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Problem
Retained surgical objects represent one of the greatest health care problems. In the United States alone, about 1,500 people face the problem of surgical objects accidentally forgotten within their bodies every year (Science Daily, 2007). Two-thirds of all objects left accidentally in patient bodies are sponges (Science Daily, 2007). The legal and medical consequences of retained surgical objects are difficult to predict. The case of Hopewell Hospital is no less problematic. Like in any other hospital, several doctors working for Hopewell Hospital deliver care not of very high quality and make more mistakes than their colleagues. Dr. Cutrite once used to be one of the most outstanding medical professionals in Hopewell Hospital. However, his professional and mental state has recently deteriorated, and he is no longer capable of delivering high-quality medical care. One day after a surgery, the director of clinical services learns that Dr. Cutrite might have forgotten a plastic needle protector in the patient’s belly. The operating room supervisor is not sure, but the risks are rather high. The problem becomes evident only when the records are reconciled. The patient has already gone home, and Dr. Cutrite believes that the retained object cannot do her any harm. The main problem is what to do with regard to this case and how to avoid the health, legal and ethical risks associated with retained surgical objects.
Options
In this case, Dr. Cutrite and the rest of the medical staff can choose to:
- Get the patient back to the hospital and initiate a series of medical examinations, to ensure that the needle protector is there/ not there;
- Keep silence and hope that the plastic needle protector will not cause the patient any harm;
- Get the patient back to the hospital for a fictional reason and, afterwards, decide how to act without informing the patient about the problem.
Arguments for each option
As always, each option has its strong and weak sides. The ethical controversy affecting this case cannot be ignored. The case can potentially affect the public image of the hospital. Therefore, the staff should be particularly cautious in its decisions and actions.
First, the hospital can call the patient and ask her to get back to the hospital for a thorough medical examination. The hospital will need to inform the patient about the situation, that a plastic needle protector might have been left in her body. Predicting the patient’s reaction to the news is virtually impossible, and the hospital should be prepared to deal with the patient’s anger. However, both informing the patient and performing a thorough medical examination is vital for the patient’s health. The fact is that “clinical morbidity resulting from retained foreign body includes persistent inflammation, obstruction, or septic complications” (Lincourt, Harrell, Cristiano, Sechrist, Kercher & Heniford, 2007, p.172). From the ethical viewpoint, the patient has the right to be informed about the current state of her health and possible health risks. By getting the patient back to the hospital, the staff can avoid further legal and ethical difficulties. It may happen that there is no plastic needle protector in the patient’s body, and the conflict is just a matter of inappropriate record-keeping. However, if the plastic needle protector is detected in the patient’s body, it is better to have it removed.
Second, the hospital can conceal the problem from the patient, hoping that either there is no plastic needle protector in her body or that the retained surgical object will cause no harm to her health. Dr. Cutrite is confident that the worst the plastic needle protector can do is cause certain discomfort in the patient’s body, and the chances that the problem will go unnoticed are rather high. Unfortunately, this decision can have far-reaching legal and ethical consequences for the hospital and Dr. Cutrite, in particular. On the one hand, the patient has the legal and ethical right to receive complete information about her health. All discussions held in primary care settings should meet the criteria considered essential for informed decision making among patients (Braddock, Fihn, Levinson, Jonsen & Pearlman, 1997). On the other hand, the doctor cannot be confident that the foreign surgical object does not result in serious health complications. Science Daily (2007) writes that retained surgical objects can lead to infections, bowel obstructions, pain and healing problems, etc. Therefore, keeping the problem in secret is not the best decision for the hospital.
Third, the hospital may choose to bring the patient for a reason other than the plastic needle protector in her body. In this way, the doctor will have a unique opportunity to perform a thorough medical examination but will also avoid unnecessary conflicts with the patient. Yet, again, in this situation the hospital violates one of the fundamental ethical rights of the patient (Braddock et al., 1997). Moreover, eventually, the hospital will have to disclose the truth and recommend another surgery, to get rid of the needle protector. Bearing in mind the systemic character of the problem (Science Daily, 2007), the proposed option will hardly secure future patients from similar risks. This situation calls for the development of a complex solution that will improve the quality of ethical atmosphere in the hospital.
Making a decision
Surgeons are legally and ethically responsible for the quality of medical care they provide. The law obligates surgeons to exercise reasonable care and guarantee that all surgical tools have been removed from the patient’s body (Lewis, n.d.). This being said, the best the hospital can do is to call the patient and inform her about the problem. The patient should be brought back to the hospital as soon as possible, for a thorough medical examination and another surgery, if needed. In this way, the hospital will avoid the risks of health complications in the patient and further litigation. Also, the hospital will preserve the patient’s right to be informed about her health and promote the greatest good for the greatest number of people (the patient will avoid health complications, and the hospital will have better chances to settle the conflict privately). Surely, the hospital may damage its public image. Moreover, the financial costs of another medical examination, surgery, and hospital stay have to be considered. Eventually, the hospital staff cannot be sure that the patient does not go to the court when the problem is solved. Even then, the extent of damage and financial losses is incomparable to the loss of the patient’s health.
To avoid further medical errors, Dr. Cutrite’s position in the surgical ward should be reviewed. Dr. Cutrite’s deteriorated mental and professional state can become a solid ground for suing the hospital. In case of a lawsuit, the doctor will be found guilty of medical malpractice (Lewis, n.d.). The hospital will damage its positive reputation. For these reasons, Dr. Cutrite will have to leave his position. Finally, the hospital should initiate the development of a broad policy that will impose the duty upon surgeons and assistants to take care of the surgical objects before the surgery is finished. All surgeons and medical staff will also be obliged to provide complete information about patients’ health. This is how the hospital can develop and sustain an ethical climate at all levels of its medical and organizational performance.
References
ANA. (2004). Position statement on nursing care and do-not-resuscitate (DNR) decisions. American Nurses Association. Web.
Braddock, C.H. (1998). Do not resuscitate orders. University of Washington School of Medicine. Web.
Braddock, C.H., Fihn, S.D., Levinson, W., Jonsen, A.R. & Pearlman, R.A. (1997).
How doctors and patients discuss routine clinical decisions. Journal of General Internal Medicine, 12(6), 339-345.
Kearney, M.K., Weininger, R.B., Vachon, M.L., Harrison, R.I. & Mount, B.M. (2009).
Self-care of physicians caring for patients at the end of life. Journal of American Medical Association, 301(11), 1155-1164.
Lewis, J. (n.d.). Surgical instruments left inside patients can cause serious injuries. Shapiro, Lewis & Appleton. Web.
Lincourt, A.E., Harrell, A., Cristiano, J., Sechrist, C., Kercher, K. & Heniford, B.T. (2007). Retained foreign bodies after surgery. Journal of Surgical Research, 138, 170-174.
Makin, A. (2005). Taking resuscitation decisions in the nursing home setting. Nursing Times, 101(41), 28. Web.
Science Daily. (2007). Surgical objects accidentally left inside about 1,500 patients in US each year. Science Daily. Web.
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