Overcrowded emergency rooms are another factor behind patient injuries. A 2006 study found that California had fewer emergency rooms per resident than any other state.
At Kaiser Foundation Hospital San Jose in March, staffers left a patient waiting in the emergency room for more than an hour after a test showed that his blood sugar was higher than the maximum measurable with a glucometer. The medics determined that he needed immediate care, but all 25 treatment bays were full. He passed out in the waiting room and died from heart failure.
Kaiser officials said that since his death, patients who need immediate care have been kept in the triage area under nursing supervision. The hospital said it also established a system to call in extra medical help when its emergency room is overwhelmed.
Doctors and hospitals warned against equating all adverse events with mistakes.
Debby Rogers, the vice president for quality and emergency services at the California Hospital Assn, said someone with a fractured neck might develop a pressure sore while resting on a backboard awaiting surgery. Treating the sore would require moving the patient, potentially paralyzing them by exacerbating the fracture, she said.
"We would like to think we can prevent all of them, but we can't," Rogers said.
Kathleen Billingsley, the deputy public health director in charge of regulating healthcare facilities in California, said that overall, "the hospitals are very responsive" about reporting injuries.
Dr. Donald Berwick, the president of the Institute for Healthcare Improvement, a Massachusetts nonprofit, said the number of mistakes is certainly much higher than what California hospitals have disclosed. His institute has estimated that as many as 15 million patients nationwide are harmed each year in hospitals.
"It will always be true that the vast majority of incidents are never reported," Berwick said.
Maine, Massachusetts, Pennsylvania and New York have restricted payments for avoidable medical errors. Hospital associations in Minnesota, Washington and Vermont have pledged never to bill patients for the costs of botched care, according to the National Conference of State Legislatures.
Starting in October, the federal Centers for Medicaid and Medicare Services will stop reimbursing hospitals for eight kinds of mistakes, including bedsores, objects left in patients, and infections acquired during surgery or from catheters.
