doctor with his hand on his forehead in disbelief

What if the cure was indeed deadlier than the disease? An analysis published in the Journal of Patient Safety suggests that as many as 440,000 hospital patients die each year from medical mistakes that cause preventable harm. A more recent review suggests that medical mistakes may be the third leading cause of death in the US (BMJ, May 3, 2016).

A Brief History:

In 1999 the prestigious Institute of Medicine (IOM) shocked the world of medicine with a report titled “To Err Is Human.” The researchers announced that as many as 98,000 U.S. citizens died each year in hospitals because of medical mistakes. The headlines were horrifying and the American public was outraged.

At first, there was denial. Many hospital administrators and health care providers insisted that it couldn’t be true. There was a great deal of agonizing, hand wringing and buck passing. Eventually, there was brainstorming on ways to improve patient safety. But nothing really changed.

Then came another bombshell. In 2004 an independent health care rating organization (HealthGrades) determined that the initial IOM report grossly underestimated the number of preventable adverse events (PAEs). These investigators determined that instead of about 100,000 deaths annually, the real number was twice as high–closer to 200,000 preventable medical errors in hospitals that led to death.

Five years later in 2009 another investigative report titled “Dead by Mistake” also estimated that 200,000 Americans died annually from hospital-acquired infections and preventable medical mistakes.

Bringing the Story Up to Date:

Four years after that report, we read a new scientific review published in The Journal of Patient Safety (September, 2013). The investigator utilized a much more rigorous technique for tracking mistakes called the Global Trigger Tool (GTT). Instead of relying on voluntary reporting by doctors, nurses and hospital administrators, the GTT flags errors in medical records that might otherwise be overlooked or ignored. The new study reveals a four-fold greater death rate in hospitals:

“…the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year.”

This makes medical mistakes in hospitals the third leading cause of death in America, right after heart attacks and cancer. But wait, it’s worse than that…far worse! This is just in hospitals! It doesn’t take into account mistakes in outpatient surgical centers where much of the surgery now occurs in this country. It doesn’t take into account mistakes in nursing homes and retirement communities where there is far less oversight. And it does not take into account clinics and outpatient doctors’ offices where misdiagnosis and medical mistakes may be more common than in hospitals where there is greater oversight and scrutiny by numerous health care providers.

If we add fatal adverse drug events in nursing homes (93,000), fatal drug events in the outpatient setting (roughly 200,000) and other health care harm in the ambulatory care setting, the total number of deaths attributable to treatment could exceed 800,000, making it the number one cause of death in America!

Debating the Numbers:

That is mind boggling. A spokesman for the American Hospital Association, not surprisingly, prefers the old 1999 number of 98,000 deaths. The reality is that no one knows how many people die in the U.S. each year from health care harm because there is no mandatory reporting system. Unlike in the airline industry, where pilots must report near misses and airplane accidents make the nightly news, medical mistakes disappear without a trace. The author of the new report came to the following conclusions:

“There was much debate after the IOM report about the accuracy of its estimates. In a sense, it does not matter whether the deaths of 100,000, 200,000 or 400,000 Americans each year are associated with PAEs in hospitals. Any of the estimates demands assertive action on the part of providers, legislators, and people who will one day become patients. Yet, the action and progress on patient safety is frustratingly slow; however, one must hope that the present, evidence-based estimate of 400,000+ deaths per year will foster an outcry for overdue changes and increased vigilance in medical care to address the problem of harm to patients who come to a hospital seeking only to be healed.”

Do not hold your breath. Since 1999 there has been precious little progress in improving patient safety. That is partly because it has not been a priority of American medicine. There is no National Institute of Patient Safety. Billions are spent on treating heart disease and cancer, but very little is devoted to helping doctors avoid misdiagnosis or mistreatment.

Will You Be a Victim?

No one thinks they will experience a medical mistake. And yet a recent study suggests that misdiagnosis is common. If you are misdiagnosed, the recommended treatment is unlikely to do you any good. It might even cause harm.

Sometimes, the treatment might cause harm even if the diagnosis is nearly correct. Gynecologists have recently been forced to recognize that the practice of “morcellation” to remove the uterus has the potential to cause long-lasting harm, and in rare cases, even to hasten death (Maturitas, March 2017). Yet this was standard operating procedure for a number of years.

Unfortunately, even though the dangers of medical mistakes have now been acknowledged for nearly two decades, graduating nursing and medical students still appear unprepared to recognize medical mistakes in realistic hospital simulations (Annals of the American Thoracic Society, online Feb. 3, 2017). A study found that more than half the teams failed to identify the common ICU hazards that faced them.

Reader Testimonials:

The trouble is that such large numbers are not meaningful. Most people trust their doctor, their pharmacist or their hospital. They do not believe anything bad will ever happen to them or those they love…until it does. It takes personal stories to make this national tragedy understandable. Here are just a few.

One Tragedy:

“My father died as a result of a missed diagnosis. He was in the coronary intensive care unit at a teaching hospital after suffering a heart attack. He was treated first at a community hospital, then transferred to the teaching hospital for angiography. While waiting for the cardiac surgeon to review the test results, and while on anticoagulants, my father developed knee swelling and pain in the leg used for the angiography. He was treated for days with narcotic painkillers for sciatica, which only made him constipated.

“No one noticed that he was bleeding massively into his abdomen. Lab results demonstrating the blood loss were ignored. Six days after the angiogram, while straining on a bedside commode, he had another cardiac event. Hours later an attending physician finally saw the lab evidence of massive blood loss and ordered blood transfusions. Inexplicably, my father did not get the transfusion until many hours later after his heart muscle was irretrievably damaged. He went into cardiac arrest and died the day before he had been scheduled to go home.

“How do I know all this? Because I am a physician, I requested the chart. The nurses’ notes and lab results told the real story. Most families will never find out about diagnostic errors. They have no way to learn the truth.”

A Prescribing Error:

Here is another report:

“It is essential that patients take a proactive role when interacting with their doctors, especially when it comes to medications. Here is my story.

“As soon as my doctor walked into the exam room I let him know about my bladder infection. He immediately started writing a prescription for me.

“I asked, ‘what medicine are you prescribing?’ Without even looking up from his clip board, he paused, said, ‘uh, ah uh, Nitro-bid.’ I said, ‘Oh, that sounds like heart medication with the word Nitro.’ Again Not looking up, he just mumbled, ‘huh, uh no.’

“So I took the prescription, got it filled & took it for 6 days. I had a migraine headache for 6 days!

“I went back to the clinic almost a month later to say I’ve still got the bladder infection. The nurse pulled my chart. She then shifted her weight & blurted out, ‘Why did he give you heart medication!?’ I said, ‘I asked him!…’

“He was gone on a month’s vacation. She told me what day & time to call back & she’d put me through to him to tell him. When I called back I asked him, ‘How was your vacation? It’s good that you had time with your family.’ Then I told him about the prescription.

“There was dead silence; no ‘oops, OMGosh or sorry’ from him…so I said to him, ‘Wow, wouldn’t that have sucked to have come back from a nice, relaxing family vacation to find out that you killed one of your patients?’

“He mumbled, mumbled, mumbled…’uugghh’!

“Needless to say, I’m more proactive with my health care & especially prescriptions. I thank God for the health professionals in this world, but they are only human and mistakes can happen. If we’re proactive while showing respect to our caretakers…we can work together with them for our active health care.”

How You Can Learn More About Protecting Your Loved Ones:

We too have experienced misdiagnoses and medical mistakes. A series of errors led to the death of someone we loved. That is why we wrote the book, Top Screwups Doctors Make and How to Avoid Them. We do not want anyone else to become a statistic. You will discover crucial questions to ask and tips to avoid screw-ups in hospitals, pharmacies and in doctors’ offices.

Everyone will be a patient at some time. If you care about your cholesterol, your blood pressure or your blood sugar levels, you should care about avoiding the leading cause of death in America, health care harm. We hope our book will help. Here is a link to learn more. Share your own story in the comment section below.

Revised 2/6/2017

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  1. Roy
    Sarasota, FL

    My wife recently died from complications related to congestive heart failure. Her heart was fine and her lungs, the problem was related to sleep apnea. When she failed to use her c-pap the body responded by adding water weight to improve blood pressure. She went into the hospital to lose some of the water excess and on day two went into cardiac arrest. Turns out she was given too much lasix (diuretic) which shut down her kidneys, causing her blood pressure to dangerously drop.

    Six hours later she needed to be intubated and on sedatives for two weeks in ICU. Then a tracheostomy was performed and she was moved to a rehab hospital. There she was making progress weaning off the ventilator until blood was noticed at her throat. She was taken to a hospital 20 minutes away and bled out during the ride. There was an equally competent hospital 7 minutes away. I’ve ordered an autopsy to determine cause of death.

    • Terry Graedon

      Roy, please accept our condolences for this tragedy.

  2. Denise

    My mom had developed pneumonia and at the very least, bronchitis. Stayed in the hospital for several days with IVs of strong antibiotics. After coming home and feeling better atleast from being sick, she developed swelling in her legs and a bad cough and her nail were turning black. This went on for several years, no one could help. She was in her mid 80’s when she was having a hard time breathing and she went to the emergency room. She ended up with a catheter in her left lung which once a week a nurse came to the house and drained her fluid. Fluid levels remained the same. Dr. wanted to administer a talc slurry of antibiotics into her left lung which he did. She went to the emergency room three days later and died. The hospital listed her death as pneumonia. No one ever considered her heart nor the amount of fluid on her lungs in giving her the slurry.

  3. Will
    Kent, UK

    440,000 incidents is a very conservative figure when many victims feel either, intimidated to criticize adverse care, are not articulate enough to take the ‘system’ on, feel that their relative was of advanced age and to not worry about complaining and many similar reasons leaving an untoward death go unrecorded.

    My case began 11 years ago after my late wife elected for a ‘day surgery’ biopsy of a neck mass. She never came home. Expert evidence has criticized the anesthetic technique, particularly the use of atracurium and Fentanyl in an asthmatic patient that led to post-op respiratory collapse. She spent 3 days in ITU and when stabilized was told the biopsy proved TONGUE cancer? Further breathing difficulties delayed her discharge home and without notifying the family of a DNR notice (Do Not Resuscitate) end of life care with a Morphine syringe was also surreptitiously begun. In absence of any cancer history she had been terminally sedated just 15 days after her diagnosis.

    Three days after death a Coroner’s Officer rang to inform me the death certificate was available. He then said “whilst I have you on the phone I can confirm death will be recorded as LUNG cancer”? I questioned “can you please explain why LUNG when the surgeon only diagnosed TONGUE cancer?”. He explained “for the purposes of death registration we have to state from where the cancer had originated”. It took FOUR years to determine that the lung nodules on the CT scan were, in fact, perfectly treatable multiple pulmonary emboli. But the complaints procedure had been carefully calculated to exceed the 3 years limitation period for medical negligence claims. I haven’t finished my pursuit to have the guilty in court for manslaughter. And I’m a very reasonable person.

  4. Cindy H

    My husband is a physician and I am a nurse. We have both worked very hard over the years to do a good job caring for our patients. To say we have done a perfect job of it would be untrue because we are not perfect. We have made mistakes. My husband is an incredible example of a man who pursues excellence and will not compromise when it comes to integrity. As a result his patients (and their families) love and trust him.
    Unfortunately as long as there are people on this earth there will always be those without integrity, and those who could care less about striving for excellence. Those people are everywhere, in every walk of life, not just in medicine. I think this is the real problem.

  5. carreanne

    That’s terrible! And quite scary! All of this.
    Right down to an undiagnosed ectopic pregnancy. The poor girl dies at home when the tube ruptures and bleeds out. All found during autopsy. Definitely not a miscarriage. 18 yrs old. She didn’t have to die. That should have been caught in the ER originally. The family excepted the mistake and did not press charges. Their daughter died because the ER doctor misdiagnosed her!
    Is this what happens when the business of medical science is treated as such, just business? How do they sleep at night?

  6. kchristopher

    my best friend was mis-diagnosed with an infection – given antibiotics that made him sick and allergic to everything. when they discovered it was MRSA they told him he had been taking the “wrong wrong wrong drugs”. he now has an ongoing series of health problems, can’t work and nearly died self-medicating. people and the media will report endlessly about gun deaths and shootings, like it was the worst problem in america, when medical mistakes cause 10 times the deaths. so many peoples energy and thought is going into gun laws, anti-health care bills, anti-abortion funding, and that is what makes the news, that is what makes people excited, that’s what makes the lawmakers pass more laws, more controls. and this problem sits quietly in the background. and thousands die and suffer. very sad.

  7. Tami

    My daughter was placed in large Midwestern children’s hospital that is rated “one of the best” in the country every year. She had a very bad case of pneumonia (from summer camp — another nightmare that needs to be reported). They got her in the hospital room and I was told they would hook her up to antibiotics.
    I told her I’d go out and get us something to eat. When I got back I opened the door to her room and she was in bed with a SWOLLEN, PURPLE FACE. I was told by the nurse that they administered the antibiotics too fast and this was the result, and that in a couple of days it would go away. My daughter said THEY LEFT HER ALONE IN THE ROOM ONCE THEY GOT THE IV IN PLACE!! They didn’t wait to make sure everything was OK. She had to ring for the nurses when she started to feel bad.
    My daughter contracted an infection in her arm that had the IV in it because they didn’t change out the IV for most of the entire week she was there. When I insisted they change the IV to the other arm when my daughter was in tears with pain, the nurse complained and said that the infection was contained because she was getting antibiotics.
    When I said I wasn’t leaving until the IV was changed (it was 9:00 at night), the nurse on duty had NO CLUE HOW TO ADMINISTER AN IV. My daughter screamed in pain every time the nurse tried to do it. I told this nurse to leave the room and she wasn’t going to touch my daughter (of course I tried to be more civil than this). It wasn’t until midnight when new nurses came on duty that there was one who had the experience to administer an IV.
    Thankfully, that was my daughter’s last course of antibiotics and she left late the next day. She could not use her infected IV arm for about two weeks. And she was given an oral antibiotic to stop the infection in her arm from the IV.
    It was a nightmare! I’ve heard horror stories about this hospital because I live in the area. The local newspaper used to publish issues about this hospital–but the hospital has lots of power in the community and nothing is ever said or written about anymore. It’s pretty creepy.

  8. Meris

    Thank you to the nurse who commented on always having someone go with you to the emergency room, preferably with a medical background. Recently, I was hospitalized for a serious infection. A friend accompanied me to a consultation and pointed out aspects that were not correct : the doctor having no record about my treatment, his being a “resident”.
    It pays to speak up – let the top person in the medical department know about medical errors. Recently, suffering from tooth and jaw pain, I went to a university dental school which delivered sub-standard care and a poor quality x-ray. I have just been diagnosed, 2 months later, with mandibular osteomyelitis (bone infection). I wrote the Director of the school to point out their mistakes – they contacted me and offered to reimburse the cost of the x-ray, more importantly, they said they talked to the persons who treated me. Everyone should learn to speak up in order to improve medical care.

  9. AIG

    My husband was given an unneeded stent when he went to the hospital (on his own) for a cluster headache. He was told to sign some paperwork so they could help him (he did not have his glasses and was told he had to sign it). After he woke up he realized that they had given him an operation, which he was not told about beforehand. A few days later he went to his regular doctor and was told that when he was operated on the doctor accidentally gave him an incisional hernia. Fortunately, we found a lawyer who helped us.
    Most people have absolutely NO RECOURSE if something like this happens to them. The hospitals will not admit errors, the AMA is useless as it is run by doctors who protect their own, and a patient only gets a run-around from everyone involved. The best thing that people can do is don’t go to any emergency room or hospital unless you are half dead.
    A family member works at a hospital and says that most of the time the people who are hired to sterilize the operating tools don’t do it property so that patients get dangerous infections after leaving hospitals.
    We are all on our own.

  10. dss

    I have experienced several “near death” experiences resulting from doctors’ mistakes. One glaring example:
    During hysterectomy surgery, a vessel accidentally was clipped, extreme blood loss caused permanent vision loss from collapsed optic nerve and severe anemia AND nearly 10 years of UTI’s accompanied by tons of antibiotics, caused by staples left inside (in an attempt to stop the bleeding vessel) which migrated to the bladder and became embedded in bladder wall,collecting lots of bacteria, etc.
    BTW, medical records do not contain info re the blood loss, vision loss, anemia or staples — even the “surgeon’s notes” which were signed off on by all who were present in the operating room do not tell what happened. (The obgyn/surgeon told my husband and I what had occurred during my surgery immediately afterward, wiping his brow, laughing, and saying it was a lot harder than he’d expected. Unfortunately, he did not mention anything about using staples or leaving them there…)
    Other medical records — from eye docs and specialists, from the doc who referred me to the obgyn, etc. are also missing info about what happened. The obgyn continues to practice despite reprimands and loss of privileges — that had nothing to do with my experience. He has settled several suits from other patients. I never took any action against him as I was told by a lawyer that I needed tons of money up front for experts, etc.

  11. ND

    As a nurse who is currently practicing, I cannot site incidents, but only say that I tell my acquaintances to never, never go to a hospital or emergency room without someone, preferably with a medical background, who can speak up for them.
    I can tell you that I had a round of bad experiences last year when my mother was hospitalized and then placed in an infirmary with one incident after the other, as well as deleterious effects from medications. I would not have been aware of the problems without my background and also the helpful information I’ve gleaned from the People’s Pharmacy.
    If you had seen Frontline’s “Life and Death in Assisted Living”, it was comparable to that. She died of unknown causes-which I suspect were caused by pharmaceutical mismanagement.

  12. LAB

    very frightening

  13. Penny H.

    My problems started with a doctor who believed everyone should be on prednisone and tetracycline on a permanent basis. I moved and changed doctors twice and both were appalled that I was on both drugs. I was having a constant yeast infection. Then I began having back pain so my internist sent me to his buddy orthopedic doctor. The orthopedic Dr. insisted that I have steroid shots in my back and never mentioned the prednisone. I had three steroid shots and during that time I had one day free of pain.
    Then my internist called and said that I now had high blood pressure and diabetes. My face swelled up like a balloon. I decided to take myself off the prednisone and did although my internist didn’t believe I could. Also quit tetracycline.
    Meanwhile, my internist kept putting me on more prescriptions to the point that I was having balance problems and falling a lot. On the way to my daughter’s wedding, I fell and pulled my shoulder out of joint and probably tore my rotator cuff. The ER doctor put my shoulder back in it’s socket and told me to see an orthopedic surgeon on Monday. I called my internist for a recommendation and was given the next name on their list. I saw the surgeon and he had me go in for an MRI. The fall also caused a pinched nerve in my back.
    The orthopedic surgeon said he could fix it and I went in for surgery. When I came out of the anesthesia I had ten hammertoes (my toes were straight when I went in) and no bladder control and very little bowel control. The surgeon insisted that my hammertoes were caused by neuropathy and dismissed me as fast as he could.
    I now wear a catheter bag on a permanent basis due to continuous bladder infections, take 20+ pills a day and wear orthopedic shoes for my toes, and have still have diabetes and high blood pressure and a lot of pain.
    The takeaway on this is that there are a whole lot of incompetent doctors our there. Second opinions don’t necessarily help and I hope the Affordable Care Act weeds some of them out because nothing else is working.

  14. Denise

    Doctors. They have ruined my poor body. From head to toe, literally.
    In the mid-to-late 1990’s, an Internal Medicine Specialist talked me into letting him “play” with my psych meds, as my psychiatrist had unexpectedly died. I see now that he was guinea-pigging me while he was getting kick-backs from his drug supplier. He tried EVERY designer drug on me, and I gained over 100 lbs. in just six or so months.
    After that, I couldn’t shake those pounds for the life of me. Ten years later (with a suicide attempt mid-way), I was being treated for Diabetes 2, High Blood Pressure, High Cholesteral, Hypothyroid, and Bipolar 2. I have lost everything (job, home, family), and exist on Social Security Disability, an income WAY less than half I was making while working.
    SO I have to go to Parkland Hospital, where I am at the mercy of baby doctors who have just graduated from med school and think they know everything. The last six years in the Internal Medicine Clinic have been okay, but my latest little girl bullies me, sneers at me, and lies to me–about things that do not matter.
    Why I’m writing this is to say that, with every new intern they throw at me, I ask them, PLEASE, can you decrease the amount of meds I’m on? This last girl said to me that most people are on a lot more meds than the paltry THIRTEEN she prescribes for me. Then each doctor would find another med and another reason to give it to me. Let’s try this! I feel like I’m trapped.

  15. Helen M

    Even when you are very proactive, s*** happens.
    I chose the finest surgeon in my section of the country to remove my cancerous thyroid (had only one lobe). He missed all the cancer on the other side and killed my parathyroid glands.
    Now I am on three different medications to replace my parathyroid hormone and another to replace my thyroid hormone. I feel lousy and have been suffering what they call brain fog since the surgery in 2002. Replacement therapies do not constantly adjust to meet the body’s needs.
    You can find the correct thyroid dose and medication; took me ten years to convince a doctor to prescribe natural thyroid; however, all you can do for the parathyroids is to prescribe uber Vitamin D and diuretics that conserve minerals. Plus, of course, prescriptions for those lost minerals. One prescription and two OTC. Because I feel so bad, I am constantly trying different supplements, an expense we can ill afford.
    Then there was the cancer in my right kidney, as well as the other one in my left. Again to SF to a kidney surgeon this time, who wanted to remove all of the left and half of the right, leaving me to go on dialysis. I found ablation, in the same hospital, and kept my right kidney.
    I could go back years to other medical errors, I am a walking history of conditions caused by them.
    People, you must be vigilant. If you are reading this on a computer then you have a fine tool for educating yourselves about your issues, conditions, problems, medications. Plus there is a yahoo group for everything where you can get information and support to sustain you. Then there are the social networks, about which I know nothing, where you may find more support and info. Tho, be careful there about what you let hang out. Your information may be sold.

  16. Donnie

    My dad had a mild anemia, and his doctor sent him to the hospital for one unit of blood, to bring his iron level up. He had type O positive blood. The hospital gave him type B blood by mistake, and killed him. I do not trust hospitals, or doctors, and avoid them as much as possible.

  17. Ann B.

    Sept. 11, 2003 I had trigger finger release surgery. While the anethesiologist administered the block in my clavicle area a pneumothorax occurred but I was not told about it. I had extreme pain in my right chest area upon sitting up in recovery. The anesthesiologist told me he had trouble with the block due to my size (I am petite) and not to worry I’ll be fine and sent me home. No vital signs or anything examination done. I called the surgeons office once home reporting my discomfort and 3 more times that day and was told to take the pain medicine he prescribed and place a bag of frozen peas on my chest and sit in a recliner. I was up all night in pain but was not gasping for breaths.
    The next morning another call to the office and was only allowed to talk to the secretary who said the Dr. and PA were not available. I began vomiting and knew I needed immediate attention. We went to the ER and waited 3 hours and an x-ray showed a pneumothorax and the ER doctor inserted the chest tube. Another x-ray and that showed the tube was inserted too low. Another doctor and another chest tube and two days in the hospital.
    Two weeks after surgery I experienced burning, stabbing pain at my right rib area where the chest tube had been, and also pain in my right chest area feeling like an elephant was sitting on me. I have been under pain management care for 10 years now. My diagnosis is right intercostal and chest wall neuralgia. I am on my second spinal cord stimulator and have a pain pump. I have endured many procedures, medications and still hope to have better pain control less than an 8. I do have a high pain tolerance and have never lost my determination to let this unfortunate situation destroy my life.
    The ER doctor told my husband this was only his 4th chest tube he had done. I wish the anesthesiologist had been up front with me and admitted me to the hospital for observation instead of thinking that the puncture would heal on its own and I would have never known about the error. Maybe then I would have had a more experienced doctor with chest tubes and I would have been spared this horrible ordeal.
    I am a retired nurse and blame myself for not acting quicker in getting medical attention and am real concerned for non medical patients. Our son is an OR tech in a well known hospital and Saturday morning a surgeon who had been terminated for a year due to his alcohol abuse, was back operating. The entire staff noticed he wasn’t acting right, but all were too afraid for their jobs to say something.
    I saw 4 doctors before finding the right pain management doctor for me. I am able to disagree with him and together we decide what is best for me and have great respect for each other. This is a good doctor.
    Medical errors are on the rise and will probably continue upward if there aren’t some type of regulations in place. Patients need to be protected against having these errors happening to them. Every patient needs to be educated on his/her diagnosis and bring an advocate with them to the office and medical center and also advocate for themselves.
    Thank you for letting me share my unfortunate situation.

  18. Barbara

    A family friend, an internal medicine doctor, always says, “Being sick is one strike against you, going to the doctor is the second strike and going to the hospital is often the third strike…and you are OUT!”

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