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    Penalties for surgical errors to sharpen

    The Florida Board of Medicine denounces the increase in mistakes and plans tougher consequences.


    © St. Petersburg Times, published April 3, 2001

    In one case, a Brandon doctor performed the wrong surgery on a patient's wrist.

    In another, a St. Petersburg orthopedic surgeon began operating on a patient's right middle finger, then realized he should have been working on the ring finger.

    And in what members described as the worst case of botched surgery presented to the Florida Board of Medicine over the weekend, a Palm Beach County man who needed a procedure to ease his incontinence instead got a penile implant.

    He was 83.

    Facing what its chairman called a disturbing "crescendo" of wrong surgeries, the Board of Medicine this weekend lashed out at sloppiness in the operating room, proposing tougher penalties for doctors who perform such surgeries.

    These include a minimum fine of $10,000 and ordering doctors to tell their peers about their mistakes, in hopes that sharing such information will prevent other physicians from making them. Before, penalties could vary.

    "There is too much rush, on the side of the doctor and on the side of the hospital," board Chairman Gaston J. Acosta-Rua of Jacksonville said Monday. "Too many things need to be done right away . . . and the patients are paying for that."

    At its three-day meeting this weekend in Jacksonville, the board heard seven cases, including two from the Tampa Bay area, of wrong or so-called "wrong-site surgeries," in which the surgery is done on the incorrect part of the body.

    Last year, the board heard 20 cases of wrong-site surgery or wrong procedures, compared with eight cases in 1999.

    Such incidents are notoriously under-reported, state investigators say, so it's unclear if Florida doctors are really making more mistakes or simply reporting more.

    Dr. Zachariah P. Zachariah complained that some mistakes are inevitable, but wrong-site surgery "is purely and completely carelessness."

    The most unusual part of the proposed rule is the requirement that doctors give one-hour lectures to the staff at the hospital or clinic where they practice. They must explain the error in detail, and explain how it was made and what could have prevented it.

    "I think the medical staff of an institution are likely of be more attentive when one of their own sits up there and says this is what happened to me, and this is what happens when you go before the board," said Dr. Rafael Miguel, a board member from Tampa.

    The new rules won't take effect until interested parties such as the Florida Medical Association can take any concerns to the board. The FMA is reviewing the proposed changes.

    Wrong-site surgery gets widespread attention during spectacular cases, as happened when a surgeon at University Community Hospital in Tampa amputated the wrong foot of a patient in 1995. But the Board of Medicine is just one of many groups addressing the problem nationally.

    A year ago, the American Academy of Orthopaedic Surgeons recommended that members initial the correct spot before surgery. The Florida Hospital Association suggests that doctors and the patient mark the spot together.

    "We encourage them to use things like "yes' or "no,' " explained Dr. Susan V. White, vice-president of quality management for the FHA. "If you put an X, an X can be misleading. X can mean "X marks the spot,' or X can mean "don't do that.' "

    On Monday, board members acknowledged that many people usually contribute to surgical errors, and doctors often blame nurses for preparing the wrong area or making other mistakes. But the surgeon is ultimately in charge, they said.

    In one case the board heard this weekend, Dr. Alfred Hess of Brandon performed a carpal tunnel release on a 38-year-old woman instead of the wrist surgery she needed.

    Because it was his second mistake, Hess was fined $20,000 and ordered to present 10 one-hour lectures to doctors around the state. Through an aide, he declined to comment.

    Dr. Jorge Rodriguez, an orthopedic surgeon in St. Petersburg, was fined $5,000 and ordered to present a lecture for operating on a patient's wrong finger. He realized the error and did the appropriate procedure. He could not be reached Monday.

    In the penile implant case, Dr. Bruce E. Wiita, a urologist from Palm Beach Gardens, successfully treated an 83-year-old man for prostate cancer for two years. He developed incontinence, a common side effect, and Wiita suggested he implant an artificial urinary sphincter.

    The patient agreed, but Wiita "erroneously dictated into his office progress notes that Patient L.S. wanted to have a penile prosthesis inserted," the state's complaint said.

    When he arrived at Jupiter Medical Center for surgery, the doctor "did not review the patient's chart, physical examination or history before proceeding with the insertion" of the implant.

    The board fined Wiita $5,000 and issued a reprimand. He also was required to take 10 hours of classes and give the one-hour lecture to the hospital staff.

    "Some of these are very good doctors, and they made an honest . . . mistake," Miguel said. But without systems to prevent it, "if you're busy, and you do enough of these, the numbers just catch up with you."


    The Florida Board of Medicine had proposed tough new penalties for doctors who perform surgery on the wrong body part or perform the wrong surgery. The minimum punishment would be:

    $10,000 fine

    Five hours of classes in risk management

    Letter of concern

    One-hour lecture to the staff of the hospital or surgery center where the problem occurred

    Twenty hours of community service providing volunteer medical or other services

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