Mayo Clinic Rochester John Bundrick MD makes no sense to allow Dr. Sarr to cut up women patients with a 3-month intern hack, to remove a normal nerve, cut 3 muscles without cause and sew it all together with a common mass deformity - for w Rochester, Minnesota

It makes no sense.  That Dr. Bundrick can be on Staff at Mayo Rochester and allow Dr. Michael Sarr to cut up women patients in St. Mary's no less (taking the name of Mary quite in vain) - deforming abdominal walls and destroying muscles for life - and not have Dr. Sarr follow the same steps for abdominal pain diagnosis as on the Internal Medicine service.  The same workup, the same maneuvers, are not required for General Surgery, so how can there be teamwork?

Clinical Pearls are not just for Internal Medicine, the Mayo Clinic Proceedings, or the rest of the world.  And maturity is required of Mayo Clinic staff - that they act with care, due diligence, and do the workup first - that they act with care, compassion, and healing - with the professionalism worthy of a Mayo Clinic appointment.  That means that they question why a woman patient comes - what is the purpose - the history - what is going on in her life - was her last visit to Mayo Clinic ok - or did they miss the swollen thyroid gland that a first year medical student should have noticed - if Sarr had noticed?  The FMG quickie didn't see much - she was on the phone to her home & kids.  Phoning home should not be done in front of patients.   

All this woman got was the history of the Mayo Clinic - from an overly sharing Dr. Sarr - a guy so into himself that he couldn't listen to the woman trying to tell him the story that Mayo Clinic caused with the missed diagnosis of the thyroid problem - that now everyone was mistreating her at home because they were all involved including the surgeon who cause the anterior cutaneous nerve entrapment and then didn't want to help.  That Chief bariatric surgeon thought a T4 was a 'thyroid profile.' 

Is Dr. Sarr, and the Surgical Service at Mayo, so special that their diagnosis of abdominal pain follows a different virtual reality paradigm: the Sarr cut first rule?  Cutting abdominal muscles destroys their length-tension curve from Physiology 101, and removing nerves causes skin & muscle atrophy - it's a no-brainer lose-lose.  Or is this not taught at Mayo, so that an intern wouldn't object or question the game plan?  But she was foreign, diversity.  The problem with diversity is that culture-to-culture people are not the same.

What was Dr. Sarr teaching the intern, anesthesiologist that day - how to (a) mutilate, (b) cut for money, (c) cut corners (one suture pack closure) & (d) get away with malpractice?  They learned a, b, c, and d that day - that for the 'glory of the Mayo Clinic,' you can get away with anything and disfigure for life anyone.  The intern should have stood-down as she was requested; she had not reviewed the case, and could not be helpful in the OR - and she wasn't - she was out of her league - beyond her confidence level.  

It is the duty of a teaching surgeon to not put any resident (or medical student) in a situation beyond their confidence level and skill - and Sarr was deficient in this judgment - like 'resign' negligent - there were huge judgment failures.  If it had been any other patient, he would have been resigned.

The patient was put under duress in that an injection for pain wasn't offered - she never got a good night sleep to think it over.  But it was a 5-minute case where Dr. Sarr should have cut, done the limited exploration, and sewed the closure - if he hadn't been doing what?  Was the coffee that good, or the boy talk?  Would you do this to your daughter?  To Andy Oldenburg's wife or daughter? 

The incision was not marked, the 3-month intern went ballistic ripping apart tissue to find what she didn't ever examine, or understand/know how it should look - she didn't know prolene from any other suture material - it was all prolene to her, and her dictation showed this.  The Mayo Clinic surgical staff don't know their suture materials.  And Dr. Bundrick is silent. 

Patients come to Mayo Clinic expecting the 'case 3' workup, and get the back street alley shoddy newbe surgeon treatment - without a grain of talent, maturity, or class.  The patients say 'NO' and are drugged out with anesthetic agents so they can't walk, they are never even asked if a family member was allergic to any anesthesia agent.  It's all a grand 'take.'  The Mayo Clinic Proceedings is a pile of lies - the Pearls aren't followed at Mayo Clinic.

The same steps that lead to a 2% lidocaine injection, instead of years of pain, should be followed by both services; Clinical Pearls apply to all.  This is not a 'whitewash' that Jill Beed-Smith should legally sanction - or have the power to sanction - the Board of Trustees needs to review this situation.  No legal counsel, at any hospital, should be approving procedures without consent or proper workup - and the patient felt bad because she couldn't tell her story - why she was there.  The Board of Trustees of Mayo Clinic is not doing their job and being grossly negligent.  Like with the Benghazi situation, there were 'systemic failures' within the Mayo Surgery Department, and there probably still are given the lame excuses.  

Dr. Sarr had to stop where the consent stopped in the OR - in every other hospital that is the law, or you lose hospital privileges.  But Dr. Sarr can rip a woman apart and get away with it - without a thought - a classic male misogynist.  Dr. Sarr did not review the H&P, did not review the labs, did not do a scan, and continued the case beyond the workup - which the Mayo OR Nursing Supervisor should have stopped - at the anesthesia without a formal consult point. 

This point was discussed with Dr. Sarr - that he was not to continue into the muscle as the workup had been abbreviated for his scheduling concerns - his moonlighting.  But the rest of you, including WarnerA, to not offer a complete repair is not Mayo Clinic - it's an off the Main Street Abortion Clinic maneuver.  No one is defamming Mayo Clinic here - there are problems which need review and a Mayo Surgery Report. 

Warner Andrew Oldenburg MD - who has to be called by the first name Warner since he hit the bigtime Mayo world - needs to justify this to the family of the above woman - a classmate from Medical School.  Her mother is saddened, as only a mother can be, at Dr. Sarr's unnecessary mutilations to get a case for the money - and that Warner and others stood by and let it happen.

There was no reason to schedule this case - the woman was not offered an injection, and was in pain - the way that the Surgery Service ensures that you will show up - withhold the medical care.  That is unethical, cruel, and stupid.  This withholding of medical care, a 2% lidocaine injection that is diagnostic & therapeutic, was negligence & unwarranted - and the woman should not have had to beg Dr. Sarr or tell him what to do - this was the Mayo Clinic where they publish about Carnett's and ACNES - the place where acronyms & eponyms are born.  And particularly negligent as Mayo Clinic writes the rules for the rest of the world on this, and criticizes heavily when such-and-such Community Hospital does not do a Carnett's test and/or trial of anesthetic injection. 

But a Community Hospital would not have done a neurectomy and common mass closure - that's overkill, psychotic delusional surgeon - behaviors that no surgeon at Mayo Clinic should be proud of.  Where was the segueway in reasoning - the smooth transition from one 'spot' of pain to an abdominal muscle ablation?  What sadistic whatever was going on in that OR, and why didn't the anesthesia guy stop it?  He didn't bill, even Pathology didn't bill for the 'normal' nerve that Sarr thought a 'foreign body.' 

There was no reason to cut the transversus muscles - and Mayo Clinic needs to repair this Warner - like they would have to for your kid or wife - exactly the same.  How would you like someone to do this to one of your kids?  And you'll come to a REUNION and tell people about this, brag about Mayo Clinic's care - get your abdomen neurectomized at Mayo?  If Dr. Bundrick had been required to review every 'neuroma' case, or possible neurectomy on the schedule - Dr. Sarr plans these things - an unnecessary surgery might have been averted. 

The woman patient came to the right place, but not the right physician, and there was no 'teamwork.'  Dr. Sarr has a 'menu' of different neurectomies - so the person that Dr. Bundrick needs to watch, or review the surgeries for is a known - a national known name. 

All abdominal neurectomy surgeries at Mayo need to have a Carnett's test, and 2% lidocaine injection trial, ON THE CHART - for the Intern, Nursing Supervisor, Anesthesia guy/gal, and the Surgical Technologist to read - checking.  This was gross neglect, stupid superficial, and beneath everyone at Mayo Clinic in that OR - no one is excused the blame.   

The Mayo Clinic needs to undo the common mass closure & apologize to the family of the patient involved.  The Mayo Clinic has to give the assurance to patients that they will not schedule a procedure without the full workup (regardless of Dr. Sarr's flight schedule) - and necessary concurring consultations.  Cancelling emails, serving defammaton suits are not appropriate behaviors.

The Mayo Clinic needs to assure patients that the full workup, and consultations will be done - without a 'quickie' - before any differential, or surgery is discussed, or allowed on the schedule.  This is called CHECKLISTS.  You don't do a surgery to find a diagnosis without a scan, blood work, and good exam - and Dr. Sarr abdominal exams are a one-two.  And if you start into a surgical procedure and don't find what you expected - you stop - no one faults you for that - they fault you for the 'normal' nerve on the pathology table - because the intern was bad help?  Or was it that the patient was a woman - the Petraeus excuse that the woman made him do it?  We are now back to blaming Eve. 

The Mayo Clinic needs to assure that no intern, resident, or student will be in on a patient's case without the approval of the patient & family - for those patients that come for the private service faculty practice - the MD patients, Professional Sports patients, Venture Capitalists, etc  - those that are not seen in General Surgery Clinic. 

The Mayo Clinic needs to assure that no intern, resident, or student will be allowed in the OR room on any case that they have not worked up, or done the homework on.  It's not Dr. Sarr's job to be digging up patients for Dr. Baghai - that's what General Surgery Clinic is for.  If she can't dig up her own procedures, she doesn't belong at Mayo Clinic - she can find her own suture removals or lump removals - everyone else does. 

But to let Dr. Baghai go at a patient without the incision being marked as to the site of pain - was sheer stupidity not found in a first medical student at most Medical Schools - they flunk medical students on clerkships for this, but not at Mayo Clinic.  The black student should have been flunked, and should not have been in the room with his overdose of male cologne (maybe that made things go wrong), but he was diversity.  Dr. Sarr did not discuss before the anesthesia, did not mark the incision, did not assure the patient of the intended procedure - and brought in a Major Surgery set - so he planned a neurectomy - without consent or discussion.  That's classic Robin Cook nightmare material.

Jill Beed-Smith has whitewashed this, but the fact is that Dr. Sarr taunts the patient that he didn't have to get consent, discuss or be honest - that he could do whatever to her as he IS Mayo Clinic - the ultimate sin of hubris in action once again.  Dr. Sarr couldn't even keep his mouth shut that he could do this without consent and get away with it. 

A neuroma is from a cut nerve - a swelling of abnormal nerve cell proliferation.  The history of a 'neuroma' is that there is numbness - there was no numbness in this patient.  And the numbness starts day #1 after the surgery - its not a diagnosis after 14 years - that's something different.  But an injection of 2% lidocaine - and Mayo Clinic is so smart - if it worked would have R/O neuroma or prolene sutures.  But Dr. Sarr doesn't think, and Dr. Bundrick does not work with him to make sure that he does not remove abdominal nerves for sport, or think.  Someone needs a BRAIN.  

The Mayo Clinic has some explaining, and repairing to do.  There's a not a General Surgeon on Staff that can repair 3 muscle fascias in a layered closure - using 3 suture packets and some skill?  Is it just Dr. Sarr clones?  The layered closure requires a better surgeon - but perhaps Mayo Clinic has none of those on staff anymore.  And Warner Andrew, you should not be going along with this rot - whatever the paycheck.  It speaks poorly of you - you should insist that all your classmates be treated with respect, care, and get the right diagnosis before a neurectomy and mutilation - and for what?

This case did not pay Mayo Clinic anything - the only person who collected something was Dr. Sarr - who got to the medical insurance before the patient could object.  This case did not help the woman patient - she will continue to have repair plastic & general procedures - until the muscles are repaired back to pre-Sarr. 

This case did not teach the intern or student what appropriate surgical diagnosis, treatment or professional behavior was - it was a sleazy act of non-thinking surgical violence.  The surgeon was not thinking because he was too full of himself and on the next plane out already in his mind - because he didn't care about his job, how this looked, how it played to residents & students, or the opinion of colleagues at Mayo.  This case made everyone at Mayo Clinic look bad = from Jill Beed-Smith, to Sarr, to Warner, to John Bundrick.  

It makes no sense anymore than the Connecticut massacre.  Surgical violence can be as lethal as gun violence.  The same security measures, and learning to use the equipment, are necessary - you don't just walk in and pick up a surgical instrument and start cutting - you study the case, mark the skin, and you ask the patient's permission to do the procedure - and you accept the 'No' when it is given as it was here.  This was a Chief of Surgery case that had flummoxed another Chief of General Surgery at another University Hospital; Chief to Chief there should have been a talk.  And any patient having a general anesthesia - you have to talk to the next of kin. 

The same maturity is needed - using guns or scalpels - both can kill, maim, injure, and be abused.  John Bundrick what was the sense of this?  Please enlighten in your next Clinical Pearls.