13 million and one reasons why simultaneous operations should be barred

burkedbglobe-212x300A big Boston hospital has offered 13 million and one ways to try to make good with a former orthopedic surgeon who assailed the respected institution and colleagues for performing simultaneous operations in which doctors went from suite to suite, working for hours on multiple patients at once.

Massachusetts General Hospital insisted this practice was safe. Dr. Dennis Burke, a hip and knee specialist whose patients have included former Secretary of State John Kerry, disagreed. He told his bosses at the Harvard-affiliated hospital that simultaneous procedures put patients at risk, and, at minimum, they should be told that the surgeons they flocked to for surgery on them might pop in and out of their procedures.

Burke infuriated his bosses by taking his criticisms outside the hospital, including to investigative reporters for the Boston Globe. The newspaper dug into hospital surgeries, particularly in orthopedic cases where operations lasted for hours.

The reporting led to changes and medical malpractice cases, including an action filed by “former Red Sox pitcher Bobby Jenks, who said he suffered a career-ending spine injury when [a surgeon] operated on his back while overseeing another operation at the same time. Jenks settled that claim against [the surgeon] and the hospital in May for $5.1 million,” the newspaper reported.

Burke also complained about a spine surgery case involving Tony Meng, a financial analyst and a patient who had become a quadriplegic a few weeks earlier after his surgeon overlapped his operation with another spine patient’s for more than five hours. In 2017, a Boston jury found that Meng’s surgeon failed to inform him that he planned to operate on two patients at once, but the jury concluded that the doctor’s divided attention did not cause his quadriplegia, the newspaper reported.

As for Burke, the hospital dismissed him when, during his rows with his bosses, he redacted hundreds of patients’ files and shared them with the Boston Globe to debunk the institution’s claim that he, too, had been involved with simultaneous surgeries. The records showed a select few cases where he had overlapping cases, situations that involved only minutes of time.

Burke lived under a professional cloud for years after his firing from an institution he had worked at for three decades. Just before his lawsuit for unjustified dismissal was to go to trial, and with changes in Mass Gen’s leadership over time, lawyers announced a settlement that vindicated him and his whistleblowing. Mass Gen offered him his job back. The hospital said it would pay a $13 million settlement and set up a safety initiative in his honor at the hospital.

Burke, who now practices at Beth Israel Deaconess Hospital, said he was pleased the case ended as it did. He will not return to Mass Gen but said he liked the safety initiative and how the institution had changed its surgical practices.

The American College of Surgeons issued new guidelines for its 82,000 members about procedures conducted at or near the same time. A U.S. Senate Committee also called on surgeons and hospitals to bar what it called “concurrent surgeries,” two operations, managed by the same surgeon, whose critical parts occur at the same time, the Boston Globe reported.

In my practice, I see the harms that patients suffer while seeking medical services, with risks not to be ignored due to debilitating and even deadly factors that seem built into the health care system, like medical error, hospital acquired infection, and misdiagnoses.

Surgeons say that allowing them to perform more than one procedure at a time allows them to be more efficient, serve more patients, and train other assisting doctors better. They also, of course, increase their earnings and a hospital’s revenues by allowing for the treatment of more patients.

Canadian researchers have come up with at least 2,500  reasons why elite surgeons should reconsider their own wishes and practices to protect patients undergoing hip surgeries from significant post-operative complications. They could do so by curbing even more their dual surgeries, in which they dash between two operating rooms. A new study has found a 90% increase in the risk for surgical complications at one year when doctors repair hip fractures or replace hips in so-called overlapping surgeries.

On the other hand, research on more than 2,000 neurosurgeries found no differences in outcomes between solo versus dual procedures, though simultaneous operations took longer and resulted in patients staying more time under anesthesia.

Burke deserves credit for forcing surgeons to rely on evidence and not their own wishes in determining what’s best for patients. At minimum, patients should be given their fundamental right to informed consent. This means they are told clearly and fully all the important facts they need to make an intelligent decision about what treatments to have, where to get them, and from whom. If their doctors plan to operate on other patients at the same time, they have the right to know this and to decide if they want this to occur.

As it stands, surgeons are cautioned against simultaneous surgeries but “overlapping” procedures are accepted. They are urged not to perform parts of a surgery deemed most critical at or near the same time in each operating room. Is the distinction clear enough between “concurrent” or “simultaneous” surgeries and overlapping procedures?

If your chosen surgeons are so fancy that they can’t focus just on you, and your operation isn’t a dire or complicated case that might benefit from a super specialist with a hectic schedule, well, there’s another option: Find another doc.  Caveat emptor.

Photo credit: Dr. Dennis Burke by Dina Rudick, Boston Globe
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