Today's Med-Mal Case - wrong side surgery
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A 53-year-old man suddenly developed severe weakness of the left arm and leg.
He was rushed to the nearby hospital and seen in the ED.
A CT scan revealed a large right MCA (middle cerebral artery) infarct (stroke).
The patient was given tPA, admitted to the ICU, and had an uneventful night.
The following morning he developed severe hypertension and tachycardia.
A stat MRI was obtained that showed brain swelling.
The ICU consulted the neurosurgery service, and a right decompressive hemicraniectomy was recommended.
He was taken to the OR that afternoon, and a hemicraniectomy with anterior temporal lobe resection was performed.
On return to the ICU, the patient had developed severe right-side deficits in addition to the unchanged left hemiparesis.
The patient returned to the OR about 2 hours later and underwent a right hemicraniectomy.
His condition deteriorated over the next few weeks. He developed pneumonia, septic shock, ischemic bowel, multi-organ failure, and tragically died several weeks later.
The plaintiffs also sued the anesthesiologist.
The lawsuit is ongoing.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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I wonder if "left brain controls right side" confusion contributed to this. They ask so many questions with double checks and triple checks when you go into surgery on a bilateral body part. Maybe the questions themselves got complicated and eventually misunderstood.
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I wonder if "left brain controls right side" confusion contributed to this. They ask so many questions with double checks and triple checks when you go into surgery on a bilateral body part. Maybe the questions themselves got complicated and eventually misunderstood.
@Horace said in Today's Med-Mal Case - wrong side surgery:
I wonder if "left brain controls right side" confusion contributed to this
He's a neurosurgeon. There should be no such confusion.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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A 53-year-old man suddenly developed severe weakness of the left arm and leg.
He was rushed to the nearby hospital and seen in the ED.
A CT scan revealed a large right MCA (middle cerebral artery) infarct (stroke).
The patient was given tPA, admitted to the ICU, and had an uneventful night.
The following morning he developed severe hypertension and tachycardia.
A stat MRI was obtained that showed brain swelling.
The ICU consulted the neurosurgery service, and a right decompressive hemicraniectomy was recommended.
He was taken to the OR that afternoon, and a hemicraniectomy with anterior temporal lobe resection was performed.
On return to the ICU, the patient had developed severe right-side deficits in addition to the unchanged left hemiparesis.
The patient returned to the OR about 2 hours later and underwent a right hemicraniectomy.
His condition deteriorated over the next few weeks. He developed pneumonia, septic shock, ischemic bowel, multi-organ failure, and tragically died several weeks later.
The plaintiffs also sued the anesthesiologist.
The lawsuit is ongoing.
@George-K said in Today's Med-Mal Case - wrong side surgery:
The plaintiffs also sued the anesthesiologist.
I can see some measure of liability here. Though not his expertise, he might, might, have been able to determine that the wrong side was being operated on. He'll probably be found not liable, or he'll settle for a trivial amount.
That said, I got sued because a surgeon left a needle in a patient. After taking time off work for deposition, I was dropped.
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@Horace said in Today's Med-Mal Case - wrong side surgery:
I wonder if "left brain controls right side" confusion contributed to this
He's a neurosurgeon. There should be no such confusion.
@George-K said in Today's Med-Mal Case - wrong side surgery:
@Horace said in Today's Med-Mal Case - wrong side surgery:
I wonder if "left brain controls right side" confusion contributed to this
He's a neurosurgeon. There should be no such confusion.
I don't think it was a simple, direct confusion on the surgeon's part. I meant, in the process of asking the patient questions about left vs right, and conveying the answers eventually to the surgeon, I wonder if left/right reversal from brain to body played a part in complicating the communication.
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@Horace said in Today's Med-Mal Case - wrong side surgery:
I wonder if "left brain controls right side" confusion contributed to this
He's a neurosurgeon. There should be no such confusion.
@George-K said in Today's Med-Mal Case - wrong side surgery:
@Horace said in Today's Med-Mal Case - wrong side surgery:
I wonder if "left brain controls right side" confusion contributed to this
He's a neurosurgeon. There should be no such confusion.
This.
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True story...
In 1984 (?) I was going to supervise a resident who was going to give anesthesia for a left fem-pop bypass (a vein graft to bypass an obstructed femoral artery). I talked to the patient in the pre-op holding area about his surgery and we rolled the patient into the OR.
Once we got the patient anesthetized, I told the resident to go get a bite to eat because it's going to be a long case. I sat down and started doing paperwork. I was behind the drapes and didn't watch what was going on while the team prepped the leg for surgery. The vascular surgery fellow was going to get everything going while the attending surgeon waited in the lounge.
The fellow said, "We're starting, Dr. K." I stood up and looked over the drape and something just didn't look right.
"Carol, can you get me the chart, please?"
"Sure, Dr. K."
I opened the chart and looked at the consent.
"Ahem, gentlemen, I see you've made your skin incision, but before you go further, you should be aware that the consent is for a LEFT fem-pop bypass."
Vascular surgeon goes pale as a sheet. "Carol, get Dr. XYXYXYXY in here."
The attending surgeon is a Hong-Kong born, Cook County trained take-no-prisoners sonofabitch. He and I got along really well...
Surgical attending arrives, looks at wound in right leg and looks at fellow.
(Insert thick Chinese accent here)
"Tommy, you fuck up. You fuck up, real bad. Why you not go make round and I finish fem-pop."
Surgery on the left leg proceeded uneventfully. I saw the patient in the recovery room and the surgeon was there also.
I said to the surgeon, "So, Jim, what are you going to tell the patient?"
"No problem, George. Gotta get vein from someplace."
I never heard of any fallout...
Now, with all that being told, this was decades before the current practice of the surgeon identifying the side/site of surgery, and the whole team participating in a "time-out" to assure that all the t's are crossed and the i's dotted.
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@George-K That is quite an interesting (and kind of fun) story!
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Speaking of "marking the side of surgery."
Staff refused to bring a patient to the OR because the orthopedic surgeon did not "mark the site of the proposed procedure."
He said, "I DID mark it. I put a FUCKING CAST on it."
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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Hate when that hapoens
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Speaking of "marking the side of surgery."
Staff refused to bring a patient to the OR because the orthopedic surgeon did not "mark the site of the proposed procedure."
He said, "I DID mark it. I put a FUCKING CAST on it."
@George-K said in Today's Med-Mal Case - wrong side surgery:
He said, "I DID mark it. I put a FUCKING CAST on it."
No, a cast is not a proper marking, for one cannot definitively rule out the side without the cast is the side that does not need surgery. There is also situations where both sides have casts, in which case the existence of a cast is not indicative of surgical need.
The protocol says "mark the site" for good reason, the hospital worker was right to refuse transporting the patient when the physician break that protocol. The physician was being careless (and even rude) in this instance.
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Another Jimmy (attending surgeon) story...
There are few forms of life that is lower than the intern on the vascular surgery service.
One time, a intern said to Dr. Jimmy, "You know, I don't think I'm learning enough on this service."
(insert THICK Chinese accent)
"You miserable son of bitch! You not here learn! You hear wok (work)."
