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Medical Malpractice, Dead By Mistake, and Wrong Site Surgery

Richard Flagg entered Meadowland Hospital in Secaucus, NJ with a diseased lung. Unfortunately, his surgeons accidentlally removed his healthy lung, leaving behind a tumor in his diseased lung. Mr. Flagg survived for three years, attached to oxygen, until the tumor ruptured and he drowned in his blood.

This is one of the stories in the Hearst Group’s Dead By Mistake. And it seems almost far-fetched. Doctors removing the wrong lung? How often could that happen? Much more frequent than you think.

It turns out that Wrong Site, Wrong Side, Wrong Procedure, Wrong Patient surgeries are common. The Archives of Surgery, the official medical journal of surgery associations across the country, did a study and found that almost 3,000 procedures were performed each year where the surgeon operated on the wrong side or site, performed the wrong procedure or operated on the wrong patient. And those are just the reported instances.

The Joint Commission On Accreditation of Healthcare Organizations is a non-profit that accredits and certifies health care organizations nationwide. The Joint Commission asks its members to report and keep track of sentinel events, unexpected events that lead to death or serious injury, and wrong site surgeries are the #1 type of sentinel event recorded.

In May 2003, the Joint Commission hosted a summit on Wrong Site surgeries. After consulting with some of the world’s leading physicians, the Joint Commission established its Uniform Protocol for surgeries. The protocol has three steps: (1) the hospital must make sure it has pre-operation processes in place to ensure the right procedure is being performed; (2) someone must specifically mark the part of the body that is being operated on; and (3) the surgical team must take a “time out” before starting surgery to verify that the proper procedure is about to be performed.

But is it enough? Perhaps not.

Steve Sanford, of the Preferred Physicians Medical Risk Retention Group, contends that the Universal Protocol has several flaws that prevent it from being effective. First, he argues against the shared responsibility advocated by the protocol. Shared responsibility is, in essence, no responsibility. When participants to a surgery think other participants are going to check the proper site, the responsibility goes unfulfilled. Instead, Sanford argues that the surgeon should have the sole responsibility and should know that he or she will be held accountable for the errors — no more suggesting that someone else should have handled it.

Sanford also argues that the protocol is not specific enough and leaves too much interpretation up to individual institutions. If the standard was more concrete and accepted between institutions, it might be easier to follow.

Statistics suggest that Sanford is right. PPM’s statistics show that the number of wrong site surgeries actually increased following the adoption of the Universal Protocol. Other studies made similar findings.

So what do we do? We’ll look at that in a later post.

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