Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes.

Robert M. Wachter Kaveh G. Shojania Rugged Land www.ruggedland.com 320 pp., $24.95

Echoing the remarks of former counter-terrorism chief Richard Clarke, this book's dedication says, "For the patients and caregivers let down by the system they trusted." Thus begins a detailed study of the much-discussed current medical malpractice "crisis."

Five years after the Institute of Medicine published its landmark work, To Err is Human, Robert Wachter and Kaveh Shojania offer their own assessment of the causes underlying the estimated 98,000 medical-negligence-related deaths each year that the institute reported. The authors are physicians and professors of medicine. Their book reflects both their intimate knowledge of medicine's inner workings and the inherent bias that comes in judging one's own profession.

Internal Bleeding presents case studies of actual medical errors, including one of my suits in which an illegible prescription led to the patient's death. Like Paul Harvey in his book The Rest of the Story, the authors use a first story/second story structure. The first story relates the actual medical error--the doctor writing the illegible prescription or administering the wrong medication--while the second analyzes the medical system's failures that let the initial error become a catastrophic event.

Trial lawyers, particularly those handling medical negligence cases, will benefit from the descriptive way the individual cases are presented. The authors break down complex medical issues into easily understood terms, similar to the way we educate a .jury about matters at trial. The wonderfully written vignettes are powerful, evoking the emotions of a person who falls victim to medical negligence.

Once they present the various causes of medical errors, the authors explore how to cure the problem. Unfortunately, their bias is evident when they assess legal means of redress. Referring to our society as "an orgy of blame," the authors lambaste the tort system; they write that the outcome of a medical negligence case benefits only the attorney. Further, they suggest that lawsuits should not be based on "medical slips"; that only gross negligence by a health-care provider should give rise to a righteous cause of action.

Despite the book's negative view of medical negligence suits, I recommend it to all trial attorneys. The authors' presentation of the case stories is excellent and provides a framework for a good opening statement. In addition, the first story/second story discussions should make us all scrutinize our cases; perhaps other potential defendants bear some responsibility for creating the systemic failures that compound a primary error, turning it into a tragic event.

B. KENT BUCKINGHAM, formerly an eye doctor, now practices law in Midland, Texas.