There is a blogger here in our WordPress family that I have great admiration and respect for. You see, she is a Mom whose adult son died under very suspicious circumstances. She firmly believes her son was murdered and is looking for justice to be done in his name. But the medical examiner did not rule his death a possible homicide or even suspicious. The police report states UNATTENDED DEATH, and six sentences of explanation. The case was closed in 1.5 hours. No investigation into cause of death.
She reports, “It has been five years and still the local coroner refuses to release all of the autopsy report or allow an investigation into the strange circumstances surrounding his death – or the poison that was in his blood.It has taken all these years to discover that NO ONE oversees the coroner, they are not required to have a medical degree (only high school diploma or equivalent) and do not have to account for their findings to anyone.
It is because of her courageous, exhausting, and unrelenting fight to find answers into the death of her beloved son that I paid very close attention to the article below posted on the exclusive website Medscape. Shirley, this one is for you. Yet, it really concerns us all.
Cause of Death: 50% of Medical Residents Fib
by Diedtra Henderson
Some 48.6% to 58.4% of residents from more than half of the residency programs in New York City have knowingly entered the incorrect cause of death on death certificates — errors that have implications for epidemiology, public health research, and disease surveillance — according to result from a recent study.
Barbara A. Wexelman, MD, MBA, from St. Luke’s–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York City, and coauthors report their findings in an article published in the May 9 issue of Preventing Chronic Disease, published by the Centers for Disease Control and Prevention.
As fewer autopsies are performed, Dr. Wexelman and coauthors note, death certificates have become even more important sources of information about how Americans die. Public health researchers rely on death certificates to gauge the leading causes of death and to identify disease outbreaks, and the certificates also influence funding policies and research priorities.
In most teaching hospitals, it falls to resident physicians to complete the forms. To examine their experiences and opinions, the researchers conducted an anonymous, Internet-based, 32-question survey of New York City’s 70 internal medicine, emergency medicine, and general surgery residency programs in May and June 2010. Some 521 residents from 38 residency programs responded to the survey; 178 of the residents were termed “high-volume” respondents, meaning they had completed 11 or more death certificates in the previous 3 years.
Forced to Do It
“Almost half of all respondents (48.6%) and 58.4% of high-volume respondents reported they had identified a cause of death on a death certificate that did not represent the true cause of death. More than half of the residents (54.0%) reported they were unable to list what they felt to be the correct cause of death after guidance from the admitting department in their hospital,” Dr. Wexelman and colleagues write.
“Of all respondents, 70% believed they were forced to identify an alternate cause of death when the patient died of septic shock (compared with 83.5% of high-volume respondents), and 34.2% believed they were forced to identify an alternate cause when the patient died of acute respiratory distress syndrome (compared with 44.3% of high-volume respondents),” the researchers continue.
Only 20.8% of respondents knew they could hedge the death determination by calling it “probable,” “presumed,” or “undetermined.” When the death certificate system would not accept the true cause of death or hospital admitting staff overruled them, 64.6% of respondents reported cardiovascular disease, 19.5% pneumonia, and 12.4% cancer as the cause of death.
Study participation was voluntary, and residents with stronger feelings about the accuracy of death certificates may have been more interested in participating. Other study limitations include the potential for recall bias.
“Residents routinely reported diagnoses on death certificates that did not match their medical judgments. These errors may have lasting effects on the public health priorities of the community. Reform is needed both in the training and education of residents and in the system itself,” the authors conclude.
Okay, so as a PhD candidate for a Doctorate of Natural Medicine, I find this sickening and disturbing. But what about all the doctors, nurses, administrators, and other licensed healthcare practitioners who deal with this on a frequent and regular basis? What do they think about all this? Below are just a small handful representative of the comments received about this finding. I have tried to present a wide cross-section of respondents from various locations in the US and even a few international. These comments blow my mind, and I hope they give you pause for thought.
Lane Longo| Health Business/Administration
1 day ago
Let me say, at the outset, that the the title of this article would be more properly worded by removing the innocuous sounding euphemism “fib” with the correct word “lie”. That is, to deliberately mislead by falsehood.
Further, the article stated that residents were “forced” by hospital admitting staff or because the program would not accept he actual cause. While I do not have direct knowledge of the death certificate program used, I assure you that the program did not design the criteria. Some governing board, after throwing out any sense of .ethics, weeded out any possible incriminating causes which might redound to the hospital or physicians account. Do you imagine that because the patient is dead that the cause doesn’t matter to the family or the state?
And the final insult…”Study participation was voluntary, and residents with stronger feelings about the accuracy of death certificates may have been more interested in participating.” This implies that there are many more who do not give a damn about the truth. Who are you people?
One would think that the much vaunted medical community would eschew debauched ethics. If you do it in the smaller things, you will blunt your conscience to the larger ones.”
Dr. WOOD DEMING| Cardiology, General
2 days ago
“It does not sound like a resident training problem , but rather administrators bent on falsifying records to make billing more enriching or to portray the hospital in a different light . I would also guess that this issue is discussed openly at meetings for hospital managers..”
Dr. stephen c
12 days ago
“Why does no one mention the elephant in the room? When older patients are admitted with known pathology it is all too easy to let them die of iatrogenic causes such as acute respiratory failure due to over prescription of opiates. When my mother was admitted in light coma with a moderate middle cerebral bleed at 83, I arrived 24 hours later to find she was on regular morphine and already cheyne-stokeing. Apparently, she had groaned on being turned and a relative had asked for pain relief. I got the morphine stopped, she woke up and is now at home with no neuro deficit and only mild confusion enjoying her grandchildren for another year or two. Her death certificate would have read “Cerebro-vascular Accident”. It would have been a lie.”
Dr. Raymond Vergne| Cardiology, Interventional
12 days ago
“For the living, medical “coders” love “NSTEMI” and “congestive heart failure”. NSTEMI is the choice diagnosis for anyone with a minimal elevation of troponin levels, regardless whether it is due to sepsis, stroke, acidosis, respiratory failure, pancreatitis, pulmonary embolism or atrial fibrillation. Congestive heart failure is preferred over COPD, acute lung injury, thyroid storm, acute bronchitis or idiopathic pleural effusion. NSTEMI and CHF yield better reimbursement from Medicare. One learns fast not to argue with the coders.”
Dr. Anton-Lewis Usala| Pediatrics, General
13 days ago
“This is an excellent description of what happens in the absence of quality systems. Medicine is the last major industry that doesn’t have quality system assurance built into the delivery of its service. While pharmaceutical companies are required to have design-reviewed processes in place, with point-of -process quality systems to assure they were completed as intended, the only part of drug development that does NOT require quality system enforcement is the clinical trial portion involving human subjects. Many hospitals have quality departments, but they review after the fact events, and are not the same as industry quality systems that assure each step in process occurs as intended to prevent an unqualified product at the end. I think such an approach would be initially difficult to implement (as they are when first applied to any service or industry) but would have profound beneficial effects for our patients, our institution, and our profession.”
I could go on and on, with many more comments, but I think you see the pattern and general consensus emerging. For anyone who wants to view all 79 and counting comments, let me know and I will send them to you. See, I can’t just post the link and have you look it up yourself because it is part of a private, members by subscription only site. All I can do is “Select All”, then ” Copy”, and then “Paste”. What does this mean? Well for one thing it means the news media and ethical investigative journalists of this world probably do not have access to this information to bring it to the public’s attention. And what does this revelation mean when it comes to all the data collected by various organizations that track the rise and or fall in the number of deaths related to a certain disease? Or to biologic family members that might be left in the dark about a possible genetic time bomb in their lineage that was inaccurately stated as the cause of death? The system is broken folks. How are we going to fix it?