Wrong body part, wrong procedure or wrong patient
Analysis examines malpractice cases
Sponges, instruments and other “retained foreign bodies” left behind inside patients. Lacerated or punctured organs. Wrong body part. Wrong procedure. Wrong patient.
A 10-year analysis of about 3,000 malpractice complaints and settlements involving surgical “incidents” in Canada is providing a rare glimpse into potentially avoidable — and sometimes catastrophic — harm occurring in the nation’s operating rooms.
The report lists communication breakdowns, “absent, sparse or illegible” documentation and failures to follow system safety checks among the factors contributing to surgeries gone wrong.
The analysis involved 1,583 cases from the Canadian Medical Protective Association (CMPA), the powerful Ottawa-based body that defends doctors accused of malpractice, in 2004-13, and 1,391 cases handled by the largest liability insurer for Canadian hospitals and their employees.
Overall, about one-third of the cases resulted in severe harm to patients, from devastating injuries such as major organ damage or paralysis, to death.
“I would not want the reader to go away with the view that surgery is unsafe. I think surgery is safer now than it’s ever been,” said Dr. Gordon Wallace, managing director of safe medical care at CMPA, the doctors’ liability insurer. “But it’s also more complex. We have better clinical outcomes from surgery than we’ve ever had. We have fewer complications than we’ve had, but there’s room for improvement.”
A landmark 2004 Canadian study estimated that at least 70,000 cases of preventable medical errors occur each year in hospitals, with more than half attributable to surgery. In the U.S., medical error is now the third-biggest cause of death, behind cancer and heart disease, according to a newly published study that estimates 250,000 Americans are killed annually by medical care “gone awry.”
“Medical error leading to patient death is under-recognized in many other countries, including the U.K and Canada,” the researchers, from the Johns Hopkins University School of Medicine in Baltimore, report in the British Medical Journal.
The new review consisted of resolved or settled medical-legal cases. They included cases in which something clearly went seriously wrong, while others involved the “inherent risks” of the surgery itself, Wallace said.
Most involved non-cancer, non-trauma surgery. The top five sites for surgical mishaps were the uterus, gallbladder, colon, muscles of the chest or abdomen (hernia repair) and breast.
Experts who reviewed the cases were critical of care provided in half those cases. Harm to patients ranged from death to lacerations, punctures, infections, hemorrhage and burns. Twelve per cent of CMPA cases, and 18 per cent of Healthcare Insurance Reciprocal of Canada, the hospital insurer, cases involved sponges, rolls or instruments left inside patients, or “wrong surgery,” meaning the wrong patient, wrong procedure or wrong body part.