Oops Doc, You Cut The Wrong Limb

CEBU, Philippines - Comedy writers often poke fun at surgical errors like cutting the wrong limb, wrong intestine, wrong breast, wrong heart or even cutting open the wrong person.

What would you do if while lying motionless on the operating table, the surgeon had a bad day, enraged and is about to open you up. What would you feel if you saw flying syringes and scalpels while surgery is underway because of animosities within the surgical team. How would you cope if after the anesthesia and antibiotic are administered, the surgeon is still not in. Or after closing up your incision, a sponge is retained in your body? Audiences who watch these comedy skits — sometimes including surgeons — actually laugh and laugh loudly until they lose their breath apparently enjoying the joke.

Not to be kill joy, this joke can kill. Certainly it’s nothing to laugh about. All this time, surgical safety has become a serious public issue worldwide and in Cebu and the Visayas, patient safety has become an enormous and urgent problem. Horrors in operating rooms – like deaths or permanently disabling complications owing to wrong site, wrong procedure and wrong patient — have often been hushed. Because there are no formal or compiled study on sentinel events or deaths and disabling complications owing to surgical errors, it is difficult to make an incisive look at trends on patient safety. While heads of the surgery departments among government and private hospitals here say that there are incident reports. That’s all there is to it – reports.

Tyranny of Numbers.

In what surgeons call “tyranny of numbers,” those here-a-report, there-a-report, everywhere-a-report when combined on a global scale will show that based on statistics by the World Health Organization, of the 234 million surgeries done each year globally, at least 0.4 to 8 percent in deaths or at least one million die from surgical errors. Likewise of the 234 million surgeries, about 3 to 16 percent or about 7 million are disabled for life each year globally owing to surgical complications.

Raising concern and alarm, some 30 surgeons, operating room nurses and anesthesiologists opened up to the blunders, lapses and realities in operating rooms during a Patient Safety Officer Workshop held at the Northwinds Hotel in Salinas Drive, Lahug. The Philippine College of Surgeons spearheaded the event to mark Patient Safety Day last June 25. Delegates representing private and government hospitals in Cebu, Bohol, Bacolod, Iloilo and Panay owned up that surgical errors prevail and that faithful and strict compliance to a Universal Protocol on Patient Safety still has to be implemented here to the letter. Criticizing themselves, surgeons and anesthesiologists deplored at how hospitals don’t make comparative benchmarks between the Universal Protocol and actual operating room practices.

Said Dr. Jesus Ravanes, “What benchmarks are we talking about? There are no patient safety benchmarks in Cebu.” Describing benchmarks as nothing more than wishful thinking Ravanes also said, “Some surgeons here have a problem with constructive criticism.” 

Taking a more incisive look at statistics, anesthesiologist Dr. Cesar William Ortiz underscored in his presentation that health care is 10 years behind other high-risk industries in terms of attention to basic safety. He referred to a 1999 study by the Institute of Medicine Report called, “To Err is Human,” where the first public realization of the true extent of patient harm and safety in health care setting was revealed. He cited the study to have disclosed that deaths occurring from medical errors (98,000) far outnumber deaths from motor vehicle accidents (43,000), Breast Cancer (42,000) and AIDS (16,000). Deaths from workplace injuries (6,000) are outnumbered by deaths from medication errors (7,000). There are less deaths from adverse events occurring in nuclear reactors and the airline industry where there are more safeguards, monitoring, proactive reporting and detailed de-briefings 

Sentinel Events.

Dr. Axel Elises went on to detail that the most prevalent surgical errors are wrong site-wrong procedure-wrong patient, wrong medication, health-care related infections and risks of falling from operating tables and foreign body retention. When patients die or are permanently disabled owing to surgical errors, these are called sentinel events.

Elises pointed out that based on a study by the Joint Commission International, 70 percent of sentinel events are caused by communication failure. Such lapses have actually happened in Cebu hospitals simply because the surgical team did not get a full briefing of procedures and in the absence of strict compliance to the Universal Protocol on Patient Safety. There were reportedly incidents here when the wrong patient was opened up and foreign objects like sponges and surgical instruments were retained in the body after surgery. Communication failure has also been found to have caused arguments between the surgeon and the anesthesiologist while surgery is underway putting the patient literally fighting for life.

What aggravates potential adverse events and sentinel events to occur is when the surgeon is late or in a hurry. There have reportedly been incidents when operating room nurses and anesthesiologists administer anti-biotic or anesthesia only to find out the surgeon couldn’t make it on time. There are also times when the surgeon is in a hurry that he leaves it to the operating room nurse to count the sponges and instruments before and after operation without double checking or verifying.

Wrong patient occurs when laboratory results are inadvertently switched or mistaken and the surgeon did not care to make a prudent check on the identity of his patient.

Thing is, because there are no punitive actions against surgical lapses, surgeons will have to police their ranks. Hospitals who want Joint Commission International accreditation will have to make sure Universal Protocol on Patient Safety is implemented. Then again, surgeons here were honest about opening up a festering wound in surgery malpractices. In Cebu, it will have to take five to 10 years for patient safety to take a full dose.