They're supposed to be the ultimate places of healing, so why have our hospitals become so dangerous? And, more important, how can you avoid the problems?

Kathy McCabe, 31, had already seen two doctors about the stabbing pain in her stomach. But when it worsened, she headed to the ER near her home in Washington, D.C. After lying on the hospital floor in anguish for more than 2 hours, McCabe was given a CAT scan so doctors could see 3-D images of her organs. The radiologist said the CAT scan showed nothing unusual, so the ER staff gave McCabe two things. A prescription: More painkillers. And directions: Go home. The next day McCabe visited three more doctors. One internist referred her to a surgeon, who wanted her to undergo exploratory surgery. The third doctor, an internist who specialized in geriatric issues, questioned McCabe thoroughly and then urged her to retrieve her CAT scan from the hospital. He took one look at the film and told McCabe that she had advanced diverticulitis, a serious infection of her digestive tract. Worse, her bloodstream was overwhelmed by the resulting bacteria.

"He couldn't believe how sick I was," McCabe says. "He said my colon was in danger of bursting."

The doctor put McCabe on antibiotics for 2 months. Although McCabe says she didn't suffer any lasting health complications from the "nothing's un-usual" diagnosis at the ER, the experience has shaken her confidence in the healthcare system and made her apprehensive of hospitals.

"I now know I can't take what a doctor says as 100 percent true," she says.

150,000

Shortage of Nurses Nationally

More than ever, medical mix-ups, errors, and misjudgments have turned safe havens into potentially dangerous ones. Just consider the stats:

As many as 98,000 people die each year in U.S. hospitals from medical errors, according to the Institute of Medicine of the National Academy of Sciences. That's more than from car accidents, breast cancer, or AIDS.

Nearly 2 million people pick up infections in hospitals each year — largely due to preventable errors — and 90,000 people die from them.

While it's tempting to blame a staff's ineptitude, ignorance, or irreverence, experts say the problem is simply 21st century health care. "It's safe to make the assumption that every person who goes to work in a hospital is there to help. Unfortunately they quite often end up doing the opposite," says Thomas Sharon, R.N., M.P.H., author of Protect Yourself in the Hospital.

The rise of HMOs during the past 2 decades, coupled with lower reimbursements by Medicare and Medicaid, has created a financial climate that has led hospitals and clinics to cut staff and attempt to do more with less. The result: Poor communication among staff, a faulty system of checks and balances, and overworked or minimally trained workers. The hardest hit has been the nursing profession. The United States has a shortage of nearly 150,000 nurses (the shortage is attributed, in part, to early retirements caused by the physical and emotional demands of the job). That shortage is expected to climb to more than 800,000 in 15 years, according to a report from the U.S. Department of Health and Human Services.

"The general public doesn't know how much of an impact the nurse has on the safety of their care," says Ronda Hughes, Ph.D., senior health science administrator at the Agency for Healthcare Research and Quality in Maryland. It's the nurse, for example, who administers medication and ensures that unsterile devices or products aren't used.

Simply, fewer nurses means more mistakes. In 2002 the Joint Commission on Accreditation of Healthcare Organizations examined more than 1,600 hospital reports of patient deaths and injuries since 1996. It found that low nursing staff levels were a contributing factor in 24 percent of the cases. And adding just one additional patient over four already in a nurse's care has been shown to raise a surgical patient's risk of death by 7 percent.

"Nurses are trying to meet the needs of the patients, but they're stressed, angry, and frustrated because they know there aren't enough of themselves on staff," Dr. Hughes says. With the average age of nurses at 45 and most nurses retiring in their late 50s, it's becoming especially challenging to find enough new recruits. Why? Nationally, there simply aren't enough good instructors to train them. "Schools are looking for doctor-trained faculty, but these people have to take huge salary cuts to teach," says Dr. Hughes, who estimates that most nursing institutions are missing an average of five full-time instructors. "Most just aren't willing to do that."


235,000

Number of Medication Errors Hospitals Make Every Year

Julie botteri, 34, of marathon, florida, was visiting a nearby hospital 4 years ago for an inflamed cat bite on her left hand. The attending physician looked at her index finger — which had swelled to twice its normal size — and immediately ordered an intravenous antibiotic drip. Because a cat's needle-like fangs inject bacteria deep into a wound, the resulting infection could enter the bloodstream and make its way into tissues and organs, causing life-threatening complications like pneumonia, heart infection, or the loss of a limb. "He warned that if the bite didn't improve quickly, he'd need to slice open my finger to release some of the infection," Botteri says.

Botteri estimates she received four or five bags of the antibiotic solution before a nurse changed the IV. "For the 30 minutes it took the new bag to drain, it felt like ice-cold water was flowing down my arm and across my chest," she says. "I pressed the nurse call button several times, but no one came until the shift change. The nurses seemed overworked and exhausted."

Although the cool sensation Botteri felt was likely because one liquid was colder than another, the temperature disparity was enough to make Botteri ask questions. At Botteri's urging, the new nurse checked her charts and discovered that her predecessor had mistakenly given saline instead of the crucial antibiotic. Botteri resumed antibiotics, the infection cleared, and she returned home within 3 days.

The most common type of medical error now is a medication mistake. In 2003, 570 hospitals and health-care facilities reported more than 235,000 medication errors to the database of the U.S. Pharmacopeia, a nonprofit watchdog group that works with the FDA. There were 13 different kinds of slipups, including vague or unreadable prescriptions, right medications given to the wrong patient, and mix-ups of similarly named medications, such as giving Zantac, an acid-reflux drug, instead of Zyrtec, an allergy drug.

Much of the problem circles back to the shortage. A 2004 study from the University of Pennsylvania found that the risk of making an error increased when hospital nurses worked more than 12 hours per shift, worked overtime, or worked more than 40 hours per week. (Several states are now banning or limiting mandatory overtime.)

"In hospitals you have the best people who are sometimes at their worst," says Sharon, who has more than 20 years of experience in the health-care field. "You can't expect 100 percent performance of them every time they go to work."

40

Percentage of Doctors Who Don't Wash Hands Enough

Ann eide, 37, from columbus, Mississippi, had a small biopsy on her leg to test for mitochondrial myopathy, a rare offshoot of muscular dystrophy. The resulting incision was just 1-inch long and sutured with seven stitches, yet Eide says that when she returned home from the hospital, the wound "looked really red and was oozing pretty badly."

She immediately called the hospital and was told over the telephone not to worry, that the redness was "normal." The next day, same thing. With the infection worsening, Eide became concerned and went to an ER at another hospital.


"The doctor who looked at my leg was shocked," Eide says. "He called the wound 'horrific' and asked who had done this to me. He told me that if the stitches had been left in my leg much longer, the infection could have become very serious." Antibiotics cleared the infection within 1 week, but the wound remained tender for nearly 4 months. "To this day it still throbs from time to time," Eide says.

Hospital-acquired infections account for $4.5 billion in excess health-care costs annually, the Centers for Disease Control and Prevention says. Infections, which can be caused by bacteria, fungi, viruses, or parasites, might already be in your body, or they can come from the environment, contaminated hospital equipment, health-care workers, or other patients. The most common: