Although none of the editors of InsideSurgery.com were involved in the case, we have noted with interest the news reports alleging that Drs. Paolo Bolognese and Thomas Milhorat were guilty of patient abandonment in a recent incident at North Shore University Hospital.
Both prominent neurosurgeons, they were initially suspended by hospital officials for two weeks until the news media broke the story. The suspensions were then lengthened while the hospital considered how best to proceed. Dr. Milhorat’s resignation was announced on May 8, 2009.
Although the details remain sketchy, the main complaint revolves around a patient who was anesthetized and whose head was shaved without attending neurosurgeon Dr. Bolognese being present in the operating room. When attempts to notify him that his patient was “asleep” and ready for surgery failed, Dr. Milhorat was then contacted and told to report to the operating room to do the case.
Milhorat apparently refused to operate on the patient. It is not clear at this time whether the patient received the planned surgery from a third neurosurgeon or whether she was brought out from anesthesia without the surgery being performed.
Bolognese and Milhorat were both suspended for patient abandonment.
The suspension of Bolognese is questionable depending on the particular circumstances and the suspension of Milhorat is an outrage.
Certainly, attending surgeons who schedule elective cases have every obligation and duty to be present to start the case as planned. However, life events happen to people on the way to work (operating room). Cars crash, children become ill, coronaries occlude.
The operating room and anesthesia staff bear some responsibility in starting the anesthesia induction and preparation of the surgical site without ascertaining the Dr. Bolognese was in the operating room suite and available for surgery.
Most large hospitals now have policies that empower the operating room and anesthesia staffs to delay starting cases until the attending surgeon (not just the resident or physician assistant) is actually physically present in the operating room. A phone call from a cell phone reporting the position of the attending surgeon “just pulling into the parking garage” is generally not sufficient.
However the blame is proportioned in this case of an asleep, shaved patient without Dr. Bolognese present, there is no justification in assigning any of it to Dr. Milhorat.
Assuming Milhorat had no previous agreement with the patient to participate in her operation, he has no ethical or legal responsibility to step in and start the operation on a patient he has not met, nor prepared for.
To do so would be gross negligence and indefensible. Almost universally, surgeons would make the same decision as Dr. Milhorat when faced with his predicament. As the surgical incision had not been made, the best course is to “bring the patient up” from anesthesia and avoid the possiblity of a catastrophic blunder.
The fact that Dr. Milhorat’s refusal of a corporate directive to operate on this patient resulted in a suspension and the destruction of a long and illustrious career is a chilling warning about the increasing risk and loss of autonomy in surgical practice. Healthcare systems apparently are now having little hesitation in telling doctors how and when to practice.
Surgeons more than most physicians use invasive procedures to try to eliminate disease and heal patients. But, even the most aggressive practitioners keep foremost in their minds the first lesson taught through the centuries to physicians – first, do no harm.