Wrong Site Surgery Day March 9, 2011

Like the five stages of death to correct and to completely avoid wrong-site, wrong-patient and wrong-procedure surgery we first have to get past denial and shame about it. Make no mistake about it, these never-events can be avoided, if we will only start talking about it when it does happen. One way to avoid these embarrassing mistakes is to read the chart and to perform a time-out before the surgery. It may seem basic but that’s why these mistakes are occurring; because surgeons and surgical suite staff need to go back to the basics. If anyone on the surgical team has a problem with doing the time-out they ought to be put in time-out.

No more wrong-site surgeries – PLEASE!

Here are the stories I’ve found this week about wrong-site, wrong-procedure and wrong-patient surgeries. Do the time-out and it’s not likely the surgeon and surgical team will have one. That’s good because then you don’t have to put up with lawyers and insurance companies and the hospital’s legal department.

Beth Israel Deaconess Medical Center Doc Heading to Lefty-Right K-Grade Rehab

Beth Israel Deaconess Medical Center is again on the hot heat with another doc needing lefty-righty-rehabilitation. Is it an oxymoron when a hospital that markets itself as a teaching institution has surgeons on staff who don’t know left from right? They won’t say who nor have they identified the patient although they did say the patient “was expected to have short-term discomfort, but does not have permanent organ damage or life-threatening problems.”

Tort Reformers say: "No porridge for you!"

Our lesson for today concerns news print reporting of medical malpractice reform measures. The lesson is that reporters should avoid heavy medication before editorializing about something they know nothing about.

To me it’s so typical. Another editorial pandering to the few advertisers newspapers have left, saying what the advertisers want to hear; regardless of the affect on society. In this case it says let’s all save money by making the injured patients pay for medical mistakes instead of those responsible for creating the injury or killing the patient. Today’s editorial is in the Coventry News and is written by Patrick Durusau. All I can say is shame on you Patrick. If anyone wishes to read the entire fairy tale that masquerades as an editorial follow the link. Here is part of what he writes.

"The current adversarial system between physicians and their patients benefits only three groups: medical malpractice insurers, medical malpractice defense and plaintiff lawyers. Abolishing medical malpractice is an important step in repairing the physician patient relationship. Getting physicians and patients on the same side will result in better medical care and, coincidentally, the demise of medical malpractice insurers and their familiars. That doesn’t bother me. How about you?" Patrick Durusau

I think he forgot the main beneficiaries of the medical litigation process: The injured patient, the surviving dependents or those patients not injured because of fear of being sued when you do something wrong that hurts the patient.

Don’t they count? Or are they the riffraff of Mr. Potter's world?

Either this reporter has a naïve view of life or he's pandering to his news organization’s paying advertise-customers. Perhaps he's just naive from never having interviewed a grieving widow raising hungry children alone after watching her husband die as a result of a failure to diagnose cancer or some other fatal disease? Get real Patrick; I suggest you visit the morgue and then interview the widows and widowers in major cities where health care can be downright factory like and prone to mistakes.

I rarely practice in this area so hold your tongue about me being just another lawyer trying to make a buck. I do consider myself a “plaintiff’s lawyer” because my practice is one where I represent people, not big insurance. I’m pretty typical for most small city or rural based lawyers. We don’t seek out medical malpractice cases; in fact we try to avoid them. They are way to expensive to litigate and wrought with landmines to make mistakes.  Like many I have friends, colleagues and relatives who are practicing physicians. In Iowa we have just a handful of lawyers who practice full time in this area as specialists. We don’t have a problem, like I’m sure New York, California and Florida does. We have just a few cities, we have good doctors and yes a few that have made professional mistakes.  Frankly we don’t need injured patients paying for someone else’s mistakes. We like our system of tort law; it’s served us well. We still have moral fiber that tells us those who make mistakes pay for their mistake.

I grew up in Rhode Island and know only too well the consequences of medical malpractice and a dead bread winner. My father died when I was 12, he left behind a 37 year-old wife and five children all under the age of 13. We never sued, even though the doctor diagnosed a pulled muscle instead of the lung cancer. I’m sure the doctor didn’t want to take an x-ray since it was as tort reformers say, “unnecessary and expensive.” That’s the defensive medicine I grew up with; it’s the same one that Mr. Durusau is advocating for the rest of us. That’s the kind of defensive medicine that you’ll say isn’t needed, is thought to be too expensive and a waste of time and money. That’s the kind of loyal patient and doctor friendly medicine that I grew up with. It’s the same kind of medicine that buried my father, put no food on our table, took away the one man who was going to send us to college and wasn’t there for my sister’s wedding, birthdays, deliveries, anniversaries or grocery shopping day. Oh it’s friendly alright. It’s friendly to big insurance company executives, but does nothing for the widows and orphans it leaves behind.

My mother kept a single can of shrimp in the pantry to let us know we weren’t poor. I guess it also meant we wouldn’t starve. At least I hoped that’s what it meant. We ate Mrs. Paul’s fish sticks and frozen French fries every Friday that we didn’t have corn chowder. God I hated both. The fish sticks tasted like burnt cardboard and were always overcooked while the fries were mushy and undercooked. Dr. Sandstone never did see what he’d created for this family of six trying to get by on Mom’s sewing money and a monthly Social Security check. Not exactly the kind of life my father had hoped for his wife and children. I often wonder what the outcome would have been like had he ordered that expensive and unnecessary $5 x-ray.

This editorializing reporter must have had a good life without any medical mistakes interrupting his education and family vacations. I say that because he’s got a naïve and foolish point of view that draws conclusions that border on being downright cruel. Before you join his world I invite you to look at his methodology for improving health care and delivering better medicine.

If we follow that logic all car collisions caused by distracted drivers would result in the digitally drunk and distracted teen driver getting a smile from the other drivers; well… at least those who aren’t dead or brain injured and the teens will somehow miraculously learn how to drive safer. How does not making those who make professional mistakes take responsibility make the system more responsible? I’m left wondering just how old our reporter is and what time of day he wrote this little ditty. Maybe he needs to stop drinking the Guinness so early in the day.

“If we abolish medical malpractice as we know it, physicians (not the government) would have to develop better ways to discover why "mistakes" happen and ways to prevent them from happening again. That is to change from a blame assignment/avoidance system to one that tries to improve the quality of care delivered to everyone. Wouldn’t that be a more useful part of a health care system?”

“The current adversarial system between physicians and their patients benefits only three groups: medical malpractice insurers, medical malpractice defense and plaintiff lawyers. Abolishing medical malpractice is an important step in repairing the physician patient relationship. Getting physicians and patients on the same side will result in better medical care and, coincidentally, the demise of medical malpractice insurers and their familiars. That doesn’t bother me. How about you?” Patrick Durusau, Coventry News

LET’S TAKE A TRIP to POTTER'S FIELD or DICKENS’ WORLD

Mr. Durusa there’s a little cemetery in a small quaint New England town with a brownish headstone bearing the name Lombardi. The stone has a polished face, a rough finish on thick edges with pink, white and red flowers that surround it. On the back side this gravestone has the name Charles A. Lombardi inscribed on it. Visit St. Mary’s Cemetery where Charlie lies and you’ll notice the surrounding grass is strong and healthy. That grass grows tall from the tears that have watered it for the past 41 years. Like Charlie, the doctor too is dead but I can say that during his lifetime I never saw him visit that grave to support the widow who stood strong for her five hungry children. The widow and her five children today live far from where Charlie lays waiting. I guess you can say we lived your friendlier medicine because we didn’t sue. That was 40+ years ago and I’m still waiting for the doctors to deliver better medicine. Are you sure of your theory? Because today as a 54 year-old-man whose had a front row seat to the “better medicine" you’ve described I’m not seeing the benefits... or a bigger can of shrimp.

The Durusau World of Friendly Medicine and Medical Tort Reform

Wrong-stie surgery - A new survey sheds light on this dark subject.

More and more doctors are being allowed to avoid paying for their mistakes. At this point in the history of our country fear seems to drive every decision. We are consumed with fear. Lobbying groups have senses this weakness in our culture and seize the opportunity to drive decisions that go against common sense. This one is no different.  Tort reform measures that allow them to avoid paying for malpractice mistakes will attract the wrong kind of doctor to these states. In this report the AAOS outlines broadly the types of medical mistakes you can expect to see more of in the future.

The most common error, making up 29% of the incidents, was equipment errors. 

“Instrumentation was reported to cause an error about twice as often as an implant (63% of incidents compared to 32%). Implant errors usually involved a missing implant (43% of these cases) or having the wrong implant (29%). Implants breaking either pre- or intraoperatively were fairly rare occurrences. “

Being able to affectively communicate remains an ongoing concern. Communication errors accounted for 25% of the reported errors. These errors took the form of written, verbal or dictated information or, in 23% of these cases; it simply amounted to a failure to communicate anything.

One interesting reported problems is described as follows: “19% of these incidents resulted in a near miss involving the patient, and the error resulted in a negative outcome (including delayed surgery or a revision) in 33% of these cases. 47% resulted in no harm to the patient.” Don’t ask because I have no clue what this means. You’d think if patient safety were involved there would be clarity in describing the problem, but this description says it all.

Wrong-site surgeries continue to be problematic. There were 27 reports of wrong-site surgery, which can include the wrong side, meaning left versus right; or just being in the wrong part of the body when they state to cut. These accounted for 59% of these were wrong-side. The other wrong-site problems were being on the correct side but ultimately in the wrong location. Things like operating on the correct hand but the wrong finger.  These mistakes included doing the wrong procedure and operating on the wrong patient.

What the survey described as the most serious of errors were medication errors. There were eight of those; a mistake that results in several deaths and serious permanent injury to the patient.

What is most interesting to note about this study is the “resistance” to change that protects the patient. “The study's authors report that there has been "resistance" to adopting patient safety protocols and that the introduction of these programs can represent a culture shift in some ORs. While this survey shows that about half of all reported errors don't result in any harm to the patient, it also highlights room for improvement in patient safety and helps to illustrate how outcomes can benefit from relatively simple measures.”

As painful as this may be it’s a necessary component of change that will result in a better health care system.