“…the scrub nurse, who had at the beginning of the procedure had told the circulating nurse, recorded on deposition, that she had everything, now announced that she could not locate the rods.”

WHAT?!?!

To me (I am a nurse), everything that happened subsequently hinges on this statement. Did she lose them?!?! Did they get thrown away? Was any attempt made to look for them? Did she think she had them but didn’t? Or had she simply lied at the beginning of the procedure?

Was she asked generally if she had ‘everything’ or was there a checklist specifying the rods? Who was responsible for getting the rods into the OR in the first place?

How could a surgery to insert rods not have rods?

That is the moment when things had already gone wrong and I think that was the moment that everything should have stopped. There was clearly a major disconnect somewhere in the facility. Something as elementary as the equipment that was to be implanted, the sole reason for the operation, could not be successfully accomplished. To me that would have been a major red flag that the patient, indeed, every patient in the facility, was already in danger.

I can sympathize with your reasoning, Dr. Ricketson. But it is not as though you were in the jungle or the patient would have perished if you didn’t improvise.

Hindsight is 20/20, but the most prudent thing to do would have been to close the patient up, get him stabilized re. his co-morbidities, initiate an internal review to investigate the protocol failure for the rods and establish a rigorous policy and procedure to ensure it never happened again.

And then, only then, reschedule.

I am very sorry for everyone involved here. Dr. Ricketson, I hope you find satisfaction and happiness as you move forward in your life.

So, I guess in this case the jury found that Dr. R’s actions were to some extent the proximate cause of the plaintiff’s injuries.

But what actions? Starting the operation without confirming the presence of all required medical devices? Improvising once that absence was discovered? I don’t know. Maybe it was based on the outcome of the second case he performed. Dr R states that after the pt fell 5 times in one day, it was later discovered that the rods were “displaced.” Maybe the jury concluded that he had never properly placed them, and that is what caused the pt to eventually have problems that led to him falling 5 times in one day. Dr R seems to belive that the falls caused the displacement. I don’t know.

I think it is wrong to start a case without verifying that all the necessary equipment is in the OR. I don’t think that this error proximately caused the plaintiff’s paralysis and death.

Based on what he told us here, I think the vast majority of the fault in this case rests with the physicians who sat on an epidural hematoma. And I further believe that if the facts are as represented here, that if Dr. R had a good attorney, he would have, and should have, prevailed.

One other question I have; Is Anon, Dr. R?

Wow. That does qualify as ad hominem. You have issues, my friend, but not of the usual kind.

Just in case your errors are simple confusion, and not malicious misunderstanding, let’s foray one last time. You said “Taking my ideas seriously atrophies the ability of others to think is not ad hominem?”

No, not really. If you recall the conversation it has to do with whether and how people think on their feet. It has to do with creativity under fire, which is itself a skill and a habit one can and should develop. There are a lot of people around (especially today) who are bureaucrats. They know all the rules they should follow and which authority to consult – but they aren’t really doing much thinking on their own. They can ‘smell’ when things are ‘wrong’ – when people are thinking ‘outside the box’, and they don’t like it. Compare the CEO of a company to an IRS agent. The mentalities are quite different. So it is not ad hominem – I am focused on your ideas – or the implication of your ideas – that in this serious situation, a physician would actually have to consider IRB approval rather than focus on the life and health of the patient he is treating. If the world generally accepted your approach, it may very well fall apart. The minds would atrophy (or become stale) from lack of use. You may be a very fine person with the best of intentions – but what you are saying can lead to badness all the same!

You also commented: “Ricketson himself says ‘Three days later, he fell and fractured the implanted substitute. … The rod was replaced the following morning without incident.’ This belies the statement that redoing the surgery was a greater risk.”

Hmmm. Have you ever played poker? Do you know the odds of drawing a flush or a straight? If you were a poker player, these are things you would need to know. They are, of course, much more calculable than what we are speaking of, but it can be used as an analogy. Now suppose you had calculated that your odds of sticking with your two pair was better than your odds of drawing a flush. You would probably stick with the two pair, then, based on simple mathematics. Dr. Ricketson stuck with the two pair.

Now, along comes the next card – wow, if you had gone for the flush – you would have won the game! (This is like you looking at the situation after the fact, and surmising that the other option was better). There is a difference between attempting to calculate what will happen in the future – and surmising AFTER AN EVENT – what really did happen. If we always knew what would happen, then we wouldn’t need the science of statistics, insurance, the gambling industry would be done for, etc., etc.

I’ll give you the opportunity for the last comment – unless you say something too outrageous and draw me in again!