By: Tatum Tipton
A month ago I had my first ever surgery. At the age of 28 I had my wisdom teeth removed. It was only a minimally invasive procedure, but it did require sedation. While this is a very common procedure that many people undergo every year without complication, I was terrified. Luckily, I had nothing to fear. The procedure went as smooth as can be expected and I was sent home with chipmunk cheeks, a pint of ice cream and a prescription for pain medication. The following days were hard; I felt like I was hit by a truck. But the pain slowly became tolerable and eventually eased completely. I am happy to be able to say that, like my wisdom teeth, the pain from the extractions is just a mere memory now.
Like my wisdom teeth removal, many millions of Americans undergo surgery each year without incident. Unfortunately, mistakes do happen and there are reportedly more than 4,000 preventable mistakes that occur during surgery each year. These mistakes are referred to as “never events” by researchers because they are the kind of surgical mistakes that should never happen. Even though these types of mistakes should never happen, researchers found that there were approximately 10,000 paid settlements and judgments in the U.S. for “never events” between 1990 and 2010.
The most common type of “never event” is when a surgeon forgets to remove a surgical instrument, such as a scalpel, clamp, or surgical sponge from a patient at the completion of the surgery. This is commonly referred to as retained surgical instruments (RSI). Between 2005 and 2012 there were 772 incidents of foreign objects left in patients reported to The Joint Commission. However, reporting to The Joint Commission is voluntary and represents only a small portion of actual events. Due to this it is felt that there are actually an estimated 2000 to 4000 RSI cases each year.
Recently, there has been buzz in the media pertaining to one particular former presidential hopeful and an alleged “never event.” On April 8, 2011, Darlene King filed a Medical Malpractice Claim in Maryland naming numerous defendants, including Dr. Benjamin Carson. In her statement of claim she said that on April 10, 2008, Dr. Carson performed brain surgery to repair a condition that caused her severe facial pain. By December of 2009 the pain was back. In May of 2010, on a recommendation from Dr. Carson, Ms. King underwent an MRI. The findings of the MRI were suggestive of a meningioma tumor. Prior to her surgery in 2008, there were no reports or signs of tumor-like lesions on any of Ms. King’s radiology studies. On July 1, 2010, Ms. King again went under the knife at the hands of Dr. Carson to have the tumor-like lesion removed. The results of the surgery pathology revealed that the lesion consisted of abundant foreign material with associated foreign body giant cell reaction and calcifications; negative for tumor. Or in laymen’s terms, what was removed was a surgical sponge, which was left in Ms. King’s brain during her April 10, 2008 surgery.
In an even more shocking case, one patient was found to have 16 medical items left in his body after surgery. In 2009, Dirk Schroeder underwent a routine surgery for prostate cancer and was told the surgery went well. However, his wounds weren’t healing properly and he was in intense pain. Several weeks later, Mr. Schroeder was operated on again. The surgeons were shocked to find several items left inside of Mr. Schroeder, including: a six-inch roll of bandage, a needle, a six-inch long compression bandage, and a fragment of a surgical mask.
Symptoms associated with RSI can appear right away, like in Mr. Schroeder’s case; many months later, as in Ms. King’s case; or not at all. Common symptoms of RSI include inflammation, local infection, pain, and tenderness. The dangers of a tool or a sponge left behind after surgery range anywhere from harmless to life-threatening, with an estimated fatality rate of 2%. Surgical tools can puncture vital organs and blood vessels, causing internal bleeding. Sponges can fester inside a body causing infection, or be misdiagnosed as a tumor. In many cases, the retained surgical item requires additional surgeries which can cost thousands of dollars.
Human error is the leading contributor to why items get left behind during surgery. That is not to say that the doctors are lazy, bad, or intentionally hurting their patients; the vast majority of doctors, even those who make mistakes, are doing their best. But doctors are exhausted after long surgeries or shifts, there are many people on the surgical team who sometimes get switched out over the course of the surgery, and operating rooms can be chaotic, especially if the surgery performed was under an emergency situation. Amidst the commotion, mix-ups of who is responsible for surgical items and sponges can occur and the count can be off. Additionally, most surgeries are under the anesthesia time constraint, which means that by the end of the surgery, the surgical team is rushing to make sure everything is completed before the patient wakes up, which can lead to missed items left in the patient.
In an effort to decrease RSIs, The Association of Perioperative Registered Nurses (AORN) has published the Perioperative Standards and Recommended Practices. The AORN recommends counting all sponges, sharps and related miscellaneous items five different times: before the procedure to establish a procedure to establish a baseline; before the closure of an incision within a cavity; before wound closure begins; at skin closure and at the time of permanent staff relief. AORN also recommends all counts be documented in the intraoperative record. If a discrepancy occurs between counts, surgical staff must search for the lost item.
While the thought of having a surgical instrument left inside of you after surgery is scary, remember it is not a common occurrence. Less than 0.008% of people who have surgery in the United States each year leave the operating room with surgical instruments left inside of them. However, if you or a loved one is the victim of RSI, contact an attorney who can help you through this difficult time.