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August 2, 2007
Update: R.I.H. doctor operates on wrong side of brain
The state Health Department today ordered Rhode Island Hospital to hire a consultant and double-check surgical sites after a neurosurgeon operated on the wrong side of a patient’s head on Monday -- the second wrong-site procedure this year at the hospital.
Additionally, the surgeon who performed Monday’s case, Dr. J. Frederick Harrington, has been ordered to stop performing surgery and undergo an evaluation.
Health Director David R. Gifford said the order against the hospital -- called an “immediate compliance order” -- is the first such order that his staff can recall being issued against a hospital. It indicates that the problem was serious enough to require immediate action even before a full investigation can be completed.
Gifford said he issued the order because of the “pattern” of wrong-site surgeries, all involving neurosurgery at Rhode Island Hospital. In addition to Monday’s surgery, wrong-site neurosurgery procedures were performed in January 2007 and in December 2001. (Earlier today, the Health Department had issued a news release giving the incorrect date for the 2001 incident.)
“The hospital needs to change its culture and its systems,” Gifford said. “Maybe these were three isolated events. It certainly doesn’t look that way.”
The patient involved in Monday’s surgery had blood between his brain and his skull, on the left side, according to Health Department documents. Harrington and others “failed to make an accurate assessment of the correct location,” the documents said, and operated on the wrong side. When the error was discovered, they immediately performed the surgery on the left side. The hospital said the patient is in stable condition today.
-- Journal medical writer Felice J. Freyer
The other wrong-site surgeries both also involved bleeding on the brain. In January a drain to relieve bleeding was placed on the wrong side, and in 2001, doctors drilled holes in the wrong side of a patient’s head after an X-ray was placed backwards on the viewing screen. After the 2001 incident, Dr. John Duncan III, the hospital’s neurosurgeon-in-chief who had supervised the surgery, was deemed responsible for the error and ordered to make recommendations on preventing such errors in the future.
“We deeply regret the incident that occurred on Monday, July 30,” the hospital said in a statement. “This should not have happened: We have policies and procedures in place to prevent an incident like this from occurring. The preliminary investigation indicates that at least one of our standard policies was not followed.”
The hospital said it was in the process of hiring the consultant as ordered by the Health Department; in addition it plans to hire “a prominent neurosurgeon to review our entire neurosurgical program.”
“The public trusts and relies on our hospital for this care,” the hospital’s statement concluded. “We can and must do better to ensure the safety of our patients.”
-- Journal medical writer Felice J. Freyer
Posted by Mike McKinney
at 5:24 PM | Permalink
fran dunn | August 23, 2007 10:45 AM link
Cindy | August 29, 2007 11:41 AM link
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I too have experienced problem with Dr. Harrington after surgery for two miangiomas performed in 1904. He had no assistant doctor in the OR and his report omitted pertinent detail re his surgery - that he later verbally said. I found his reports purposely omitted detailed he could be held responsibility. It is almost 3 years since and I have not been able to work. He would not help with disability and have been on seizure meds since. Savings gone. As a real estate agent - carreer gone, etc, etc. Anyone out there experiencing similar post-treatment problems, please contact me. Would love a class action suite. more people will be hurt. thanks.