Three Gynecologists Blasted by Assuta Over Conduct in Cancer Case

An internal review completed recently by the private hospital chain Assuta found serious failings on the part of three gynecologists who conducted exploratory surgery on a woman suspected of having cancer, despite lacking the requisite expertise to excise any malignant tissue discovered in the process.

The gynecologists indeed found cancerous growths in the woman's uterus and ovaries, but stopped the operation because no gynecologic oncologist was available to determine the extent of the excisions needed and to perform them.

The suspended operation took place at Assuta's Petah Tikva branch on November 17, 2006. The woman successfully underwent surgery at the Tel Aviv branch two weeks later to remove her uterus and ovaries.

The findings of the investigation were submitted recently to the management of Assuta Medical Centers and its owner, the Maccabi Healthcare Services Group. Two of the doctors involved have been permanently barred from working at Assuta, while the third doctor is obliged to obtain written permission before every operation.

When questioned, the doctors traded accusations and gave contradictory statements, raising the suspicion that some information given to the review board was unreliable or untrue.

Moreover, the patient was not invited to testify before the review board. Assuta's management did not even inform her of the investigation; she learned about it only following Haaretz's inquiry two weeks ago.

Nor did Assuta and Maccabi report the incident or subsequent findings to the Health Ministry, claiming they were not required to do so under ministry criteria.

The patient, L., 51, of Tel Aviv, is a member of the Maccabi HMO. In August 2006, L.'s Maccabi gynecologist, who also works at Sheba Medical Center, Tel Hashomer, discovered signs indicating ovarian cancer and referred her patient to Sheba's gynecology clinic. L. was examined by a senior physician, who recommended removal of the cancerous organs should exploratory surgery verify the suspected malignancy. She elected to undergo surgery at Assuta's Petah Tikva hospital, and her doctor asked a Maccabi doctor to perform the operation along with her and another gynecologist who had examined L. at Sheba.

According to the investigative report, all the tests performed ahead of the operation indicated it was likely that cancer would be found. The doctors therefore agreed that the Maccabi gynecologist would arrange for two doctors to be available during the operation: a pathologist to test the malignancy of the growth, and a gynecological oncologist. However, when the three doctors in fact found evidence of cancer, the expert on call was not present and the operation was stopped.

The woman gynecologist told Haaretz that on the morning of the operation, the Maccabi gynecologist told her explicitly that he had arranged for a gynecological oncologist to be on hand and even gave her the expert's full name. Only during the operation did she and the other doctor learn, "to our total astonishment," that the expert would not be coming, she said.

The review board severely criticized the conduct of all three doctors. The woman gynecologist was accused of taking responsibility for the patient's surgery despite lacking the requisite skill and of failing to ensure the presence of a gynecologic oncologist even though she knew cancer was likely. The board also said she should have canceled the operation in the absence of the pathologist and the gynecologic oncologist.

The doctor responded that "the gynecologist from Maccabi, as the [senior] surgeon ... is responsible for assembling the necessary team."

The Maccabi doctor was faulted for taking on the operation without personally examining the patient and her medical chart, and despite knowing that he was not qualified to perform the surgery. The board also accused him of giving the woman gynecologist the false impression that he could handle the patient's medical problem. He, too, was faulted for not calling off the operation.

His lawyer responded that "because of the partial information the woman gynecologist gave him, he was misled into thinking this was merely an operation designed to remove cervical tissue. Only when the operation began were we astonished to learn that it was a cancerous growth, and this information, despite being known to the woman doctor, was not conveyed to the surgeons."

The Sheba doctor was faulted for failing to ascertain the patient's medical details before the operation and make sure the necessary staff were on call. His lawyer stated that he was informed prior to the operation that experts had been called to Assuta, and that he acted properly in halting the operation.