Surgical Safety in Canada: A 10-year Review

By Paul Mitchell, Q.C.

A 10-year analysis of approximately 3,000 malpractice complaints and settlements involving surgical “incidents” in Canada has just been released by the Canadian Medical Protective Association.

It is entitled Surgical Safety in Canada:A 10-year review of CMPA and HIROC medico-legal data.

The report provides a rare glimpse into potentially avoidable — and sometimes catastrophic — harm occurring in the nation’s operating rooms.

The report lists communication breakdowns, “absent, sparse or illegible” documentation and failures to follow system safety checks among the factors contributing to surgeries gone wrong

The analysis involved 1,583 cases from the Canadian Medical Protective Association (CMPA) — the Ottawa-based body that defends doctors accused of malpractice — between 2004 and 2013, and 1,391 cases handled by the largest liability insurer for Canadian hospitals and their employees.

Overall, about one-third of the cases resulted in severe harm to patients, from devastating injuries such as major organ damage or paralysis, to death.

A landmark 2004 Canadian study estimated that at least 70,000 cases of preventable medical errors occur each year in hospitals, with more than half attributable to surgery. I

In the U.S., medical error is now the third-biggest cause of death, behind cancer and heart disease, according to a newly published study that estimates 250,000 Americans are killed annually by medical care “gone awry.”

As National Post writer Sharon Kirkey writes, “Medical error leading to patient death is under-recognized in many other countries, including the U.K and Canada,” the researchers, from the Johns Hopkins University School of Medicine in Baltimore, report in the British Medical Journal.

The new Canadian surgical review doesn’t include obstetrics-related cases. It also excluded class-action suits to avoid “weighting” an issue. In addition, an investigation by the National Post’s Tom Blackwell revealed only a fraction of errors are ever reported by staff internally.

Most involved non-cancer, non-trauma surgery. The top five sites for surgical mishaps were the uterus, gallbladder, colon, muscles of the chest or abdomen (hernia repair) and breast.

The analysis examined incidents that occurred before, during and after an in-hospital surgical procedure. The average patient age was 49. Most (76 per cent) were relatively healthy going into surgery.

Experts who reviewed the cases were critical of the care provided in half of them.

Harm to patients ranged from death to lacerations, punctures, infections, hemorrhage and burns.

Results

  • The analysis identified 1,583 CMPA and 1,391 HIROC
    medico-legal cases involving an in-hospital surgical
    incident.
  • Peer expert reviews identified system and provider issues
    in 53% of CMPA and 49% of HIROC surgical incidents;
    no criticism was documented in 42% and 25% of these,
    respectively. Table 1, below, illustrates the categories of
    contributing factors in which issues were identified.
  • Almost two-thirds of cases involved non-oncology/
    non-trauma repairs or excisions (e.g. inflammation and
    infection). Trauma-related care represented 12% of
    CMPA and 3% of HIROC datasets. Oncology-related
    cases represented 14% of CMPA and 8% of HIROC
    datasets.
  • Patient harm (i.e. physical and psychological outcomes)
    involved injury to organs, blood vessels or nerves;
    wrong surgery (wrong body part, patient, procedure);
    unintended retained foreign bodies; hemorrhages;
    or burns.
  • Retained foreign bodies or wrong surgery were identified
    in 12% of CMPA and 18% of HIROC surgical incidents.
  • Severe patient outcomes, including death and
    catastrophic harm, were identified in 32% of CMPA and
    39% of HIROC surgical incidents.
  • The most common system issues included inadequate,
    lack of, and/or non-adherence with a surgical safety
    protocol (e.g. surgical safety checklist).
  • Most incidents occurred during the intra-operative
    phase.
  • Neurosurgeons and orthopaedic surgeons had the
    highest incidence of cases per 1000 CMPA members.
    Anaesthesiologists were involved in 4% of CMPA surgical
    incidents. Residents were involved in 4% of CMPA and
    1% of HIROC surgical incidents.

See the full CMPA report here:
Surgical Safety in Canada: A 10-year review of CMPA and HIROC medico-legal data

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Paul Mitchell, Q.C.is a BC personal injury lawyer who has extensive experience with severe injury claims, including brain injury claims, spinal injury claims, death claims, ICBC claims, medical malpractice claims, and other catastrophic injury claims.

Paul has successfully concluded BC medical malpractice cases for amounts up to 3.5 million in individual cases.

He acts for injured clients all over BC and Alberta, and will not act for ICBC or any other insurance company.

For more information on this article, or for a confidential discussion of your injury claim, contact Paul Mitchell, Q.C. 250-869-1115 (direct line), or send him a confidential email at mitchell@pushormitchell.com.