How Medical Mistakes Have Led to New Laws

Dr. Mike begins by saying that the healthcare system is not perfect, and that doctors like to stress that they can always improve. He argues that in some cases the mistakes are so serious that the government steps in to create a new law so that they never happen again.

He introduces the first example as the case of Libby Zion, an 18-year-old college freshman.

Dr. Mike describes Libby Zion as an 18-year-old college freshman who was admitted to a New York hospital in 1984 with a high fever and jerking movements. The two residents overseeing her care suspected a viral infection and attempted to hydrate and sedate her. They gave her Demerol, a painkiller that can react dangerously with the antidepressant she was taking.

The next morning, around 6:00 a.m., nurses found her temperature at 107 degrees and rushing to act, the staff could not save her, as she suffered a cardiac arrest and could not be resuscitated. Her cause of death was eventually attributed to serotonin syndrome caused by the unusual medication interactions.

The video asks how her temperature could rise all night without anyone noticing. One resident was covering about 40 other patients and ordered restraints and another sedative by phone instead of returning to examine her. The other resident had worked multiple 36-hour shifts and had stumbled across the street to sleep. The attending physician had approved the plan by phone from home and had never come into the hospital.

Libby's father, a journalist and lawyer, pursued the case. A grand jury considered murder charges against the doctors, but no one was indicted. A scathing report described how residents were worked and supervised. Across the proceedings, blame was placed on the three doctors and on Libby herself, who was said to have concealed a history of cocaine use. The hospital was faulted for the residents' workload but cleared of causing her death. Dr. Mike stresses that the residents were breaking under the strain of 36-hour shifts with little oversight.

Dr. Mike says the burden on residents was simply too much and the system had to change. In 1989, New York State adopted what became known as the Libby Zion law. It capped resident work at 80 hours a week, limited shifts to no more than 24 hours, and required much stronger resident oversight.

He adds that similar standards were eventually adopted for all residents across the US.

Dr. Mike takes viewers back to mid-1700s Great Britain, when the scientific revolution and the Enlightenment were under way. Medical schools began performing autopsies and dissections to understand anatomy, but the limiting factor was finding bodies to dissect. The Murder Act of 1752 allowed judges to hand the bodies of executed murderers to surgeons, but the gallows could not supply enough bodies.

That shortage created a monetary incentive to find bodies elsewhere, and Britain developed a booming trade in body snatchers who took freshly dug graves or killed people and sold the bodies to anatomy schools. Dr. Mike notes that this practice lasted for decades and in some ways led to important medical achievements. Edward Jenner, who later pioneered the smallpox vaccine, trained under a surgeon who paid for bodies, and as a young man his job was to negotiate with body snatchers.

After two serial killers, Burke and Hare, were arrested in 1828, the Anatomy Act of 1832 ended the dissection of executed murderers and created a licensed, inspected system for supplying bodies. Under it, medical schools could receive bodies from prisons, hospitals and workhouses that went unclaimed for 48 hours, or that were donated by families.

Zack Lystedt was 13 when, during a junior high football game, he made a tackle and his head came down hard on the turf. He was helped off the field with what the video describes as a devastating concussion, a condition in which a blow or jolt makes the brain move rapidly inside the skull. The usual treatment is a period of relative rest followed by a supervised, gradual return to activity.

That did not happen. Zack came off the field and returned after halftime, then played the entire second half. When the game ended he collapsed. He was flown by helicopter to a nearby hospital, where part of his skull was surgically removed to relieve pressure from brain swelling. He survived, but struggled to regain his ability to speak and walk and had to eat through a feeding tube for 20 months.

Dr. Mike says there is no way to know what would have happened if Zack had been kept out of the game, but he should not have been allowed back onto the field without a proper medical evaluation. That is the principle behind the law now in place.

In 2009, Washington state passed the Lystedt law. It requires youth athletes suspected of having a concussion to be removed from play. They can return to the field only after receiving written clearance from a licensed healthcare provider trained in concussion evaluation and management.

Dr. Mike recalls being 11 years old on 9/11 and living in New York City, and says that while the loss of life that day was horrific, the suffering of first responders has continued. When the towers fell, a large amount of toxic dust and smoke was thrown into the air. It lasted for months as cleanup crews searched the rubble for survivors, and workers breathed the fumes day after day.

The exposure has been linked to many chronic health problems, including asthma, GERD, sleep apnea, PTSD, and more than 60 types of cancer. Detective James Zadroga spent about 450 hours at ground zero. He died in 2006 at age 34 and became the first first responder whose death was officially attributed to breathing toxic air after 9/11.

Dr. Mike says he still does not think enough has been done for these responders, but he notes the passage of the James Zadroga 9/11 Health and Compensation Act. It was authored by US Senator Chuck Schumer, who also led the effort to pass it through both chambers of Congress. Along with other bills, it provides medical funding and resources to those affected by chronic health problems from that day.

The fight for funding proved harder than expected. By 2019, cash for the 9/11 Victim Compensation Fund was drying up. Comedian Jon Stewart testified that the country needed to do everything possible to protect those who ran toward the towers. Detective Luis Alvarez testified alongside him and died 18 days later of colorectal cancer that was likely caused by the 9/11 aftermath.

According to the video, the Victim Compensation Fund is now funded through 2092, thanks to the Never Forget the Heroes Act, and the World Trade Center Health Program created by the Zadroga Act has its budget secured through 2040.

In 2012, Rory Staunton dove for a ball in middle school gym and cut his arm. His gym teacher did not clean the wound and covered it with two Band-Aids. Dr. Mike describes sepsis as an extremely rare complication in which the body's response to infection becomes too aggressive and the immune system ends up attacking the body itself.

That night Rory began to feel stomach and leg pain. His pediatrician guessed he had a stomach virus and sent him to the hospital for fluids. The ER doctors took blood samples, prescribed Zofran, an anti-nausea medication, discharged him, and wrote 'patient improved' on his chart. The doctor who ordered the blood test never reviewed the results, and the lab had no mechanism to alert the emergency department to what it found. The hospital did not follow up with the family, and the pediatrician never followed up with the hospital. Rory died three days later.

In his honor, Rory's regulations were put in place. New York State became the first in the country to implement screening and early recognition of sepsis patients, and to document and treat the condition across multiple healthcare departments.

In 2016, a teenager named Oliver McGowan was taken by ambulance to a hospital in England after having seizures. A few days later, during a period of distress, doctors prescribed olanzapine, an antipsychotic used to treat schizophrenia and bipolar disorder. Oliver had neither condition. He had cerebral palsy, mild autism and epilepsy, and did not need the medication to calm down.

Oliver had received antipsychotics the previous year and had asked not to be given them again, saying, 'Please do not give me antipsychotics. I don't like them. They mess with my brain.' His parents said earlier antipsychotic treatment had caused terrible side effects. The doctors gave him olanzapine anyway. His temperature rose, a sign of neuroleptic malignant syndrome, a side effect of the drug. The medication was stopped and a CT scan showed he had sustained a serious brain injury. Two weeks later he died.

An independent review found that Oliver's death was potentially avoidable. As a result, England has introduced the Oliver McGowan mandatory training, which teaches health and social care staff how to communicate with and treat people with autism or learning disabilities.

In the 1980s, a teenager named Ryan White had hemophilia, a genetic disease in which the blood lacks proteins needed to clot properly. A normal part of his life was receiving factor VIII infusions, a clotting concentrate made from pooled donor plasma. Dr. Mike says that in December 1984, Ryan was hospitalized with pneumonia, and that the transfusion he had received during an earlier visit was later found to contain HIV.

The narrator explains that HIV attacks specific immune cells, leaving people more vulnerable to other infections. If untreated, it can progress to AIDS, when the immune system is so weak that people become susceptible to opportunistic infections such as tuberculosis and toxoplasmosis. Without treatment, people with AIDS typically survived only about three years. The narrator notes that the US government's response to the HIV/AIDS crisis was slow.

Word spread through Ryan's small Indiana town, and his school and community rejected him out of fear. The narrator says that stigma was not based on science. HIV spreads only when blood, semen or other bodily fluids enter the bloodstream of an HIV-negative person. Casual contact, such as sitting next to Ryan during a school day, would not transmit it. The bullying became so severe that Ryan moved 30 miles away.

Ryan became a national icon, meeting former President Ronald Reagan, receiving a car from Michael Jackson, and sitting alongside Elton John with his family. He died at 18 in 1990. In his honor, Congress passed the Ryan White Care Act, which continues to fund grants to states, counties, cities and community groups for medical and support services for low-income people with HIV.

In 2014, 18-year-old Dylan Miller was stung by a bee while helping a friend with yard work in rural Wisconsin. He was allergic, went into anaphylactic shock, and his heart stopped. His friend called 911 and began chest compressions until an ambulance arrived. Dylan was taken to hospital and stayed in a coma. After a week on life support, doctors said his quality of life might never improve, and his parents removed him from life support in line with what they knew he would want. As an organ donor, his donations restored sight to two people and helped more than 20 families.

The narrator says an epinephrine auto-injector could have counteracted his anaphylaxis, but neither Dylan nor his friend had one. That led to Dylan's Law, which allows anyone in Wisconsin with training to buy an EpiPen at a pharmacy without a prescription. Dylan's father said everyone should carry an EpiPen in their first aid kit.

In the 1980s, the emergency room at Chicago's Cook County Hospital noticed it was receiving many patient transfers from private hospitals, and those patients were dying at higher rates. The investigation found that private hospitals were sending patients in distress to Cook County when they learned the patients had no insurance and could not pay. The narrator says 24 percent of transferred patients were medically unstable, and their risk of death more than doubled as a result. The narrator adds that this patient-dumping practice was happening across the US.

In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act, known as EMTALA. It requires hospitals to provide an appropriate medical screening exam and, if an emergency medical condition exists, to stabilize the patient within their capabilities or arrange an appropriate transfer. Hospitals cannot delay required screening or treatment to ask about insurance or payment. The narrator says Americans still have a long way to go, but EMTALA pushed the system in the right direction.

In the 1980s, the VA Medical Center in Lexington, Kentucky had lost two large malpractice lawsuits, and a third could have ended the hospital. Rather than fight in court, it adopted what the narrator calls an extreme honesty policy of full proactive disclosure. When a mistake occurred, staff immediately told the patient, apologized appropriately, and offered a financial settlement to make things right.

The narrator says the approach worked. When the hospital made mistakes, patients sometimes accepted the settlement instead of entering years of litigation, and the VA's legal fees dropped significantly. Patients felt seen and heard, red tape was cut, and the VA operated with some of the lowest litigation costs in the US.

The narrator asks whether a doctor's 'I'm sorry' can be treated as an admission of guilt in court. In most of the US it cannot. In about 40 states, doctors are protected by what are called I'm Sorry laws. These protect physicians who feel compelled to apologize for negative outcomes, so the apology alone does not count against them in court.

The narrator says these laws let doctors operate on a more human level and speak to patients as they would want to be spoken to. The video also notes that a doctor's honesty can sometimes go too far and insult patients to their faces.