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February 22, 2003

The moral clarity never stops: She’s not even dead yet, and Bob Novak already knows the contents of her grieving family’s hearts:
I hate to say this, but I just smell the sign of her relatives are building up for pain and suffering to get a killing, to get not $250,000, but millions of dollars for this. I mean, isn’t that what this is about?
What a disgusting piece of shit Bob Novak is. (Via Eschaton.) [10:22 AM]
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Hard-Hitting Moderator: Teresa Nielsen Hayden.

Comments on The moral clarity never stops::

Brad DeLong ::: (view all by) ::: February 22, 2003, 10:53 AM:

"Errors and No-Facts." That's how Robert Dole's staff on the Senate Finance Committee in the mid-1990s would refer to Robert Novak and his partner, Rowland Evans...

David Moles ::: (view all by) ::: February 22, 2003, 10:55 AM:

Bob, don't say "I hate to say this" when we all know you're relishing every damned syllable.

"I mean, isn't that what this is about?"

I guess it is, for you, Bob, isn't it? Yeah, it's also about the AMA lobby and the insurance lobby and the trial lawyers being big Democratic donors and the fact that $250K is a minor accounting error to a big HMO and not much more than an inconvenience to a skilled specialist. But what lets you look at yourself in the mirror — heck, pat yourself on the back — is your secure knowledge that all plaintiffs are venal greedy lying bastards.

It's not like such people don't exist. I've met some of them -- the next-door neighbors who when I was seven years old and entirely because of my own reckless stupidity was in the hospital with a broken wrist and a broken leg, tried to convince my parents to sue the poor guy whose car I'd darted out in front of.

But to accuse someone of that on national television while their daughter's still in critical condition, that's -- I'm at a loss for words. Obscene, for starters.

Still, I guess that's what the guy's paid for.

Patrick Nielsen Hayden ::: (view all by) ::: February 22, 2003, 11:01 AM:

It is indeed.

the talking dog ::: (view all by) ::: February 22, 2003, 12:04 PM:

Patrick--

I'm surprised at you for comparing Bob "Prince of Darkness" Novak to a piece of feces. Just plain disrespectful. To feces.

Bill Altreuter ::: (view all by) ::: February 22, 2003, 12:49 PM:

Of course, Novak's remarks are offensive, because they are personal to the unfortunate victim and her family, but they would also be offensive if what he was saying was more general. A statement like, "Persons who are injured as a result of the negligence of doctors are greedy, and should not be compensated for their damages," is also offensive. Because it is a more diffuse remark, however, or more abstract, people tend to react less strongly. The fact is, we are all being sold a bill of goods with respect to both medical malpractice reform, and tort reform in general.

Med mal cases are (a)comparatively rare; and (ii) comparatively unsuccessful. It is very difficult to prove medical negligence, usually. The third thing that is generally true about med mal litigation is that they tend to be comparatively serious. Because they are hard to prove, only the serious cases are litigated, and the damages in those are almost inevitably substantial. Death, brain damage, paraplegia, a lifetime of incontinence-- these are just some of the bad things that can happen to someone who has a doctor who screws up. It is also worth noting that usually the victim in these cases is not going to be found to have contributed to the harm-- it is all on the doc that didn't read the label, or count the sponges, or in some other way slipped up.

Love it or hate it, when someone is harmed, there is a cost, and someone has to pay it. In the neo-liberal welfare states in Western Europe they don't have a tort system like ours, which makes the wrongdoer pay-- they spread the risk across the economy. I don't see that "reform" coming to the US.

Kevin J. Maroney ::: (view all by) ::: February 22, 2003, 01:35 PM:

"Med mal cases are ... (ii) comparatively unsuccessful."

Amen to that. When I lived in North Carolina, the father of my best friend had a serious heart attack and then spent the next four years unsuccessfully trying to prove that his doctor was negligent in not diagnosing it properly.

The data that the doctor had to work with were: a) "Bob" had a history of severely high cholesterol and arterial congestion; b) a recent (as in, five days previous) EKG which showed troubling signs; and c) Bob's report of, for the first time in his life, "severe pain radiating out from his left shoulder".

This doctor decided it was heartburn (the term "acid reflux" was not in vogue yet) and told him to take some antacids and come in on Monday. By Saturday night, Bob was in the ER, and he was debilitated for months.

If I were the king of the world, the doctor would have had his license stripped immediately, and then been flogged. Severe pain in the arm can be anything from, yes, gas or a muscle cramp; it can also be a massive coronary blockage, and given Bob's recent medical history, it was criminal to assume the best.

Of course, in the current case, the girl is clearly at fault for having had an immune system. How dare she?

Xopher ::: (view all by) ::: February 22, 2003, 01:45 PM:

Yes, Mr Dog, you're right...Q: What's the difference between Bob Novak and shit? A: Shit is necessary.

aphrael ::: (view all by) ::: February 22, 2003, 02:28 PM:

Dave, I think you've hit it right on: Novak's comment is the biggest example of public poor taste I've encountered since Rev. Phelps' people showed up to protest against the funeral of Gwen Arajuo. The idea that parents of a child who has just suffered irretrievable brain damage due to side-effects of a bad transplant might be faking their distress is truly mind-boggling.

What makes it worse, somehow, is that this is as clear a case of medical malpractice as i've seen in the press in some time: the doctor didn't even check the blood type but assumed that someone else had done so. Even if Novak's despicable implication that the family is faking their distress were true, I don't understand how he could object to the family getting a large settlement from the doctor who performed the operation.

David Moles ::: (view all by) ::: February 22, 2003, 02:42 PM:

Well, even with a successful transplant she wouldn't have lived that long anyway, right? (So says Bob.) And her family's poor, right? So obviously the value of her life just can't possibly be that high.

Claude Muncey ::: (view all by) ::: February 22, 2003, 03:19 PM:

Well, I don't expect much better from Novak -- this is the way he's been for years. But I expect just a little better from someone with the background of Toobin.

This is a largely manufactured crisis, and the insurance companies have done it before when their investment income has gone into the toilet. The last time this happened, in the 1980's, the insurance companies got the CA Leg (as well as other states) to pass the kind of reform Bush wants and both Toobin (as the "neutral" expert) and Novak seem to see as needed. It did nothing to help the price of insurance but it did restore profits at the insurance companies The same thing is going on now. The only thing that finally got the rates down in real terms was reregulating insurance companies in CA.

Also, during the boom times of the 90's when you could make money in insurance no matter how stupid you were, lots of companies came in and offered low rates to win customers. Some of these companies have gone bankrupt or withdrawn from the market and rates are now skyrocketing, partially from less competition (and undercapitalization) as well as the now vs then comparison starting from an unrealistically low starting rate.

This information is easy to get to but doesn't seem to trickle up too far.

Reimer Behrends ::: (view all by) ::: February 22, 2003, 06:01 PM:
Bill Altreuter wrote: "Love it or hate it, when someone is harmed, there is a cost, and someone has to pay it. In the neo-liberal welfare states in Western Europe they don't have a tort system like ours, which makes the wrongdoer pay-- they spread the risk across the economy. I don't see that "reform" coming to the US."

As somebody who is a citizen of a "neo-liberal" [1] welfare state (Germany, to be precise) I am somewhat surprised by that statement. There is a tort system ("Schadensersatzrecht") in place in Germany (which looks different, because continental European law is in general quite different from Anglo-American law), and you can most definitely bring lawsuits against doctors for malpractice. Of course, I've yet to see a doctor without malpractice insurance, so I'm not sure if it matters all that much.

That being said, I'm not trying to express a preference here (I'm not even sure I have a strong preference in this matter). But I thought I should clarify this point.

[1] On a historical note, the "neo-liberal" German system was introduced in the 19th century by the archconservative Bismarck to take the wind out of the sails of the social democrats.

Lydia Nickerson ::: (view all by) ::: February 22, 2003, 06:08 PM:

I work at the University of Minnesota. For 3 years, I worked in the Bone Marrow Transplant office, and for the last two, I've worked in the Surgery Department, which handles heart, lung, kidney, and pancreas transplants -- as well as lots of other things. I'm way over in admin in the Surgery Dept., so I don't know the specific procedures for transplanting solid organs. I have a perfectly huge number of questions that the mainstream news isn't even bothering to acknowledge, much less answer.

I know how it works with bone marrow transplant patients. There's a huge difference there, though. The donor is alive, and will remain alive. That means that there is more wiggle room on one end of things. Typing is done by several different institutions along the way, and the final decision on what donor to choose is almost never done without the typing having been confirmed in the transplant hospital's own lab.

What I want to know is, what's the standard procedure for solid organs in the US? It won't be different for Duke than it is for other hospitals. Oh, there may be minor variations, but in order to be accredited and so be allowed to receive organs, there are protocols that have to be followed.

How on earth did they come to request the organs of someone of the wrong blood type? That shouldn't be possible. How did the national bank allow them to come and harvest them? That shouldn't be possible. I don't know where in there a confirmatory typing is typically done, but I'd be surprised that there wasn't one required somewhere in between identifying the donor and harvesting the organs. The only thing that can lead to that kind of screw up, as far as I can tell, is that either the donor or the recipient's blood type was wrong in the registry.

The one person who might very well be blameless, depending on the set-up, is the surgeon. I wouldn't expect the surgeon to be the one who personally checked the blood type of the patient or the organs. I would expect the team that harvested the organs to have done it before harvest, perhaps. Surgeons walk into the OR all sterilized and wrapped head to toe in sterile scrubs. The patient is completely covered, except the area where the surgeon needs to work. The surgeon would open the girl up, pull stuff out, put stuff in, sew her back up, and move on to the next case. When the rejection started to happen right away, he'd have a pretty good idea of what happened. But I don't see why he'd have known before doing the surgery that there was a problem. He's the cut and sew guy. Unless he's even less competent than the news is claiming, the information he saw confirmed that the girl and the organs were a good match. Somebody's data was totally fucked, but I simply do not believe that the surgeon installed mismatched body parts knowingly.

There's a good deal of scandal around here about a surgeon who sawed off the wrong leg. I can't tell you how horrible I think that is, or what level of incompetence I think that takes. However, I must say that it wasn't the surgeon's fault. Or, not very much the surgeon's fault, depending on what the reason for the amputation was. In the first place, they overwork surgeons. They really do. In the second place, as I said, when the surgeon walks into the room, there's a sheeted body with a bit sticking out and nurses to tell him what to do about it. In the case of the incorrect limb being amputated, the nurses mismarked the limb. Before you get all pissed off at the nurses, remember that nurses are even more overworked than doctors, and get paid a fraction of what doctors get paid.

We do have a real crisis in health care professionals. The only way to solve the nursing shortage is to pay them more money, but the hospitals don't have more money, they have less. So instead of hiring more nurses, they're hiring LPNs and even lower level practitioners to fill in. This does not improve medical care. In disgust, good nurses quit. The physicians' time is too valuable to waste on what i think of as normal care, so they don't become very involved with or knowledgeable of their patients. They are treated like highly paid technicians, which causes them to come adrift, and start thinking about patients like broken machines.

Oh, and guess who does most of the paperwork. The stuff that keeps track of all these details and puts it in order where the nurses and doctors can grab it and see what's going on with a patient and donor...less and less often is it someone like me, a tolerably good clerical with a good eye for detail and the ability to absorb medical terminology as necessary. To save money, they lay off people like me, and the nurses have to keep all the paperwork straight, themselves. In their copious free time. Uh-huh.

(P.S. Should you end up going to the hospital for surgery, the Sharpie is your friend. If it's an amputation, right on your good limb "Not this one" in big, big friendly letters. Nurses put a dotted line where they expect the doc to cut for an amputation. You do it, too. If the surgery is something else, write or get a friend to write what the hell is supposed to be happening on a portion of your body that the surgeon will be able to see when you're draped. I'm not making this up, you know. Take a sharpie. Ideally, in addition to the sharpie you want to take a real hell-raising bitch of a friend who will insist on going into the OR if that's what it seems to require to make sure you get the kind of care you need. The friend needs to be smart, not antagonistic, but also someone who doesn't care whether or not she's going to be friends with your medical team. Ask questions, know what's going to happen when, and make sure that your friend. When going to the hospital, take a Sharpie and a Harpie.)

John Farrell ::: (view all by) ::: February 22, 2003, 06:11 PM:

Novak looks like Herbert Lom, which is an insult, I know, to the late character actor. On the other hand, he was renowned for playing arch villains....

Bob Webber ::: (view all by) ::: February 23, 2003, 06:38 PM:

What was particularly shameful in this instance was that the people involved had not even started any malpractice action. In the middle of their very personal tragedy they are suddenly the center of an argument in which one side makes them out to be greedy and their beloved daughter's name is suddenly the focus of animosity and disparagement.

If they want to be litigious they should probably skip the malpractice suit and go after CNN and its talking heads for defamation. Maybe then Novak would understand the difference between the part of the award for pain & suffering and the punitive part, which seems from the transcript to escape him in the context of medical malpractice litigation.

Barry ::: (view all by) ::: February 24, 2003, 10:05 AM:

There's a saying to keep in mind, that I first heard during the Clinton scandals - "the right never, never accuses anybody of something unless the right is already doing it". A variation applies here - Novak is accusing the family of using the girl's death for monetary gain. He's doing it on behalf of people who forsee huge monetary gains from 'tort reform'.

Simon Shoedecker ::: (view all by) ::: February 24, 2003, 06:55 PM:

Lydia - if I have read correctly, the answer to your principal question is that the organs were originally requested as a possible match to two other patients in that hospital who were indeed of the right blood type. When they turned out to be unsuitable recipients for other reasons, someone noticed that a third patient in the same hospital was also waiting for such organs, and that's where the failure to check blood types occurred.

Lydia Nickerson ::: (view all by) ::: February 24, 2003, 11:55 PM:

Simon-- Oh, my god. ohmigod. Look, if the recipients were unsuitable, what the fuck were the organs doing there in the first place? Did _two_ recipients really fall out of eligibility in the space of, what, 12 to 24 hours? Cadaveric transplants happen _fast_. They have to. Those organs should not have been harvested, much less taken to Duke, unless there was an eligible recipient right there, waiting. It is possible, of course, that two recipients both fell out of compliance at the same time. People that sick go over the line in no time at all. Still, two?

The problem, of course, is that I know just a little too much about how these things work, and not enough to be authoratative. "A little knowledge is a dangerous thing" is my motto. What I'm sure of is this: Duke has a precise procedure for dealing with the intake, confirmation, and transplantation of solid organs. I want to know what it is. UNOS also has precise, specified procedures for confirming the donor's typing and characteristics, choosing appropriate recipients, notifying the appropriate hospital, arranging for the harvesting of the organs, and for the transportation of the organs to the hospital. I want to know what they are, too. What I've found so far has been insufficiently detailed for my purposes.

I have an awful feeling that somebody whose job is an awful lot like mine was when I was working in Bone Marrow Transplant mistranscribed a blood type, and the usual confirmation procedures didn't correct the error, and some poor clerk is complicit in the death of a teenaged girl. The critical stuff isn't supposed to rest on the shoulders of the clerks. When applying for the job of principal secretary at the Bone Marrow Transplant Division, the first question I asked during the interview was, "Can I kill somebody if I make a mistake?" If they had said yes, I would not have taken the job.

Maybe this is a fluke, but it seems as if too many different things had to go wrong for the transplant to have happened. Lack of nurses, lack of staff, overworked everybody... The wonders of American medicine.

GP ::: (view all by) ::: February 24, 2003, 11:55 PM:

As I have read the comment sections of several blogs regarding this case, I am just amazed at the sheer perfection of non- physicians, who clearly have never made a mistake in their lives. Myself, I'm one of those greedy, uncaring doctors who only cares about my Mercedes and my golf game. I scammed my way through college and managed to graduate 0.17 GPA points short of a perfect 4.0. I even cheated my way into med school by graduating at the age of 20. When I'm on call for emergencies, I'm such a slime ball, I even try to get a few hours of sleep at night.. Even though I'm such a scumbucket of a human being, my failure rate is not as bad as airport security screeners, or space shuttle missions. Life must be great when your feces has no unpleasant aromas.
What gives all of you the right the right to demand perfection in medicine, where no one- doctors, nurses, orderlies, ward secretaries, etc.,- ever makes mistakes, when you have allowed medicine to be cut to the bare bones? (if that's not true, explain the severe nursing shortage everywhere). And spare me the crap about doctors protecting other doctors; first, no one would appreciate it more to see incompetent MD's stripped of their licences than me. Second, in order to strip a physician of medical privledges, medical incompetence, which is notoriously hard to prove, must be be meticulously documented; otherwise, the MD in question has numerous LEGAL recourse to countersue. Finally, state medical boards ARE a public institution, and would respond to a public outcry about bad doctors and hospitals, if the public were so motivated.

GP ::: (view all by) ::: February 25, 2003, 12:16 AM:

Now that I have vented those evil humors...
Lydia, in response to your question, those involved in solid organ transplants are presumably in a "use it or lose it" situation. With bone marrow transplants, I believe HLA matching is far more important than ABO compatibility for a successful transplant, and as you mentioned one has the luxury of a little time. Nonetheless, what happened at Duke was a massive clusterf--k, and a career ending debacle for the surgeon involved. My feeling is "there but for the grace of God..." In regards to surgeons who amputate the wrong leg, bad hospitals have bad doctors because they can't attract good doctors, and bad doctors go to bad hospitals because good hospitals find ways to run them out.
Kevin Maroney, a patient of mine had a large myocardial infarction. I later found out his primary care physician (the "gatekeeper") told him his chest pains prior to his heart attack were chest wall pains and prescribed ibuprofen. I was so pissed off by this (afterall, I was the one in at 2AM, doing his emergency coronary stent, while the other doctor was asleep at home), I told him to talk to some lawyers, but noone would take his case.
And Brad Delong, I recall it was Tip O'Neill who first mentioned "Errors and No-facts" in his book "Man of the House." I can't believe you credited Viagra boy with that. What are you, a closet wing-nut? (I actually very much enjoy your work).

Kevin J. Maroney ::: (view all by) ::: February 25, 2003, 12:26 AM:

GP: In fact, "Bob"'s physician was a cardiologist. As I said, I'd like to see him stripped of his license and flogged. He had no trouble getting a lawyer, but the case did not go well.

Patrick Nielsen Hayden ::: (view all by) ::: February 25, 2003, 12:35 AM:

GP, don't stop posting.

Lydia Nickerson ::: (view all by) ::: February 25, 2003, 04:40 PM:

GP, thank you very much. One of the things I've tried to say but never quite managed to find space and clarity for is that it seems to me that the news media is specifically scapegoating the surgeon, Dr. Jaggers, and I'm pretty sure he's high on the list of the victims of whatever clusterfuck it was that led to the initial transplant. This drives me nuts.

If my crack about "a sharpie and a harpie" bothered you, I apologize. I do recognize that the reason why this is, in my opinion, a good idea is the critical shortage of nurses. If we had adequate staffing, then this wouldn't happen. I still feel for the doctor that amputated the wrong leg. Overworked, patient completely draped, maybe had never met the patient, it would be such an easy mistake.

You are correct about bone marrow transplant matching being done on HLAs. Blood type is, in fact, irrelevant. The procedures are such that the typing is confirmed in our lab before any decision is made to transplant. When the decision is made, and the date set, the donor is asked to refrain from horseback riding or sky diving or mountain climbing, or anything else that might kill him accidentally. The patient is put through enough chemo and radiation to almost but not quite kill them, the marrow is harvested, and then transfused. The marrow can't really be saved for another day, either. Frozen marrow has a much less successful rate of grafting. If the patient needs additional marrow, the donor has signed a form agreeing to donate it. Not that any of this stops a determined donor from backing out if they want to. (Had a donor do that, once. Killed the patient.)

Solid organ has a whole different set of restrictions on it, I can see that. However, it seems as if it would be downright foolish to permit anyone to harvest the organs until UNOS knew to whom those organs were going. Do they do a quickie work-up on the patient before they harvest the organs? Given that the shelf life for hearts and lungs is so short, it seems like they'd prefer to. I don't know how long a brain-dead body can be caused to maintain the organs, but it is certainly longer than the organs by themselves. So, I wonder how it is that the organs got assigned to someone who fell out of compliance. However, even though it is a "use it or lose it" situation, I don't think that a hospital can just cram those organs into any old person who happens to be lying around -- even if that person happens to be of the correct blood type. Surely they must at least have to talk to UNOS first. There must be a stated policy on what happens next. I'm really curious as to what it is.

And I still get the willies thinking that one of the clerks made a mistake which led to this. Sometiems we're good, sometimes we're not. There's a great deal of comfort, though, knowing that the actual medical professionals are going to review our work. It sounds like you have some of the same feelings towards the surgeon that I do towards the clerical staff. Makes sense.

GP ::: (view all by) ::: February 26, 2003, 12:02 AM:

Lydia, I have not had any direct experience with bone marrow transplants BMT since I was a resident doing a 3 week rotation at the Dana-Farber Cancer Institute in Boston (home of the Jimmy Fund, Ted Williams's favorite charity). You probably recall the FUBAR involving the Boston Globe columnist, who had metastatic breast cancer, underwent an autologous BMT, and unintentionally received 5 times the dose of chemo (Cytoxan) needed for the the protocol. It killed all her breast cancer and her heart. One of her Boston Globe colleagues, who has tons of compassions for all sorts of dregs of society, called for severe sanctions (prison?) for those involved.
In regards to solid organ transplants, once a trauma victim is declared brain dead (usually a motorcycle accident, or a gunshot to the head victim), the clock starts ticking. If the family consents to organ donation, the "harvesting" team flies to the hospital, evaluates the donor's suitabilty to donate organs, and draws blood for immediate HLA and ABO typing. This must be done immediately, as a brain dead donor will suffer circulatory collapse in 24 hours, and his/her heart, lungs, kidneys, pancreas and liver will then be unusable. (I have done heart catheterizations on brain dead donors in order to evaluate their suitability for transplant). If the donor has suitable organs, those patients who are awaiting transplant and are a suitable antigen match get paged (they all wear beepers), they rush to their respective hospital, and the harvested organs get flown by private jet for transplant.. It is an emergency, and it is well documented that more FUBAR's occur during emergencies. I don't know how the surgeon at Duke screwed-up, whether he just overlooked it, or if he assumed someone else checked it. Let me tell you though, there are plenty of people in medicine/hospitals whose attitude is "it's not my problem" (Some fucker just told that today) and they deserve a kick in the crotch, or a pink slip..
In regards to a surgeon amputating the wrong foot, there is absolutely no excuse for a surgeon not to see and examine a patient prior to surgery. Being overworked is not a valid excuse either. First of all, not to do so is sanctionableby the hospital and medical boards. Second, the family and the patient are greatly comforted by talking with the person performing the invasive procedure, and studies show even if you have a bad outcome, if you talk to and comfort the patient/family, they are far less likely to sue you. Nonetheless, bad doctors and bad hospitals attract each other. I have been called to do emergency cardiology consults on post-op patient (who are asleep), and found that neither the surgeon, nor the anesthesiologist have written or dictated a preop or postop note. Good hospitals don't let crap like that happen (and it is a JCAHO violation); bad hospitals need the business, even from crappy doctors.
Kevin Maroney, I would love to see the bottom 5% of physicians, who apparently are responsible for 66% of malpractice claims, lose their license. Wouldn't it be nice if the bottom 5% of all profession were forced to find different jobs?
Finally, if you want to avoid heart disease, don't be a couch potato, get exercise, don't let yourself become obese, don't smoke cigarettes, eat vegetables and fruits with plenty of anti-oxidants (Vitamine E, C, and beta- carotene do NOT work) and have a glass or 2 of red wine a day. Oh, and use olive oil with your bread, not margarine or butter.

Simon Shoedecker ::: (view all by) ::: February 26, 2003, 12:57 PM:

All human beings make mistakes, true; but some mistakes are more life-threatening than others. To some extent we are justified in holding to higher standards people whose errors could kill.

But draconian punishment on those who make such errors is not the best incentive to keep them from happening again. Better to find institutional procedures that make such errors harder to occur. As far as clerks go, I can't speak for medical clerks, but in my much less life-threatening line of clerkly work, most human errors occur with the tremendous assistance of badly-designed software. About which I can do nothing: I am forbidden by corporate policy from complaining about it.

GP writes, "In regards to a surgeon amputating the wrong foot, there is absolutely no excuse for a surgeon not to see and examine a patient prior to surgery. Being overworked is not a valid excuse either."

I wouldn't have thought pre-surgery examinations were the problem. It's the surgery itself - coming in when the patient is prepped and ready to go, and remembering which patients are having right-foot surgery and which ones are having left-foot surgery, and which ones are having totally different surgery. The injury is not always visible to the naked eye. I don't think it's reasonable to expect the surgeon to be present from before the patient goes under, or to handle all the paperwork personally. That's what the staff is for. There are better ways to prevent this problem than blaming the surgeons, and some of them are described in this government document.

Lydia, the article I read describing how the heart-lung blood-type error occurred is here. Instead of relying on my summary from memory, take a look and give us your professional opinion.

aphrael ::: (view all by) ::: February 26, 2003, 06:33 PM:

GP, of course doctors make mistakes. I don't think anyone in their right mind would suggest that doctors don't make mistakes.

The thing is, though, that the system should have built-in checks and counter-checks to prevent critical mistakes. In the same way that I wouldn't release source code to a pacemaker unless that code had been verifid a thousand times over, I would expect that organs wouldn't be implanted unless the blood type had been checked and verified and re-verified. Because humans make mistakes.

That didn't happen here, and I think the family of the deceased has a legitimate right to complain about it, and demand compensation.

GP ::: (view all by) ::: February 26, 2003, 10:51 PM:

Simon, I am a physician. If I am performing a procedure on patient, with which I can cause great harm to that patient if I screw up, you can be sure that just prior to the procedure I am reviewing my dictated notes, lab work and other pertinent data regarding that patient. I guess that comes from training- if as an intern/resident/fellow, I didn't know the patient's complete history, my attending physician/boss would rip me a new one. Relying on one's memory is a roll of the dice- that's why good doctors DOCUMENT, DOCUMENT, DOCUMENT. BTW, the "staff" screws up all the time.
aphrael, in my experience, massive FUBAR's occur when everyone-MD's, nurses, ward clerks, pharmacists, etc.-make mistakes (or are apathetic). My personal, completely ignorant opinion is that medicine is a very late comer to the IT revolution because hospitals had to save pennies instead of investing in IT, and because older MD's are computer phobic (when I was in college taking P-chem, I programmed in FORTRAN...on punch cards!). How much compensation the family deserves is a completely different topic, but it will be settled out of court.

Vicki ::: (view all by) ::: February 28, 2003, 09:42 AM:

For what it's worth, the latest RISKS digest says that the news media are saying (yes, I know, but the Washington Post won't let me in even when I answer their stupid surveys) that the young woman's doctor asked for the organs for her after the hospital concluded that neither of the two patients who came up as matches at that hospital were actually appropriate recipients for those organs. Why neither he nor the transplant coordinator realized that her omission from the match list indicated a problem, I don't know.

The RISKS piece is largely trying to sort out whether the error was in system programming or design (for example, if the computer that generated the match lists had overlooked the blood type problem); in how the system was used (if the data were entered incorrectly and not checked); or something that wasn't connected to the computer system (as it appears in this case).

Lydia Nickerson ::: (view all by) ::: February 28, 2003, 04:37 PM:

Simon, Thanks for the link. That was very interesting. It continues to look like a FUBAR of epic proportions. I am not sure precisely what corner they cut, but somebody cut at least one. I note that the lab didn't provide confirmatory tissue typing until the operation was over, some five hours after receiving the organs. That sounds like a problem to me. ABO typing doesn't take 5 hours -- I think it's closer to 5 minutes. Tissue typing takes longer, but why not type the blood stat, why wait for all the results? Again, I don't know how these things are usually done, maybe there's a good reason.

Simon Shoedecker ::: (view all by) ::: March 11, 2003, 12:27 PM:

GP - and what do you think of the gov't procedures I linkd to above? Do you consider it the fault of physicians that patients are advised to write THIS ONE and THE OTHER ONE on their respective legs (or whatever)? Or is it just a reasonable precaution because everyone makes mistakes? It sounds like you're claiming the former.

Lydia - I just read a more detailed article on the subject of how the screw-up occurred, published in Newsweek a week or two back (the issue with the "successful black women" cover, I don't have it with me and don't have the date).

Some of this is covered in the newspaper article I linked to, but this is clearer:

Nobody harvested the organs and sent them to NC before checking whether the potential recipients were suitable. They called around, as is normal procedure, and asked; when the NC doctors reported that their matched recipients were not suitable, one of them said, "Hey, I've got this other patient ..." who was Jesica.

Nobody had failed to make a blood typing. It seems to have been a miscommunication. The NC doctor thought the donor hospital had checked for compatability. The donor hospital thought they'd said the heart-lung was Type A, and relied on the NC doctor to know whether it would suit his patient.

What nobody seems to have asked is, why didn't Jesica's name come up in the potential-match database in the first place? I presume that the reason is that the database checks for blood type.