Is a surgeon's refusal to investigate a nurse's concern about an incorrect gauze count, leading to a delayed diagnosis of a retained foreign body (F.B), considered malpractice?

Medical Malpractice in Case of Retained Surgical Foreign Body

The surgeon's refusal to investigate a nurse's concern about an incorrect gauze count, which led to a retained foreign body discovered one week later, is considered malpractice.

Understanding Medical Malpractice in This Case

Medical malpractice occurs when a healthcare professional deviates from the standard of care expected in their field, resulting in harm to the patient 1. In this specific scenario, several elements of malpractice are present:

1. Deviation from standard protocol: When a nurse reports an incorrect gauze count after surgery, the standard of care requires investigation, typically through imaging studies.

2. Disregard for safety measures: Surgical count procedures are established safety protocols specifically designed to prevent retained foreign bodies (RFBs).

3. Refusal to take appropriate action: The surgeon's refusal to perform an abdominal X-ray despite the nurse's insistence represents a clear deviation from standard practice.

Evidence Supporting This Assessment

Retained surgical foreign objects (RFOs) are a recognized surgical complication with significant implications:

• RFOs occur in approximately 0.3 to 1.0 per 1,000 abdominal operations 2
• They can cause serious morbidity and even mortality 3
• They represent a preventable medical error with both clinical and legal consequences

Standard Protocol for Incorrect Surgical Counts

When a surgical count discrepancy occurs, the World Journal of Emergency Surgery guidelines recommend:

1. Immediate imaging: Lateral and anteroposterior plain X-ray films of the abdomen should be performed to identify potential retained objects 4

2. Thorough investigation: The surgeon has a responsibility to investigate any potential retained foreign body, especially when alerted by nursing staff about count discrepancies

Why This Case Constitutes Malpractice

This case meets the criteria for malpractice because:

• The surgeon had a duty of care to the patient
• The surgeon breached this duty by refusing to investigate the incorrect count
• This breach directly resulted in harm (retained foreign body)
• The patient experienced damages (required additional medical intervention)

The surgeon's refusal to perform an X-ray despite the nurse's warning represents a clear deviation from standard care protocols. This is not merely stubbornness or a simple error in judgment, but a failure to follow established safety procedures designed to prevent exactly this type of complication.

Prevention Strategies

To prevent such incidents:

• Multiple "checks and balances" should be employed during surgery 2
• Improved provider-to-provider communication is essential 2
• When count discrepancies occur, imaging should be performed without exception
• A culture of collaboration rather than blame should be fostered in healthcare facilities 4

Conclusion

This case represents a clear example of medical malpractice, as the surgeon failed to follow standard protocols when alerted to a potential problem, resulting in a preventable adverse outcome for the patient.