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Trisha Torrey

Surgery Bait-and-Switch - Who Will Perform Your Surgery?

By November 15, 2010

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Imagine scheduling knee replacement surgery after having extensive conversations with the orthopedic surgeon. On the day of your surgery, a resident surgeon shows up and gives you paperwork to sign giving consent for the operation. Post surgery, you don't recover. In fact, before it's over, you have had 24 surgeries and your leg has been amputated.

That's what happened at Parkland Memorial Hospital in Dallas to Jessie Mae Ned, according to the Dallas News.

Sadly, Jessie Mae's story isn't even that unusual. In fact, a spokesperson for Parkland says that Jessie is only one of almost 750 patients per year (their quote - 2 patients per day) who are seriously harmed while accessing treatment at Parkland. Those problems are considered "potentially preventable." And here's the kicker - Jessie Mae was an employee at Parkland. (With friends like that.... )

Like dominoes, once problems started, they compounded each other. It started when Jessie Mae expected the specialist surgeon would be the person who actually performed her surgery. But no.

Just prior to going under with anesthesia, a young resident showed up with the informed consent document for her to sign. When she asked where her surgeon was, she got no answer - but she signed the document anyway.

As it turns out, the surgeon, Fred Gottschalk, was nowhere to be found. The surgery was performed by the resident, who had just begun his second year as a surgeon. Further, it was almost three days after Jessie Mae's surgery before a doctor even visited her - and then it was a vascular surgeon who was called in because Jessie Mae's leg had ballooned and her toes had turned purple and cold. Later she became infected, and the rest of the dominoes began to fall. A year later, over Christmas holidays, her leg was amputated.

But this post isn't intended simply to focus on Jessie or Parkland. It's to help you be sure the same kind of catastrophe can't happen to you. This student-replaces-surgeon scenario takes place in teaching hospitals every day. We patients need to be on our toes.

[A side note here -- yes, students need to learn. They need the practice. They need to build their skill sets, too. You will need to weigh your needs against theirs. For my part I say - let them practice on someone else.]

The major clue, and the one episode that seems to be the pivot point that heralded the first problem, was that informed consent document. It didn't specify who Jessie Mae's surgeon would be. It stated that Fred Gottschalk was the "anticipated" surgeon. But, as we know, it was a student who performed - and botched - the surgery.

That's where our big lesson is for today. If you are going to have any procedure performed - a surgery, or even a difficult test - you have a right to know and to expect one specific doctor to perform it. If you meet with a surgeon ahead of time, it's your right to specify that surgeon take care of you.

The key is that informed consent document. You must read it carefully and be sure it says THAT doctor will be the one to perform your surgery. If it uses any kind of hedge words like "anticipated" or "or a member of his team" or anything at all that indicates someone else could step in to perform the surgery, then consider crossing out those words and writing something like "Dr. Joe Surgeon and only Dr. Joe Surgeon may perform my surgery."

Of course, if the staff knows ahead of time that you may be that specific with your expectations, they may wait until you've been partially anesthetized before presenting you with the document. If you are coming down to the wire before a surgery, inform the staff that you will refuse any drugs that may affect your ability to think through the informed consent document. Once you have reviewed and signed the document, watching the surgeon sign his or her part of it, too, then it's time to let them put you under with the anesthesia, or even those pre-anesthesia relaxation drugs.

It's too late for Jessie Mae. But it's not too late for you if you haven't had your surgery yet. Be informed - and specific - before you sign those consent forms.

Learn more about informed consent.

Have you suffered a trauma from a medical error and/or a lack of informed consent? Share your story.

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Comments
November 15, 2010 at 11:26 pm
(1) venkatachalam says:

This is the typical outcome of a Socialistic health care system which the US has now become. I have had a similar story of two patients, one from the UK and another from the Netherlands who had botched up surgery. One elderly patient from the UK lost his leg after a knee replacement. Here is the link. http://www.dailymail.co.uk/news/article-513850/Pensioner-flies-India-knee-op-didnt-trust-NHS-bungled-surgery.html

November 16, 2010 at 11:22 am
(2) mar says:

well, i dont think this is a result of “” socialistic medicine”" which the other person reffered to, the medical practices here in the USA are totally different than care in the Netherlands or British system, I did live in all three countries mentioned here and have received medical care inall countries,, stop bashing the USA! And for the articke concerning surgeons, it IS typical for teaching hospitals to have residents assist and do the surgery but supposed to be under supervison of the prinary surgeon. Myself , I had 2 surgeries in 2009 for cancer . The first surgery at U of P hosp, a teaching hospital was not a nice experience. I was on the operating table in the OR, waiting for my surgeon to show up, but surrounded by “” residents”" botched my IV to start with,, I jept askin g where is DR W? They said he’s on his way, do you want to wait to “‘ get the IV for anesthesia ” until you seehim?? I SAID HELL YES. I waited till he showed up in full on operating gear , he was a very arrogant Dr. I had to find a different surgeon for the second surgery. Good advice, make sure you know who is cutting you!

November 17, 2010 at 6:21 am
(3) marahd says:

in my city i have two very huge world renowned hospitals , both teaching hospitals, and for at least one they are now giving each and every patient forms to fill out when you visit any doctor, even one you have seen for decades, that you are to sign and are told if you alter one word in the documents that you wont get to see the doctor, because they are a teaching hospital and as such can have doctors teams perform anything ………… so what are we supposed to do with this kind of bullying then? i cant alter one word, even if i wanted to…….. and we are not talking about even surgery, its just to see the doctor and to agree to this in the future…….. what are we to do when they are onto this method of scratching out what we wont agree to? and they dont care if we go elsewhere, the thing is there is no ‘elsewhere’ in this town but these hospitals because all the independents are now part of this system now……….. there is no where to go. now what?

November 17, 2010 at 7:42 pm
(4) Doug PULSE of Florida says:

A patient has two opportunites to ensure the surgeon you choose performs your surgery.
The first upon admission, you can designate if you do not want students, interns or residents be involved in your care.
The second is when reviewing your sugical consent-make it clear to your surgeon who is to perform the entire surgery – in addition of no students, residents, nurse first assistants or manufacturer representitives.

November 21, 2010 at 6:33 am
(5) marahd says:

DOUGPULSE, THANK YU FOR THAT INFORMATION……. its scary though, that patients have to be so detailed as to who you dont want to touch you…… id think just saying you only want your surgeon period would be enough, i never thought a specialized nurse or a company rep would even apply………. thank you so much for the information.

November 24, 2010 at 12:59 pm
(6) Emily says:

Now that I remember, I never saw my surgeon’s name on any of the multitude of documents I signed right before surgery. However, when I got a copy of the operating report afterwards, it stated that he dictated the report and listed his name as surgeon with the names of 2 assistants.
Would this be assurance that the surgeon was at least in the room when I was operated on?

November 24, 2010 at 1:03 pm
(7) Trisha Torrey says:

Emily,

I don’t know that paperwork is any reassurance at all. Anyone can write anything down later…

I would ask him outright what role he played – then watch his body English to see how forthright he is with his answer.

Unless he’s a great actor, that will tell you far more than a piece of paper does.

Trisha

January 4, 2011 at 10:02 pm
(8) Parkland's Dr. Evil says:

Actually for harming at least 2 patients a day, that’s at least 760 (not 750) patients a year that are seriously harmed or killed by Parkland. Over 17 years, that’s at least 12,920 patients seriously harmed or killed in that time (if we extrapolate the data).

It’s a frightening number of patients harmed by medical errors, deceit, bait and switch fraud, or other reasons that are all avoidable and preventable.

Great job on the writing, Trisha. Very informative.

August 11, 2011 at 11:09 pm
(9) patientx says:

I recently had surgery after being told that my surgeon and his anesthesiologist would personally do my case. On the day of surgery they wanted me to sign a blanket consent allowing even the secretart to do the case; I crossed it all out and made corrections. On the anesthesia consent I specified that the anesthesiolgist would personally so the entire case (NOT SUPERVISE A CRNA) or supervise other cases. I specified: no students, ovservers,interns, med reps or anyone not directly involved and critical to my case to be in the OR or involved in any way. The surgeon and the anesthesiologist had to sign the consent. I certianly don’t want a nurse (A CRNA is just a nurse with 20 months additional nursing training in anesthesia) performing my anesthetic. Turns out, the anesthesiolist said that she wouldn’t let a CRNA do her case either, but that most hospitals let the patient believe that CRNA are really anesthesiologists. And CRNA are NOT safe working without an anesthesiologist. By this time, I totally did not trust the anesthesia “team” despite assurances that the anesthesiologist would do my case; albeit with a CRNA helping (but not working solo). Did the CRNA hate me? Nope, she told me that she had many years of experience as a CRNA but she also had a kid that needed frequent surgeries and that she always demanded an anesthesiologist for his cases, not a CRNA. That CRNA was upset that I had been mislead about who would be doing my anesthesia (she said it happens all the time). The CRNA seemed worried that I made them sign a redacted consent limiting my anesthesia to a Bier Block only without sedation and with fentanyl only if I asked for it. When the anesthesiologist tried to slip sedation into my IV (against my wished), she pushed his hand away and yelled at him.

November 3, 2012 at 11:52 pm
(10) maryd says:

Patients are allowed to alter anything that they want to on any consent form. I recently had a colonoscopy and specified no drugs. When I was asked to sign a procedure and anesthesia consent, I added “no drugs”. The CRNA nurse went nuts! She demanded to be present during my exam; but why, since I was refusing sedation? answer: so that she could bill for anesthesia “care”!

December 21, 2012 at 11:02 pm
(11) peggy RN says:

Marys comments above are exactly right. Don’t sign a blanket consent form for anesthesia or surgery! Cross out the parts that you do not agree with; you (the patient) are in control, not the surgeon, the endoscopist and certianly not the crna nurse pretending to be an anesthesiologist (crna are just nurses with 20 months or so of watered down nurse anesthetist training). I would not consent to a crna being involved in any of my cases..Yep, I’m an advance-practice NP..but nurses aren’t “anesthesia care providers” not by a long shot.

July 1, 2013 at 9:46 am
(12) KayMTASCP says:

We recently went to one of the most respected teaching hospitals in the Midwest. A member of my family is facing heart surgery. Before we went, I kept asking about a form that we could sign that stated you did NOT want to have any residents, nursing students, trainees of any type performing any procedures. I talked to a woman that said her title was something like “patient navigator”. All I got was a script speech from her that is an issue we would have to talk about with the surgeon but she was pretty sure that wasn’t something we were going to be able to ensure. When we met with the surgeon, he kept using the term “medical team”. That there was no way they could deliver “world class care” without using residents for part of the operation. He said he would perform the “critical part of the operation”. I was no accepting this form of bait and switch. I confronted him about it and he didn’t like it. I said that I had worked in the blood bank of a large medical center and knew for a fact that we had to cross match twice the number of units of blood when they let the students start cutting. He changed the subject to something about a “cell saving device” so their patients don’t usually need blood. I came away feeling that he had done exactly the same things as mentioned in the first posting. Even as an informed educated patient and family, I feel we have no options with this form of deceit.

October 10, 2013 at 9:33 pm
(13) Heidi says:

All of the comments here are typical experiences at teaching hospitals. If you go to a teaching hospital, you WILL be treated by students and residents. Any attempts on your part to limit their involvement will be met with outright contempt and a stern scripted speech about the importance of providing opportunities for learners and well, since you chose to avail yourself of the superior technology and skill at this academic hospital you agreed to participation by learners. Teaching hospitals have a habit of giving people versed and other amnesia inducing drugs BEFORE you arrive in the OR so you are either unable to comprehend who is in there and who is doing what, or even if you are, you simply won’t be able to remember it later. That is what happened to me and I bitterly resent the fact that I had my own doctor, was duped into going to a teaching hospital and then was a guinea pig for a bunch of medical students and residents who were in attendance at my surgery. I would never voluntarily set foot in another teaching hospital again. If you find yourself in one you will need to have an advocate there to protect you from their predatory practices.

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