Boston Surgeon Update 2: Hospitals not forced to inform of suspensions

[NRSKarenRN, BSN, RN]

A Massachusetts lawmaker has jumped into the controversy over a patient who was left on an operating table while the surgeon ran an errand. Senator Richard T. Moore has vowed to file legislation requiring hospitals to tell patients when doctors lose their hospital privileges.

Hospitals not forced to inform of suspensions

By Anne Barnard and Quynh-Giang Tran, Globe Staff, 8/16/2002

http://www.boston.com/dailyglobe2/228/metro/Hospitals_not_forced_to_inform_of_suspensionsP.shtml

Jumping into the controversy over the surgeon who left his anesthetized patient on the operating table to go to the bank, the Senate chairman of the state Health Care Committee yesterday vowed to file legislation requiring hospitals to tell patients when doctors lose their hospital privileges.

Senator Richard T. Moore also said he would consider filing a broader bill that would require hospitals to tell patients about unexpected events and errors in their medical care.

Charles Algeri, the abandoned patient in the July 10 incident, yesterday filed a complaint with the state against Mount Auburn Hospital, contending that hospital officials should not have waited four weeks to tell him that Dr. David Arndt had left him unconscious on the operating table for 35 minutes.

The Department of Public Health will investigate the allegations. But the larger issue of whether and when the hospital should have told Algeri about the incident or about Arndt's suspension is murkier. There are currently no state regulations or national hospital standards that require hospitals to inform patients of a doctor's suspension.

Mount Auburn president Jeanette Clough defended the hospital, saying officials did their best to protect Algeri's interests, including transferring his care to another orthopedic surgeon, Dr. Robert Miegel. However, Algeri said yesterday that he did not remember anyone introducing himself as his new doctor.

''I would have asked, `What happened to my old doctor?' '' he said. ''They didn't want me to know.''

The Arndt case intensified interest in what was already a hot issue in medicine. Arndt's trip to the bank was not exactly a medical error - regulators called it a lapse of professional conduct - but the lapse raises similar issues.

''This is an area under intense discussion - whether or not patients should be informed about errors that may or may not have affected the outcome - how much, when, and so on. There's a lot of controversy,'' said Dr. Richard Coteau, executive director for strategic initiatives at the Joint Commission for Healthcare Accreditation, which accredits hospitals.

Last year, the Joint Commission adopted a new standard that requires hospitals to tell patients about adverse outcomes, but it does not require them to tell patients whether the outcome was the result of human error.

Coteau said the rule was in response to concerns that hospitals sometimes were not telling patients about unexpected problems that might not be obvious to the patient - such as a spleen having to be removed unexpectedly during surgery, which could affect a patient's immune system.

However, it's not clear whether hospitals are following the year-old rule, said Nancy Ridley of the state Department of Public Health, who oversees Massachusetts hospitals. Under a $4.5 million federal grant for reducing medical errors, the department is trying to find out by surveying patients on what they were told about their cases - and comparing that to medical records.

''We're trying to find out what patients are being told and what they want to be told,'' Ridley said.

Algeri yesterday also disputed Mount Auburn's view that he was unharmed by the surgery. He said he has chronic leg pain that he did not have before the surgery. His lawyer, Marc Breakstone, said he was waiting to decide whether to file a lawsuit until it becomes clearer whether Algeri will recover completely.

Clough said Algeri was not initially told of Arndt's unusual departure from the operating room because Algeri appeared to be recovering normally and the hospital's usual policy is not to tell patients about unusual events during surgery unless the patient has been harmed.

''We believed that it was in the patient's best interests not to do anything that would interrupt his care and recovery,'' Clough said in a statement. ''We have endeavored to do the right thing and to protect the interests of our patient, Mr. Algeri, and other future patients. We deeply regret that Mr. Algeri perceives Mount Auburn as having acted otherwise.''

Coteau said the Joint Commission is investigating the Arndt incident to determine ''whether the hospital responded appropriately and whether there are any systemic issues that would potentially place other patients at risk.''

Clough said yesterday that Arndt had not yet passed the written portion of the exam for board certification in orthopedics, but that he was allowed to perform surgery because he had completed an orthopedics fellowship and was thus considered ''board eligible.''

She apologized to patients and staff for the stress from the incident and said the hospital was examining areas where it could improve policies or performance.

''Clearly, we have learned some lessons from this experience,'' she said.

Anne Barnard can be reached at [email protected].

This story ran on page B1 of the Boston Globe on 8/16/2002.