Medical mistakes are a problem for Massachusetts General, and for Mayo Clinic, but the difference is the handling of the mistake, and the wrong procedure, or a procedure that was never consented to for good reasons. When a woman MD won't consent to a procedure, and you don't have more than 5 minutes to discern the reasons, there is a good reason - which there was in one case at Mayo Clinic that went horribly wrong 15 years ago. The case is still not undone.
And you can't shut the patient up so that she/he can't help mark the sight of pain (sign-the-site), or tell the surgeon the other facts if she/he needs to - with an anesthesia that she/he did not agree to. OR vacancies don't cost as much as the care to undo this one mess. OR vacancies should be handled not by the individual surgeons, but by OR management that then puts another case into the room. You don't say to a MD patient that the only 'opening' you have is an OR slot tomorrow. So take it or no care.
The Mayo Clinic has Jill Smith Legal Counsel blame the patient, cut the patient emails by administrative blocking so that there can be no follow-up care, and not undoing the surgical harm - for even 15 years - resulting in a mess of compounding surgical and decision-making errors that are not improved. It's not just the individual patient that suffers, if the Mayo Clinic refuses to undo the harm, admit the harm and change protocols. Jill Smith handles things in an outdated quality-minus way.
When patients come to Mayo Clinic they are second-opinions. It means that surgeons can't be taking people to the OR the next day, without checking all the facts & scans, to fill an OR slot - as Dr. Michael Sarr does. It's not a language difficulty, it is an information transfer problem - that any physician can only take in so much patient history per 20 minutes. And the patient will be in pain, and misdiagnosed, but you still can't have the medical evaluation done by a fellow studying for her Boards, and bring in the graveyard crew of a hapless surgical intern, and the worst medical student in whites, to help with the surgery.
Attendings at Mayo Clinic are expected to throw out the unprepared, and not keep an inadequately trained intern & medical student for the procedure - no matter the race or gender. All Mayo Clinic attendings should be able to insist on proper 'help' at the level of Chief of General Surgery - and if Dr. Sarr can't, he should be removed. Because that is bad management.
The wrong procedure was done for this problem, the medical consultation might have picked things up if done in a routine way, and a scan needed to be done. The OR staff should have bounced the procedure without a consent form, no anesthesia consult, no scan, and no surgical marking done.
But no one did.
Mayo Clinic needs to accept responsibilty for this case, and undo the wrong procedure - there was no correct procedure needed. But more than that, Mayo needs to adopt quality care management.
A OR mistake at Massachusetts General was published in the New England Journal of Medicine in 2010. Mayo Clinic needs to adopt a similar protocol.
First when a patient comes for a workup - you don't fill an OR slot with that patient without checking with the physician from out-of-state. Even a physician patient needs to be checked on - because sometimes they don't know all the facts - no one is completely honest even with a physician patient. You don't not do the workup - even if it has been reported as negative - you do or re-do all scans and labs and not pressure the patient about the time needed for this - it's well spent. It's not a patient's fault that an OR slot is suddenly vacant for a Mayo MD - that's the problem for the OR staff & scheduling team - they can fill this slot.
If a patient does not agree to more than a limited 'biopsy' kind of procedure - there does not need to be an intern & student on the case. If that 'help' does not know the case, they should be sent out of the room and 'off' the case. No excuses. If anesthesia has not seen the patient with clothing on, then the case needs to be off the schedule until anesthesia clears. Surgeons should not be scheduling cases before anesthesia clearance - in person, with clothing on, with the labs & scans and then an exam in a gown - as all other consults go.
If the patient hasn't got the consent form, the anesthesia clearance, and the site is not marked - that is not the fault of the patient - Mayo Clinic needs to cancel the procedure. And Jill Smith needs to insist on this - and she doesn't.
Once a wrong, or unanticipated procedure happens, it is Mayo Clinic's fault & responsibility to undo as soon as possible. When a procedure that the patient did not consent to is done, it is the same problem - it has to be undone. Jill Smith Esq can't negate this physician responsibility - it is Mayo Clinic's responsibility. Other physicians can improve the deformity temporarily, but it is Mayo Clinic's responsibility to undo as soon as possible - not 15 years later.
When the wrong, or an unconsented procedure, is done the physician - even the Chief of General Surgery - has to call the patient & family, admit the problem, and offer to undo. Most surgeons will not undo a wrong procedure that Mayo Clinic has done - because Mayo Clinic does some signature procedures and closures.
What should be done with OR mistakes at Mayo Clinic? First the physician, OR staff, and Jill Smith, should admit that the procedure was not consented to, waive all charges (including Dr. Sarr's fee), and offer to undo without cost to the patient. A financial settlement can be negotiated depending on if the procedure can be undone.
When all charges are waived except Dr. Sarr's fee, and then Dr. Sarr tries to sue the patient for defammation - the Mayo Clinic is not admitting the problem. Patients need to know this - that instead of admitting surgical errors, that certain Mayo surgeons will try to sue the patient for defammation. Defammation suits are messy, and the Mayo Clinic will try to say that the patient needs psychiatric help. So going to the Mayo Clinic, all patients need to discuss 'errors' with their surgeon or internist - what will happen if errors occur? If that Mayo surgeon will sue for defammation to deny the facts, then you need to leave the room.
Denial doesn't help, and in one case the law firm had to refuse to file the defammation suit. The law firm had to tell Dr. Sarr that he made a mistake, and needed to correct the problem, and accept the blame. But Jill Smith should have told him the same thing, as Chief Legal Counsel for Mayo Rochester, and she didn't.
Mayo Clinic has been doing unnecessary abdominal wall neurectomies on patients for the last 15-20 years. The Medical Board of Minnesota has been informed of this, but not been willing to intervene because of the fact that neurectomy is a procedure even if being misused by Mayo Clinic surgeons - General, Vascular, Neuro, etc. It's a system error apparently - you can't take the licenses of a group of physicians misusing a procedure, or it's messy. It's a Mayo Clinic error, which Mayo Clinic Proceedings has published the correct treatment on. The surgeons need to be held to the standards published in Mayo Clinic Proceedings.
The treatment of this nerve inflammation is just a 2% lidocaine injection - as discussed in a Mayo Clinic article in Mayo Clinic Proceedings in January 2011. So all these neurectomy procedures need to be undone - the treatment since 1926 has been an injection of an anesthetic agent - not a trip to the OR. The procedure needs to be stopped at the highest levels at Mayo Clinic. Dr. Sarr needs to inform patients of all options, and that surgery is a last resort - not a next day picnic.
All patients requesting undoing of this - undoing of the common mass closure and repair of the abdominal wall fascia cut - need to be offered the corrective procedure. Cleveland Clinic, University Hospitals of wherever, etc. can't undo these procedures - and they are painfully deforming closures. The neurectomy procedure is a general surgery procedure needing anesthesia - which should not be done without informed consent - earth to Jill Smith.
Dr. Sarr needs to 'sign-his site' of surgery. Writing his initials over the planned incision site with a permanent marker before the patient enters the operating room. The sight of neurectomy pain needed to be marked - if he was ill-advisedly taking these to surgery. He was deficient in this - and it was not the responsibility of the 3-month woman intern, or patient, to do this. Dr. Sarr - as Chief of General Surgery at Mayo Clinic - needs to mark & sign his surgical sites. Patients reading this, who have appointments at Mayo Clinic, need to have their 'site-signed' even for x-rays - so that a marker can be applied for the radiologist.
This is the Sign your Site program & campaign - and it works. Then there needs to be a systematic & consistent approach to identify the correct patient, correct operation, and correct site before each operation is started - the intern needs to insist that the site is marked. And in the one case the intern was a 3-month inadequate poorly trained assistant - worse than a surgical technologist as she didn't know the suture types, and she had apparently never used a scalpel. Medical Student training is not uniform, and the first thing with new surgical residents is to put them through lab simulations and some surgical technology training - with sign-offs by staff viewing the labs & simulations.
All Dr. Sarr's errors need to be disclosed with this procedure: how many of these procedures were never consent to? And they need to be undone with a general & plastic surgeon at Mayo's expense as soon as possible. Jill Smith needs to get up-to-speed, or Mayo needs another Chief Legal Counsel.