What do you think of this surgical flub-up?

jemb · Sep 10, 2004

OMG! Just the thought of a July surgery in a teaching hospital gives me shivers!

I'm so sorry all this is happening to your family.

I really don't have any advice, but I certainly agree that there was a major screw up. It sounds like a series of errors/oversights that started with a misdiagnosis.

Tweety, BSN, RN · Sep 10, 2004

The most important thing is your dad's health. Make all decisions regarding keeping this in mind.

I do know that hospitals usually fall all over themselves offering settlements for this kind of thing. It might be worth looking into, at least getting the hospital to pay your hospital bills. Too much energy looking backwards, looking for blame and isn't going to help either. You sound very level headed and well balanced about it.

I'm sure behind the scenes investigations are underway and heads are rolling. Retained sponges are big big big deals to hospitals, and something went horribly wrong here.

Best wishes to your dad and your family.

Trauma Columnist · Sep 10, 2004

So sorry for this indeed screw-up. Don't know what I would do...hopefully your dad will now recover uneventfully!

talaxandra · Sep 10, 2004

Hi Begalli,

sincerest sympathies to you and your family. I can understand your brother's point of view, but I think (as is so often the case!) that Tweety's advice is excellent - explore settlement issues witht he hospital. They'll be eager to avoid litigation, and it'll be less stressful for you all. Right now it sounds like the less other stuff you have to juggle the better.

I'd also like to add, as other posters have, that it sounds as though you're doing a great job of balancing yourself between your family demands, your own professional role and you other commitments.

I know it's hard, but try to look after yourself in all this as well. When the families of nurses get sick it's really difficult to let go of the nurse role - and if you manage it, everyone else thrusts it back on you again: staff who use you to help out or interpret, family members who feel lost, and in similar situations I've felt as though it's something I've needed to do to best serve my loved ones. Just keep in mind that carers get run down :)

leslie :-D · Sep 10, 2004

(((begalli)))

such a nightmare, and i am so sorry.

understandably the anger re: the sequelae of erroneous events has climaxed into an emotional catapult.

with that said, i would put litigation and/or settlements on the back burner for now....and concentrate on your dad and his recovery/comfort.

you can always pursue the legal stuff later. it's not priority.

the anger/frustration and injustices will be attended to; but hopefully you will use remaining energies directed towards the healing of your family.

wishing you and yours, much peace.

leslie xo

nurseygrrl, LPN · Sep 10, 2004

What an awful situation. You must be very emotionally drained. I'm sorry your dad and your family has to go through this. I hope he recovers now that they've removed the sponge. Good luck!

Da Monk · Sep 10, 2004

I worked for a number of years in the OR during my career. As the circulating nurse, I experienced the scenario several times of my closing count being incorrect, but the surgeon kept saying there was no sponge left in the patient. In each incident I was proven correct when a post op x-ray revealed the missing sponge to be inside the patient. There is no excuse for this type of incident. It is so simple to avoid such screwups. The whole system of performing counts in the OR is just to avoid such calamities. I hope your loved one is OK, but I would recommend retaining an attorney. The hospital and MD will try to weasel out of this somehow. I worked privately for a neurosurgeon. His comment on law suits was this: "The ones who sue you are the one's you've made angry, not necessarily the one's you've injured."

Jolie, BSN · Sep 10, 2004

I am so sorry for what your father and family have endured. We are in a similar position with a family member who has received clearly negligent medical care and is suffering because of it. I am too emotional right now to go into details, but want to offer you an option that we are considering. I am looking into medical mediation to resolve our disputes, which are complicated by the very real possibility that we were deliberately deceived by the facility involved.

On one level, I would like to go in with both barrels and sue the facility. On the other hand, that goes against my grain. What I really want is not monetary damages, but change. I want administrators punished by the appropriate authorities, I want changes put into place to lessen the possibility that the harm which came to my loved one will come to anyone else. I want the community to know the calibur of the facility they are trusting with their lives. And I want an acknowledgement that what happened was completely preventable and that the facility accepts responsibility for it. I know I'll never get an apology. I probably won't get anything else, for that matter.

Just know, I feel for you and will keep your family in my prayers.

MG-NotANurse · Sep 10, 2004

July 6, 2004 my dad underwent a Whipple procedure for what was thought to be pancreatic cancer (turned out to be a type of intestinal cancer more amendable to treatment).
He spent about a month+ in the ICU and has now been on the floor for about a month as well.
He's had a myraid of complications too numerous to list here. He's still very very sick. I never expected a cure from this surgery (actually, I recommended that my dad not do it), but I also never expected what I'm about to talk about.
Over the Labor Day weekend we had changed my dad's code status from a full code to just a chemical code (no cpr no intubation). I'm afraid every rib in his body would seperate from his sternum if anyone did cpr...I've seen this too many times...he would never survive it. I live 2000 miles from my mom and dad and I've made the trip home 5 times since July 6th. I just happened to be there this weekend and was finally able to get my mom and dad to really talk about what was going on and what my dad really wants. It was very sad but a huge relief for everyone at the same time.
So I leave on Monday to fly back home and I get a frantic telelphone call from my mom. It seems that the doctor wants to take my dad back to the OR because he thinks that there may be a sponge or a piece of a drain in my dad's belly!?!
Come to find out, I guess that my dad has had this "shadow" that appeared on an xray of his belly that was taken on post-op day one and this same shadow has appeared in subsequent xrays and CT scans. The surgeon thought it (the shadow) was part of a drain that they placed. Well, the drain fell out over this past weekend. They did another belly xray only to find that the shadow was still there.
My mom and dad painfully decided to return to the OR knowing full and well that he may come back intubated and with his respiratory status already dangerously compromised, knew that he may never come off that tube. I supported their decision. This was one of the hardest things that I've ever had to do. All I could do is point out the pros and cons of going or not going back to the OR.
I talked with the surgeon ealier this afternoon after surgery was done. There was indeed a sponge left in my dad's belly. They removed it today more than two months after his initial surgery and after having already returned to the OR a second time to fix a hernia. He came back extubated - thank GOD! I really didn't think that he would.
#1. Why did they wait so long to explore the possibility that this shadow could have been a sponge? It's been more than two months since the Whipple and he's had a very complicated post-op course. They knew the shadow was there.
#2. Why on earth did they wait until we changed my dad's code status to tell us about this if they new of this shadow since the beginning and why did they wait until I left town leaving my mom virtually all alone to deal with this news and to make this decision!?! They wanted to take him back to the OR to explore his belly which meant general anesthesia which meant INTUBATION for a person who just decided that wasn't what he wanted! :angryfire
#3. Who's at fault for this? I'm not an OR nurse, but I do know that the circulating nurse and the scrub nurse do the sponge count TWICE, right? Don't they wait before closing the patient to make sure the sponge count is correct? I have read the complete operative report. It's clearly documented that the sponge count was correct. Someone did not do their job and I would even go as far as to say that the documentation is false or falsified.
Now my brother is on the SUE EVERYONE rant. He's been talking about this for about a month already simply because my dad was not getting well (he hasn't a clue) and now after today - I don't know, it's probably pushing him over the edge. He's absolutely useless in supporting our parents. I just want my dad, my mom and everyone else to just get through this, no matter what the outcome.
My dad received excellent care during his stay in the ICU by awesomely amazing nurses there. I can't stress enough how much I appreciated these ICU nurses. Since being on the floor his care is sporadically good. It kind of bugs me as the quality of his care depends on who's on.
My dad is such a nice guy and the most compliant patient you'll ever meet. He's been through so much and has teetered on the edge, but his will and spirit to survive is so strong. My mom's daily presence is probably one of the reasons that he has lasted as long as he has.
I have done nothing but try to work as part of his health-care team keeping in close touch with his doctors, nurses, physical therapist, and social worker and making sure my mom, who's there very single day for 8-9 hours/day, knows what is going on. Sometimes, I wish I didn't know so much.
You know, I really trusted this attending physician at this teaching hospital. I now wonder what else they're not telling us. I feel so betrayed and a little bit stupid for trusting that I was really informed.
Phew! Long post. Maybe I'm not looking for any answers. Maybe I just needed to get this out. Any comments?

Hello Begalli.

What an awful series of events. I agree with Leslie and 3rdShiftGuy that your first priority is your father's condition. I wish him a speedy recovery.

3rdShiftGuy is correct that the hospital may offer a financial settlement, but please do not sign anything or agree to anything in your current anxious state. Please consult with an attorney before making any decisions; otherwise, you may be giving up valuable rights.

(You have some leeway: the statute of limitations varies from state to state, but, in New York, you have one year after you discover the foreign object. This is ample time to consider your options).

MG

Maggie in NC · Sep 10, 2004

If suing is something that would make your brother's anger subside, let him do it but, try to keep it away from your father. Seems like every family member feels like they have to contribute to "fixing" something when our parents/siblings are deathly ill.

If your family decides to get an attorney, don't tip your hand to the hospital and ask about the sponge count or why they took so long to tell you about the possible sponge. Let the attorney do it. I'd also ask him to write the medical board and nursing board in that state regarding falsification of documents. Leave any emotion out of conversations with attorneys. I know that may sound callous but, they charge you by the hour and you should spend your emotional feelings on a therapist, not an attorney.

Get something out of it other than money-a new policy at the hospital that requires double signatures on sponge count, a new policy requiring immediate notification to the family when x rays reveal something out of the ordinary, etc. It's a much better tribute to your family's ordeal than a settlement-they only have to write a check once but signing everyday for sponge count has a lasting effect.

I wish your father and your family well. You have obviously been through the emotional ringer and prevailed (so far huh?) with a clear head-which isn't easy when you are talking about a parent's illness with possible dire consequences.

begalli · Sep 10, 2004

I just want to thank everyone for the thoughtful responses.

Yes, this has been an emotional roller-coaster, especially for my mom. It's such a messed up situation right now.

I think about it in a couple of different ways. One is as the daughter--and that's reflected in my original post.

The other is as a healthcare professional. Imagine taking care of this patient now. If I knew that this had happened to one of my patients, I would be extremely nervous about the care I provide with the possibility of it, in the end, being totally scrutinized by the hospital, an attorney or whoever. I don't want this pressure put upon his caregivers.

Our main focus is getting dad well. He's already looking better just a little more than a day out of surgery which tells me that this sponge did have something to do with some of the complications he's experienced such as a dehisence of his incision and a fistula thats been unable to heal for two months now. I'm willing to bet that this was his body's way of trying to expel the sponge. These thoughts and feelings, I do not share with either my mom or my brother. I'm trying to keep them focused on dad's actual progess and daily condition.

My mom has asked my brother to slow down. Hopefully he will heed her request but I know that he had planned on informally talking with someone this weekend. He has promised me that he will not bring this subject up during any visits with our dad.

At any rate, thank you for allowing me to bounce my thoughts around here and thank you for your thoughts and sound advice as well.