There is an interesting medical malpractice case winding its way through the courts of Florida. It describes an egregious case of malpractice and a coverup by the doctor and hospital after the fact. While it is egregious, it is not an isolated case. The medical industry (doctors, hospitals, and their insurance companies) regularly go to great lengths to keep the public in the dark about which doctors and hospitals give bad care. Secrecy and coverup are never good for the public and, in some cases, can have fatal consequences.
Today’s story teaches many lessons.
The patient was a 70 year old man visiting the Florida panhandle with his wife from their home in northern Alabama. He developed pain on his left side which kept getting worse. He ended up at the emergency department of Ascension Sacred Heart Emerald Coast hospital in Miramar Beach, Florida, where he was seen by an on call surgeon.
After examining the patient, taking a history, and reviewing some studies, the surgeon told the patient that his spleen was the problem and that it needed to be removed. The man was reluctant and wanted to return home, a 400 mile trip, where he could be treated by his regular doctors. The surgeon cautioned against such a trip and finally persuaded the patient to have the spleen removal procedure at the Florida hospital.
The plan was for a laparoscopic procedure in which the surgeon makes some small incisions, inserts instruments and a camera into the abdomen, and removes the spleen that way. Laparoscopic procedures are much less traumatic to the patient than open procedures in which a large incision is made and the surgeon performs the procedure under direct vision.
The patient’s wife was a retired registered nurse, who did all of the homework any prudent person should do before allowing a surgeon to operate. She looked up both the doctor and the hospital on line. The hospital had high ratings. She could not find anything bad about the surgeon either so she and her husband agreed to allow the operation to proceed.
Even though she could not find anything negative about the surgeon, he had big problems. He was apparently not a good surgeon. He had been sued successfully in the past. He had a history of making serious operative errors and the hospital knew it. Some people at the hospital were concerned enough about the surgeon and his ability to successfully perform the planned surgery that they allegedly approached the hospital’s chief medical officer to stop the operation. He took no action and the operation went forward.
Things went sideways almost immediately. The surgeon said he could not clearly see the operative field through the camera and converted the procedure to an open one. Strangely, he made the incision on the right side of the body, even though the spleen is on the left. Instead of removing the spleen, he removed the liver and, in the process, severed some arteries which caused the patient to bleed to death.
The cover up began immediately. The surgeon told a nurse to label the removed organ as “spleen,” even though it was much larger than a spleen and was obviously the patient’s liver. She did as she was told. Other doctors came to the operating room. Hospital surveillance footage allegedly shows the hospital CEO and several other doctors conferring in the hall outside the operating room shortly after the death of the patient.
In spite of the clarity of what happened, the operative report prepared by the surgeon and made part of the hospital records described the procedure as a splenectomy, a removal of the spleen. There was no mention of the liver. The patient’s death certificate stated that he died as a complication of removal of his spleen. The surgeon told the wife her husband’s spleen was so swollen that it had migrated to the other side of his body. He reported that the husband died of a splenic aneurysm. A hospital nurse got the wife to sign a form requesting that there be no autopsy.
Up to this point, for the doctor and hospital at least, so far so good. Everyone was keeping their mouths shut. The medical records and the death certificate had been falsified to show that the spleen was removed and that the patient died of complications of a spleen removal procedure. Not only had no one informed the widow of the true facts, she had been lied to about the actual cause of her husband’s death and it was going to be very hard for her to discover what really happened. It looked as though the cover up was going to hold.
Then it all came crashing down. For a reason that is not clear, the local medical examiner performed an autopsy anyway. He found that the patient’s liver had been removed and that his spleen was right where it was supposed to be. The medical examiner listed the cause of death as homicide. The Florida Surgeon General conducted an investigation and suspended the surgeon’s license. He is now listed as “retired” in the records of the Florida health department.
During the Surgeon General’s investigation, it was revealed that in the year preceding this incident, the surgeon had operated on the wrong organ of another patient at the same hospital.
One of the widow’s allegations against the hospital arising out of the death of her husband is that the hospital knew the surgeon was incompetent and allowed him to practice at the hospital anyway. Since the suit was filed, more instances of major errors by this surgeon have surfaced.
The basic facts here happen all the time and everywhere. When doctors and hospitals settle malpractice suits against them, they routinely insist on a confidentiality provision to keep the facts of the case and the settlement a secret. The public, which needs this information so it can avoid these bad actors, is kept in the dark. Look all you want, you won’t find out that your doctor has been accused of incompetence on multiple occasions and has paid off multiple patients.
Like the case here, the medical records don’t always tell the true story of what happened. They may not contain the same degree of outright falsehoods as the records here, but they are frequently incomplete and misleading. In only the rarest of cases will the patient or her family be told that there has been a mistake. Almost always, the doctor and the hospital staff will keep quiet and it will be up to the patient to discover that there has been a terrible mistake.
Why are incompetent doctors allowed to practice at hospitals? Didn’t the hospital look into this surgeon’s credentials, training and experience? Of course, it did. What did it find? Sorry, says the hospital, that information is protected by state law so you can never see what we saw and never know why we let this person on staff. You will just have to trust us that we did a great job of vetting him.
Why does the State of Arizona, and most other states as well, permit this state of affairs to continue? The answer, of course, is money. Doctors, hospitals, and their insurance companies have lots of it and are happy to spend it on political campaigns to assure they have sympathetic people down at the state capital. It has been working great for them so far. Not so much for the public, which never gets to know how much medical malpractice there actually is and has no reason to demand that the system get fixed.
