As a kid, Michael Eisenberg was vaguely aware that his physician father did important work.
The son was 17 when he learned just how important. John M. Eisenberg, an early director of what is now the federal Agency for Healthcare Research and Quality, died of brain cancer at age 55. Tributes poured in, recognizing his pioneering efforts to make medical care more effective, less wasteful, and less prone to deadly mistakes.
Now 33, Michael Eisenberg, a filmmaker based in Chicago, is shining a light on preventable medical harm with his new documentary, To Err Is Human.
The film takes its title from the landmark 1999 Institute of Medicine report, which estimated that hospital mistakes and carelessness killed as many as 98,000 Americans a year.
That figure — described by the film as the equivalent of a jumbo jet crashing every day for a year — was shocking at the time, and put the issue of patient safety on the national agenda. The documentary cites an even more shocking updated estimate of 440,000 fatalities a year, making medical errors the third leading cause of death, behind heart disease and cancer.
The film "is in every way inspired by my father," Eisenberg said before a recent screening of the film at the University of Pennsylvania, where his father spent the first 20 years of his medical career and earned an M.B.A. from the Wharton School.
The documentary, three years in the making and partly underwritten with crowdfunding, is the first feature-length film for Tall Tale Productions. Eisenberg founded the company with two film school classmates, Matthew Downe and Kailey Eisenberg (who is also his wife).
Initially, they planned to focus on the 30-year-old Agency for Healthcare Research and Quality, which remains relatively little-known and politically vulnerable. This year, it survived the Trump administration's proposal to fold it into the National Institutes of Health, a move supporters feared would neuter it.
"We got in touch with people who knew my dad and would be interested in talking on camera," Eisenberg recalled. "But with every interview, it became: 15 years later, where are we with the work he felt was so important?"
In addition to interviews with health-care leaders, the documentary examines changes in medical training. It also traces an Idaho family's journey from suffering two tragic medical errors to becoming advocates to improve the health-care system.
At a panel discussion after the Penn screening, Eisenberg brought up the fact that the recent analysis linking 440,000 deaths to medical errors is rather controversial, leading the filmmakers to worry that some might dismiss the documentary as a polemic.
Responded panelist J. Sanford Schwartz, a Penn professor of medicine and health management: "Whatever the number is, it's too much."
Behind the hospital death toll are systemic failures that range from minor carelessness to major disasters. About 1.7 million people a year suffer hospital-acquired infections; perhaps 69 percent of those could be prevented with measures such as more diligent hand-washing by health-care workers. Over a five-year period, there were 2,413 surgeries performed on the wrong body part, 4,857 surgical tools left in patients, and 27 operations on the wrong patient.
AHRQ has helped to reduce such problems, and the film spends a few minutes giving it credit. But the heart and soul of the film are the interwoven tales of Sue Sheridan and her children, Cal, 23, and Mackenzie, 21.
Cal suffered profound brain damage when his jaundice at birth was overlooked by the hospital. Four years later, Susan's husband, Patrick, had surgery for what they thought was a benign tumor in his spine. Pathology tests found cancer, but because of a miscommunication, the results were not shared with the couple until the aggressive cancer had progressed, dramatically reducing his chance of survival. Patrick died in 2002, the same year as John Eisenberg.
Sue is now a nationally recognized patient safety activist, Mackenzie is majoring in public health, and Cal has not let cerebral palsy sideline him. He does a comedy routine, joking that "everything I do, I do to the best of my disability."
To Eisenberg's surprise, when he asked Sue to be part of the film, she recalled being on a patient safety panel assembled by his father in 1999.
"So many people who are in the film agreed to do it because of my dad's legacy," Eisenberg said. "They knew we weren't just out to make an expose. We wanted to contribute to the betterment" of health care.
Many hospitals and medical schools have adopted error-prevention strategies, such as surgical training simulation programs, modeled after flight simulators long used by the aviation industry. The documentary shows medical students learning to recognize the early symptoms of sepsis, a fast-moving, life-threatening blood infection, using a sophisticated mannequin. The University of Toronto, meanwhile, has developed a system to record audio, visuals, and data during complex surgeries. Like the aviation "black box," the innovation provides a record of exactly what happened in the event of a disaster.
Another evolving aspect of care involves informing patients that an error occurred. Today's push toward transparency and apology is a departure from the traditional approach of hiding and denying errors, then letting lawyers sort out the mess.
During the post-screening discussion, Patrick Brennan, Penn's chief medical officer, said being more forthcoming has actually reduced lawsuits by aggrieved patients, because many want improvement, not vengeance. They want the hospital to understand what went wrong so it can prevent a repeat.
Brennan also stressed an aspect that the film showed: doctors have to be taught how and when to break bad news. Sometimes, Brennan said, anguished doctors rush to apologize for a presumed lapse, then an investigation reveals that events unfolded differently than the doctor presumed.
"Accountability is the biggest issue," Eisenberg said, "but it's tricky. And we shouldn't be punishing everybody who makes mistakes. We should be learning from them."