Last month’s $10 million settlement of a suit brought by a woman who underwent surgery for diverticulitis of the colon wherein a surgical sponge was left behind is a reminder of how frequent this complication occurs and of how potentially dangerous it can be.
A 2003 study in the New England Journal of Medicine reported that sponges and other foreign objects were left behind after abdominal surgeries at a rate of 1 for every 1,000 to 1,500 such operations. Several medical-products companies say sponges are the most common foreign objects left behind in surgeries. Surgical sponges are made of gauze and are used to soak up blood and protect organs during surgery, but if left inside the body they can cause potentially deadly infections. Retrieving a sponge in a further surgery can cost $50,000 or more.
In the case of the woman, she was on a ventilator and had signs of abdominal poisoning. Although she underwent a second surgery to remove the sponge, her kidneys failed. Over the next several months she spent significant time in the intensive care unit, underwent subsequent surgeries to treat her kidneys and was treated for depression.
The pressure to avoid unnecessary costs is getting more intense. Beginning in October 2008 the federal Medicare program will not pay providers for procedures involving a foreign object left behind from a surgery. Technology is being introduced into the market to replace the manual tracking of surgical sponges by having doctors and nurses manually count them. SurgiCount Medical and its distribution partner, Cardinal Health Inc., have developed a bar-coding system that helps operating-room nurses and technicians keep track of sponges and other items. Medline’s RF-Detect system, which alerts health-care workers via radio frequency that sponges are still in the patient before the doctor closes. Surgical sponges, tagged with a radio frequency detection system, can be found after a wandlike device is waved over the wound.
Medline says RF-Detect adds $50 to $60 per thoracic procedure. Cardinal officials say the SurgiCount system costs about $12 to $15 a procedure. For comparison, having to crack back into a patient’s chest cavity to retrieve a sponge and treat an infection caused by a foreign object can cost $50,000 or more. Industry figures indicate that more than 20 million chest procedures are performed in the U.S. each year. Procedures such as obstetrics and other surgeries could result in a potential market of more than 35 million applicable procedures, Cardinal Health said.
States are increasing pressure on hospitals to make them more accountable. Several states have instituted mandatory medical-error-reporting policies that require hospitals to disclose when they have made errors, or “never events,” like leaving a sponge in a patient. Effective January 1, 2008, Illinois became the third state to enact a “never events” law, which enumerates 24 mistakes.
The National Quality Forum has compiled a list describing 27 mistakes that are so serious they should never happen: 1. Surgery on the wrong body part 2. Surgery on the wrong patient 3. Wrong surgical procedure performed on a patient 4. Object left in patient after surgery 5. Death of a patient, who had been generally healthy, during or immediately after surgery for a localized problem 6. Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics 7. Patient death or serious disability associated with the misuse or malfunction of a device 8. Patient death or serious disability associated with intravascular air embolism 9. Infant discharged to the wrong person 10. Patient death or serious disability associated with patient disappearing for more than four hours 11. Patient suicide or attempted suicide resulting in serious disability 12. Patient death or serious disability associated with a medication error 13. Patient death or serious disability associated with transfusion of blood or blood products of the wrong type 14. Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy 15. Patient death or serious disability associated with the onset of hypoglycemia, a drop in blood sugar 16. Death or serious disability associated with failure to identify and treat hyperbilirubinemia, a blood abnormality, in newborns 17. Severe pressure ulcers acquired in the hospital 18. Patient death or serious disability due to spinal manipulative therapy 19. Patient death or serious disability associated with an electric shock 20. Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances 21. Patient death or serious disability associated with a burn incurred in the hospital 22. Patient death associated with a fall suffered in the hospital 23. Patient death or serious disability associated with the use of restraints or bedrails 24. Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider 25. Abduction of a patient 26. Sexual assault on a patient 27. Death or significant injury of a patient or staff member resulting from a physical assault in the hospital.
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