Why one surgeon wants to fine hospitals $100k for every surgical error

Study: More than 4,000 surgical 'never events' occur in the U.S. each year

U.S. surgeons each year make more than 4,000 preventable surgical errors—"never events" such as removing the wrong limb or leaving a sponge in a patient during a procedure—and some experts say it's time to get tougher on discipline.

For a study in the journal Surgery, Johns Hopkins University researchers looked at 9,744 medical malpractice cases filed between 1990 and 2010 in the National Practitioner Data Bank. Researchers found that as a result of those surgical errors:

  • 6% of patients died;
  • 32.9% had permanent injury; and
  • 59.2% suffered temporary injury.

Nearly half the errors involved a surgeon leaving a foreign object in a patient, about 25% were wrong-site surgeries, another 25% were wrong procedure errors, and less than 1% involved a surgeon operating on the wrong patient.

Researchers estimate that at least 4,082 such preventable mistakes occur each year based on the number of paid claims and data from a previous study that found only 12% of surgical adverse events actually result in indemnity payments.

And that estimate is low, according to lead author Martin Makary. Many patients never file claims and not all errors are discovered—as many as one in three or four left sponges may never be discovered, Makary says.

These surgical errors are "totally preventable" according to Makary—hospitals have protocols and tools at their disposal to prevent "never events." Many hospitals enforce a pre-surgery "timeout" to double check all surgical details with the patient and some have barcoded surgical tools so surgeons can quickly identify anything left behind with an X-ray.

The study covers years before many of those prevention efforts were put in place, according to AHA's vice president of safety and quality Nancy Foster. "Clearly, every hospital leader in the country knows one such incident is too many, and now the challenge is to make sure we understand which strategy we can implement that would be effective in diminishing the numbers even further," according to Foster.

Perhaps surgeons would be more vigilant in preventing "never events" if hospitals were fined steep financial penalties, Harvard University patient-safety expert Lucian Leape says. He suggests a $100,000 penalty for a wrong-site surgery and double that for a repeat offender. Fines like those "would make the news" and hospitals would "get serious about" preventing surgical errors, Leape says (Landro, Wall Street Journal, 12/19).

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