Wednesday, April 04, 2007

Another set of UCLA data points – both obvious and obscure.

OK, today’s LA times has a story about Benjamin Houghton, who had the wrong testicle removed by a UCLA resident surgeon in June 2006. The LA Times makes the obvious points: the proximate cause of the wrong surgery apparently included failure to correctly obtain consent for the planned procedure, failure to mark the correct testicle for surgery, and so on. It’s a catalog of errors, but by themselves this set of errors appears due to simple human failings (although if you read the posts below this one, you might get the idea that the University of California seems to have more simple human failings than might be expected).

The part that appears to have been unremarked on by the LA Times however, is this:

“The VA surgeon, fifth-year UCLA medical resident John T. Leppert, was supposed to remove Houghton's left testicle and perform a vasectomy on his right side for birth control purposes, according to medical records that Houghton and his attorney gave The Times.”

And that sentence says something a little more insidious about UCLA’s attitudes about it’s own interests. As stated in the article, Dr. Leppert is a resident. He’s not the surgeon in charge. He’s supposed to be supervised by an attending physician. There is no doubt that an attending physician billed for services rendered in this case, even if only for supervision (although when I was a resident, the University of California apparently “routinely misbilled” procedures done by residents as if the procedures had been done by attendings. The University agreed to pay $22.5 million in that case, but their billing practices may still be flawed).

It’s the ATTENDING who is ultimately at fault for this wrong surgery. That’s why he’s called an “attending.” From the fact that there’s no mention of an attending, it’s a pretty fair bet that UCLA has left Dr. Leppert to twist in the wind. Note that Dr. Leppert has just been through medical school, and has been working for at least the last 5 years at wages that probably don’t allow him to pay the interest on his medical school debt. In other words, it’s going to be very difficult for Dr. Leppert to hire his own attorney, if he needs one. If UCLA is already attempting to foist the blame on Dr. Leppert, as opposed to one of it’s attendings, then it’s a pretty good bet that Dr. Leppert will need his own attorney. Too bad he might not be able to get one.

For what it’s worth, when I had a patient die from anesthetic misadventure at UCLA, my attending had never had time to leave the room, since the patient had cardiac arrest just after induction. I suspected then, and now believe, that if there had been any way to pin that death on me that the case would have been more vigorously addressed. Once it became clear that only my attending, not the resident (me) could have been responsible for that death, the case seemed to “disappear." There was no formal attempt known to me to determine or address the cause of death.

Anyway, one of the reasons I think it's so sad that Dr. Leppert is apparently being left to twist in the wind is that his part in the chain of errors is exactly in keeping with UCLA practice. According to the story, when it came time to get consent for the surgery, this is what the patient recalled:

"The surgeon said, " 'This is what we talked about before. Just sign here and here' ""

Now that is, in my opinion, a typical UCLA "consent" procedure. Multiple times, when I was at UCLA, I was told that the goal of obtaining consent was to get the signature on the paper. When I tried to do more, I was critisized. Of course, I knew that the actual legal goal (different from the UCLA goal) of obtaining consent was more than simply getting a mark on a piece of paper, but it's easy to believe that Dr. Leppert, after 5 years at UCLA, had internalized the UCLA beliefs. That's why it's so sad, and ultimately pointless, for Dr. Leppert to be the fall guy for this error. At least part of the problem is that he did what he had been trained to do.

1 comment:

Jackie said...

Doctors all know that the REAL reason to get an "informed consent" signed is NOT for patient information, but as a "hold harmless" document. The deliberate misinformation, omitting of pertinant facts, and outright lying in order to get a "Doctor's Insurance" paper signed is unconscionable. It is liable to get you sued! This deliberate glossing over of the facts pertaining to medical procedures is a blight on the whole profession. Whining about malpractice insurance costs when you are lying to patients about the honest drawbacks to their procedure or drug "therapy" is disingenious isn't it? Disappearing or altered medical records, no "informed consent" for things like "conscious sedation," abuse of patients while sedated, sloppily done surgery, surgery performed that has devestating side effects which are not divulged, the list goes on. We are loosing our faith that Doctors are honest, forthright and have our best interests at heart. You Doctors don't "KNOW WHAT'S BEST" all of the time. Start having meaningful dialogue with your patients or you are going to find that yours is no longer a respected profession. Respect demands that you behave in a respectable manner. Manipulating patients and having them sign fraudulent documents stating that they were informed of the facts is not in the respectable behavior column, is it?