View Full Version : Medical SOP Violation With a Really Bad Outcome?

07-30-2015, 12:23 AM
When I started writing my latest story, I led off with these sentences.

"Dr. Nate Alexander, Major, U. S. Army, Retired, barely resisted the urge to pull over and start checking the piles of lumber, brick and glass that had been houses just an hour ago. SOPs exist for a reason, Doc. You learned that the hard way years ago."

And that's pretty much all I know about Dr Alexander. He's not a main character (but could easily be a recurring character).

I had assumed as I first wrote that that it was going to be a medical SOP violation that killed someone, but then it occurred to me that it didn't necessarily have to be a medical SOP. Seems like it is though. So do any of the medical experts here have any suggestions? I'm going to assume at this point that while this was a career-ender in the military aspect of his life, that it might not result in penalties or punishments on the civilian side.

07-30-2015, 01:00 AM
He forgot to verify he was operating on the correct limb/organ/patient, and the patient died/had the wrong surgery.

07-30-2015, 01:34 AM
Yeah, this made me think of that case many years back where they amputated the wrong limb (http://www.nytimes.com/1995/09/17/us/doctor-who-cut-off-wrong-leg-is-defended-by-colleagues.html). It wasn't a military hospital, however, and I'm guessing there was a huge lawsuit at the very least. Though one fact about the case that's often forgotten is that both limbs were very diseased, and the wrong limb was slated for amputation in the hospital computer system. Someone screwed up at some step of the process, however, and a dearth of checks along the way prevented it from being caught. Performing the wrong surgery or surgery on the wrong patient is another possibility.

Some other cases that come to mind are people being infused with the wrong blood type or someone being given the wrong cancer drug, or the wrong dose of a cancer drug. There was a horrific case where a patient got a much higher concentration of her chemotherapy drug, for instance, and it killed her. I don't remember if the fault was with the nurse administering the IV or with the physician for ordering the wrong dose, however. At the opposite end, there was a case where some patients received doses of cancer drugs that were too weak, and while they sailed through their chemo with flying colors, their remission rates were unacceptable.

And there was the situation with the ebola patient in Texas who was missed initially by the ER personnel. We had a long thread about it last year (and it turned out the computer system had issues, if I remember correctly, where the nurses and doctors had access to different versions of the records), but it's certainly possible that a failure in SOP could lead a physician to miss a reportable (http://www.nlm.nih.gov/medlineplus/ency/article/001929.htm) or highly contagious disease, whether it's ebola, TB, or even "just" some kind of food poisoning (like salmonellaisis) or venereal disease that has public health implications. I know more about reportable diseases in livestock, because I worked at a veterinary diagnostic lab years ago, but they're definitely a thing in human medicine too.

Hope that some of our MD members and members with military experience show up for this thread. It's piqued my interest. and I don't know anything about how it works with military doctors and hospitals. I'm guessing that there are separate rules and regulations they're integrating, and something could get you in trouble, or in a different kind of trouble, in a military setting that wouldn't in a civilian one. Plus, you have the issue with soldiers returning from overseas, and some could be incubating diseases or parasites that aren't common here. Maybe a doctor who hasn't had a lot of experience with recent combat veterans could miss something like schistosomaisis (http://www.cdc.gov/parasites/schistosomiasis/) or something nasty like that?

07-30-2015, 03:39 AM
Add an extra zero to someone's heparin prescription, where you're giving someone 100,000 units instead of 10,000. It happens.

07-30-2015, 06:06 AM
My wife argued for ages with an arrogant doctor that ordered an adult does of a drug for a child. The nursing supervisor argued with him. The were trying to find the night emergency number of the head physician when the doc called back to sheepishly ask if they'd given the drug yet, and then lowered the dose.

Deb Kinnard
07-31-2015, 02:54 AM
The violation I see most often as I'm coding hospital charts is dosage error. Of course the charting tiptoes around it, but an experienced coder can tease out the details even if nobody wants to chart what actually happened. Anticoagulants (heparin, warfarin, Coumadin) particularly come to mind. Sometimes the pharmacist catches it, sometimes the nurse does, sometimes nobody does. And then your fictional patient could bleed somewhere nasty, like into his brain.


08-11-2015, 07:14 PM
About the wrong limb amputation/surgery thing. As far back as the 2000s I was, per hospital policy, handing the skin marker (the ink doesn't wash off) to the patient so they could mark their own correct limb. They were instructed to write "YES" on the correct limb and "NO" on the wrong limb. For a while now, the onus has been on the patient to mark their own limbs correctly.

Here's a legal complication for you or anyone else. You could make it apply to the skin marker scenario. Let's say whatever is happening with you, you need pain medication. Serious pain medication like morphine. You CANNOT legally sign a consent to have surgery while on narcotics and yet it still happens sometimes. That said, if you have a medical power of attorney, which most people do not have the presence of mind to get before they're 80, they can sign it for you. Either way, no consent form, no surgery.

Doctors do the surgery consent forms themselves, which is sometimes a major holdup since the docs aren't actually there very often. Nurses don't touch consent forms. Everything else, like the skin marker scenario, is more or less done by nurses and nurses aides. People don't often understand how little docs are seen out on the hospital floors...doing anything.