Grave medical errors jump 36% in Quebec
August 23, 2023
MONTREAL – Medical errors and accidents causing “grave and permanent consequences” to patients soared by more than 36 percent in Quebec in the 2021-22 fiscal year, according to an in-depth report made public in June. By law, hospitals and clinics must declare medical incidents (which almost always involve errors) as well as accidents, but many don’t always do so. Still, the report identified a total of 442,726 so-called “undesirable or adverse events” in Quebec’s health system, up by 0.46 percent from the year before.
“Adverse events … continued to have an impact on care and on the delivery of health services” during the COVID-19 pandemic, the 118-page report concluded.
“Falls (involving patients) and medication-related errors continue to be the most frequently reported events from one year to the next. This trend has been maintained over the past few years,” the report stated.
“Similarly, data by age group of users revealed that more than half of all events involve (those) aged over 75,” the report continued. “In addition, we note that the increase in the reporting of adverse events generating grave and permanent consequences … is being closely monitored. The same applies to problems of abuse, harassment or intimidation.”
The spike in grave medical incidents and accidents underscores the pressures Quebec’s health system has been under during the pandemic amid a backlog of surgeries and a shortage of nurses and other personnel. In total, the Health Ministry recorded 517 grave medical incidents, up from 379 in the 2020-21 fiscal year. There were 515 deaths as a result of a medical error or accident, down from 550 the year before.
The most common adverse events were falls by patients, of which there were 187,032; followed by medication errors, of which there were 109,174. There were also 13,413 instances of abuse, aggression, harassment and intimidation against patients.
Paul Brunet (pictured), executive director of the Conseil pour la protection des malades, expressed concern over the spike in the number of grave medical incidents and accidents.
“This tells you a lot about the dangers you face when you enter a hospital,” he said. “It’s sad.”
Brunet quoted the remarks of a patient who recently told him: “Every time I go to a hospital, I have to protect myself. It’s like a war zone. A hospital is the worst place to go.”
Brunet urged hospitals and nursing homes to lower the beds of patients and to place padded mats on the floors to reduce the risk of fractures when older individuals get out of bed and fall.
“The government is going to tell us that they were lacking resources in the pandemic, but we had the same challenges before the pandemic – with a significant number of falls as well as other incidents and accidents,” he added.
Most of the adverse events occurred in long-term care centres (217,083), followed by hospitals (161,475). In third place were CLSC clinics (39,555), among other institutions.
The report defines a grave medical incident or accident as causing “permanent consequences for the user’s physiological, motor, sensory, cognitive or psychological functions.” Such incidents are labelled a letter G on an alphabet scale that runs to the letter I.
Incidents labelled the letter H cause “consequences that require life-sustaining interventions like intubation, assisted ventilation and cardiopulmonary resuscitation.” The report combined G and H incidents in its statistical increase of 36.4 percent. Incidents labelled the letter I are defined as contributing to the death of a patient.
The causes of other adverse events included the wrong treatment, faulty test and medical imaging results and defective medical equipment or materials. What’s more, the number of suicides and suicide attempts in the health sector increased to 53 from 48.