What Is Death by Misadventure?

Medical misadventure is a vague term referring to an unexpected patient injury outside of the control of the physician — an ‘act of God,’ as some might call it. Misadventure can represent a countless number of nonspecific scenarios; errors in prescribed medication can be considered a ‘misadventure,’ for example. A related phrasing may be more commonly used: death by misadventure. This is a coroner’s term that originated in the UK to describe a death due to risk willingly incurred — a preventable death.

Surrounding these mysterious mishaps is a murky gray area where it can be hard to objectively separate misadventures from the much more implicit and accusatory label of medical negligence — meaning the physician either made a poor choice that directly lead to patient harm or failed to treat the patient at all.

To make matters more confusing, medical error bears an unfortunate similarity to both previously mentioned terms and is often used synonymously with misadventure — even though ‘error’ is technically more aligned with medical negligence. Medical error is when a preventable incident occurs due to an inaccurate diagnosis or treatment, or something of the like.

Why are medical misadventures a serious problem in the U.S.?

Research done at Johns Hopkins, based on death rate data over an eight-year period, claims that on average the U.S. sees more than 250,000 deaths per year  due to medical error. This estimation ranks medical error as the third highest cause of death in America, despite respiratory disease having been originally reported as the third highest cause of death by the Centers for Disease Control and Prevention (CDC).

Researchers involved in this study say that the CDC’s means of collecting healthcare statistics neglects to appropriately represent ‘medical error’ on death certificates. “Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics,” said one professor of surgery at the Johns Hopkins University School of Medicine.

The major problem with the data the CDC currently uses for its mortality statistics is this: when the U.S. first adopted the International Classification of Diseases (ICD) billing system in 1949, decision-makers at the time failed to consider that medical errors might commonly result in patient death.

This oversight resulted in a lapse in modern healthcare statistics. National mortality rates are being calculated based on billing codes that could not properly anticipate the prevalence or importance of medical misadventures. Furthermore, ICD billing codes were never intended to be used for statistics — their primary purpose was and still is payer reimbursement.

Definitive Healthcare’s Medical Claims database reflects this idea as well. The only ICD-10 codes related to medical misadventures are codes Y62–Y69, and can be found through secondary diagnoses records.

Hospitals ranked by highest volume of medical misadventures

Fig. 1 Data from Definitive Healthcare’s Claims Analytics database. Annual Medicare Data is from the Centers for Medicare and Medicaid Services (CMS) Medicare Standard Analytical Files (SAFs). Data is from calendar year 2018 (most recent complete data available). Accessed May 2020.

There are a few red flags with this data set. Firstly, if we suspect that approximately 250,000 patients die of misadventure per year, then why is the highest reported volume of misadventure by a provider on 60 total diagnoses? Lastly, why is the only code being used to report a misadventure Y658 (Other specified misadventures during surgical and medical care)?

Properly reporting medical mishaps is not just about accountability. Top-ranked causes of death inform research priorities and funding in the U.S. If the CDC is inaccurately representing the severity and commonality of medical misadventures, then researchers will not be studying new techniques that could reduce relevant incidence rates. This is undoubtedly a problem in the U.S. healthcare system that deserves more attention.

Learn more

Want to learn more about medical misadventures and errors in the U.S. healthcare system? Good luck! Information is hard to come by on this topic. In the meantime, however, you can check out this Healthcare Insights list from a few years ago that also attempted to fill in some these anomalous blanks: Top Hospitals by ICD-10 Misadventure Diagnosis.