When your surgeon isn't the one you expected
Mary Ann Bart, seen with granddaughter Madison Bart and grandson Dominic VanDerWal, sued a urologist at Northwestern Memorial Hospital, alleging he did not perform her kidney operation as promised. (Antonio Perez, Chicago Tribune)
A different physician can step in for legitimate reasons, such as a medical emergency involving the surgeon. And at academic medical centers, residents and other junior health professionals often perform procedures under supervision. Medical experts and patient advocates agree that is acceptable as long as patients are informed and give consent.
But in some cases, patient advocates say, there can be an actual bait-and-switch, when a prominent surgeon promises to carry out the procedure but does not.
It's not clear how often such "ghost surgeries" occur, because they are not tracked or studied. But lawsuits provide a glimpse into the allegations of unhappy patients who had bad outcomes, started to look into what went wrong, and learned they were mistaken about which doctor performed the procedure.
Denyse Richter of New Hampshire filed a medical malpractice case after her heart was severely damaged in a cardiac operation. She had sought out a renowned, triple board-certified cardiologist, but instead the procedure was performed by a less experienced provider. Now Richter requires a pacemaker.
"I sought the rock star, and I got the opening act," said Richter, whose case went to a jury in 2008 before being settled for an undisclosed amount.
In Chicago, an orthopedic surgeon filed a suit in 2004 that accuses Rush University Medical Center and a group of fellow surgeons of billing Medicare for operations conducted by unsupervised medical residents. And last month, a patient sued a urologist at Northwestern Memorial Hospital, alleging he did not perform her kidney operation as promised.
Patient advocates say it's not uncommon to hear from people with similar stories, though such cases can be difficult to win in court.
"We can go into the operating room, be sedated and have a different person we know nothing about cut into our bodies," said Dr. Julia Hallisy, a dentist who is president of The Empowered Patient Coalition, based in San Francisco. "It's alarming and disconcerting on so many levels, not just from a medical or legal standpoint, but from a trust and ethical standpoint."
Hallisy got interested in ghost surgery in 1998, when a review of her late daughter's medical records revealed that the name of the surgeon she had expected to perform a biopsy wasn't in the operative notes. Listed instead were two medical residents, Hallisy said.
Yet the surgeon had appeared after the procedure — dressed in scrubs and holding a vial containing a piece of her daughter's bone — to say it went well, Hallisy said.
It "seemed intentionally misleading," she said, and although her young daughter wasn't harmed, the family felt manipulated and filed a complaint with the California medical board. Hallisy said the experience helped motivate her to start an advocacy group; patients, she said, want informed, transparent and shared decision-making.
The American College of Surgeons tells its members that it's unethical to mislead a patient about the identity of the person performing an operation.
"This principle applies to the surgeon who performs the operation when the patient believes that another physician is operating ('ghost surgery') and to the surgeon who delegates a procedure to another surgeon without the knowledge and consent of the patient," the organization's guidelines state.
The guidelines also make clear that the surgeon is responsible for the patient's welfare throughout the operation, including remaining in the operating room or the immediate vicinity.
"The surgeon may delegate part of the operation to associates or residents under his or her personal direction, because modern surgery is often a team effort," the guidelines state. "If a resident is to perform the operation ... under the general supervision of the attending surgeon, the patient should have prior knowledge."
Dr. Joanne Conroy, chief health care officer for the Association of American Medical Colleges, the organization representing the nation's medical schools and teaching hospitals, said informed consent has greatly improved in an effort to be more transparent about who is doing what.
"Over the last 30 years, we have become much more explicit about the fact that students will be involved in your care," she said. "We have been much more granular about talking about their involvement and talking to patients about their presence."
But even patients who shop around for a surgeon may not take the time to understand what exactly will happen in the operating room. At least one study reported that most people don't read their consent form, which spells out who will be involved in critical parts of the procedure.