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Medical Malpractice Surgery

Fairfax Injury Lawyer Brien Roche Addresses Medical Malpractice Surgery

Brien Roche

Surgical skill is a function of how often a surgeon has done the procedure.  The Whipple procedure is a tough one. It is a pancreatic cancer operation.  It may the toughest one for a surgeon.  What is involved is removing part of the pancreas and small intestines. In addition the gall bladder is removed. What is left is then rejoined.

Medical Malpractice Surgery:Practice Makes Better

In the world of surgeons numbers are not always looked at. In other words a surgeon need not have done a procedure before attempting it with a new patient. As a result surgeons with no track record may perform the Whipple procedure.  This is a danger. In addition the hospital may not have seen the procedure before. Hence the danger is even greater.  

In 1979 Stanford conducted a study on surgical success. Patients who had operations at hospitals that did more of that surgery had much lower death rates.  A 2016 study found that the risk was far higher among surgeons who performed only one thyroid removal per year. In contrast those who did 25 or more per year got better results. Thyroid removal is tricky. Call, or contact us for a free consult.

Minimum Requirements for Surgeons

Several respected hospitals have made a pledge. They require their surgeons to meet minimum annual thresholds for high risk procedures.  Hence surgeons must perform at least five (5) pancreatic surgeries annually. In addition they must do them in places where 20 such operations are done each year.  This means the surgeon is well tuned. Also the patient is getting a hospital that is well tuned.

Medical Malpractice and Healthcare Laws

Under the current healthcare law hospitals face money sanctions if patients
come back due to problems with the surgery. In contrast under the prior law they were rewarded with more fees if patients came back. That is now gone.

Medical Malpractice Surgery-True Complication Rate

A CNN investigation of an extremely low volume Florida surgery program was launched in 2011. It found that six (6) babies died in a two (2) year period.  That was far more than what was expected.  The program closed shortly after that expose’.  US News has also reported in 2015 on Medicare patients who had knee replacements. If done at the lowest volume hospitals in the country they were 70% more likely to die. In contrast are patients having surgery at higher volume centers.  Much the same is true for new hips.  

Surgeons may maintain that they have top results. The problem is that most surgeons don’t track results.  Therefore they don’t know if there was a good outcome.  All they know is whether or not the patient returned to them. Call, or contact us for a free consult.

General Surgery Negligence

This negligence comes in a number of forms.  General surgeons operate from the breastbone down to the pubic area. 

Any type of general surgery has an increased chance of infection given the area of the body involved. An article in the September 2012  edition of Trial Magazine addresses fault of the general surgeon. Things to look for are:

    Blood Count and Pathology

  • The complete blood count. A white blood count over 12,000 may mean infection. A white count over 15,000 is even more indicative.  Also elevated lymphocytes may be an indicator of infection.  Likewise, an increased BUN may indicate a host of problems.  Low hemoglobin or hematocrit point to internal bleeding. 
  • Pathology reports should identify the tissue. Also they should identify where it came from. In addition they should state any anatomical variation in the patient.
  • Length

  • Lengths of procedures and gaps in time between stages of the procedure. They need to be explained.   Comparing notes of the anesthesiologist and surgeon may give some clue as why there were delays or gaps.
  • Air

  • The peritoneum is the area in the gut that contains the stomach, liver, bowel, colon and bladder. In women it also contains the uterus, fallopian tubes and ovaries.  The presence of some air after an open procedure or a laparoscopic procedure may be normal. However that air should escape.  Likewise, the presence of fluid may point to a cutting of the bowel, bladder or other organ.
  • Anatomy

  • Gall bladder surgery can be complicated by anatomical variation. The gall bladder may be on the right or left hepatic duct.  The OR report should note such. Therefore this may explain why the wrong structure was cut.
  • Post Surgery

  • Infection is always a huge problem.  When the infection is diagnosed must be noted.  The longer the delay in diagnosis the more likely there was some fault.  Also a delay in treatment may suggest fault. 
  • The absence of bowel function after surgery may suggest a cut.
  • The patient’s return to the OR or return to the hospital may suggest fault.
  • Abdominal pain with hardness suggests an infection.

Call, or contact us for a free consult.

Medical Malpractice Surgery Center

Surgery center negligence has become a big issue since the death of Joan Rivers.

The famous comedian passed away during the course of a routine procedure.  It was performed in a surgery center. The center was operated by her GI doctor.  The doctor at the time was performing an endoscopy.  An endoscopy is where a scope is placed down the esophagus. The goal is to look at the esophagus and stomach if need be.

Rivers died on September 4th,2014. The surgery center in this case was in Manhattan.

Surgery Center Negligence-The Risks

Federal officials found numerous violations at this center.  There was a failure to notice or take action to correct Rivers vital signs for 15 minutes.  Also there was a gap in the records of the amount of anesthesia given. There was a failure to weigh Rivers.  This was needed to gauge the amount of anesthesia needed.  In addition a procedure was performed which Rivers had not consented to. Call, or contact us for a free consult.

Consumers Union

The Consumers Union has been keeping a close eye on surgery centers.  They note that hospitals are more tightly regulated.  Also hospitals have to report on errors and infections.  The number of surgery centers has increased greatly over the years.  Also the number of procedures they perform has gone up greatly. They now perform colonoscopies, cataract removal, joint repairs and spinal injections.  This is all done as an outpatient.  Furthermore over two-thirds (2/3) of operations performed in the U.S. now occur in outpatient centers.  

Some of those centers are owned by hospitals.  However most are owned by the doctors who work there.  In 2011 the number of procedures performed in surgery centers was 23 million.

Pros and Cons

Going to a surgery center reduces the exposure to infection, chaos and delay that is seen at hospitals.  However the risk is that the people working there may not be as well trained or equipped to deal with an emergency.  One thing to look for in any surgery center is whether or not it has a crash cart. That is a wheeled cart containing a defibrillator, medicines and other lifesaving supplies.

Pre-Screening of Patients To Prevent Surgery Center Negligence

What is critical in these centers is pre-screening.  Pre-screening means that unhealthy patients are weeded out. They are referred to hospitals.  Hospitals are better able to deal with patients with certain problems. These include obesity, sleep apnea and breathing difficulties.  

Hospitals are more likely to be fully equipped. They have staff members with greater experience in handling emergencies.  Unless surgery center personnel have drilled for it and trained it is difficult for them to deal with a true emergency.

Postoperative infections in hospitals is a problem. Little is known about the rate of post surgery infection at surgery centers.

What To Ask Before Going To A Surgery Center

In looking at any surgery center for your procedure you should ask questions. Such as “How are you going to deal with an infection?”  “How are you going to deal with a medical emergency?”  Those are all fair questions to ask. Call, or contact us for a free consult.

Wrong Site Surgeries

Wrong site surgeries continue to be a problem. There is some data to suggest that the problem is actually on the increase. Medicare and some insurers now refuse to pay for wrong-site surgery. In addition Medicaid has announced that it will implement such a policy.

Part of the reason for the persistence and possible increase of wrong site surgery is increased time pressures. The pressure is to increase productivity.

There are a number of other potential causes. Simply mixing up the left and right side or mixing up test results may be a cause. Call, or contact us for a free consult.

Precautions

Some basic things to reduce or eliminate wrong site surgery are:

1. Make doctors verify the site and the procedure before the patient is moved to the OR. In the pre-operative area the patient is fully conscious. Marking the site with a pen designed for that purpose reinforces to the doctor where the operation is to take place. Likewise it gives the patient a chance to correct the doctor.
2. A time-out is a routine step in the pre-surgical process. The time-out is taken after the surgeon has scrubbed down. The surgical site is sanitized and draped. At that point the OR nurse calls a time-out. This should consist of reading from the consent form the patient’s name, the procedure to be performed, the place on the body where it is to be performed. In addition the use of antibiotics and any allergies are confirmed. Also each of these things is independently confirmed as being correct. This is done by the surgeon, the anesthesiologist and the scrub nurse.
3. No instruments are given to the surgeon until the time-out is completed.

Unnecessary Surgeries

The surgeries to avoid, or so-called unnecessary surgeries, are numerous. There are several that are reported to be subject to over use.

Stents

Stents are tiny, mesh tubes that surgeons use to keep open the blood vessels. Sometimes they can be a lifesaver. However, all too often they are installed in patients with heart disease who have stable angina. Angina is chest pain brought on by exertion or stress. A 2007 study from the VA indicates that a stent is no better at preventing a heart attack in those types of patients than are simple lifestyle changes. These may consist of exercise, taking statins, and other steps to lower cholesterol.

If the patient’s problem is plaque in the vessels the stent is not going to help. Rather the stent will only maintain the aperture in a small length of the vessel.

Back Surgery

Complex spinal fusions are the staple of many doctors. Studies have shown that most fusion patients have no more pain relief than those who had therapy. The surgery is often undertaken to treat stenosis. Stenosis causes pain. Stenosis is pressure on the spinal cord. This surgery is designed to relieve that pressure. However the vertebrae above and below the fusion site end up having to do more bending. This puts added stress on that portion of the spinal column.

Surgical Removals

Each year over a half million hysterectomies are performed on American women. With a cancer patient, hysterectomy may be needed. However hysterectomies due to heavy bleeding or pain from benign growths are probably not needed. In addition they are fraught with dangers. The dangers are incontinence, higher risk of heart disease and lung cancer.

A total hysterectomy also immediately puts the patient into menopause. Alternatives where there are benign growths are embolization and focused ultrasound. The embolization cuts off the flow of blood to the fibroids. This starves them. The ultrasound shrinks the fibroids.

Appendicitis treatment typically is surgery.   However an article in The Washington Post on September 17, 2013 suggests there may be other treatments.  It reports a Swedish study about treating with antibiotics. It reports that the success rate was 77%.  The cost of such antibiotic treatment is about $50.00. The cost of the workup and surgery can exceed $30,000.00.

This does not mean that antibiotic treatment is always a cure. It may be a preferred first form of treatment.  Once the appendix has ruptured, then removal is necessary.

Studies

Knee arthroscopy may be needed where a patient has a torn meniscus. Where it is performed to deal with osteoarthritis it is no more successful than noninvasive remedies. So alternatives to the surgery are fairly simple lifestyle changes.

Call, or contact us for a free consult. Also for more information on Medical Malpractice Surgery see the other pages on this site and see the pages on Wikipedia.

Comments are closed.

Contact Us For A Free Consultation

Medical Malpractice Surgery

Fairfax Injury Lawyer Brien Roche Addresses Medical Malpractice Surgery

Brien Roche

Surgical skill is a function of how often a surgeon has done the procedure.  The Whipple procedure is a tough one. It is a pancreatic cancer operation.  It may the toughest one for a surgeon.  What is involved is removing part of the pancreas and small intestines. In addition the gall bladder is removed. What is left is then rejoined.

Medical Malpractice Surgery:Practice Makes Better

In the world of surgeons numbers are not always looked at. In other words a surgeon need not have done a procedure before attempting it with a new patient. As a result surgeons with no track record may perform the Whipple procedure.  This is a danger. In addition the hospital may not have seen the procedure before. Hence the danger is even greater.  

In 1979 Stanford conducted a study on surgical success. Patients who had operations at hospitals that did more of that surgery had much lower death rates.  A 2016 study found that the risk was far higher among surgeons who performed only one thyroid removal per year. In contrast those who did 25 or more per year got better results. Thyroid removal is tricky. Call, or contact us for a free consult.

Minimum Requirements for Surgeons

Several respected hospitals have made a pledge. They require their surgeons to meet minimum annual thresholds for high risk procedures.  Hence surgeons must perform at least five (5) pancreatic surgeries annually. In addition they must do them in places where 20 such operations are done each year.  This means the surgeon is well tuned. Also the patient is getting a hospital that is well tuned.

Medical Malpractice and Healthcare Laws

Under the current healthcare law hospitals face money sanctions if patients
come back due to problems with the surgery. In contrast under the prior law they were rewarded with more fees if patients came back. That is now gone.

Medical Malpractice Surgery-True Complication Rate

A CNN investigation of an extremely low volume Florida surgery program was launched in 2011. It found that six (6) babies died in a two (2) year period.  That was far more than what was expected.  The program closed shortly after that expose’.  US News has also reported in 2015 on Medicare patients who had knee replacements. If done at the lowest volume hospitals in the country they were 70% more likely to die. In contrast are patients having surgery at higher volume centers.  Much the same is true for new hips.  

Surgeons may maintain that they have top results. The problem is that most surgeons don’t track results.  Therefore they don’t know if there was a good outcome.  All they know is whether or not the patient returned to them. Call, or contact us for a free consult.

General Surgery Negligence

This negligence comes in a number of forms.  General surgeons operate from the breastbone down to the pubic area. 

Any type of general surgery has an increased chance of infection given the area of the body involved. An article in the September 2012  edition of Trial Magazine addresses fault of the general surgeon. Things to look for are:

    Blood Count and Pathology

  • The complete blood count. A white blood count over 12,000 may mean infection. A white count over 15,000 is even more indicative.  Also elevated lymphocytes may be an indicator of infection.  Likewise, an increased BUN may indicate a host of problems.  Low hemoglobin or hematocrit point to internal bleeding. 
  • Pathology reports should identify the tissue. Also they should identify where it came from. In addition they should state any anatomical variation in the patient.
  • Length

  • Lengths of procedures and gaps in time between stages of the procedure. They need to be explained.   Comparing notes of the anesthesiologist and surgeon may give some clue as why there were delays or gaps.
  • Air

  • The peritoneum is the area in the gut that contains the stomach, liver, bowel, colon and bladder. In women it also contains the uterus, fallopian tubes and ovaries.  The presence of some air after an open procedure or a laparoscopic procedure may be normal. However that air should escape.  Likewise, the presence of fluid may point to a cutting of the bowel, bladder or other organ.
  • Anatomy

  • Gall bladder surgery can be complicated by anatomical variation. The gall bladder may be on the right or left hepatic duct.  The OR report should note such. Therefore this may explain why the wrong structure was cut.
  • Post Surgery

  • Infection is always a huge problem.  When the infection is diagnosed must be noted.  The longer the delay in diagnosis the more likely there was some fault.  Also a delay in treatment may suggest fault. 
  • The absence of bowel function after surgery may suggest a cut.
  • The patient’s return to the OR or return to the hospital may suggest fault.
  • Abdominal pain with hardness suggests an infection.

Call, or contact us for a free consult.

Medical Malpractice Surgery Center

Surgery center negligence has become a big issue since the death of Joan Rivers.

The famous comedian passed away during the course of a routine procedure.  It was performed in a surgery center. The center was operated by her GI doctor.  The doctor at the time was performing an endoscopy.  An endoscopy is where a scope is placed down the esophagus. The goal is to look at the esophagus and stomach if need be.

Rivers died on September 4th,2014. The surgery center in this case was in Manhattan.

Surgery Center Negligence-The Risks

Federal officials found numerous violations at this center.  There was a failure to notice or take action to correct Rivers vital signs for 15 minutes.  Also there was a gap in the records of the amount of anesthesia given. There was a failure to weigh Rivers.  This was needed to gauge the amount of anesthesia needed.  In addition a procedure was performed which Rivers had not consented to. Call, or contact us for a free consult.

Consumers Union

The Consumers Union has been keeping a close eye on surgery centers.  They note that hospitals are more tightly regulated.  Also hospitals have to report on errors and infections.  The number of surgery centers has increased greatly over the years.  Also the number of procedures they perform has gone up greatly. They now perform colonoscopies, cataract removal, joint repairs and spinal injections.  This is all done as an outpatient.  Furthermore over two-thirds (2/3) of operations performed in the U.S. now occur in outpatient centers.  

Some of those centers are owned by hospitals.  However most are owned by the doctors who work there.  In 2011 the number of procedures performed in surgery centers was 23 million.

Pros and Cons

Going to a surgery center reduces the exposure to infection, chaos and delay that is seen at hospitals.  However the risk is that the people working there may not be as well trained or equipped to deal with an emergency.  One thing to look for in any surgery center is whether or not it has a crash cart. That is a wheeled cart containing a defibrillator, medicines and other lifesaving supplies.

Pre-Screening of Patients To Prevent Surgery Center Negligence

What is critical in these centers is pre-screening.  Pre-screening means that unhealthy patients are weeded out. They are referred to hospitals.  Hospitals are better able to deal with patients with certain problems. These include obesity, sleep apnea and breathing difficulties.  

Hospitals are more likely to be fully equipped. They have staff members with greater experience in handling emergencies.  Unless surgery center personnel have drilled for it and trained it is difficult for them to deal with a true emergency.

Postoperative infections in hospitals is a problem. Little is known about the rate of post surgery infection at surgery centers.

What To Ask Before Going To A Surgery Center

In looking at any surgery center for your procedure you should ask questions. Such as “How are you going to deal with an infection?”  “How are you going to deal with a medical emergency?”  Those are all fair questions to ask. Call, or contact us for a free consult.

Wrong Site Surgeries

Wrong site surgeries continue to be a problem. There is some data to suggest that the problem is actually on the increase. Medicare and some insurers now refuse to pay for wrong-site surgery. In addition Medicaid has announced that it will implement such a policy.

Part of the reason for the persistence and possible increase of wrong site surgery is increased time pressures. The pressure is to increase productivity.

There are a number of other potential causes. Simply mixing up the left and right side or mixing up test results may be a cause. Call, or contact us for a free consult.

Precautions

Some basic things to reduce or eliminate wrong site surgery are:

1. Make doctors verify the site and the procedure before the patient is moved to the OR. In the pre-operative area the patient is fully conscious. Marking the site with a pen designed for that purpose reinforces to the doctor where the operation is to take place. Likewise it gives the patient a chance to correct the doctor.
2. A time-out is a routine step in the pre-surgical process. The time-out is taken after the surgeon has scrubbed down. The surgical site is sanitized and draped. At that point the OR nurse calls a time-out. This should consist of reading from the consent form the patient’s name, the procedure to be performed, the place on the body where it is to be performed. In addition the use of antibiotics and any allergies are confirmed. Also each of these things is independently confirmed as being correct. This is done by the surgeon, the anesthesiologist and the scrub nurse.
3. No instruments are given to the surgeon until the time-out is completed.

Unnecessary Surgeries

The surgeries to avoid, or so-called unnecessary surgeries, are numerous. There are several that are reported to be subject to over use.

Stents

Stents are tiny, mesh tubes that surgeons use to keep open the blood vessels. Sometimes they can be a lifesaver. However, all too often they are installed in patients with heart disease who have stable angina. Angina is chest pain brought on by exertion or stress. A 2007 study from the VA indicates that a stent is no better at preventing a heart attack in those types of patients than are simple lifestyle changes. These may consist of exercise, taking statins, and other steps to lower cholesterol.

If the patient’s problem is plaque in the vessels the stent is not going to help. Rather the stent will only maintain the aperture in a small length of the vessel.

Back Surgery

Complex spinal fusions are the staple of many doctors. Studies have shown that most fusion patients have no more pain relief than those who had therapy. The surgery is often undertaken to treat stenosis. Stenosis causes pain. Stenosis is pressure on the spinal cord. This surgery is designed to relieve that pressure. However the vertebrae above and below the fusion site end up having to do more bending. This puts added stress on that portion of the spinal column.

Surgical Removals

Each year over a half million hysterectomies are performed on American women. With a cancer patient, hysterectomy may be needed. However hysterectomies due to heavy bleeding or pain from benign growths are probably not needed. In addition they are fraught with dangers. The dangers are incontinence, higher risk of heart disease and lung cancer.

A total hysterectomy also immediately puts the patient into menopause. Alternatives where there are benign growths are embolization and focused ultrasound. The embolization cuts off the flow of blood to the fibroids. This starves them. The ultrasound shrinks the fibroids.

Appendicitis treatment typically is surgery.   However an article in The Washington Post on September 17, 2013 suggests there may be other treatments.  It reports a Swedish study about treating with antibiotics. It reports that the success rate was 77%.  The cost of such antibiotic treatment is about $50.00. The cost of the workup and surgery can exceed $30,000.00.

This does not mean that antibiotic treatment is always a cure. It may be a preferred first form of treatment.  Once the appendix has ruptured, then removal is necessary.

Studies

Knee arthroscopy may be needed where a patient has a torn meniscus. Where it is performed to deal with osteoarthritis it is no more successful than noninvasive remedies. So alternatives to the surgery are fairly simple lifestyle changes.

Call, or contact us for a free consult. Also for more information on Medical Malpractice Surgery see the other pages on this site and see the pages on Wikipedia.

Contact Us For A Free Consultation

Contact Us For A Free Consultation