Medication mix ups and removing the wrong organs- the deadly mistakes doctors don't want you to know about

A urologist removes a kidney from the wrong patient. A nurse incorrectly administers a paralyzing drug that results in the patient's death.  A neurosurgeon operates on the wrong side of a woman's brain. 

Medical errors like these harm 1.2million Americans and result in the death of an estimated 251,000 patients every year.

Both on and off the record, doctors whose specialties range from general practice to emergency medicine told DailyMail.com of the dangerous medical mishaps occurring within hospital walls that providers are inclined or encouraged to cover up. 

Among the most common: Prescribing the wrong medication and dispensing a drug to the wrong patient, which cause an estimated 8,000 patient deaths every year.  

Errors in getting proper lab testing, as well as filing and clerical errors, such as mislabeling results or diagnoses, are also mistakes commonly seen in hospitals and private practices, perhaps more than patients realize.

Dr Andrea Austin, an emergency medicine physician in Southern California, told DailyMail.com: ‘Some of the errors that I've seen happen [are] wrong medications being ordered - and while the person ordering the medication is ultimately responsible, none of these errors happen in a vacuum. It's a larger systems issue.

‘Sometimes the wrong test gets ordered… And depending on where we're working, sometimes the amount of distraction and interruptions... It's very common in the emergency department [to] be interrupted eight, 10 times in an hour period when you're trying to order high-risk medications and tests. 

'So that's a setup for potentially ordering the wrong test on the wrong patient or the wrong medication.’

A devastating case of a medical mistake took the nation by storm in 2022 when former Vanderbilt Medical Center nurse RaDonda Vaught was convicted of neglect  and negligent homicide and sentenced to three years of supervised probation.

In December 2017, Ms Vaught was meant to give her patient Charlene Murphey a dose of Versed, a sedative to calm her before going into a large MRI-like machine, but the 75 year old was instead injected with vecuronium, an extremely powerful paralytic.  

By the time the error was spotted, Ms Murphey had died.   

When Vanderbilt reported the death to the medical examiner, it did not mention the error and the cause of death was deemed 'natural.' 

Ms Vaught acknowledged her mistake, while also drawing attention to the myriad of other factors that played a role in her deadly error, including that she was also orienting a new nurse, which was a distraction, the new electronics records system had only been implemented seven weeks earlier in a very rocky rollout, and there were timing policies for administering the drugs, making her actions hurried. 

The case became a rallying cry for nurses, who maintained that prosecuting Vaught would have a chilling effect across the healthcare field, discouraging practitioners from admitting errors for fear of losing their jobs or getting prison time.

Linda Aiken, a nursing and sociology professor at the University of Pennsylvania, said of the case: ‘One thing that everybody agrees on is it's going to have a dampening effect on the reporting of errors or near misses, which then has a detrimental effect on safety.

‘The only way you can really learn about errors in these complicated systems is to have people say, "Oh, I almost gave the wrong drug because…" Well, nobody is going to say that now.'

Dr Drew Remignanti, a retired emergency medicine physician in New Hampshire, detailed to DailyMail.com the time he misdiagnosed a mark on a patient's cornea as a fingernail scratch from putting in his contacts. 

Scratches on the cornea are typically treated with antibiotic drops and heal relatively quickly. 

But Dr Remignanti had misdiagnosed the patient, who actually had an ulcer on his cornea. 

A year later, Dr Remignanti received notice that he was being sued for malpractice because he did not catch the infection at the time, which later required the patient to undergo surgery from a different doctor to have part of his cornea replaced with tissue from a donor. 

Dr Remignanti, who wrote about the mix up in his book The Healing Connection, said: 'This is an example of what is termed confirmation bias in which one sees what one expects to see... Even though the defect was round and regular, I was unwilling to think beyond the very first conclusion offered up. 

'I should have known better and been more thorough in my evaluation and decision-making.' 

In another medical error, Dr Ashish Jha, as an internist practicing at Harvard, once prescribed medication to the wrong patient, who he confused for another.

He said: 'They were two patients of mine with very similar names and I just prescribed it to the wrong patient.

‘I felt terrible, I felt incompetent, I felt a little ashamed. My first instinct was not just to fix the problem, but not to tell anybody.

‘It’s clearly not the right thing, but we have to begin by acknowledging that it’s a very human response.’

Doctors have said they are often taught to conceal mistakes because admitting to them could lead to litigation from patients or their families. 

But Dr Austin said this highlights how the system is broken. Without admitting errors, the doctor who committed them likely won’t improve and more could occur.

And because most medical errors often go unreported, the exact scale of the problem is unknown.

Dr Danielle Ofri, an internist at New York City's Bellevue Hospital, told NPR: ‘I don't think we'll ever know what number, in terms of cause of death, is [due to] medical error — but it's not small.’

She added: ‘Near misses are the huge iceberg below the surface where all the future errors are occurring. But we don't know where they are, so we don't know where to send our resources to fix them or make them less likely to happen.’ 

The most extensive study of adverse events is the Harvard Medical Practice Study, a review of more than 30,000 randomly selected discharged patients from 51 randomly selected hospitals in New York State in 1984.

The proportion of adverse events attributable to errors was 58 percent, and the proportion of adverse events due to negligence was 28 percent.

Although most of the patients on the receiving end of these errors were disabled for fewer than six months, 14 percent resulted in death, and three percent caused permanently disabling injuries. 

Drug complications - such as allergic reactions, errors in the way they were dispensed, among others - were the most common type of adverse event (19 percent), followed by wound infections (14 percent) and technical complications in surgery (13 percent), such as injuries sustained while undergoing an operation or bleeding during or after. 

Injuries such as excess bleeding during or after an operation, infection, and broken bones occurred in 3.7 percent of the hospitalizations. 

Not much other research has been published on the issue, but a smaller 2023 review of 2,810 patients' records from Boston-area hospitals showed about 24 percent experienced at least one adverse event like allergic reactions to medications or falls that jeopardized their health. 

It's also not uncommon for doctors to misdiagnose patients, especially in stressful emergency departments. 

A study published last year in the journal BMJ Quality and Safety Protocol found 795,000 patients die or are permanently disabled every year due to being misdiagnosed.

In addition to misdiagnoses, doctors may order the wrong tests or misfile their findings, get patients confused and lose or misinterpret test results.

Meanwhile medication errors can occur at any stage of the care process – ordering, dispensing, administering and monitoring.

Although most medication errors do not result in patient injury, those that do are more likely to occur at the prescribing – 56 percent – and administering – 34 percent – stages in the hospital setting and are more commonly intercepted during the prescription phase.

Doctors often cite electronic health records (EHR), documentation that tracks a patient's entire medical history, including vaccinations, surgeries and diagnoses, as a source of medical errors.  

EHRs are often logged using antiquated technology, Dr Austin said.  The most commonly used systems were created in the 1980s and many hospitals are still running programs from that era. 

Doctors and nurses have long held that EHRs take too long to fill out and have a jumbled, confusing workflow that takes valuable time away from treating patients.   

Antiquated EHR systems also lack built in controls to monitor or alert to coding errors that might mean the wrong diagnosis or medication is entered. 

It represents a wider systemic issue that hospitals have not allocated time and resources to fix.

Dr Austin told DailyMail.com: ‘There should be no reason today that systems wouldn't be checking if a patient has an allergy or be alerting a provider about the age and pregnancy status of a patient.’

She added: ‘To err is human. So anytime humans are involved, there's the field of human factors that essentially explains why a lot of these hair errors happen. So they're very predictable.

‘If we have a functioning system, and we're essentially supporting physicians with a functioning electronic medical record, and then also the proper checks and balances, then a lot of these errors are preventable.’