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The Associated Press

 

N E W Y O R K —The patient in surgeon Michael Schafer’s Chicago operating

room scrawled a note on his arm in felt-tip marker. It said, “I hurt here,”

with an arrow pointing to his elbow.

 

In New York, Dr. Andrew Rokito’s patient wrote YES on one leg and NO on the

other. Nearby, Dr. Steven Stuchin’s patient lay with a pink ribbon she tied

around her injured leg.

The message was clear: Following surgical gaffes in which doctors amputated

the wrong foot, removed the wrong kidney and opened the wrong side of a

woman’s brain, patients were frightened and mistrustful.

Now hundreds of surgeons are getting the message and putting their John

Hancocks on every Tom, Dick and Harriet who comes under the knife.

The trend toward autographing patients’ bodies marks a low-tech effort to

avoid what doctors call “wrong-site surgery.”

 

Sign on the Spot to Be Cut

The 17,000-member National Academy of Orthopedic Surgeons urged surgeons

last March to sign their names on the spot to be cut.

In recent months, hospitals across the nation have adopted the practice to

try to curb lawsuits and spare patients undue agony. Among them: the

orthopedic surgery departments at New York University, Chicago’s

Northwestern University Medical Center and Strong Memorial Hospital in

Rochester.

“For all the science and technology and out-and-out hardware, which is worth

millions of dollars in any operating room, the most important thing that

patients and doctors do is talk to each other,” said Stuchin, director of

orthopedic surgery at NYU’s Hospital for Joint Diseases. “The $1.50 pen is

part of the communications process.”

Wrong-site surgery is common enough that the practice has its own

euphemisms, such as “bilateral confusion” and “symmetry failure.”

>From 1985 to 1995 the Physicians Insurers Association of America counted 225

claims for wrong-site surgery by its 110,000 doctors. Willie King won $1.2

million after a Tampa, Fla., surgeon amputated the wrong foot in 1995.

Perhaps most alarming to surgeons: Patients win monetary settlements 84

percent of the time, according to the Physician Insurers Association of

America.

“In other words, if you operated on the wrong leg, they were going to pay

off,” said Dr. S. Terry Canale, who led the surgeon association’s national

campaign and operates at the Campbell Clinic in Memphis, where surgeons now

sign their patients.

Orthopedic surgeons, who specialize in skeletal operations, saw another

alarming statistic: One in four of them will operate on the wrong organ in a

30-year career, according to the insurance group.

 

Uncommon, but Indefensible Problem

A number of things can go wrong. In the Tampa case, doctors said both the

patient’s feet showed signs of gangrene. Dr. Joseph Zuckerman, director of

orthopedic surgery at NYU, has walked into the OR to find a patient prepared

for surgery on the wrong knee. The X-ray had been labeled backwards.

“This is an uncommon problem,” Zuckerman said, “but it’s indefensible.” Some

victims of wrong-site surgery experience only inconvenience and an unneeded

scar. Others pay a hefty price.

Harry Jordan visited the hospital often after doctors removed the wrong

kidney in 1983. The Long Beach, Calif., insurance broker was left with one

kidney at one-fifth its normal size. He died 13 years after the operation

after winning $250,000 in damages.

“Nothing can give me back the kidney they took from me by mistake,” he said.

“Or let me walk more than a block or so, or relieve the constant fatigue and

pain and examinations and tests.”

Rajeswari Ayyappan underwent a second traumatic operation to remove a brain

tumor after a surgeon at New York’s prestigious Sloan-Kettering Memorial

Cancer Center operated on the wrong side.

“The idea of signing where you’re actually doing it is the best idea I’ve

heard yet,” said Ayyappan’s lawyer, Dr. Harvey Wachsman, who also teaches

neurosurgery at the State University of New York at Stony Brook.

Some of the nation’s most prestigious hospitals don’t make marking patients

mandatory. Among them: the Mayo Clinic of Rochester, Minn., Johns Hopkins

Medical Center in Baltimore, and Sloan-Kettering.

Some hospital officials privately said they fear adding to patients’ stress

by pointing out the possibility of error.

Marjorie Young, operating room director at NYU, gets a different reaction

from patients when a doctor scrawls on them.

“They’re loving it,” she said.

 

 

 

Copyright 1998 The Associated Press. All rights reserved.