QUESTION

The fifteen year-old patient was scheduled for surgery on the right side of his brain to remove a right tem- poral lobe lesion that was believed to be

causing his epileptic seizures. The surgery began with the sur-

geon making an incision on the left side, opening the skull, penetrating the dura and removing significant portions

of the left amygdala, hippocampus and other left-side brain tissue before it was

discovered that they were working on the wrong side.

The left-side wound was closed, the right side was opened and the pro-

cedure went ahead on the right, correct side. The error in the O.R. was revealed

to the parents shortly after the surgery, but only as if it was a minor and incon-

sequential gaffe. The patient recuperated, left the

hospital, returned to his regular activi- ties and graduated from high school before his parents could no longer deny

he was not all right. After a thorough neurological assessment he had to be

placed in an assisted living facility for brain damaged individuals.

When the full magnitude of the consequences came to light a lawsuit

was filed which resulted in a $11 mil- lion judgment which was affirmed by the Supreme Court of Arkansas.

A circulating nurse has a le- gal duty to see that surgery does not take place on the wrong side of the body. The preoperative documents failed to identify on which side the surgery was to be done. It was below the standard of care for the circulating nurse not to notice that fact and not to seek out the correct infor- mation.

SUPREME COURT OF ARKANSAS December 13, 2012

Operating Room: Surgical Error Blamed, In Part, On Circulating Nurse’s Negligence.

Surgical Error Blamed, In Part, On

Circulating Nurse’s Negligence

The Court accepted the testimony of the family’s nursing expert that a

circulating nurse has a fundamental responsibility as a member of the surgi- cal team to make sure that surgery is

done on the correct anatomical site, especially when it is brain surgery.

The circulating nurse is supposed to understand imposing terms like se-

lective amygdala hippocampectomy and know the basics of how it is sup-

posed to be done. Hospital policy called for the sur- geon, the anesthesiologist, the circulat-

ing nurse and the scrub nurse or tech to take a “timeout” prior to starting a sur-

gical case for final verification of the correct anatomical site.

The circulating nurse should have available three essential documents, the surgical consent form, the preoperative

history and the O.R. schedule. The full extent of the error, that is,

a full list of the parts of the brain that were removed from the healthy side,

should have been documented by the circulating nurse, and failure to do so