When I go to the hospital or to the doctor’s office, I expect several things. First, I expect to be treated with kindness. If my problem was self-imposed (e.g. obesity), I expect the healthcare provider(s) taking care of me to not point to me and laugh or blame me for my problem, even if it is my fault. I expect them to nod and be agreeable, especially when I’m already feeling crappy. Second, I expect them to act in my best interest. They are supposed to do whatever needs to get done to ease my pain and heal me, at whatever cost. Finally, I want them to use the best science, evidence, and available knowledge in taking care of me. If something has been proven to work better than something else, and that something is readily available, then I expect them to use it.
Of course, healthcare providers at all levels are people, humans beings. They’re fallible. They can and will make mistakes. So I’m not surprised when people throw around statistics blaming errors in healthcare as a top reason for death in the United States. I’m not surprised because hospitalized people are, by definition, in a weakened state. Under those circumstances, even a small error can mean certain death for them. (I’ll leave the discussion on the exaggeration of these statistics, e.g. “allopathic medicine is killing you, try my homeopathy,” for some other post at a later time.)
The other thing about humans is that a subset of us will “snap” and do something that can only come out of a nightmare. Thankfully, it’s a very, very small subset. But it is not beyond reason to say that there are people in healthcare right now, at all levels, who are psychopaths.
When I was studying for my MPH, I wrote a paper on one such person. His name is Michael Swango, or “Double O Swango” to his friends. Mr. Swango went to medical school. While there, he worked as an ambulance worker, so much so that his studies suffered. He barely got through medical school and was allowed to pursue a career in medicine. The suspicion is that Mr. Swango killed people as early as the time when he worked the ambulances while in med school. He would then go on to a series of jobs as a paramedic and as a physician, all the while, it is believed he killed people. He even went to Zimbabwe, where the suspicions continued. Mr. Swango was finally aprehended and convicted of several murders, but many deaths that happened around him, while he was working, remain unexplained and are possibly associated with him, if not outright caused by him. My paper was a study on the many opportunities to stop him that were missed because of all sorts of reasons.
More recently and closer to home, a radiographic technician has been arrested and charged with misuse of narcotics intended for patients and, worse yet, infecting said patients with Hepatitis C. He worked some of that time in Maryland, and he is believed to have infected some patients there. Because of this, the health department compiled a report on what happened, how it happened, and what recommendations should be followed to keep it from happening. It’s really quite a read, and I found myself continuously shaking my head as I read it. Like with Swango, it appears that there were plenty of opportunities to stop this guy, but they were missed. Go read it (PDF). It’s really something.
On the one hand, I understand that people will make mistakes and things will be overseen by accident. A provider may prescribe something that is not recommended or even dangerous for a patient because of an allergy. It happens. As long as it doesn’t happen continuously, or continuously after remediation has been done, I’m okay with that. I’m willing to accept that medical errors kill people because it’s one of those realities in life that we must seek to minimize but will never eliminate. On the other hand, it fightens me to think that things like “professional courtesy” or, as was the case with the radiographic technician, fear of litigation may allow a killer to walk the halls of a hospital or come to my aid during an emergency.
You see, threats to public health are not just within us and around us in the form of disease and disasters. They are also around us in the form of fallible people. Worse yet, they are around us in the form of criminals who manage to become healthcare workers.
One more thing on my “to-do” list in my career, I guess.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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