If anyone knew how to get the best medical treatment, it was Betsy Lehman. A health columnist who had worked at the Boston Globe since 1982, she had covered everything from leading-edge research to the finer points of a physician's bedside manner. When she learned she had an advanced case of breast cancer, she carefully studied her options and chose to undergo an experimental treatment offered at the Dana-Farber Cancer Institute, a prestigious hospital affiliated with Harvard Medical School. Tragically, the 39-year-old mother of two died in December. But as a front-page story in the Globe disclosed last week, her death was not the result of her disease. The cause was a huge overdose of a powerful anticancer drug accidentally administered by the hospital's staff.
Lehman's case is just one of a spate of medical foul-ups that have made headlines in recent weeks. In two Florida incidents, a doctor amputated the wrong foot of a diabetic man, and a hospital worker mistakenly turned off a stroke victim's breathing machine. In Michigan a surgeon doing a mastectomy removed a woman's healthy breast instead of the diseased one. Are these isolated, if horrifying, events? Or could they be harbingers of a deadly trend? Though no statistical evidence shows that malpractice is on the rise, state licensing boards have stepped up their investigations of doctors. According to Public Citizen's Health Research Group, the number of physicians who have had their licenses revoked, suspended or restricted rose from 1,974 in 1992 to 2,190 in 1993, an 11% increase.
Still under intense investigation, Lehman's death appears to have resulted from a mathematical error that wasn't discovered until February, when two clerks undertook a routine review of her case. As thousands of cancer patients know well, standard chemotherapy involves figuring out a treatment that is aggressive enough to destroy a tumor without also killing the patient. For each person, doctors must calculate how much drug to use in relation to the individual's size and body weight.
Once malignant cells have spread beyond their original location, however, traditional chemotherapy is usually much less successful at producing a cure. In an attempt to develop a treatment for these more advanced cases, the researchers at Dana-Farber have been experimenting with levels of antitumor agents that are much higher than those normally prescribed. In Lehman's case, the treatment was to last four days, and the amount given during each 24-hour period was supposed to be barely shy of lethal. The physician in charge of figuring out her daily dosage, whose identity has not been released, apparently made the mistake of writing down the amount that should have been given over the whole four-day period.
Still, all hospitals double-check the dosage of chemotherapy drugs that are given to a patient--and Dana-Farber is no exception. According to Gina Vild, a hospital spokeswoman, once the physician has written the order, Dana-Farber's rules require two pharmacists to verify it. "Pharmacist 1 is supposed to check it and, yes, is supposed to make the calculations himself," she told TIME. He then "gives it to Pharmacist 2, who looks at it and checks it" before sending the drug to the patient's room. When the order for Lehman came through, neither pharmacist caught the mistake in dosage.