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Hospital Patients: Will I Leave Here Better Or Worse?

They’re tales from the hospital that sound like “Tales from the Crypt.”

The Michigan mastectomy patient whose surgeon removed the wrong breast.

The New York woman who died when a doctor mistook her dialysis catheter for a feeding tube and ordered food pumped into her abdomen.

The Tampa, Fla., diabetic who came to a hospital to have his diseased right foot amputated and woke to find it was the only one left.

At that same Florida hospital, all within the past month, another patient had surgery on the wrong knee, and a 77-year-old man died when a therapist mistakenly disconnected his ventilator.

Such medical horror stories don’t necessarily constitute a trend, but they raise a question that has occurred to many a hospital patient in the lonely hours before an appendectomy, a heart bypass or a hip replacement: Will I leave here better or worse?

The system’s defenders say egregious cases of medical malpractice are like airline crashes - catastrophes so newsworthy because they are so rare.

But critics contend they are all too common.

“It would be wonderful if the malpractice death toll was as small as in a plane crash,” says Harvey Rosenfield, a Los Angeles-based consumer advocate. “But it’s much higher, and it happens behind closed doors.”

A landmark Harvard University study published in 1991 concluded that nearly one in every 25 patients in New York state hospitals was injured by doctors or staff. More than a quarter of those injuries were due to negligence.

Another study in California found that about 5 percent of hospital patients suffered doctor-related injuries, with about a quarter of those due to negligence.

Medical groups complain the Harvard study is overused because its cases are 10 years old.

But it’s unclear that much has changed since then; while most experts say they believe diagnostic procedures are more precise now, they also point out that the rise in invasive procedures means more can go wrong now.

Although the hospital cast is large, including nurses, technicians, orderlies and administrators, some critics blame doctors.

Experts say 3 percent to 10 percent of the nation’s physicians are incompetent or impaired. But less than 1 percent of them are disciplined, and an even smaller proportion lose their licenses.

But doctors are only part of the problem. In one of the Tampa cases, for example, the patient scheduled for amputation arrived in the operating room with the wrong leg prepped. The surgeon should have double-checked, but the staff did him no favor.

While lawmakers debate tort reform - doctors claim lawsuits are driving costs up, while consumer advocates say the suits are the only insurance against poor care - some hospitals have tried to tighten up.

In Tampa, for instance, hospital officials unveiled a plan this month to avoid unplanned amputations: Any time surgery involves an organ or limb that comes in pairs, staffers will write “NO” with a black Magic Marker on the limb or organ that should be left alone.

Absent systemic reform, what can patients do to reduce risk?

Consumer advocate Rosenfield wrote a book on the subject. He has two recommendations:

“First, choose a doctor the way you’d choose a car - kick the tires. I mean ask questions, ask for references and take a test drive, a test visit.

“Second, never spend the night alone in the hospital. Bring someone with you, even if they have to sleep on the floor. A lot of the things that go wrong don’t go wrong in the operating room.”