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


Updated June 19, 2014

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

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.

•  Find this Safe Surgery Guide for Patients

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

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