Former Lancastrian

Now here is an interesting one for readers to ponder over

Definition of negligent

1 a :marked by or given to neglect especially habitually or culpably
was a careless workman, negligent of details —Edith Hamilton
b :failing to exercise the care expected of a reasonably prudent person in like circumstances negligent about traffic regulations
2 :marked by a carelessly easy manner

So if a hospital surgical team leave a 33 cm metal plate inside a patient and its later discovered have they been negligent or it was a failure of procedure?

I guess if the Commissioner investigating deemed it to be negligent then perhaps a lawsuit and substantial payout might have been awarded.

An apology was made and a lawyer has been hired.
'No negligence was involved' after 33-cm plate left inside surgery patient, says report - Montreal - CBC News

caretaker

The lawyer will love that, great visual, and that's what insurance is for. Oink could make a honking great flasher out of that and catch a salmon.

dave_j

An interesting problem.

In my view it's both.

I've no doubt that procedures existed that were designed to prevent this type of event. We've all heard of cases where various items have been left behind after surgery and in this case whatever procedures existed were insufficiently robust to identify a missing item of equipment following the surgery.

That being said, whatever procedures that were in place allowed behaviour to pass unnoticed that was clearly negligent because someone put it in and mistakeny mis-accounted for it afterwards. I suspect that the statement that procedures are being changed is an attempt to pass responsibility from staff to procedure.

It could be argued that procedures should have been sufficient since they allowed for an accounting of surgical instruments before and after but they didn't apprently ask the question "What if someone makes a mistake?" and we all make mistakes.

If I work in a garage and I remove a wheel from a car and give it back without tightening the lug nuts holding the wheel on would you regard it as a failure of procedure. If a notice is fixed to the garage wall saying vaguely 'make sure it's ok before you hand it back' who is to blame, me or the wall?

BristolUK

I'd have thought negligent would be not doing the count before and after as a comparison.

It appears the count was done, just not very well.

I suppose, though, one could argue they neglected to do it properly but that would mean neglect could be applied to everything that went wrong.

old.sparkles

If you had to count hundreds of these things, and miscounted I would think that was accidental and not negligent. But I don't expect that they were counting more than a handful so how can getting the count wrong be anything but negligent due to carelessness and lack of attention?

bats

It's most likely procedural error from what's said in that article. The nurses followed procedure so were not negligent. Procedure should have had counts before and after closure plus the surgery pack contents should have been checked before it went back to be reprocessed/sterilised. Also CSSD/reprocessing should have checked that all the reusable instruments were returned in the pack.
That said it could have been in a separate pack and would not have shown in the before and after counts

BristolUK

A few guesses:
Maybe by someone moving an item before or after they counted it? By someone mishearing what someone said they'd counted? By someone noting how many they started with and the number being misread?

That bit I underlined...that's what I meant when I said negligent could be used to describe anything going wrong.

Lack of attention - you could certainly say it was negligent not to pay attention. But what if time, circumstances, whatever meant you did pay attention? Say you specifically listened to a colleague saying how many items they now had and he said SIX. Then suppose the person who counted them at the beginning also said SIX. Or perhaps one of them wrote a 5 that looked like a 6 or vice versa or one of them miscounted because someone was arranging them while they were counting?

Is the last person to look at the numbers negligent by not double checking with both? Negligent in thinking the others know how to count or write clearly?

This might actually be a clue as to the ruling on the procedural aspect. Having investigated they may have seen that everyone did what they were supposed to do, nobody was negligent because they all did what procedures said should be done but something still went wrong. So now they see a change in procedures is necessary.

Do you ever cook something for a group of people and find you don't have. say, four each for everybody after all? Does that mean you were negligent? I mean if you're 4 and you want 4 each of something that means you put 16 on to cook. But you end up with 15 instead.

But you specifically worked out how many you were, how much per person and then did the sum. You even did the sum accurately.

Would you accept you simply miscounted? Perhaps you picked up two to add to the pile, one fell back and you didn't notice.
To me that's not being negligent...you did the calculation, you did the counting and the cooking. It was all reasonable on your part. You just didn't see one fall back into the bag.

But maybe you were negligent in not double counting and rechecking at each stage to see if one fell off the tray as you put it back in the oven.

BristolUK

I should have given it a few more minutes, read what you said and then I needn't have written that essay.

old.sparkles

The work I do sometimes means that I have to do a count in / count out of all tools, fixtures, etc - people object to finding nuts and bolts in food items. There are usually two counters, but both count and list items independently of the other and double check at the end. If I think I took 5 bolts in to a machine, used 4 in the repair and only exited with the 4 replaced then I would know I was one short, and so would the checker. I could not 'miscount' and hope to get away with it as I have to show items to the checker.

Maybe food companies are more susceptible to negative press, but I would have thought that surgery requires more stringent procedures than maintenance or repair of a machine.

BristolUK

Yes, that would certainly apply in that one example. What if the other counter reported one extra. You'd then think between you that you were not one short, but you might be if they'd got it wrong. Perhaps they'd found one that someone previously left behind in error.
How about the other counter had to leave suddenly and left you a note with less than clear handwriting?

I couldn't help but note that you only 'think' you took 5 bolts.

Everything that followed may have been by the book but wrong because it was wrong to start with.

old.sparkles

Bad choice of words on my part

If I had a count in / count out of 5/5 but checker has 6/5 (or even 5/6) then the job cannot be closed - you have to account for the discrepancy.

And if the checker leaves, they have to hand over to a different person - I can't be responsible for both counts. The handover, if it happens, is another process in itself.

At the end of the day though this was an operation on a person - how can you fail to notice that they have a 13 inch bit of metal inside of them?

BristolUK

Perhaps have a metal detector in the exit.

I can think of a couple of ways but it's quite an alarming thought
I'm guessing that it had a use in the operation they were doing (as opposed to being one where they insert it) and that once temporarily in place it could be hidden by various bits of body tissue and liquids.

Surgeon then leaves it for someone else to remove who thinks it was removed.

I don't know how these things work but on TV the big cheese does his or her bit and then asks someone else to finish up. Does finish up mean different things to different people? And if they're working with someone different there may be a misunderstanding...but that's where procedure should come in to avoid that.

I'm sure I'm wrong, otherwise it would happen all the time

The other explanation is...

A young, lowly orderly working in a busy hospital who dreams of bigger and better job opportunities for himself. One evening, he witnesses a car accident outside a local pub where the driver of a car is killed after colliding head-on with a lorry. He learns that the man was a doctor at the hospital where he works and had been applying for a residency at another hospital in another city. He takes the dead man's mail, fills out a job application, and applies for the job himself under the late doctor's identity. After studying medical books and getting "hands on" involvement with other patients at his hospital, He applies for the job and is accepted. He quits his orderly job and resettles where he is assigned to a busy Accident & Emergency (A&E) department.

Despite his lack of experience, he completes his first few days without incident. He meets and is soon aided by a friendly A&E nurse....

The plot of Paper Mask, 1990 movie with Paul McGann

Former Lancastrian

Im interested if the Commissioners finding of failure of procedure as opposed to negligence would affect any lawsuit launched.

Would there be a bigger payout if negligent rather than failure of procedure.
Could people lose their jobs over a negligence finding rather than a failure of procedure.
Does a finding of failure of procedure look better for the hospital as opposed to a negligence finding?

We are all human and mistakes happen and Im not suggesting this was done wilfully but there again Im not the lawyer for the plaintiff

Almost Canadian

In the common law world, the test for negligence in such a situation is: Would a reasonably competent practitioner, or group have practitioners, have made the same mistake? I imagine the Quebec has a different set of rules.

However, one defines negligence, there is no doubt in my mind it was negligent. I can't imagine how it could have been accounted for without someone being negligent. Blaming the procedure is nonsense, as the person that formulated the procedure was negligent, if the procedure is not fit for purpose. Having been involved in such cases in the past, I imagine that there will lots of shirking of responsibility.

BristolUK

That's interesting. Usually when there's been a hearing, examining of statements from involved parties, that sort of stuff and someone not involved in it expresses some reservations about a decision, you make some comment about them not having all the information that those investigating had available.

There's been an investigation here and you disagree with the ruling made by those who had the information.

Why the change of heart?