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The sorry state of U.S. surgeons

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My MRI showing Tarlov cyst (which U.S. doctors failed to note)

My MRI showing Tarlov cyst (which U.S. doctors failed to note)

Surgeons at Beth Israel Deaconess Medical Center operated on the wrong location on three patients who underwent spine surgery from September 2010 through December 2010.

The surgeons apparently miscounted the patient’s vertebrae and operated on a vertebra directly above or below the diseased segment according to Dr. Kenneth Sands, senior vice president of health care quality at the Boston hospital.

Dr. Sands declined to identify the surgeons – one of whom operated on two of the patients – but he said both are experienced and had followed standard procedures in the operating room.

“Wrong-level” spine surgery is one of the most common types of surgical errors, partly because the 33 vertebrae appear remarkably similar. Each vertebra is little more than an inch tall, with only a small separation between the bony structures.

Still, between 2006 and 2008, just 11 such spine surgery errors were reported to the state, making Beth Israel’s three errors in two months unusual.

Sands attributed the three recent cases to human error and said the hospital could not find a connection among them. Since October, when the third error occurred, the hospital has improved its procedures and informed investigators of the changes, he said.

“It is really strange, and we don’t have an answer as to why these happened” around the same time, Sands said. Even while following the appropriate steps, he said, “it’s still possible to make a human error.”

Doctors discovered two of the errors by reviewing post surgical X-rays after the patients complained of continuing back pain. Those two patients were then given second surgeries on the correct vertebrae. The third patient’s back pain got better, although the surgeon had operated on the wrong location. That error was recognized during routine postoperative X-rays.

Sands claimed incredulously that none of the three patients suffered harmful side effects as a result of the mistaken surgery.

But Andrew C. Meyer Jr., a lawyer representing one of the patients, said that is not true for his client, a 37-year-old woman who underwent surgery to remove herniated disc material at the end of September. She then underwent a second discectomy at the hospital after doctors noticed the error.

The client, who did not want to be identified, has limited mobility as a result of the error, he said.

“Every time you have back surgery, scar tissue develops,” Meyer said. “Having to have a second surgery means there is going to be even more scar tissue,” which reduces flexibility, he said. He added that his client suffered other complications in the surgery and still experiences pain.

Ignoring the development of post-surgical scar tissue is one of the main faults of U.S. surgeons.

This is possibly due to the fact that post-operative patients are given strong and addictive opiates. These opiates mask the pain and allow patients to move around (generating even more scar tissue), than would otherwise be the case.

In a Beth Israel Deaconess report that the hospital’s patient safety coordinator said the neurosurgeon in the case and the fellow assisting him had different understandings of how to count and mark the correct vertebrae. (Time to teach doctors to count?)

“The neurosurgeon did not recheck the location of the clamp because he thought he and the fellow were using the same reference point,” the report said. “When the fellow removed the clamp to proceed with the discectomy, this placed him above the level that was intended.”

The hospital reported the errors to the state Department of Public Health, which conducted an onsite investigation. The department’s report is not public until the hospital submits a plan of correction, which was due on January 7th 2011.

Federal inspectors also reviewed the cases, because they coincidentally conducted a routine inspection of the hospital last month.

A previous review of surgical errors found that Massachusetts surgeons operated in the wrong location on patients 38 times between 2006 and 2008; the 11 botched spine surgeries were the largest category of mishandled operations. New England Baptist accounted for four of the 11 spine operations. In all four cases, the patients came in to have vertebrae fused, and vertebra either directly above or below the diseased bone were operated on instead.

Despite intense efforts by many hospitals to stop wrong-site surgery and wrong-patient operations, the surgeons continue to make the same mistakes.

A study published earlier this year in the Archives of Surgery found 107 wrong-site and 25 wrong-patient surgeries in Colorado over a 6 1/2-year period.

Most insurers will not pay for these types of errors now, potentially leaving the damaged patient with a crippling hospital bill.

Incompetence by U.S. surgeons is nothing new. Back in 1985, Dr. Norman Scott operated on the wrong knee of well-known actress Peggy Cass. She won a $450,000 judgment of the error.

I was more fortunate than most as I had my spinal Tarlov cyst operation in Mexicali, Mexico and with an excellent result. My doctor did not prescribe strong addictive pain narcotics and forbade me to exercise. After the operation, I had to spend four weeks in bed, and not hop around thanks to narcotics as many do in the U.S.

In the U.S. neither the MRI technician nor my doctor spotted the obvious Tarlov cyst on my MRI. In Mexico, it was picked up immediately by the MRI technician.

Viva Mexicali!

5 comments to The sorry state of U.S. surgeons

  • Gina

    Maryann, how r u doing now?
    i understand how they give u the runaround, and I am very happy to read that u got the CORRECT DIAGNOSIS.
    Many Tarlov sufferers here who have 2 or 3 surgeries, they come out worse than before.
    sincerely,
    Gina

  • You might try Hospital De La Mujer, the women’s hospital. It is spotlessly clean and is located just east of the east border crossing to Mexicali. Turn left as you are headed for Mexicali, and you will see Hospital De La Mujer on your right (north) – it’s a large place, and you can’t miss it. We got a blood test there for $60 as compared to the $600+ we paid in the US. The east border crossing is south of Highway 8. There should be a sign – it is not the main border crossing to Mexicali which is to the west in Calexico.
    God Bless,
    MaryAnn

  • Mari

    Hi Maryann you are a god sent!!! i think i’ve told ya that before but none the less you need a reminder every now and again! I am in need of a GYN can u pls recommend a place for me to go HELLPP!!!

  • SoCal

    I went to India to get my knee replacement surgery. Went very well. My insurance wouldn’t cover the costs for my surgery.

  • JN

    These surgeons should go back to high school, and learn how to count!

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