Hospital Administration Expert Comments on Delay in Critical Surgery

This case involves a female patient that was hit by a car while riding on her motor scooter. She was taken to a local hospital, where she was diagnosed with multiple fractures in her spine, as well as a minor fracture to her facial bones. She was transported from the local hospital to a larger facility that was better equipped to treat her injuries. There, she was first seen by a neurosurgeon, who diagnosed her with a small carotid artery dissection, who then instructed hospital staff to give the patient aspirin and signed off the case. She was then seen by an orthopedic surgeon who decided that her spinal fractures needed surgical repair. However, the surgery was scheduled several days in the future, allegedly due to staffing issues in the OR. The procedure was then pushed back again because several routine procedures were taking precedence. At some point while waiting for surgery to be performed, the patient became a quadriplegic. An MRI was performed for the first time since the accident, at which point it was discovered that the fracture had been displaced, cutting off blood supply to her spinal chord. As a result of the delays in surgical intervention, the patient now lives with severe mobility limitations and will require a lifetime of ongoing care.

Question(s) For Expert Witness

1. Should this patient's surgery have taken precedence over routine or elective procedures?

Expert Witness Response E-023880

Whether or not the surgery should have taken precedence depends on how it was characterized by the operating surgeons. Urgent and emergent cases always take precedence. The initial evaluation given here would have set in motion the hospital's triage of operative cases. I think that "staffing issues" are a problematic excuse to delay surgery if this patient was identified as having an unstable cervical spine fracture. The same goes for what occurred later on - it is very curious that the surgery was scheduled for later in the day and not first thing in the morning. I'm assuming the patient was under-triaged or under-diagnosed by both the neurosurgeon and the orthopedic surgeon. If the orthopedic surgeon and/or neurosurgeon identified this as an urgent case, then the administrative issues are clear: no routine case should have taken precedence and pushed back the surgery. I have reviewed requests for urgent cases on weekends when there are other cases scheduled. This is not an uncommon management dilemma that involves the Chief Medical Officer, the Surgery Admin Committee, and (less likely) the Medical Executive Committee at this particular hospital.