Melanoma and Inappropriate Site

Dr. Cancer is a highly esteemed dermatological surgeon who is recommended by numerous medical professionals. His proficiency in removing skin cancer is widely recognized. He is a nationally recognized lecturer on melanoma treatment and holds an academic title. It is necessary for all referred patients to bring reports from their biopsies. Some even include pictures of the area that was biopsied.

Most patients can tell you pretty well where the biopsy was performed. Dr. Cancer saw a patient two years ago who had a right cheek melanoma in situ that had been confirmed by biopsy. During the first consultation, the patient brought a picture of the affected area. Dr. Cancer recommended the patient take an anti-anxiety medication before her surgery because she was extremely nervous about it. In the course of the consultation, consent forms were signed.

Dr. Cancer's patient took her anti-anxiety medication twice on the day of surgery. When she arrived at Dr. Cancer's office, she was disoriented and drowsy. Regretfully, the day in Dr. Cancer's office was not pleasant. The incorrect location received local anesthesia from the staff.

Subsequently, Dr. Cancer removed a sizable portion of the incorrect skin region while leaving the melanoma intact. The patient's family discovered that the surgery was done in the incorrect location as the staff started teaching the patient proper wound care. They were horrified. They filed a claim with Dr. Cancer's state board of medical examiners and a medical malpractice lawsuit, but they never came back to the office. What happens next?

Regrettably, incorrect site surgeries do occur. A prominent neurosurgeon from New York temporarily lost his medical license more than 20 years ago after performing surgery on the incorrect side of a patient's brain. A hospital in Rhode Island was fined for permitting five surgeries to be done at the incorrect location during the preceding three years. A $150,000 fine was imposed on the hospital, all staff members involved in performing elective surgeries had to complete a one-day safety training course, and a proctor was needed to ensure that the surgical teams were adhering to safety procedures.

The hospital was required by the state health department to install audio and video monitoring equipment in each operating room. Now there would be a record of the music of the day as well as the jokes that are exchanged during surgery. Such drastic measures were thought to be the best way to address the underlying cause of the issue. Consent was required from patients in order to film them.

Surgical errors are regarded as "never events." Reoperations that are performed on the incorrect part of the body are not covered by Medicare. Numerous commercial insurance providers have done the same. Surgical errors can be avoided.

Involving the patient is one way to lessen the possibility of such humiliating (and possibly mutilating) occurrences. Inform the patient prior to surgery that the most crucial part of the procedure is operating on the correct side. To mark the spot, a marker can be given to the patient. He or she should sign the consent form specifying the proper location. On the day the patient is scheduled for surgery, this needs to be verified again.

The majority of patients will value the additional care taken during this procedure. But that's not all. Additional precautions include a "time out" before cutting, confirming the correct side with any pre-operative biopsy report, pre-biopsy photos, and the consent form, and ensuring that multiple team members identify the correct spot.

Patients occasionally have questions about the precise site of a biopsy. Biopsies are occasionally given incorrect labels. There are numerous instances in which there are none at all. Do no harm, however, is the defining principle of medicine. Operating on one location while the cancerous lesion was actually present on another is an obvious violation of the standard of care.

The aforementioned fact pattern forms the basis of the malpractice lawsuit. Most lawyers would suggest that Dr. Cancer resolve the matter outside of court. Dr. Cancer should also make an effort to reach a settlement with the state board of medical examiners. The location of the biopsy may not be entirely clear. It's necessary to define the site properly.