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Surgery court cases
SPECIAL
D~E’SARTMENT~ ’
Surgery
Court
Cases
HOWARDNEWCOMBMORSE,* Chicago, Illinois FITZGERALD
VS. LEACH
discIosed that the proxima1 segment of the median nerve was sutured to the dista1 portion of the subIimis tendon going to the middIe finger. The distal end of the median nerve was found lying free. The nerve ends were trimmed and anastomosed with No. .003 tantaIum wire. The tendon was sutured with No. 4-o siIk. The diagnosis was: median nerve paIsy, Ieft proximal median nerve sutured to dista1 flexor subIimis tendon. The patient made some degree of recovery, but she had a sensory loss at the base of her paIm which affected her abiIity as a typist. There was a Iump in her Ieft wrist which is caIIed a neuroma (a group of nerve fibers which grow into a baI1 when after suturing they do not grow back into the nerve sheath). The median nerve is approximateIy the same size as the subIimis tendon but its coIor is sIightIy different. The texture of the sublimis tendon is more firm than that of the median nerve, which may be compressed with one’s fingers. AnatomicaIIy, the median nerve is not at any time connected with the sublimis tendon. The records of the second hospitai showed that one end of the median nerve was Iying free in the wound. The operation performed there was necessary to suture the median nerve properIy. So far as the median nerve was concerned, the result unfortunately was not good. If the median nerve had been compIeteIy sutured instead of Ieaving one end Iying Ioose in the wound, and if one end of the median nerve had not been sutured to the sublimis tendon, the probabilities are that the patient would have obtained .a better resuIt from the operation performed by the first surgeon. If the median
Supreme Judicial Court of Massachusetts ISO N. E. zd
12
This was an action for malpractice in the Superior Court of Suffolk County, Massachusetts, wherein the jury returned a verdict for the pIaintiff-patient and the defendant-surgeon appealed. The patient, who was fifteen years of age, sought to recover damages for persona1 injury sustained by her as the result of negligence on the part of the surgeon in the performance of an operation on her Ieft wrist. She had pushed her Ieft hand through two panes of glass and suffered a Iaceration of her Ieft wrist and flexor tendons. The operative report showed that a11 the superficial tendons, except the ffexor tendon to the Iittle finger, had been severed. The deep tendons were intact. The “upper band of the tendon was isoIated and brought down and sutured to the wound.” The skin was then cIosed. The patient remained in the hospita1 for four days. Her hand was in a pIaster spIint and bandages for several weeks. Following the remova of the cast the patient went to a highIy reputable hospital for physiotherapy where the physiotherapist discovered Joss of median nerve function. She was referred to the NeurosurgicaI CIinic of the second hospitaI where confirmation of palsy of the median nerve was made. She was then admitted as a house patient for expIoration of the median nerve. ExpIoratory operation by a second surgeon
* CounseIIor at Law of the Supreme Court of the United States of America.
635
American
.Journa[of
Surgery.
Volume
98,
October.
1939
Morse nerve had been properIy sutured by the first surgeon, the patient probabIy wouJd not have suffered a neuroma, which produced the sensory loss. The Supreme Judicial Court of Massachusetts affirmed the decision of the court below. The Supreme Judicial Court declared: “We are of opinion that the jury couId warrantabIy find that the defendant (the first surgeon) was negIigent in not distinguishing the subIimis tendon from the median nerve . . . the operation was not done with the care and ski11 generaIIy used and possessed in this community was neghgent in (Boston) . . . the defendant his treatment of the pIaintiff.”
RURAL
other end. This tape and ring hang outside the incision as a safety measure or precaution against the possibility of Ieaving the sponge in the abdomen. When this type of tape is used it is impossible to cIose the incision and Ieave the sponge in the body, for the tape and ring wouJd be hanging on the outside of the incision. The nurse who prepared for the operation did not provide this type of sponge. She mereIy provided and used sponges without safety tapes and rings attached. The surgeon inquired as to the sponges and was informed by the scrub nurse that the sponges were a11 accounted for, whereupon the surgeon cIosed the incision. No circuIating nurse had been provided for the operation, aIthough one was required and commoniy used. The sponges had not been correctly counted. One large, Iong sponge was left in the abdomen of the patient and Iodged in one of his intestines. The Court of Appeals of Tennessee sustained the decision of the Iower court. The Court of AppeaIs stated: “When a nurse acts under the orders of a private physician in matters involving professiona ski11 and decision, she is absoIved from JiabiIity for her acts. Many acts of a nurse, however, do not resuIt from orders of the physician. Furnishing proper personnel and equipment for an operation are duties of a hospita1. The seIection of proper sponges was the duty of the hospita1. Counting the sponges so as to see that no sponge was Ieft in the body of the patient required no specia1 professiona skiJ1 or decision of the surgeon. Indeed . . . (the surgeon) reIied upon the sponge count of the nurse. In these matters we hoId the jury were justified in reaching a factua1 conclusion that the nurse was the agent of the defendant (the hospita1) .”
EDUCATIONAL ASSOCIATION VS. BUSH Court of Appeals of Tennessee 298 S. W. zd 761
This was an action against a private hospita1 for injuries received when the surgeon, who was on the resident staff, left a sponge in the patient’s intestine after an operation due to the nurse’s miscount of sponges. A jury in the Circuit Court of Davidson County, Tennessee, returned a verdict for the patient and the court entered judgment accordingIy. The hospital appealed. In connection with the abdomina1 operation on the patient, the nurse pIaced in the surgery room certain sponges which were necessary for use during the operation. The approved and commonIy used type of sponge for such operations has a Jong tape fastened to the sponge at one end of the tape, with a safety ring at the
636
D~E’SARTMENT~ ’
Surgery
Court
Cases
HOWARDNEWCOMBMORSE,* Chicago, Illinois FITZGERALD
VS. LEACH
discIosed that the proxima1 segment of the median nerve was sutured to the dista1 portion of the subIimis tendon going to the middIe finger. The distal end of the median nerve was found lying free. The nerve ends were trimmed and anastomosed with No. .003 tantaIum wire. The tendon was sutured with No. 4-o siIk. The diagnosis was: median nerve paIsy, Ieft proximal median nerve sutured to dista1 flexor subIimis tendon. The patient made some degree of recovery, but she had a sensory loss at the base of her paIm which affected her abiIity as a typist. There was a Iump in her Ieft wrist which is caIIed a neuroma (a group of nerve fibers which grow into a baI1 when after suturing they do not grow back into the nerve sheath). The median nerve is approximateIy the same size as the subIimis tendon but its coIor is sIightIy different. The texture of the sublimis tendon is more firm than that of the median nerve, which may be compressed with one’s fingers. AnatomicaIIy, the median nerve is not at any time connected with the sublimis tendon. The records of the second hospitai showed that one end of the median nerve was Iying free in the wound. The operation performed there was necessary to suture the median nerve properIy. So far as the median nerve was concerned, the result unfortunately was not good. If the median nerve had been compIeteIy sutured instead of Ieaving one end Iying Ioose in the wound, and if one end of the median nerve had not been sutured to the sublimis tendon, the probabilities are that the patient would have obtained .a better resuIt from the operation performed by the first surgeon. If the median
Supreme Judicial Court of Massachusetts ISO N. E. zd
12
This was an action for malpractice in the Superior Court of Suffolk County, Massachusetts, wherein the jury returned a verdict for the pIaintiff-patient and the defendant-surgeon appealed. The patient, who was fifteen years of age, sought to recover damages for persona1 injury sustained by her as the result of negligence on the part of the surgeon in the performance of an operation on her Ieft wrist. She had pushed her Ieft hand through two panes of glass and suffered a Iaceration of her Ieft wrist and flexor tendons. The operative report showed that a11 the superficial tendons, except the ffexor tendon to the Iittle finger, had been severed. The deep tendons were intact. The “upper band of the tendon was isoIated and brought down and sutured to the wound.” The skin was then cIosed. The patient remained in the hospita1 for four days. Her hand was in a pIaster spIint and bandages for several weeks. Following the remova of the cast the patient went to a highIy reputable hospital for physiotherapy where the physiotherapist discovered Joss of median nerve function. She was referred to the NeurosurgicaI CIinic of the second hospitaI where confirmation of palsy of the median nerve was made. She was then admitted as a house patient for expIoration of the median nerve. ExpIoratory operation by a second surgeon
* CounseIIor at Law of the Supreme Court of the United States of America.
635
American
.Journa[of
Surgery.
Volume
98,
October.
1939
Morse nerve had been properIy sutured by the first surgeon, the patient probabIy wouJd not have suffered a neuroma, which produced the sensory loss. The Supreme Judicial Court of Massachusetts affirmed the decision of the court below. The Supreme Judicial Court declared: “We are of opinion that the jury couId warrantabIy find that the defendant (the first surgeon) was negIigent in not distinguishing the subIimis tendon from the median nerve . . . the operation was not done with the care and ski11 generaIIy used and possessed in this community was neghgent in (Boston) . . . the defendant his treatment of the pIaintiff.”
RURAL
other end. This tape and ring hang outside the incision as a safety measure or precaution against the possibility of Ieaving the sponge in the abdomen. When this type of tape is used it is impossible to cIose the incision and Ieave the sponge in the body, for the tape and ring wouJd be hanging on the outside of the incision. The nurse who prepared for the operation did not provide this type of sponge. She mereIy provided and used sponges without safety tapes and rings attached. The surgeon inquired as to the sponges and was informed by the scrub nurse that the sponges were a11 accounted for, whereupon the surgeon cIosed the incision. No circuIating nurse had been provided for the operation, aIthough one was required and commoniy used. The sponges had not been correctly counted. One large, Iong sponge was left in the abdomen of the patient and Iodged in one of his intestines. The Court of Appeals of Tennessee sustained the decision of the Iower court. The Court of AppeaIs stated: “When a nurse acts under the orders of a private physician in matters involving professiona ski11 and decision, she is absoIved from JiabiIity for her acts. Many acts of a nurse, however, do not resuIt from orders of the physician. Furnishing proper personnel and equipment for an operation are duties of a hospita1. The seIection of proper sponges was the duty of the hospita1. Counting the sponges so as to see that no sponge was Ieft in the body of the patient required no specia1 professiona skiJ1 or decision of the surgeon. Indeed . . . (the surgeon) reIied upon the sponge count of the nurse. In these matters we hoId the jury were justified in reaching a factua1 conclusion that the nurse was the agent of the defendant (the hospita1) .”
EDUCATIONAL ASSOCIATION VS. BUSH Court of Appeals of Tennessee 298 S. W. zd 761
This was an action against a private hospita1 for injuries received when the surgeon, who was on the resident staff, left a sponge in the patient’s intestine after an operation due to the nurse’s miscount of sponges. A jury in the Circuit Court of Davidson County, Tennessee, returned a verdict for the patient and the court entered judgment accordingIy. The hospital appealed. In connection with the abdomina1 operation on the patient, the nurse pIaced in the surgery room certain sponges which were necessary for use during the operation. The approved and commonIy used type of sponge for such operations has a Jong tape fastened to the sponge at one end of the tape, with a safety ring at the
636