An increasingly common yet controversial practice is being implemented in hospitals around the country. Concurrent or simultaneous surgery is a practice in which one surgeon is simultaneously involved in two or more surgical procedures on different patients in different operating rooms. To legitimize this practice, medical studies have been published arguing that the practice is safe and that there is no difference in mortality or complications. It is further argued that the practice allows medical residents to take on more responsibility and that it allows exceptionally gifted surgeons to make their talents more widely available. Studies have also been published which found an increase in complications with overlapping surgeries. These studies argue that the practice is not safe and suggest that the real motive for double booking is financial—greater profit for both the surgeon and the hospital. When the surgery goes well, there is little cause for alarm; however, when the patient is injured during double booked surgery, it is up to the plaintiff’s lawyer to explore whether the double booking contributed to the outcome. The plaintiff’s attorney must explore whether the attending surgeon was truly present for all “critical” portions of the procedure, whether the resident performed more than “non-essential” portions of the surgery and whether the patient was advised before the surgery, of the plan to double book and gave informed consent to this.
As recently as November 2017, JAMA Surg. published a study which concluded that overlapping surgery in complex neurosurgical cases can be performed without risking patient safety. More recently, however, in January 2018, JAMA Intern Med. published a study which reviewed data from overlapping surgeries and found a significant increase in complications for patients undergoing hip replacements or other surgery for hip fractures. While arguments can be made that these studies are not inconsistent, such arguments miss the point. The goal of the trial lawyer is not to try and support a given study but to scrutinize the underlying basis for the conclusions or to argue that there were reasons for the publication of a particular study (placing profit over patient safety). Once the attorney has identified flaws in a study or developed a motive for the study, the flaws and motives can be used as ammunition for the examination of the target surgeons and medical experts.
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