No wonder they were ordered to install cameras in all operating rooms in addition to another heafty fine last week....
An orthopedic surgeon at Rhode Island Hospital operated on the wrong finger during outpatient hand surgery on Thursday, the fifth in a string of wrong-site surgeries at the hospital over the past 2˝ years.
The mistake occurred despite multiple efforts to eliminate such errors, including statewide adoption of surgical safety procedures and a recent collaboration between Rhode Island Hospital and the Joint Commission, an accrediting agency.
“Frustrated –– in capital letters –– is probably the way to describe the mood here at the department,” said state Health Director David R. Gifford. In 2007, the department reprimanded Rhode Island Hospital and fined it $50,000 for the third wrong-site error that year, each involving a different doctor drilling into the wrong side of a patient’s head to drain blood.
Chronology of wrong-site errors
1998: A Kent Hospital surgeon performs arthroscopic surgery on the wrong knee.
Dec. 21, 2000: A surgeon operates on the wrong child, removing tonsils and adenoids from a girl scheduled for eye surgery, at Hasbro Children's Hospital, which is part of Rhode Island Hospital.
Dec. 12, 2001: A Rhode Island Hospital neurosurgery resident drills holes in the wrong side of a patient's head, in a procedure to relieve bleeding on the brain. The CT scan was placed backward on the viewing box.
2004: A Miriam Hospital anesthesiologist inserts a catheter on the wrong side of the neck of a patient about to undergo a procedure to bypass a blocked artery.
March 2005: A Women & Infants Hospital obstetrician removes the ovaries of a woman who was supposed to have only her uterus removed, confusing the woman with another patient who had the same last name.
September 2006: A neurosurgeon at Roger Williams Medical Center drills into the wrong side of patient's head in an emergency procedure to drain blood after an injury.
January 2007: A Rhode Island Hospital neurosurgery resident and a nurse place a drain on the wrong side of a patient's head to remove blood.
July 30, 2007: A neurosurgeon at Rhode Island Hospital cuts open the wrong side of a patient's head, also to drain blood.
Nov. 23, 2007: A Rhode Island Hospital neurosurgery resident starts to operate on the wrong side of a patient's head in a bedside procedure to drain blood on the brain. Health Department reprimands the hospital and fines it $50,000.
September 19, 2008: A Miriam Hospital doctor operates on the wrong knee of a patient undergoing arthroscopic surgery.
February 2009: The state Health Department reprimands a doctor and two nurses for their roles in the Miriam knee operation.
May 11, 2009: A Rhode Island Hospital surgeon operates on the wrong side of child&rsquos mouth during surgery to correct a cleft palate.
June 2009: A Kent hospital doctor inserts an intravenous line into the wrong arm of a patient and later injects dye into the wrong hip of another patient.
June 11, 2009: A Miriam Hospital surgeon anesthetizes the wrong eye of patient about to undergo eye surgery, but the error is discovered before the patient enters the operating room.
June 30, 2009: Hospital Association of Rhode Island announces that all hospitals and surgical centers have agreed to follow the same process to prevent errors in surgery.
July 1, 2009: Rhode Island Hospital and Newport Hospital join with the Joint Commission, a national accrediting agency, to deploy a problem-solving methodology to eliminate wrong-site surgery.
Oct. 22, 2009: A Rhode Island Hospital surgeon operates on the wrong finger during outpatient hand surgery.