Doctor removes the wrong kidney from kid

BostonB · 03-09-2010 02:15PM

drkpower wrote: »

Nonsense!
His suspicions were raised by seeing a healthy kidney; there are many other ways he could have sought to confirm or deny his suspicions (look at x-rays, look at x-ray reports, ask nursing staff, parents, check other parts of the chart); he simply read one doctor's handwritten note. Not good enough, by a long shot.

+1

You'd have thought there would have to be two independent sources for the cross check. Two checks from the same source is pointless.

prinz · 03-09-2010 02:21PM

drkpower wrote: »

:eek: Yes, best to rely on something written somewhere by someone else rather than making an independent clinical judgment on the basis of the evidence of his own very eyes.

If by written somewhere by someone else, you mean the notes written by the consultant presumably in charge of the kid's case, and on the consent form signed again presumably by the consultant and the parents.... then yeah it is probably best. It's easier to check the paperwork beforehand than take a time out in the middle of an operation such as this I would suspect. Surely it's not a case of a post-it on the body with "FAO Surgeon, Take out left"...
It was a cock-up to present the kid to this surgeon to begin with IMO. Would it not be a matter of scheduling a time, arranging a theatre, making sure the right equipment is present, the right staff etc?

I don't fancy having surgeons with no knowledge of the case making decisions last minute and double guessing instructions from whomever was in charge of my case. If he had done this and taken out the wrong one there'd be hell to pay presumably as to why he didn't abide strictly to the instructions he was given.

What would the repercussions be for the surgeon if he had popped the kidney back in and refused to take either out until someone clarified matters?

03-09-2010 02:25PM

drkpower wrote: »

Lol - your opinion is wrong!
He double checked against the handwritten note of the same consultant, rather than trusting his eyes & clinical judgment, or looking at the x-rays, or asking the parents, or asking the nursing staff, or checking a report of the x-rays.....

Every doctor makes their own independent decison; and live and die by it - the consultant is not blameless but in any percentage blame game, the operating surgeon, whose responsibility the operation is, wins.

All while the kid is lying open on the operating table under a general anaesthetic? Or does he sew him up and start again when it's sorted out? Surgery is inherently a risky procedure, the longer he's on the table, the more dangerous it is.

his eyes & clinical judgment - He didn't diagnose the kid, the consultant did. Second-guessing a diagnosis with a patient on the table is very dangerous, and no hospital should allow it unless there is something incredibly obvious wrong
looking at the x-rays- which wouldn't be in the OR, and may take hours for the Xray department to find?
asking the parents - that's a joke, right?
asking the nursing staff - that's another joke, right?

congress3 · 03-09-2010 02:26PM

biko wrote: »

This is why they often write onto the patients skin in marker pen.
Apparently not done here.

It wouldn't have made a difference the notes said he was supposed to take out the left one. So even if they had marked him they would have marked the wrong kidney.

_feedback_ · 03-09-2010 02:32PM

Richard Noggin wrote: »

God almighty. Are you kidn' me ?

kidney failure

--Kaiser-- · 03-09-2010 02:32PM

elviscostello wrote: »

urea-ly are on top form with the puns today AH

It's nephron to let you down

drkpower · 03-09-2010 02:47PM

prinz wrote: »

What would the repercussions be for the surgeon if he had popped the kidney back in and refused to take either out until someone clarified matters?

Dont get me wrong, the operating surgeon was put in a bad position, thats for sure. There is plenty of blame to go round in this case.

But he had a multitude of options to him; the best would have been to look at the x-rays which were available to him - that would have told him immediately. So there would have been no need to go off making further investigations.

But even if there had been such a need, and to answer your Q. above, keeping the kid under GA for half an hour or an hour, while investigations were made/the parents were asked would have absolutley no repurcussions for the kid or for the doctors. It would have been highly prudent.

irelandrover · 03-09-2010 02:47PM

drkpower wrote: »

Lol - your opinion is wrong!
He double checked against the handwritten note of the same consultant, rather than trusting his eyes & clinical judgment, or looking at the x-rays, or asking the parents, or asking the nursing staff, or checking a report of the x-rays.....

Every doctor makes their own independent decison; and live and die by it - the consultant is not blameless but in any percentage blame game, the operating surgeon, whose responsibility the operation is, wins.

you LOL and tell me I'm wrong and then suggest asking the parents. I presume that was a joke. What would you ask the nurses? surely if you were to ask anyone it would be the consultant who handled the case.

prinz · 03-09-2010 02:50PM

drkpower wrote: »

But even if there had been such a need, and to answer your Q. above, keeping the kid under GA for half an hour or an hour, while investigations were made/the parents were asked would have absolutley no repurcussions for the kid or for the doctors. It would have been highly prudent.

Something very Dr. Nick about the scenario of the surgeon going to ask the parents what kidney he's supposed to take out. :pac:

Surely if a surgeon was double guessing his instructions from a superior and got it wrong there'd be some fall-out, professionally?

CrazyRabbit · 03-09-2010 02:52PM

irelandrover wrote: »

He was told the left kindney and then double checked the paperwork which also said left kidney.
In my opinion 99% of the blame lies with the consultant. Maybe 1% with the surgeon.

True, that the Consultant is ultimately to blame for specifying and confirming the incorrect kidney.

However, the surgeon himself has stated that the kidney he was told to remove looked pefectly healthy. That should have triggered alarm bells and made him seek confirmation. A diseased kidney looks very different from a healthy one, and should be obvious to any surgeon.

drkpower · 03-09-2010 02:52PM

28064212 wrote: »

All while the kid is lying open on the operating table under a general anaesthetic? Or does he sew him up and start again when it's sorted out? Surgery is inherently a risky procedure, the longer he's on the table, the more dangerous it is.
his eyes & clinical judgment - He didn't diagnose the kid, the consultant did. Second-guessing a diagnosis with a patient on the table is very dangerous, and no hospital should allow it unless there is something incredibly obvious wrong

looking at the x-rays- which wouldn't be in the OR, and may take hours for the Xray department to find?

asking the parents - that's a joke, right?

asking the nursing staff - that's another joke, right?

The X-rays were in the OT; read the bloody newspaper! Some people, eh......

The rest of your post irrelvent now but I would also like to point out that it is also inaccurate and a little stoopid. You think asking the parents or the nursing staff is a 'joke'? :eek: Why the hell wouldnt you.....? As for 'diagnosis', it is a continuing process; where something new presents itself that may change the diagnosis (ie. like the real life look of a kidney in your hands), you DO NOT charge on regardless - you pause and think.

drkpower · 03-09-2010 02:56PM

irelandrover wrote: »

you LOL and tell me I'm wrong and then suggest asking the parents. I presume that was a joke. What would you ask the nurses? surely if you were to ask anyone it would be the consultant who handled the case.

It is laughable that people think asking the nurses is a joke....! Does anyone knopw the role of the nurses within a healthcare team? Or do you have a very 1800s view of modern medicine.

I find it truly disturbing that people think asking the parents is a joke....! You are all aware that the consultant initially told the parents what kidney (ie the correct one) was affected so THEY KNEW precisely what kidney should have been removed and could ahve alerted the staff to the problem, right......? And you are all aware that the consultant himself has since expressed his deep regret at not asking the parents. Or have any of you actually read the article?

amovingstatue · 03-09-2010 03:00PM

http://www.startribune.com/lifestyle/health/16769816.html

http://consumerist.com/2008/03/doctors-remove-wrong-kidney.html

drkpower · 03-09-2010 03:01PM

prinz wrote: »

Something very Dr. Nick about the scenario of the surgeon going to ask the parents what kidney he's supposed to take out. :pac:

Surely if a surgeon was double guessing his instructions from a superior and got it wrong there'd be some fall-out, professionally?

Looks a lot less silly than removing an unaffected kidney. I am genuinely amazed at the attitude towards asking the parents; if you were undergioing an operaton under spinal anaesthetic, do you thin kyou should be asked if genuine confusion arose like in this case, or should the doctors just fire on ahead? If you should be asked, why wouldnt you ask the parents of a kid.

As for proferssional fall-out: doctors are independent practitioners, each one of them - while standing up top a senior is difficult at times, it is his obligation - its no longer good enough (especially having learned the lesson of Neary, hopefully) to bow to the pressure of a superior. Medicine is not the army.

prinz · 03-09-2010 03:06PM

Tbh it wouldn't fill me with any confidence whatsoever in the staff. I'd rather tell them to stop and go to another hospital. As for bowing to the pressure of a superior, unfortunate indeed, but it happens, often with more tragic consequences.

drkpower · 03-09-2010 03:08PM

prinz wrote: »

Tbh it wouldn't fill me with any confidence whatsoever in the staff. I'd rather tell them to stop and go to another hospital.

Which is your choice; but do you think that YOU should be asked if genuine confiusion arose about an issue pertinent to YOUR treatment? Or should they have proceeded without asking you?

_feedback_ · 03-09-2010 03:12PM

Man, it's getting serious as kidney disease in here.

. . . . . . . . and rhythm is a dancer.

Nah, doesn't have the same ring to it.

prinz · 03-09-2010 03:15PM

drkpower wrote: »

Which is your choice; but do you think that YOU should be asked if genuine confiusion arose about an issue pertinent to YOUR treatment? Or should they have proceeded without asking you?

Ask away. Seriously unprofessional though.

03-09-2010 03:18PM

drkpower wrote: »

The X-rays were in the OT; read the bloody newspaper! Some people, eh......

It's mentioned in one article, and not one linked to in this thread.

drkpower wrote: »

The rest of your post irrelvent now but I would also like to point out that it is also inaccurate and a little stoopid. You think asking the parents or the nursing staff is a 'joke'? :eek: Why the hell wouldnt you.....? As for 'diagnosis', it is a continuing process; where something new presents itself that may change the diagnosis (ie. like the real life look of a kidney in your hands), you DO NOT charge on regardless - you pause and think.

The surgeon asking the parents' opinion would be insane in the middle of an operation. The parents had signed the consent form which stated the left side. You do not ask an unqualified, emotionally-involved bystander for a medical opinion.

drkpower wrote: »

It is laughable that people think asking the nurses is a joke....! Does anyone knopw the role of the nurses within a healthcare team? Or do you have a very 1800s view of modern medicine.

I find it truly disturbing that people think asking the parents is a joke....! You are all aware that the consultant initially told the parents what kidney (ie the correct one) was affected so THEY KNEW precisely what kidney should have been removed and could ahve alerted the staff to the problem, right......? And you are all aware that the consultant himself has since expressed his deep regret at not asking the parents. Or have any of you actually read the article?

The article which is not linked to in this thread?

A nurse is not qualified to tell a healthy kidney from an unhealthy one by "looking". Neither is a surgeon for that matter. A parent most definitely is not

Unless you can find a quote saying different, the consultant has not "expressed deep regret at not asking the parents". Even if he had, at no stage does that shift blame on to the operating surgeon

humanji · 03-09-2010 03:44PM

In fairness, asking the parents really is a bit of a joke. As said above, they don't have medical knowledge and can't be trusted to know fully what is going on. Plus the emotional damage of a surgeon phoning you during your childs operation to ask you what he's meant to be doing, isn't really something you should have to go through.

If the surgeon had doubts, he should have asked the staff in the OR, checked any charts available in the OR (this would all take a minute or two) and if there was still confusion, get in touch with the consultant. Going ahead with the surgery and assuming you're doing the right thing is just f*cking moronic. The consultant has the majority of the blame, but the surgeon is following close behind.

drkpower · 03-09-2010 04:06PM

28064212 wrote: »

It's mentioned in one article, and not one linked to in this thread.

Its in the front page of the IT; you were happy to assert that there were no x-rays in the OT earlier, despite no article anywhere saying that. Oh, and read p.7 of the Indo, the consultant said that the 'brakes should have been put on' once the parents expressed concerns. Have you read any of the coverage of this case or are you basing your assertions on reading a few lines in the OP?

28064212 wrote: »

The surgeon asking the parents' opinion would be insane in the middle of an operation. The parents had signed the consent form which stated the left side. You do not ask an unqualified, emotionally-involved bystander for a medical opinion..

I think I have to nail this one on the head right here, because a remarkable number of people seem to have this view that the parents should not be consulted where doubt remains - which is lunacy!

1. Noone was going to ask their medical opinion; asking them whether they had been told what kidney was affected does not require medical knowledge or medical opinion - it requires a working memory and knowledge of left and right.

2. Asking the parents is obviously not the first choice, its not even the second choice; if any confusion could be fully resolved without asking the parents, absolutely, dont ask them; in this case, it is clear that such confusion was not resolved (although it should have been via the xrays). And in such a case, where an option is between taking a risk on removing a kidney or consulting with the parents; consult the bloody parents!!

3. Where a child is being operated upon, for practical purposes you are operating on the parent; they must be consulted, counselled, guided, they give consent, they make the decisions, all of the decisions; why, therefore, is there such reluctance, assuming confusion still exists, to ask them about their recollection of what they have been told? They are the decision-makers; shouldnt they be involved where genuine confusion remains?

28064212 wrote: »

A nurse is not qualified to tell a healthy kidney from an unhealthy one by "looking".

Who books the patient for theatre?; who checks if the consent has been done?; who makes sure the xrays are with the patient in OT?; who looks at and writes in the chart more than any other professional?; who has the most contact with the patient and parents? Yes, you've got it, the nurse - you would not be asking her to look at the kidney, you would be asking her as to her recollection of what kidney was affected.

drkpower · 03-09-2010 04:12PM

humanji wrote: »

In fairness, asking the parents really is a bit of a joke. As said above, they don't have medical knowledge and can't be trusted to know fully what is going on. Plus the emotional damage of a surgeon phoning you during your childs operation to ask you what he's meant to be doing, isn't really something you should have to go through.

See my post above; that really is laughable. They cant be trusted to know fully what is going on? Who do you think makes the decisons in the context of medical care? The patient, or parents in the case if children. They bloody should know what is going on; and if they dont, the medical staff arent doing their job. They certainly should know what kidney is being removed; and if they dont, that is a serious sign that something has gone wrong.

There seems to be an almost Victorian-era style view of medical care prevalent in this thread. The patient/parents are not background noise in the practice of medicine; they are the central figure - if any doubbt arises that cannot be satisfactorily and completely resolved, they must be consulted. That is how the practice of medicine (should) works, folks.

humanji · 03-09-2010 04:27PM

Shocking the parents with a phone call in the middle of an operation will panic them. They cannot be relied upon, especially in a state of panic. Your option 2 above would be acceptable, only if there was nobody at all who could be contacted about it, and even in that case the surgury should be cancelled before the parents are spoken to.

You don't know the parents and don't know how much they understand of the procedure. In a perfect world they'd know every detail of it, but you can't assume they do.

drkpower · 03-09-2010 05:40PM

humanji wrote: »

Shocking the parents with a phone call in the middle of an operation will panic them. They cannot be relied upon, especially in a state of panic. Your option 2 above would be acceptable, only if there was nobody at all who could be contacted about it, and even in that case the surgury should be cancelled before the parents are spoken to.

My option 2 would only be used if confusion remained after all of the treating practitioners had been consulted. That is only sensible. In this case, had the parents been consulted, they would have confirmed the confusion, so to speak, and would have insisted, as is their right, that the procedure be cancelled pending further clarifications. So clearly, consulting the parents is potentially a wonderful idea.

On the flip side, I readily admit that very rarely would consulting the parents where confusion reigns, result in the proceure going ahead - in other words, it would be very rare that discussion with parents would fully resolve the confusion. It is possible mind you, so while in the main i agree with your sentence in bold above, there would be some occasions where i would keep the child under GA pending clarification with the parents.

As for the panic, sure, it may panic them, but in a choice between potential parental panic and potential clarification of a critical issue, I'll go with the latter every time.

Scuid Mhór · 03-09-2010 05:48PM

sdonn wrote: »

BTW folks, not really funny when its kids. Keep the sick jokes to yourselves.

it suddenly becomes much more humourous when there's adults involved?

--Kaiser-- · 03-09-2010 05:50PM

Giant Squid wrote: »

it suddenly becomes much more humourous when there's adults involved?

Thank God it wasn't a kitten or a puppy or there would be calls for the Doctors in question to be tortured and killed

SarahBM · 03-09-2010 06:21PM

the majority of the blame lies with the consultant.
some blame can also be put on the surgeon.
But I dont understand why you wouldnt as the Nursing team who have probably been looking after that little boy since he was diagnosed. they would know and UNDERSTAND his condition more than perhaps even the consultant. and they would definitely know which kidney was affected and to be removed.

the mother, from what I have read did question whether the correct kidney had been put down on the forms for the op.

why didnt the surgeon look at the images available to him!

Callan57 · 03-09-2010 06:40PM

Just heard on the NEWS no one was a fault .... that's all right then! Away to the golf club

Just a thought though if that surgeon had been operating on his own kid would he have carried on regardless of his concerns? Can't help but wonder :eek:

CrazyRabbit · 03-09-2010 06:49PM

Callan57 wrote: »

Just heard on the NEWS no one was a fault .... that's all right then! Away to the golf club

Just a thought though if that surgeon had been operating on his own kid would he have carried on regardless of his concerns? Can't help but wonder :eek:

I'm a bit surprised that this is suddenly being swept under the proverbial carpet.

How can removing the wrong Kidney not be considered serious professional misconduct? FFS, a boy is left with one kidney that is so damaged it needed to be removed. That's one hell of a mistake.

Link to updated story.
http://www.rte.ie/news/2010/0903/kidney.html

The Fitness to Practise Committee of the Irish Medical Council has halted its inquiry into allegations of professional misconduct against two doctors over the removal of the wrong kidney from a young boy.

The committee chairman, John Monaghan said that 'a series of catastrophic errors' had been made but it did not amount to serious professional misconduct.

After four days of hearings, the committee decided to accept undertakings from Professor Martin Corbally and Mr Sri Paran on their future medical performance.
Advertisement

Lawyers for the Medical Council said its chief executive objected to the course proposed by the Fitness to Practise Committee.

Pat Leonard insisted the case of professional misconduct had been proven beyond reasonable doubt and it was hard to envisage more serious issues before an inquiry.

He said it was unusual for the Fitness to Practise Committee to invoke Section 67 of the Medical Practitioners Act and accept undertakings from doctors, when the inquiry was nearly completed.

The two doctors, Professor Martin Corbally, a consultant surgeon, and specialist registrar Mr Sri Paran have undertaken 'not to repeat the conduct complained of' and never operate without reviewing all imaging.

In a statement read out on behalf of the boy's parents, they said lessons must be learned and the mistakes must never be repeated, given that doctors hold the lives of children in their hands.

The two doctors owed Master Conroy the promise to employ the best practises in their future work.

Earlier, the paediatric surgeon told the inquiry he was 'taken aback' to be asked by a consultant to perform the surgery on the child, with less than five minutes' notice.

Mr Paran said that as a junior doctor, he could not say no to Professor Corbally, the senior consultant surgeon at Our Lady's Children's Hospital in Crumlin

On the day of the operation, he was working in theatre doing minor day case procedures.

Mr Paran said he had previously performed 11 nephrectomies, but just two or three on his own.

During the operation he was baffled to find that the left kidney to be removed appeared healthy.

Mr Paran said he paused and re-checked the notes made by the consultant, which said the procedure was a left-sided nephrectomy and this was confirmed by the consent form.

During emotional evidence today, Mr Paran said he had trusted what he had been told about the operation but admitted that he had seriously failed the patient.

pippox · 03-09-2010 07:05PM

What an absolute disgrace.
:mad:

Doctor removes the wrong kidney from kid

Comments