Does general surgery do a lot of c-sections at your facility? I've only see general surgery do c-sections in trauma patients with fetal distress (i.e. due to a traumatic placental abruption) where they are going to need to go to the OR anyway. Ideally at our facility OB would scrub on these also and do the c-section but sometimes for staffing/timing reasons that is not possible so I have seen a few over the course of my career. I have never seen FM or CNMWs referring patients to general surgery for c-sections. Are you at a facility that just doesn't have OB?
I think the critical question, at least regarding surgeon liability, is whether the scans were also mislabeled in the PACS (or whatever digital imaging system that hospital uses). In that case, if the surgeon had reviewed the scan ahead of time, saw evidence on the scan of abnormality which was consistent with the gross appearance observed in the OR, then it may be difficult to fault him/her. This doesn't completely fit the scenario with the majority of renal ca primary or metastatic disease because a mass would be noted on the CT scan and noted on the gross appearance of the kidney. So I somewhat question that scenario did exactly play out, however, there are a few details we're missing for me to comfortably assert that.
Yes, I'm credentialed in 13 facilities, only two of which have any OB/ GYNs. In one of those facilities, the OB is a "circuit doc" and only present in clinic about 2-3 days a month for mostly GYN consults, no OB. In the other, the OB lives in the area, but does not do any OB, doesn't take any call, and only has clinic one day a week (sees GYN, GYN cancers, bladder issues, etc. She is not near-retirement age, either-- she's in her early 40s with lots of kids at home, so working part time.) In my area, OB's typically only work in urban and medium to larger suburban areas-- hospitals with more than 100 beds, due to the on call requirements, and their desired income levels, etc. It's hard to recruit multiple OB/GYNs to smaller communities to share call-- FP and CNMs do almost all the OB in clinic, and L & D. General surgery does all the GYN surgeries, also (tubals, hysterectomies, ovarian procedures, laparoscopies, D&C's, bladder suspensions, A&P repairs, etc).
I work mostly in facilities with less than 75 beds, which is the bulk of hospitals in my region outside the large metro areas. General surgery does nearly all C/S, scheduled or urgent. Several of these facilities have around 50 deliveries a month, and about half to 2/3 are C/S (the high C/S rate is another discussion, but it largely has to do with where the surgeon is, and how fast he/ she can get there, and if the OR crew on call is busy with another case, and the demise of VBACs.) Occasionally I've come across an older FP/ GP that is trained and credentialed for C/S, D & C's, sometimes T & As, but that is increasingly more rare. I worked with one GP that lacerated the bladder during a C/S, and had to have general surgery come in to help. And I had a nightmare scenario at an Indian reservation hospital that DID have an OB, who got in way over his head in surgery, but didn't have a general surgeon for more than 100 miles away, but that's another story all together.)
That said, I completely agree with your comment about the kidney tumor, and how the patient data was initially coded in the radiology record. As I said above, if the imaging record was coded with the wrong information, then that is where the problem began, and no one (the initial doc who ordered the CT, and the operating surgeon) would have had any way to know that the images didn't belong to the patient in front of them.
I want to believe the surgeon DID consult with the original doc, and I also want to believe that the surgeon met with the patient in the clinic before surgery, and at some point reviewed some kind of images (not just the reports). But I agree that there are some gaps in the way this was reported in the media that means we will likely not know exactly what happened (unless it ends up in a professional publication).
I'm not sure how we "fix" these kinds of problems, unless we "require" duplicate imaging to verify, or duplicate verification with imaging. (If it was a patient information data entry issue.) Maybe we have to implement widespread verification measures like we have in the OR, in radiology-- verifying the imaging site/ procedure with several people, verifying the record is coded correctly with the right information by several people, etc. Maybe the problem is rare enough, that would be overkill? IDK.
I wonder if there is a national database that tracks how often "wrong image" mishaps occur, such as the tracking we have for "wrong site" surgery?
