Wrong Organ Operated On? Patient Won't Pay

Health Ministry defines six instances where hospitals will cover all costs.

The Health Ministry is drafting a document describing six unusual circumstances in which patients will be reimbursed for their hospital expenses.

The scenarios are all based on incidents that have taken place in local hospitals in recent years, and include situations in which a foreign object is left in a patient's body after an operation; surgery is performed on the wrong organ; a second- or third-degree burn is caused during an operation; a mistaken blood or blood-product transfusion leads to the death of the patient; a patient falls and fractures a bone; and when surgery is done to correct a thigh bone fracture after five days of hospitalization and without real medical need. There is also a recommendation that the hospital apologize to the patient.

The instructions, drawn up by ministry director general Dr. Ronnie Gamzo, will come into force in March. If any of the incidents described occur in a private hospital, the patient will not be charged for the botched procedure; if they occur in a public hospital, the patient will not be charged for any part of the procedure not covered by the health services basket. The fact that the recommendations will become part of ministry procedure could have implications in cases of a medical malpractice suits.

The document - part of a general effort by Gamzo to improve patient safety - also instructs hospitals to report any of these incidents to the ministry, launch a thorough investigation, and ensure that the patient does not bear the cost of the procedure or the hospitalization.

The incidents described are far from hypothetical. In August 2008, a 37-year-old woman undergoing a Caesarian operation at Sheba Medical Center in Tel Hashomer suffered burns when a fire broke out in the operating room, and required skin implants. In September 2009, an 80-year-old woman died at Sheba after receiving a transfusion of the wrong blood, and in 2005, the wrong leg of a patient was operated on during joint-replacement surgery. In 2009, a piece of bandage was left inside a patient who underwent a throat operation at Rambam Medical Center in Haifa.

The new instructions have already been met with criticism by some leading physicians.

"The ministry mostly releases instructions that do not require the budgeting of funds," charged Prof. Yoel Donchin, director of the patient safety unit at Hadassah University Hospital in Ein Karem. "You can't define every malfunction as negligence per se. Although one can never allow an operation on the wrong organ, if a patient fell out of bed or had a piece of bandage left in his stomach cavity - it's very problematic to immediately say it's a matter of negligence."

Donchin pointed out that if the ministry truly wants to augment patient safety it needs to work to expand medical personnel. "If you want to prevent blood-transfusion errors, you need more nurses to check the procedures," he said.

The Health Ministry said in response that director general Gamzo agreed with Donchin's proposal, and would issue a tender next week for director of the ministry's own patient safety unit and would increase its staff by three positions - two physicians and a nurse.

"The unit will focus on guiding the health-care system on the issue of patient safety, and will be answerable directly to the deputy director general," the statement said.