Retained surgical sponges and
instruments are a common occurrence in surgical practice despite all the count
policies, electronic counting and adjunct methods used in the operation
theater. When discovered years later, they raise many medicolegal questions.
Lawsuits are brought forth by patients
against the operating surgeons and medical facilities and the question about
who is responsible for sponge and instrument count is often debated in the
court of law. The captain of the ship or the surgeon is no longer responsible
for a correct sponge or instrument count at the end of surgery and members of
the entire operating team can be held liable in litigation for retained foreign
bodies.
In August 2005, Maurine Villapando went
to the emergency room at Raritan Bay Medical Center (Raritan Bay), New Jersey
complaining of severe abdominal pain on her right side. Physical examinations
and imaging studies revealed an ovarian cyst. The attending obstetrician/gynecologist (OB/GYN) surgeon Dr. Nath,
performed a laparotomy, an open incision directly into the abdomen, to remove
the cyst.
As per the hospital policies, a
laparotomy involved three distinct "counts" of instruments and lap
pad sponges performed by the nurses, who, in this case, were defendants
Virginia Ko Chua, the circulating nurse, and Liza Abundo, the scrub nurse.
The initial count was done before the
start of surgery, the second count occurred during the initial closure of the
peritoneal lining, wherein the nurses would count aloud for everyone in the
operating room to hear. The third and final count occurred when the surgeon was
ready to close the skin.
After the third count, the nurses
would verbally inform the surgeon that the count is correct, puts a hash mark
against each item on the “count-sheet” to ensure that nothing is missing. At
the end of the procedure, the circulating nurse would sign the sheet indicating
that the surgeon was verbally notified of the final count status, and the
surgeon would acknowledge the count report by signing the count sheet.
In this case, the circulating nurse
committed an error while adding the hash marks on the “count-sheet” and
reported that all the 13 sponges were accounted for. The hash marks denoting
the tally revealed a count of only twelve sponges retrieved, thus one was
missing. However, the circulating nurse mistakenly wrote the number “13” next
to the hash marks after adding them incorrectly. Neither nurse noticed the
counting error and after verbally being advised that the count was correct, the
gynecologist acknowledged the count by signing the count sheet.
After surgery, the plaintiff developed
a fever and continued to have pain, but a repeat CAT scan did not reveal the
forgotten sponge. She was then discharged after her symptoms resolved.
On February 20, 2013, the plaintiff
sued the hospital, the surgeon who performed the laparotomy, the circulating
nurse, and the scrub nurse. She eventually settled with all the other
defendants except the OB/GYN surgeon, Dr. Nath who proceeded to trial.
At trial, the gynecologist testified
that he relied on the nurses' count and didn’t himself do the math. The plaintiff expert witness, an OB/GYN
himself admitted that at the other two hospitals where he has worked, it was
the nurses, not the surgeons, who were responsible for the sponge count, but argued
that the doctor’s mistake was in not reading the form in detail before he
signed it.
Two expert witnesses from the
defending gynecologist side testified that the doctor simply signed the form to
acknowledge that the nurse told him the count was correct and the surgeon is
not required to double-check the nurses tally.
At the end of the trial, the jury did
not find Dr. Nath guilty of medical negligence, and according to the
established standard of care, the doctor is not required to confirm the nurses’
count. The doctor’s signature only meant that the doctor had received an oral
confirmation from the nursing staff that the count was complete was
correct.
While this legal case revolved around
the individual responsibility of the operating team, it requires teamwork to
prevent such type of complications. Whether cases of retained surgical sponges
occur because of negligence, mistake or merely human error is irrelevant in the
overall picture. What is relevant is that healthcare providers can now
potentially eliminate the risk entirely using new computer-assisted advanced
technologies.
 |
SITUATE™ DETECTION SYSTEM X
|
Medtronic’s Situate™ Detection System
utilizes low-frequency radio waves to detect sensors embedded in the sponges.
Another method, Stryker’s SurgiCount Safety-Sponge System®, utilizes a
technology that tracks each medical sponge used with a unique identifier. In
the case of SurgiCount, the manufacturer offers a $5 million indemnification
guarantee to hospitals that implement it.
In the end, surgeons being the captain
of the ship, face increased liability, ultimately assuming responsibility for
any negligence committed by those working under their directions. Hence, it is
incumbent upon the surgeon to do everything in his capacity to protect the
health of patients and protect himself or herself—as well as his or her support
team—from potential medical malpractice claims.
