading. According to its survey of .94,000 liposuction procedures between
September 1998 and August 2000, the estimated risk of death was one per 47,415 procedures. The survey also showed that 61% of all cosmetic procedures performed by its members during
the period took place in office-based surgical facilities, and that complications were no more common than for surgeries performed in hospitals. Still, the plastic-surgery group concedes there are risks, particularly when
liposuction Is performed along with other procedures, such as tummy tucks~ The group offers a number of consumer-safety tips on its Web site www.surgery.org

Wall Street Journal 8-29-02


Medical Mistakes 
A breakdown of errors in outpatient settings:

Communication errors  24%

Discontinuity of care errors,  
including patient referrals  20%

Abnormalities of lab results,
logistics and follow-up  19% 

Missing values and charting   13%

Prescribing errors In dosage,
choice, allergy or interaction  8%

Clinical mistakes knowledge or skills   8%


Other  8%

Source: California Academy of Family Physicians

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