Adverse medical complications: an under-reported contributory cause of death in New York City

Gill, James R.; Ely, Susan F.; Toriello, Allison; Hirsch, Charles S.

doi:10.1016/j.puhe.2013.12.003

Cited by 10 publications

(6 citation statements)

References 21 publications

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“…Death certification in relation to medications and medical procedures can vary widely among practitioners; however, many currently accept that deaths arising from the appropriate and accepted treatment of a disease are certified as natural (14 –16). In a limited number of jurisdictions, these types of deaths are classified separately under the manner “therapeutic complication,” which many help alleviate concerns that the contribution of the medical therapy is being hidden or even “covered up” by coroners and medical examiners (17, 18). This concern does raise the question of whether homeopathic treatments should be considered as an appropriate and accepted medical treatment or if they may fall under a different classification.…”

Section: Discussionmentioning

confidence: 99%

Hyperoxalosis Secondary to Intravenous Vitamin C Administration as a Non-Allopathic Treatment for Cancer

Giffen¹,

McLemore²

2019

Academic Forensic Pathology

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Vitamin C (ascorbic acid) has long been known to have antioxidant properties, with associated claims that it can boost the immune system, fight off infection, and help in the treatment of cancer. Similar to many other over-the-counter and herbal medicines, vitamin C can cause potential side effects with significant morbidity and rarely mortality. We discuss a case of an elderly woman with metastatic adenocarcinoma of the lung that was treated with several rounds of allopathic chemotherapy; however, treatment was stopped because of worsening quality of life and disease progression. She was treated with 10 courses of intravenous high-dose vitamin C at a local homeopathic medical center as an alternative treatment method. Five days after the last vitamin C administration, she was admitted to an allopathic hospital due to acute renal failure and oliguria culminating in a myocardial infarct due to underlying atherosclerotic disease. Workup revealed dehydration secondary to poor oral intake and acute renal failure which was clinically concerning for calcium oxalate– induced kidney injury. At the time of autopsy, in addition to her widely metastatic adenocarcinoma and myocardial damage, hyperoxalosis of the kidney with acute kidney injury was present. Hyperoxalosis of the kidney is a documented phenomenon related to administration of intravenous and oral vitamin C at superphysiologic doses as recommended by some natural and homeopathic practitioners and is, therefore, a significant complication of treatment. This case highlights the renal complications of supertherapeutic vitamin C administration and the associated morbidity which can contribute to death.

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Section: Discussionmentioning

confidence: 99%

Hyperoxalosis Secondary to Intravenous Vitamin C Administration as a Non-Allopathic Treatment for Cancer

Giffen¹,

McLemore²

2019

Academic Forensic Pathology

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“…Estimates derived from forensic pathology data in New York City suggest that therapeutic complications are the tenth leading cause of death, not the third, and most complications could be attributed to predictable risks of medical treatment rather than unambiguous mistakes. 24…”

Section: Why Do Inaccurate Estimates Spread?mentioning

confidence: 99%

Strengthening the Medical Error “Meme Pool”

Mazer

Nabhan²

2019

J GEN INTERN MED

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The exact number of patients in the USA who die from preventable medical errors each year is highly debated. Despite uncertainty in the underlying science, two very large estimates have spread rapidly through both the academic and popular media. We utilize Richard Dawkins' concept of the "meme" to explore why these imprecise estimates remain so compelling, and examine what potential harms can occur from their dissemination. We conclude by suggesting that instead of simply providing more precise estimates, physicians should encourage nuance in public medical error discussions, and strive to provide narrative context about the reality of the complex biological and social systems in which we practice medicine.

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“…These studies have focused on medical malpractice (13–17), therapeutic complications (18, 19), anesthesia-related deaths (20), medication-related deaths (21), and overall iatrogenic deaths (22, 23). Of note, only three of these studies were conducted in the United States (18, 19, 23). Additionally, only one study examined the rate of therapeutic complications (i.e., anticipated complications) versus medical malpractice (i.e., unanticipated complications/inappropriate management) (13).…”

Section: Introductionmentioning

confidence: 99%

“…One proposed method for overcoming these obstacles is the addition of “therapeutic complication” (TC) as a manner of death (18, 19). A survey using medical therapy-related case vignettes demonstrated that forensic pathologists in a jurisdiction with “therapeutic complication” available as a manner of death had greater consistency in the certification of iatrogenic deaths than forensic pathologists in jurisdictions without this option (24).…”

Section: Introductionmentioning

confidence: 99%

“…A survey using medical therapy-related case vignettes demonstrated that forensic pathologists in a jurisdiction with “therapeutic complication” available as a manner of death had greater consistency in the certification of iatrogenic deaths than forensic pathologists in jurisdictions without this option (24). Additionally, this manner of death allows for ease of retrospective identification of these cases (19). However, there are exceedingly few jurisdictions that utilize TC (or an alternative wording) as a manner of death.…”

Section: Introductionmentioning

confidence: 99%

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Medical Therapy-Related Deaths and the Medical Examiner

Krehbiel

Matshes

Lathrop

et al. 2015

Academic Forensic Pathology

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Medical therapy-related deaths are incidents with great significance to public health and the medical community. However, there is controversy regarding the prevalence and the appropriate manner certification of these deaths given the paucity of guidelines regarding these cases. Our study aimed to identify potential medical therapy-related deaths in a large medical examiner jurisdiction and to determine the consensus rate regarding 1) identification of a case as being attributable to medical therapy, 2) manner of death, and 3) hypothetical utility of the “therapeutic complication” (TC) manner. Retrospective review over a 12-year period (2002–2013) revealed 113 appropriate cases, which were summarized and provided to forensic pathologists in our jurisdiction. Results were analyzed for consensus rate between pathologists and cases were categorized by complication type. The largest majority of these cases fell into the medication category (n=44; 39.0%) followed by operative (n=38; 33.6%), cases not medical therapy-related (n=31; 27.4%), and nonoperative (n=19; 16.8%). The interobserver agreement rate for original manner classification ranged from fair to moderate. The addition of TC as an available manner improved the consensus rate in four cases and decreased the consensus rate in 37 cases. There were 73 cases that at least one pathologist attributed to medical therapy, 19 of which were attributed to medical therapy by all pathologists. Our study indicates that there is disagreement about which cases are attributable to medical therapy and poor consensus in manner classification of medical therapy-related deaths. As such, guidelines are proposed for the classification of deaths thought attributable to medical therapy.

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Adverse medical complications: an under-reported contributory cause of death in New York City

Cited by 10 publications

References 21 publications

Hyperoxalosis Secondary to Intravenous Vitamin C Administration as a Non-Allopathic Treatment for Cancer

Hyperoxalosis Secondary to Intravenous Vitamin C Administration as a Non-Allopathic Treatment for Cancer

Strengthening the Medical Error “Meme Pool”

Medical Therapy-Related Deaths and the Medical Examiner

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