Melanoma and the Wrong Site [Video]

March 27, 2024Dermatology TimesDermatology Times, March 2024 (Vol. 45. No. 03)In this month’s Legal Eagle column, learn about the liabilities and how to prevent wrong-site procedures.“Dr Cancer” is a well-respected dermatologic surgeon who receives referrals from many physicians. He is well known for his expertise in skin cancer removal. He holds an academic title and lectures nationally on the treatment of melanoma. All patients referred to him are required to bring biopsy reports. Some even come with photographs of the biopsied area. Most patients have a pretty good idea of where the biopsy was taken. Two years ago, Dr Cancer saw a patient with a biopsy-proven melanoma in situ of the right cheek. The patient, during initial consultation, brought a photo of the involved area. Because the patient was so anxious about her upcoming surgery, Dr Cancer suggested she take an anti-anxiety medication prior to surgery. Consent forms were signed during the consultation appointment. On the day of surgery, Dr Cancer’s patient took a double dose of her anti-anxiety medication. She was sleepy and confused when she entered Dr Cancer’s office. Unfortunately, it was not a good day in Dr Cancer’s office. The staff provided local anesthesia to the wrong site. Dr Cancer followed by removing a significant segment of the wrong area of skin and did not remove the melanoma. As the staff began to teach the patient appropriate wound care, the patient’s family noticed that surgery was performed on the wrong site. They were appalled. They never returned to the office and filed both a medical malpractice lawsuit and a claim with Dr Cancer’s state board of medical examiners. Now what? Unfortunately, wrong-site surgeries do happen. Over 2 decades ago, a world-renowned New York neurosurgeon temporarily lost his medical license for operating on the wrong side of a patient’s brain. A Rhode Island hospital was penalized for allowing 5 wrong-site surgeries to be performed over the previous 3 years. The hospital was forced to pay a $150,000 fine, a 1-day safety training session was mandated for all personnel involved in performing elective surgeries, and a proctor was required to monitor that the surgical teams would be following safety protocols. The state health department mandated that the hospital install video and audio monitoring equipment in each operating room. There would now be a record of not only the banter that goes on during surgery but also the chosen music of the day. It was felt that such radical measures would get to the root cause of the problem. Patients needed to give consent to be videotaped. Wrong-site surgery is considered a “never event.” Medicare does not pay for repeat surgery if the first one is on the wrong body part. A number of private insurance companies have followed suit. Wrong-site surgery is preventable. One way to decrease the likelihood of such embarrassing (and potentially mutilating) events from happening is to get the patient involved.

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