It is the health-care system's dirty little secret. Thousands of patients die in Canadian hospitals every year because of medical mistakes, and almost nothing is said or done about it.
Now, with the first comprehensive study of the problem in Canada showing just how grim the toll from preventable errors is, patient-safety advocates are hoping an alarmed public will press for action.
The study quickly became fodder for the federal election: Conservative Party health critic Rob Merrifield jumped on the findings yesterday, calling the Liberals "complete frauds when it comes to patient safety."
The groundbreaking investigation found that between 9,250 and 23,750 Canadian hospital patients died in 2000 after a doctor, nurse or other health-care professional made an avoidable mistake in their treatment.
"That's a pretty high number, surprisingly high," said Toronto physician Philip Hébert, who took part in the study, to be published this week in the Canadian Medical Association Journal.
"People ought to be saying, 'This a major catastrophe for Canadian medicine, and let's double or triple the amount we spend on patient safety.' "
Over all, the study concluded about 7.5 per cent of the country's 2.5 million hospital patients experienced at least one adverse event because of medical error in 2000.
That is significantly higher than the rate found in the United States, where studies have reported adverse events in 2.9 to 3.7 per cent of patients, causing an estimated 44,000 to 98,000 deaths a year.
Dr. Hébert said Canadians tended to downplay the significance of the U.S. findings in hospitals here, "because we're not as interventionist, and we think care is better in Canada. Well, we now have data showing we ain't better."
However, he added that Canadian researchers may have included more minor adverse events in their study.
"The studies had a different perspective. The American studies looked at negligence that produced very serious errors."
The Canadian study was headed by Peter Norton of the University of Calgary and Ross Baker, of the University of Toronto.
Researchers looked at 3,745 randomly selected charts from 20 hospitals in five provinces. They concluded that 9,250 to 23,750 patients died after a mistake was made, either during or after surgery, or while receiving non-surgical medical care.
The range is so broad because the sample size was relatively small, the researchers said.
"In most of these cases, it is not a single act. It is not that one person did something bad," Dr. Baker explained.
"It is usually a series of things, and at the same time a failure for others to notice, either because they are too busy or distracted."
Obvious errors with tragic results are often covered in the media, such as the death of four-year-old Ryan Lucio from a cancer drug overdose in Ontario in 2002 or the deaths of two dialysis patients this year in Calgary who received intravenous drips of a poisonous potassium chloride solution instead of sodium chloride. However, in general, there is little hue and cry from the public over medical mistakes, Dr. Hébert said.
"We're pretty complacent about these events. People just seem to say, 'Oh, well . . .' "
He noted some recent signs that awareness of the problem is growing in Canada, such as plans for a new, federally funded Canadian Patient Safety Institute based in Edmonton.
All participants in the study stressed that their findings do not mean Canadians should avoid surgery or the hospital when they need it.
"Looking after patients is a complex business. It's not like taking your car into a mechanic," Dr. Hébert said. "The human organism is not that predictable, and adverse events often happen to very complicated patients.
"Hospitals are indeed dangerous places, but 92.5 per cent of the time, things go well. I think that's pretty good, given the complexity of what goes on there."
Meanwhile, Mr. Merrifield of the Conservative Party said the study brings "the disgraceful Liberal record on patient safety into sharp focus."
He pointed to the Auditor-General's report earlier this year that criticized the government for its ineffective medical devices program, designed to protect Canadians using such devices from risk.
While the Liberals attack Conservative leader Stephen Harper over health care, "their [own]appalling record on patient safety speaks for itself," Mr. Merrifield charged.