Crazy Cases Against Doctors -- and Inexplicable Settlements

Jeffrey Segal, MD, JD

Disclosures

May 14, 2015

In This Article

Was This Surgeon "Grossly Negligent"?

On December 4, 2010, at 11:47 AM, a patient was admitted to the emergency department (ED) of a hospital in California's Bay Area with a self-reported history of having inserted a bottle into his rectum 2 days earlier.[4] He was in pain and had gone 2 days without a bowel movement. A physician assistant documented distention and diffuse tenderness. A plain abdominal radiograph showed a glass bottle in the mid-pelvis. There was no free air, although the patient was in the supine position.

The surgeon arrived at 2:11 PM and ordered 25 μg of fentanyl for pain.[4]

What happened next resulted in a complaint to the California Board of Medicine. An interview with the surgeon by a board investigator provided the details.[4] The surgeon explained that she had given the patient two options: He could have the bottle removed surgically, or it could be extracted manually in the ED. The surgeon stated that the patient chose the ED route because he did not want to lose his new job. (It is unclear whether this decision was related to a longer perceived recovery time if he had surgery, a higher bill for a surgical procedure, or something else.)

During the interview, the surgeon said that she could feel the bottom of the bottle with one finger but could not move it at all.[4] However, the history and physical documented something else: The surgeon "was able to palpate the bottle and was able to manipulate the bottle and move the foreign body around but was unable to rectally extract it."

During the first part of her interview, the surgeon stated that she placed her hand into the rectum to remove the bottle while the patient pushed.[4]

Nursing notes indicated that the surgeon placed her arm into the rectum up to her bicep, and the patient was screaming in pain.[4] This same nurse said the surgeon did not want the patient to receive any additional pain medication, because she needed the patient conscious for him to help push the bottle out.

The surgeon then performed a rigid sigmoidoscopy, which showed the sigmoid colon to be dusky and swollen. A new abdominal radiograph suggested perforation. The patient was taken to an operating room (OR) for a laparotomy.[4]

The board of medicine detailed its parade of horribles[4]:

  • Gross negligence: Excessive force while attempting to remove the bottle demonstrated disregard for patient safety and departure from standard of care or incompetence.

  • Gross negligence: The decision to continue with the procedure in the ED without securing appropriate assistance from nursing staff demonstrated disregard for patient safety and constituted extreme departure from the standard of care.

  • Repeated negligent acts: Inadequate sedation during attempts to manually extract the bottle constituted departure from the standard of practice.

  • No informed consent and substandard documentation of procedure note.

  • No "timeout" was performed before starting the procedure. [Author's note: It's unclear whether the timeout would have been used to verify that the correct patient was about to undergo a procedure, or to confirm that the procedure addressed the correct side of the rectum.]

  • Dishonesty: There are multiple story lines—was a finger, hand, or arm involved? Was the bottle mobile, or not mobile?

The penalty the board imposed[4]:

  • 25 hours a year (for each year of probation) of education addressing the deficiencies outlined in the complaint.

  • Complete an approved course on professionalism—at the surgeon's expense, and in addition to other continuing medical education (CME) requirements.

  • Complete an approved course on medical record-keeping—at the surgeon's expense, and in addition to other CME requirements.

  • License revoked, but revocation temporarily suspended and surgeon's license placed on probation for 3 years as long as she has no further infractions.

  • The surgeon will pay the costs of monitoring her probation—currently set at $3999 per year—for each year of probation.

The surgeon was licensed to practice in Ohio as well as California. The Ohio Medical Board learned of the California board's imposed discipline. The Ohio Board wrote to the surgeon stating that it was investigating whether to impose discipline in Ohio as well.[4] The board gave her 30 days from the date of mailing to request a hearing. That deadline was May 12, 2014.

The board received the surgeon's letter on May 15, 2014, and that letter did not include a request for a hearing.[4] (The record is silent on what information the letter did contain. Presumably, it was an explanation of the surgeon's treatment of the case, or why she failed to respond to the Ohio board in a timely manner.)

The board revoked her license.[4]

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