Los Angeles County Cites King/Drew Medical Center for Failure To Follow Surgical Safety Regulations

Los Angeles County Department of Health Services Director Thomas Garthwaite on Wednesday cited Martin Luther King Jr./Drew Medical Center for "widespread failure" to comply with safety standards, including counting instruments after surgeries to avoid leaving them inside of patients, the Los Angeles Times reports. County officials disclosed the problem after doctors in June found that a metal clamp had been left inside a patient for 10 days following surgery. The clamp was discovered during an X-ray of the patient for a second procedure and was successfully removed. The doctor overseeing the surgery has not acknowledged responsibility for the error and has not blamed any other staff member, according to the Times.

A hospital audit of several hundred surgeries over the last four to five months found no documentation that King/Drew doctors verified the number of instruments before closing patients' incisions after surgery. Garthwaite said he could not explain why or how long King/Drew staff members violated the policy and industry standards, but he said the incident "wasn't just random." King/Drew staff said they were not aware of other cases in which instruments had been left inside of patients, according to Garthwaite. County Supervisor Yvonne Brathwaite Burke said that King/Drew Interim Nursing Director Larry Kidd told her he had "assumed all of the routine kind of things that were normally being done were being followed." Research shows that doctors leave instruments inside of patients in about one of every 1,500 abdominal surgeries, the Times reports.

Brathwaite Burke said that consulting firm Camden Group plans to bring in an operating room expert to determine whether all surgical policies are being followed at King/Drew. Brathwaite Burke raised concerns that the company -- which was hired in December to address other systematic concerns and oversee changes at the hospital -- did not detect the problem earlier. The error is the "latest in a series of patient care lapses identified in the last year" at the hospital, according to the Times. Brathwaite Burke said, "You bring in the top consultants and experts, and you think that all these things are going to be solved." Kenneth Kizer, president of the National Quality Forum, a Washington, D.C.-based patient safety group, said that verifying the number of instruments before closing patients' incisions is "what you do when you're taking care of patients the way you're supposed to be taking care of them. And they're not doing it. What can you say?" (Ornstein, Los Angeles Times, 7/29).