Surgical errors - when surgeons think they have it all sewn up...

On admission to hospital for surgery you are warned of the possible risks and complications connected with any procedure. These range from increased pain and anaesthesia complications to infection and blood clots. More often than not, the patient emerges from the operating theatre better off and in an improved state of health, however frightening statistics have emerged recently from The State Claims Agency identifying a large number of incidents in which patients in Irish hospitals have been victims of serious surgical system errors. Among the adverse events were 62 cases where surgeons marked incorrect body parts for surgery, 400 foreign objects such as swabs or surgical implements left inside patients after surgery, 1,000 surgeries where the incorrect patient medical records were referred to and 365 patients who had incorrect identity bands attached to their wrist when they arrived in theatre for surgery.

On admission to hospital for surgery you are warned of the possible risks and complications connected with any procedure. These range from increased pain and anaesthesia complications to infection and blood clots. More often than not, the patient emerges from the operating theatre better off and in an improved state of health, however frightening statistics have emerged recently from The State Claims Agency identifying a large number of incidents in which patients in Irish hospitals have been victims of serious surgical system errors. Among the adverse events were 62 cases where surgeons marked incorrect body parts for surgery, 400 foreign objects such as swabs or surgical implements left inside patients after surgery, 1,000 surgeries where the incorrect patient medical records were referred to and 365 patients who had incorrect identity bands attached to their wrist when they arrived in theatre for surgery.

Under the Medical Practitioners Act 2007, the Medical Council of Ireland are obliged to “protect the public by promoting and better ensuring high standards of professional conduct and professional education, training and competence among registered medical practitioners.” This implies that we should be confident in and willing to place our absolute trust in our medical professionals to carry out their duty with the highest possible standard of excellence. Despite the complex system of safety measures in place in our hospitals to ensure patients are treated with the highest standard of care, the incidence of surgical system error in Ireland is still excessive.

The vast majority of surgeries are carried out successfully, but occasionally mistakes do occur and some surgical errors can have catastrophic effects for the patient. Research from the United States tells us that patients who are injured as a result of a mistake in the course of being operated on are seven times more likely to subsequently die in hospital. Surgical error is also the eighth leading cause of death in the US and results in 100,000 fatalities every year.

Wrong Site Surgery (WSS):

Sixty two cases of WSS were reported in Ireland in the past two years according to State Claims Agency statistics. This inordinate number is notwithstanding the fact that these types of incidents tend to go unreported in the absence of a proper procedure to recognise, report and monitor. Wrong site surgery encompasses surgery performed at the incorrect location of the body, the wrong type of procedure performed on the patient and even surgery on the wrong patient entirely. Wrong organ removal and wrong limb amputation are two such examples where the patient will require further surgery on the correct site with possible complications arising as a result. Between 2005 and 2010, surgeons working in Ireland operated on the wrong body parts a staggering nineteen times. While none of these were fatal, the Health Service Executive paid out €185,000 in compensation to the patients who brought claims as a result. What is perhaps more worrying is that the World Health Organisation believes numbers of wrong site surgeries worldwide are on the rise due to a lack of communication between surgical staff and false or unavailable information.

Retained Surgical Instruments:

Typically during the course of a major surgery, 250-300 implements are required. The retention of surgical instruments occurs when one or more of these implements are unintentionally and unknowingly left in a patient’s body after surgery. It occurs more commonly than wrong site surgery with a reported four hundred cases by The State Claims Agency in Ireland since 2010 alone.

Needles, clamps, intravenous tubes and swabs are among the items that have been left inside patient’s bodies after the completion of surgery. This problem is easily eliminated when surgical tools are correctly counted by a member of the surgical team before and on completion of surgery to ensure that all items have been accounted for. Problems present themselves when surgical swabs stick together, a particularly complex operation is underway or a lapse of concentration among surgical team members in a high pressure atmosphere results in counting errors and subsequent retained surgical instruments.

Retained instruments may pose harmless or life threatening consequences for the patient depending on the type of reaction suffered by the foreign body and the extent of the damage done should it perforate an organ or obstruct a blood vessel. Undoubtedly the patient will have to take the costly step of undergoing surgery for a second time to remove the foreign body, possibly risking their health in a situation which could have been easily avoided. Moreover it puts undue pressure on a hospital’s valuable resources.

Infection:

Infection can be suffered by the patient if the surgeon is given non-sterile or contaminated equipment or the relevant staff fail to sterilise the wound, instruments and working area satisfactorily before, during and after use, and bacteria can be introduced into the surgical wound. This can have devastating effects for a patient’s recovery because post-operative infections can hinder it considerably. In worse case scenarios the patient is at risk of septicaemia and death. In many cases such infections can be treated successfully with antibiotics however in other cases, further surgery is required to evacuate infective material or abscesses. The harm caused to patients can be very great indeed.

Preventative Measures:

Alan O’Gorman, a 31 year old Irishman has been suffering from the harsh consequences of a surgical error for the past decade. Doctors misdiagnosed him with stomach cancer and incorrectly removed his stomach after they mistook him for an entirely different patient in St Vincent’s University Hospital, Dublin. What had happened was that his routine biopsy results had been confused with those of another man who was 70 year old and suffering from cancer. This colossal mistake and the negative effect it has had on his life could have been easily prevented had the necessary attention been paid to Alan and the proper procedures carried out to verify his identity and condition prior to him being operated on.

Hospitals have protocols to ensure that all surgical instruments and swabs are counted properly, that patients and locations of operations are checked thoroughly and that operating conditions are sterile. Additional risk management methods which should be implemented are reduced reliance on memory, improved employee training and better communication between staff. Pre-operative verification of vital information is of paramount importance. Factors such as lack of communication, distractions, and lack of access to pertinent information should be eliminated.

Where injury or harm to patients occurs from such errors, the injured party is in most cases entitled to compensation. If a health care provider has failed in its duty of care towards a patient and evidence is present that the mistake which has caused the patient’s injury could have been avoidable had the health care provider and/or the surgical team paid “due care and attention”, then the patient will be entitled to compensation for the pain and suffering and all additional loss and expense that they have incurred as consequence of that surgical error.

Human error is a fact of life and it is difficult to imagine a time or a system when errors are eliminated. Nevertheless, there is no excuse for preventable surgical errors. Stricter measures need to be put in place to ensure accurate surgical processes and adequate control mechanisms in order to mitigate the factors which could lead to potentially devastating effects for a patient. At the very least when one goes for surgery one should be entitled to feel confident that their procedure will be performed free from such easily preventable system errors.

If you have a query regarding this article you can contact Cian O’Carroll Solicitors on Freephone 1-800 60-70-80 or visit www.TIPPLAW.com

Cian O’Carroll Solicitors, A Medical Negligence & Personal Injury Law Firm