Ghost Surgery:Be Advised

Ghost surgery exists whenever an individual performing an operation is not the same person that the patient expected to be wielding the scalpel.

I recently took a case based upon the deprivation of rights of an elderly insolvent Medicare Patient to know her medical providers and hospital's refusal to be held accountable or accept responsibility. The hospital made commitments to my client upon admission to protect her rights and honor the rights of her agent to make decisions. Those commitments were violated.

What I learned was that in some Southern California teaching hospitals, patients are led to believe (let’s simply say ‘underinformed’) that their surgeon will perform the procedure. Sadly, Dr. Nobody may actually operate on the unknowing (asleep) patient. Young surgeons in need of experience sometimes develop their techniques on unsuspecting patients-many times elderly/medicare patients who believed that the attending staff surgeon who obtained consent was performing the procedure. This is a deeply unethical medical practice.

Now, let’s be realistic. Residents have to learn how to perform surgery somewhere, right?!? A well-structured clinical residency program is the ideal environment for senior surgeons to train their successors. Standing side-by-side the staff and resident surgeons collaborate to get the best results for their patients. If portions of a case are too precarious or too unfamiliar to the young protegé the more experienced attending surgeon typically takes over. The patient is protected every step of the way.It is the responsibility of the attending surgeon to approach the patient and ask this important question. If a patient declines to have a surgeon-in-training scrub-in the choice needs to be respected. Fortunately, this is a rare occurrence.

If you or a loved one is anticipating surgery make sure you clearly understand all options. Make sure that ghost surgery is not tolerated in your hospital. Specifically ask who will serve as primary surgeon and their level of proficiency. Do not abdicate that decision to anyone!

If you or a loved one are going to be admitted into a teaching hospital realize that the patient rights and responsibilities that you are given which states that you have the right to know the name of your medical provider may be worthless. The courts will not enforce your rights unless the patient is actually injured during the procedure and the patient can prove via expert testimony that the injury was an injury that would not have occured if the intended physican had performed the procedure. Remember all "witnesses" will work for the hospital and all evidence will be created by the hospital.

Upon admission, you must complete an advance healthcare directive giving someone authority to make medical decisions for you. Ensure this is given to the hospital and ensure that your agent is designated on the form.

Upon admission you will be requested to sign a form stating "Conditions of treatment." This is a general consent form. Write on this form that "NO PROCEDURE WILL BE PERFORMED ON ME EXCEPT IN EMERGENCY UNLESS MY ADMITTING PHYSICIAN SPECIFICALLY DIRECTS THE PROCEDURE AND UNLESS I OR MY AGENT CONSENT."

If you need to sign a CONSENT/INFORMED CONSENT for a procedure, write on the consent in all caps " THIS SURGERY IS TO BE PERFORMED BY DR. xxxx ONLY. NO OTHER SURGEON IS TO PERFORM PROCEDURE WITHOUT MY APPROVAL OR THE APPROVAL OF MY AGENT."

Summary:

• Request the surgical consent form in advance of your operation and give yourself enough time to read it.

• Consider who will perform all aspects of your procedure, including the anesthesia.

• Educate yourself about the facility's and surgeon's policies on teaching and supervising students and trainees.

• Ask if the surgeon is going to perform the entire operation.

• Find out if the surgeon will be present the entire time, and if not, how long he or she might be gone and who will be in charge during the absence.

• Cross out parts of the consent form you are not in agreement with and write down your expectations, initialing the changes, but discuss it with your surgeon first. Don't wait until the last minute.

• Realize that if your surgeon disagrees with you, the operation could be canceled and you might have to find another doctor. You, too, can call off your operation.

• Make sure your surgeon is named on the consent form; don't sign a blank form.

• Inquire about the policy for informing patients about changes in who will perform parts, or all, of your operation.

• Remember that informed consent involves more than just filling out a form. It involves communication and transparency. Try to be respectful and nonconfrontational throughout the process.