What can a patient do if a surgeon performs a wrong-side nephrectomy (kidney removal) and injures the intestine and peritoneum during the procedure?

Wrong-Side Nephrectomy with Intestinal Injury: Patient's Legal Options

A patient who experiences a wrong-side nephrectomy with intestinal injury can sue both the surgeon and the hospital, as this constitutes a sentinel event that requires mandatory reporting and investigation.

Understanding the Event Classification

The wrong-side nephrectomy with intestinal injury described in the scenario is classified as a sentinel event, not a near miss. A sentinel event is defined as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof 1. This incident clearly meets the criteria because:

1. It involved surgery on the wrong body part (wrong kidney)
2. It resulted in additional injury (intestinal and peritoneal damage)
3. It required surgical repair of the intestine

Near misses, by contrast, are events that could have resulted in patient harm but did not, due to chance or timely intervention.

Patient's Legal Options

When a patient discovers they have been subjected to a wrong-side nephrectomy with intestinal injury, they have several legal options:

1. Sue the Surgeon

The patient can pursue legal action against the surgeon who performed the wrong-side procedure. This would typically involve a medical malpractice claim based on:

• Deviation from standard of care
• Failure to follow proper site verification protocols
• Negligence in performing the procedure 2

2. Sue the Hospital

The patient can also pursue legal action against the hospital based on:

• Institutional failure to implement proper safety protocols
• Inadequate verification procedures
• Vicarious liability for the actions of employed healthcare providers
• Failure to provide proper oversight and safety measures 2

Why This Constitutes a Sentinel Event

Wrong-site surgery is a preventable adverse event that should never occur with proper protocols in place. The Joint Commission and other regulatory bodies classify wrong-site surgeries as "never events" that require:

1. Mandatory reporting to regulatory agencies
2. Root cause analysis
3. Implementation of preventive measures
4. Disclosure to the patient

Medical Implications of the Error

The medical consequences of this error are significant:

1. Loss of a healthy kidney: The patient has unnecessarily lost a functioning kidney, which impacts long-term renal function and quality of life.

2. Intestinal and peritoneal injury: These complications could lead to:

   • Risk of infection
   • Potential for adhesions
   • Possible long-term gastrointestinal issues 1

3. Need for additional surgical procedures: The patient required intestinal repair surgery, exposing them to additional anesthesia risks and potential complications.

Preventive Measures That Should Have Been Implemented

This error could have been prevented through:

1. Universal Protocol: Implementation of the "Sign Your Site" protocol, which includes:

   • Pre-operative verification process
   • Marking the surgical site
   • "Time out" immediately before starting the procedure 2

2. Proper Imaging Review: Confirmation of the correct kidney for removal through review of imaging studies with the surgical team.

3. Intraoperative Verification: Final verification of the correct surgical site before making any incision.

Conclusion on Patient Options

While the patient may have multiple legal avenues (including demanding compensation or posting on social media), from a medical-legal perspective, the appropriate and most effective recourse is to pursue legal action against both the surgeon and the hospital for this serious sentinel event that resulted in unnecessary harm and loss of a healthy organ.