Surgery is stressful enough without having to worry whether the surgeon is going to operate on the correct body part. Awrong-site surgeryoccurs when the doctor mistakenly performs a medical procedure on the incorrect organ or wrong side of the body.
Although some of these sorts of medical mistakes may be corrected after the fact, they are often irreversible, such as with an amputation or removal of an internal organ.
Recent New England Example
The Rhode Island Department of Health on November 2 publicly reprimanded Providence's Rhode Island Hospital, affiliated with Brown University, for an October surgery on a patient's wrong finger. The Health Department found that the hospital did not follow its own safety procedures governing proper surgical-site marking and planned timeout from the surgical process to check that nothing was amiss.
For only the second time ever, the Rhode Island Department of Health imposed a fine on a hospital ($150,000). The first was on the same institution in 2007 for another wrong-site surgery. In addition to the current incident, this hospital has had four other wrong-site surgeries since 2006: three brain surgeries and one for cleft palate.
In addition to the fine, regulators required the hospital to install video and audio equipment in operating rooms and mandated observation for a year of each surgical procedure by a medical professional with special training in safe surgery and implementation of a statewide surgical safety protocol that was developed by the World Health Organization (WHO).
Hospital President and Chief Executive Officer Timothy Babineau, M.D., acknowledges the most recent incident on the hospital's Web site, pledging ongoing safety improvement. He estimates that "wrong site surgical errors continue to occur at hospitals all over this country at a rate of nearly 40 per week."
Root Causes and Prevention
Researchers have found wrong-site surgeries to be symptomatic of bothpoor communicationamong involved medical professionals, the patient and family and ofinadequate teamworkamong the doctors, nurses and other medical professionals on the surgical team. Other contributing factors include fatigue, stress, complexity of our healthcare system, inadequate institutional information management systems, hurriedness and inexperience.
WHO developed an international pilot program that introduced a Surgical Patient Safety Checklist and found that when followed, use of the protocol resulted in nearly one third significantly fewer deaths and complications among a diverse adult patient population undergoing non-cardiac surgery. The pilot program researchers, who are part of the WHO Safe Surgery Saves Lives Study Group, published their findings in the January 14, 2009 edition of the New England Journal of Medicine.
Essentially, the WHO protocol has evolved into a 19-item checklist that contains a series of points during all surgical procedures that a surgical team goes through and when doing so, the team must confirm they had completed each step in the protocol. For example, the study identified three critical points during a surgical procedure: before anesthesia, just before incision, and before the patient leaves the operating room.� A significant requirement of this protocol is that a member of the team must verbally confirm that each step of infection control, anesthesia safety and other important considerations�are met, such as confirming the correct surgical site is marked at the start and at the time the surgery begins, or the right number of sponges and instruments are on the table and of course, at the end of the procedure.�
In addition to WHO, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO or Joint Commission), the biggest and oldest U.S. professional organization setting healthcare safety standards and accrediting medical facilities, has developed, with input from major medical associations, professionals and the public, the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery (Universal Protocol). Widely endorsed, the protocol has three main parts:
- Presurgury verification of documents
- Clear and unambiguous surgical-site marking
- Timeout immediately before surgery
The timeout is used to confirm the right surgical procedure, surgical site and patient identity. All members of the surgical team are urged to verbalize during the timeout questions or confusion about the surgery the team is about to perform.
The jury is still out as to the long-term effectiveness of the Universal Protocol in preventing surgical-site errors. Its use is required in JCAHO-accredited facilities and its basic elements have been adopted and enhanced by many state governments, professional organizations and medical institutions in developing their own protocols.
New York Surgical Errors
The problem of wrong-site surgery is also alive and well in New York. For example, from 2003 to 2005, 347 wrong-site, wrong-patient or wrong-procedure events were reported through the New York Patient Occurrence and Tracking System (NYPORTS), the mandatory state medical-error reporting system.
After reviewing the Universal Protocol and other resources, New York developed its own New York State Surgical and Invasive Procedure Protocol (NYSSIPP). NYSSIPP is the official and required standard of care for most surgical procedures in New York. It includes and enhances the three basic elements of the Universal Protocol -- verification, marking and timeout -- plus standards for scheduling, consent, disagreement resolution and compliance oversight. NYSSIPP especially encourages active communication among all members of the surgical team, particularly during the scheduled preoperative timeout.
New York Medical Malpractice
A New York patient who is the unfortunate victim of wrong-site surgery should consult with an experienced medical malpractice attorney to discuss possible legal remedies. In order to be successful on a claim for medical malpractice in New York, a plaintiff must prove that the doctor or other medical professional departed from an accepted standard of practice, and that the deviation proximately caused the complained-of injury. Other possible legal claims could be general negligence, gross negligence, wrongful death, lack of consent or reckless indifference. In a New York wrong-site surgery case, a likely issue will be whether the surgeon and his or her team complied with the requirements of the Universal Protocol and the NYSSIPP, and whether deviation from the standards in those protocols caused injury.
A personal injury lawyer should be contacted as early as possible so as not to miss any deadlines for giving notice or bringing a lawsuit.
