Although there should really be no doubt about the matter, Texas law makes it clear that surgeons, doctors, and nurses aren’t supposed to leave unintended items in the bodies of their patients.
Retained surgical item or foreign body cases are considered sentinel events that should never happen in healthcare—yet they do.
In a landmark opinion, Walters v. Cleveland Regional Medical Center et al., 307 S.W.3d 292 (Tex. 2010), the Texas Supreme Court essentially said that retained sponges—and by implication, other retained surgical items—"never occur absent negligence."
In most cases, it’s relatively easy to determine who left a sponge, piece of gauze, or sharp item inside a patient’s abdomen or body. The culprits are typically a surgeon, operating room nurse, or surgical tech, or a mix of one or more of them.
This week, though, I deposed a surgeon in a more unusual foreign body case. In this one, a home health wound care nurse used a specialized type of gauze to pack a patient’s wound after an open gallbladder surgery. Wound packing refers to the process of pushing gauze or packing material down into the base of the wound. This iodine-soaked gauze, called iodoform, is designed to soak up material over the course of 24 hours before it must be removed. Otherwise, it impairs healing and becomes a magnet for infection.
To make sure everyone’s aware that it’s there, doctors and nurses are required to document the measurements of the iodoform strips packed in the wound and leave a tail coming out to make it obvious to anyone who looks at the wound it’s there. And once it’s removed, the standard care requires documentation of that fact.
The home health wound care nurse packed the wound, didn’t document measurements, and made no note in the medical record that he had removed it. The last part is easy to understand because the fact is, he forgot about it and left it there.
Two years later, the patient has abdominal pain and returns to the hospital where she’s diagnosed with an abdominal abscess. It was in the same area of the gallbladder surgery. She made a trip back to the operating room for an incision and drainage procedure. During the operation, the surgeon discovered and documented the old iodoform gauze.
The poor patient developed sepsis and faced long months of rehabilitation care. In sum, the poor home health wound care almost took her life.
In the medical malpractice lawsuit that we filed on behalf of the client and her family, the home health agency is taking the bizarre position that its nurse didn’t leave the gauze in the patient’s abdomen, despite clear evidence that:
• The home health wound care nurse is the only one who documented using iodoform gauze in the medical record.
• The gallbladder surgeon didn’t use iodoform gauze in the operating room or his office.
• The gallbladder surgery operating room staff didn’t use it either.
This is going to make an interesting trial. The home health agency’s lawyer is going to have to try and convince a jury to disregard the medical records that show its own nurse placed the iodoform gauze and, instead, believe that the patient, a family member, or someone else did it. Good luck with that!
If you’ve been seriously injured because of poor medical, hospital, or home health care in Texas, then contact a top-rated experienced Houston, Texas medical malpractice lawyer to discuss your potential case.
