Reporting an unsafe surgeon

[PamJRN]

I’m the charge nurse at a 4 OR surgery center. We have an ophthalmic surgeon who does cataract extractions with implant of lenses who has block time every week. She usually does 4-6 procedures each week. She is 74 years old. 
 

At least once a month, sometimes more often, a procedure will result in an unplanned anterior vitrectomy. She always has an excuse (it was a difficult eye, the patient was not a good candidate, etc). She has blocked the wrong eye more than once, prompting an investigation that basically blamed the circulator for not stopping her. We submit an occurrence report every time a vitrectomy happens as well as mark it on our huddle board as a “patient injury” - all to no avail. She continues to practice and send people home without a lens in their eye because of her incompetence. Our manager is aware and says we must “follow the process” but this has been going on, and getting worse, for the past two years with no guidance from above. 
 

My question is, can I as a nurse report this surgeon? I hate telling patients that they’re in good hands when I know it isn’t true. These people are trusting her with their precious eyesight. I feel that the nurses are being ignored regarding the lack of safety concerning this surgeon. 

[sleepwalker, MSN, NP]

Delaware has a mandatory duty to report requirement: 

"Delaware law mandates you to report a medical practitioner when you reasonably believe that the practitioner is (or may be) guilty of unprofessional conduct or unfit to practice (24 Del. C. §1731A). The term medical practitioner means anyone who is licensed by the Board of Medical Licensure and Discipline, including physicians, physician assistants, respiratory practitioners, acupuncture practitioners, and genetic counselors. Unprofessional conduct is explained in 24 Del. C. §1731."

Check with your regulatory agency for the state you're practicing in to see if they have something similar. 

[PamJRN]

That is a great idea, I’m in Illinois so I will check on that immediately. Thanks. 

[Rose_Queen, BSN, MSN, RN]

You most likely have a medical director in addition to your manager. This needs to be on their radar 

[JKL33]

On 7/28/2021 at 1:05 PM, PamJRN said:

Our manager is aware and says we must “follow the process” but this has been going on, and getting worse, for the past two years with no guidance from above. 

Don't forget to also report your surgery center to medicare and/or your state regulators. After all, things like this basically continue on for one reason: Money. You said they've known about it for some time. They are apparently unwilling to do what's right. That's even more dangerous to patients on the whole than a single surgeon.

[Hannahbanana, BSN, MSN]

Of COURSE a nurse can report this. You must. That’s part of your nurse practice act, protecting patient safety. Medical Board, risk manager, Medicare who’s probably paying for most of them, the insurance company who covers liability for the clinic…. 
If somebody loses an eye and sues you can bet the deposition will ask you about this and other things such as you describe. Never let her proceed c a wrong procedure, even if you have to physically restrain her. 
You should be doing a time out before anything happens, so that should take care of the wrong-eye thing. 
Somebody, likely the clinic medical director, DON, and risk manager have to sit down  c this physician ASAP.

[delrionurse]

On 7/28/2021 at 12:05 PM, PamJRN said:

I’m the charge nurse at a 4 OR surgery center. We have an ophthalmic surgeon who does cataract extractions with implant of lenses who has block time every week. She usually does 4-6 procedures each week. She is 74 years old. 
 

At least once a month, sometimes more often, a procedure will result in an unplanned anterior vitrectomy. She always has an excuse (it was a difficult eye, the patient was not a good candidate, etc). She has blocked the wrong eye more than once, prompting an investigation that basically blamed the circulator for not stopping her. We submit an occurrence report every time a vitrectomy happens as well as mark it on our huddle board as a “patient injury” - all to no avail. She continues to practice and send people home without a lens in their eye because of her incompetence. Our manager is aware and says we must “follow the process” but this has been going on, and getting worse, for the past two years with no guidance from above. My question is, can I as a nurse report this surgeon? I hate telling patients that they’re in good hands when I know it isn’t true. These people are trusting her with their precious eyesight. I feel that the nurses are being ignored regarding the lack of safety concerning this surgeon. 

If they're blaming the nurse, when it was actually the surgeon, you should report it. A wrong procedure (wrong eye) or wrong candidate is not an excuse. It should always be right procedure, right candidate. 

[amoLucia]

The OP hasn''t posted back since first in July 2021.

I don't know which route would be more result-fruitful. In-house, altho OP says it has been going on for a while. Or going outside to Board of Medicine or Medicare. DOH??

If the paper trail can be started and then presented (with distribution), then the chances for remediation can be improved, I believe.

[Hannahbanana, BSN, MSN]

Whatever it is, you can believe that when somenbody sues your facility for ruining their eyesight, those reports WILL be revealed in deposition, and the nurse manager and all nurses on the chart for that patient WILL be deposed under oath as part of discovery. And they WILL ask, "Has this ever happened before? Did the nurse do the required time-out to ascertain which eye? Did the nurse know it was the wrong eye and communicate that to the surgeon/ did the surgeon make a move to proceed anyway, and did the nurse stop her? How / Why not?" If the OP is watching this thread from afar, or if anyone else finds him/herself in a similar situation, be sure to do the right thing.

And if you DON'T know what that is (and even if you do) be good and darn sure your malpractice insurance is active. No, no matter what they tell you, the facility is not under any legal obligation to cover any judgment against you for YOUR malpractice, although they will have to pay damages to the patient for allowing their employee to be party to the injury.

[canoehead, BSN, RN]

I wouldnt make a report to any official entity, out of fear for my job and interfering with "the process." I'd email my manager every time I observed an incident in addition to in house incident reports. If asked Id be able to say I reported up the food chain, and be able to produce the documentation.