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Comment by smeej | Hacker News Reader

I'd like to know more detail about the methodology and definition of "preventable."

My sister's death in 2017 while 8 months pregnant is (apparently) included in this data, but I wonder how they would rate it.

She experienced sudden cardiac death, but had no prior indication anything was wrong with her heart, and no symptoms that would otherwise cause someone to examine her heart.

Had anyone examined it, they might have realized it was compromised, but does "we could require cardiac ultrasounds on all pregnant women, and sign vulnerable ones up for transplants" count as "somewhat preventable"? Can you even do a heart transplant on a pregnant woman?

I don't think her death was preventable, but the fact that I don't know how they would have counted it based on the information here makes me wish for more details.

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From the article:

> A death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors. MMRIA allows MMRCs to document preventability decisions in two ways: (1) determining preventability as a yes or no, and/or 2) determining the chance to alter the outcome by using a scale that indicates no chance, some chance, or good chance. Any death with a yes response or a response that there was some chance or a good chance to alter the outcome was considered preventable. Deaths with a no response or no chance were considered not preventable.

Yes, I read this, but it's too vague to answer my question, which is the point of my post.

"Some chance"? " Reasonable changes"? "System factors"?

Cardiac ultrasounds are fairly inexpensive. There is some chance of discovering critical heart problems through them through a systems change. And heart replacement surgery would likely be covered by insurance anyway, so is not an unreasonable new cost to the system.

I can't determine what their decision in her case would have been by the criteria they did list, which is why I said I would be interested in more details.

Sorry for your loss.

"Sudden cardiac death" is more of a description than a diagnosis, so it's hard to say. You may be being intentionally vague for her privacy, which makes sense.

Common causes vary widely, from cardiac dysrhythmia (perhaps due to pregnancy-related cardiomyopathy or an electrolyte imbalance?) or a pulmonary embolism... I'd say the level of "preventability" depends on the etiology.

Unfortunately I'm being vague because the ME couldn't draw a conclusion.

I've had three doctors read it to make sure I'm not missing anything (including the cardiologist I saw as a result), and they've all said, "It says her heart muscle just died, for no clear reason. It speculates about a heritable cardiac channelopathy, which is why you and your brother needed cardiac ultrasounds and stress tests, but ultimately they don't actually know why her heart died."

It's as close to a diagnosis as we'll ever have.

There are amenable and non-amenable medical errors.

The above article is describing amenable medical errors. I don’t want to make assumptions about how your sister’s death would be classified.

However, I am so sorry for your loss, which is a tragedy. We need to do better, as this should not be happening.

I don't think there were any errors here, and I didn't get the impression this was only evaluating errors.

I don't think her doctors missed anything that ought to have been caught. She seemed completely fine five minutes before she was irrecoverably dead (i.e., her heart muscle hadn't just stopped, but part of it had died).

And that's what confuses me about this rating system for evaluating what was and wasn't preventable. My best guess is that there truly wasn't anything anyone should have done, that it was just a freak thing that happened.

And I guess that's emotionally simpler. The grief isn't any less deep, but it's not complicated by anger. "Sometimes bad things just happen with no warning" sucks, but it's not complicated.

I suppose I do have a bias toward continuing to assume that's true in her case, for my own sake.

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