Surgical cockup or error?
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Surgical cockup or error?
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I just thought I would run this by you. It is a true story unfortunately. A 28 year old lady who had gained asylum in the UK after escaping torture from Somalia. She went to her GP w
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Forums » Open clinical » General clinical » Surgical cockup or error?
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Surgical cockup or error?
posted at 26/1/2012 6:40 PM GMT
on bmj.com
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Posts: 383
First: 15/7/2011 Last: 21/5/2012 |
I just thought I would run this by you. It is a true story unfortunately. A 28 year old lady who had gained asylum in the UK after escaping torture from Somalia. She went to her GP with abdominal problems and following extensive tests was admitted under an experienced General Surgeon for a nephrectomy. Following her premed she was asked to consent to the procedure by a Spr who was to carry out the surgery. She consented to a Left Nephrectomy. The Consultant Surgeon was in recovery assisting with a patient who was deteriorating so the Spr began the surgery. The theatre checklists were adhered to and the patient prepped for Left Nephrectomy. Once surgery has begun to the surprise of the surgeon the patient had already had a left nephrectomy. He examined the right kidney and noted that there was evidence of disease and would require surgery in the near future. What should the Spr do at this stage? |
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Re: Surgical cockup or error?
posted at 26/1/2012 8:02 PM GMT
on bmj.com
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Posts: 851
First: 12/3/2010 Last: 20/5/2012 |
A/ "General surgeon" - surely the age of the "general surgeon" is long gone? Not modern practice. B/ Consultant and SPR. In my hospital (nothing special, I assure you. Excellent but not outstanding) such complex major urology is performed by two consultants, assisting each other. Modern urology practice? Not sure, but excellent. C/ All the 'Correct side?' checks apparently done properly, but she had a previous left nephrectomy? No scar? - it's usually obvious. D/ Big gap between pre-op. examination and investigation, and the consent form. It's a big decision to remove a kidney - do urologists not check the other one when asking for imaging? E/ What was that work-up? Imaging, direct and via retrograde? What other examinations? F/ She is a Somali. What language did they speak the SPR took consent, or whoever took the history? G/ And so on. As usual, there is no single event that leads to catastrophe, or I hope, near catastrophe. The SpR must get his consultant in at once, or another consultant, preferably a urologist. He should warn the anaesthetist of the situation and probably ask for an HDU bed for post-op. care - this woman may be needing a prolonged double operation, if he has exposed the bed of the absent left kidney. Oh, and he should cancel the rest of the list! John |
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Re: Surgical cockup or error?
posted at 27/1/2012 6:16 AM GMT
on bmj.com
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Posts: 2075
First: 10/3/2009 Last: 18/5/2012 |
Why would a surgeon remove a perfectly normal kidney? If a kidney is so diseased it needs removal, I would suggest a Boy Scout with a First Aid certificate and Google Kidney would question its removal. Where were the junior surgical staff or are they LEFT-RIGHT challenged? DIdn't he look at the CT scan prior to the opening of the lady's abdomen.
Sounds like the surgeon needs to be removed. Rx Radical total consultantectomy required with post-operative solar dehydration to test his kidneys and a slow exsanguination by due legal process. |
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Re: Surgical cockup or error?
posted at 27/1/2012 11:47 AM GMT
on bmj.com
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Posts: 383
First: 15/7/2011 Last: 21/5/2012 |
The case above is abysmal and fortuitously the Consultant and his Spr are now somewhere safe where they cannot hurt anyone. By way of a small point (considering the catastrophe of the case) is it really wise to gain consent from a patient after they have received their premed. I have known a number of cases where this has come up and has been frowned upon. Is it common John D? |
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Re: Surgical cockup or error?
posted at 27/1/2012 2:19 PM GMT
on bmj.com
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Posts: 37
First: 29/8/2010 Last: 18/5/2012 |
Funny the extensive tests didn't show up the solitary kidney. Surely if functional, unless malignant, her remaining kidney should just be left in situ? Perhaps a nephrologist could comment. The practice failures in getting to this point are mind-boggling; general surgeon, yes, there are still plenty of small DGHs in the UK where general surgeons perform most surgery that they feel to be within their skill repertoire, but there are plenty of checks on good practice, such as a translator to explain the op (when the pt might have mentioned a previous nephrectomy), outlawing consent under premed, ward and theatre checks on side of surgery, and the consultant in theatre even if not operating for such a major case, not in Recovery. Though if bilateral nephrectomy was common policy in the team, perhaps he did need to be in Recovery. I hope that by "somewhere they can do no harm", you do not mean they have left the UK for another country? If this can happen in the UK, which has myriad checks in place, it is to be hoped they are not operating somewhere where there are no checks.
I |
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Re: Surgical cockup or error?
posted at 27/1/2012 3:08 PM GMT
on bmj.com
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Posts: 383
First: 15/7/2011 Last: 21/5/2012 |
MRH - as you mentioned it did not surprise me unduly that the surgeon was a 'General' as to my understanding many DGHs have such experienced surgeons capable of performing this type of surgery. The catalogue of failures including preoperative imaging, assessment, use of translator to ensure full history is obtained and all information crossed to and fro was as accurate as possible is beyond comprehension. When I said that both Doctors are now in places where they can do no harm I mean this: /> The Consultant Surgeon 'decided' to retire and trim roses /> The Spr (following a formal inquiry into his capability) had all surgical rights removed and is now working for a locum agency abroad) in a purely recruiting capacity. He cannot register again in the UK. I can say no more for fear of identifying the 'gentlemen' or patient involved. You would probably be amazed at the cases that come across my desk. There are a significant number of cases that never reach the media and are very carefully handled to ensure they go away. Morals and ethics can be quite liquid concepts. I have an independent Medicolegal practice and receive work from Defence Organisations and other sources to. What always pees me off is when the Doctor in a case has a perfectly defensible case but those higher up the chain than me decide it is way cheaper to make a payment to the claimant that go to trial and let the jury hear the evidence with a very high probability of 'aquitting' the Doctor. The trial is expensive, attracts media attention and no Trust enjoys the attention. It makes me wonder why Doctors are forced to pay expensive payments to defence organisations to help maintain their good name but then get railroaded into acquiescing to their employers instructions. |
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