Often referred to as medical errors that are 100% preventable, wrong-site surgeries nevertheless continue to occur. In Florida, the state's board of medicine is exploring what additional steps it can take to stop them.
According to a July 13 report prepared by board member Ronald Dyches, a high school social studies teacher, the board adjudicated 41 wrong-site or wrong-patient surgery cases between August 2004 and June 2005, including nine at its April 1-2 meeting.
The typical penalty imposed is a $10,000 fine, 50 hours of community service and five hours of continuing medical education. Most physicians also must give a lecture on how their error occurred.
"The board is taking a look at all of the policies assigned to wrong-site surgeries . . . (we need) to find out what is making this happen and how we can find the cause," said Florida Department of Health spokesman Doc Kokol, speaking on behalf of the Florida Board of Medicine.
Previous published reports mentioned how the board, in addition to ramping up its efforts to find the root cause of wrong-site or wrong-patient surgeries, would also explore harsher penalties, including imposing higher fines or suspending the licenses of repeat offenders.
When asked about this, however, Kokol avoided that topic.
"Quite frankly, they're very straightforward about this: it is unacceptable," he said. "The ultimate goal is that there will never be a wrong-site surgery again, and that's what you strive for."
Florida Medical Association spokeswoman Lisette Gonzalez Mariner said her organization was carefully monitoring the board's deliberations and it appeared to the FMA that the board was focused more on refining system approaches than retooling its sanctions.
An official with the Florida Society of Ophthalmology said members have contacted the organization with concerns about what the board is doing and the issue has been placed on the agenda for its Aug. 26 board meeting.
The board has taken action on the issue in the recent past. In 2001, the penalties were increased to their present level. And on Feb. 18, 2004, a "pause rule" went into effect requiring the surgical team to pause before operating to make sure that they had the right patient and they were about to perform the right procedure on the correct side of the body.
Since the imposition of that rule, two more cases of incorrect surgery have come before the board, according to the July 13 report, including a case in which a cardiac catheterization was performed on a patient who was not scheduled for the procedure and for whom the procedure was not required.
Kokol said it's too early to say how much of an effect the pause rule has had.
"Certainly the pause rule is part of the solution to this problem," he said. "But, with less than a year's worth of data, it's too early to say we've turned this around."
Jacksonville-based neurosurgeon Arnold Zeal, M.D., who performed a lumbar disc operation on the wrong side of a fellow physician four years ago, said the board's traditional approach has been "too penalty-oriented and not enough constructive criticism."
After his case was decided, Zeal said there was "zero explanation; nobody cared about not doing it again."
Zeal was ordered by the board to pay a $10,000 fine plus the expenses for investigating and adjudicating his case, and to give a lecture discussing his error. His highly personal talk impressed officials with the Joint Commission on Accreditation of Healthcare Organizations, and he was invited to speak at one of its patient-safety conferences.
In contrast, Zeal said he has listened to other physicians discuss their errors in the third person. "They say 'Here's a case that happened in Florida,' " Zeal said.
A former team physician for the National Football League's Jacksonville Jaguars, Zeal said he still has nightmares about his mistake and is embarrassed when he sees the patient who was a close friend of his former partner.
"It's still bugging me," he said. "I don't think it will ever leave me."
Before his own error, Zeal said he had a much different attitude when he listened to other physicians lecture on their errors.
"I sit on the board of my hospital, and when I heard these cases, I was abhorrent," he said. "I couldn't imagine ever doing such a thing. Now, I'm a little more humble."