Chapter 5A Case Study

Cultural Competence

Directions: Read the case and respond to the questions below. Your response must be detailed and provide evidence to support your response. Follow APA guidelines and use proper in-text citations and references.

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Whenyou'veworkedinmedicalcentersaslongasIhaveandbeeninvolvedinvarioussituations,everyonceinawhile,youthinkyouwitnessamiracle.ThisisoneofthosecaseswhereIthinkamiraclehappened.Oneday ageneralsurgeoncametomyofficeandtoldmethatwehadaproblem.Now,whenaphysicianhasaproblem,heorshegenerallyhastheattitudethatthehospitalalsohasthatproblem.Thisisbecausethehospitalislegallyresponsibleforwhateveraphysiciandoesinthat hospital, including malpractice. During surgery, he had left a sponge in a 16-year-old developmentally disabled patient.Asarule,thesurgicalteammakesthreecountsofthespongesusedonecountbythesurgeonbeforeheorshestitchesthe incision closed, one count by the circulating nurse, and one by the technician. How this got by all three of them is unex-plainable,butitdid,andtheboydevelopedgangrene.Thegeneralsurgeontoldmethatthechildwasgoingtodie,andhewantedtoknowwhatweshoulddo.Ianswered,"Well,thefirstthingwe'regoingtodoisadvisetheparentswhathappened here.Andthenafterwetelltheparents,youwillnottalktoyourattorneys,butI'llgotalktoourattorneys."

So, as the child laid dying in the Intensive Care Unit, we took the parents aside for this very difficult conversation. Wewent to what we call the quiet room, which is where physicians have private discussions about the condition of patients withfamilies.Thegeneralsurgeontoldthemthetruth.Hetoldthemhehadleftaspongeintheirchildduringsurgery.Because ofthatmistake,thechildhaddeveloped gangrene,andthechildwasgoingtodie,probablywithinthenext2weeks.

Now, if that had been my child, I think I would have been quite upset with the surgeon. So, I was expecting the parents torespond with great emotion and possibly even anger. Surprisingly, when the surgeon told the mother and father the truthaboutwhathadhappenedinthiscase,theywereverycalm.Theysaidtheydidnotfaultthesurgeon, andtheyactually wouldprayforhim.Bothofusweretotally shockedbytheirreaction.ThemiracleofthisstoryisthattheboywalkedoutoftheICUand the medical center about 12 weeks later and continued his life. This was one of the few miracles that I think I witnessedduringmy25years inthehospitalsetting.

Questions:

1. Shouldthesurgeon andIhavediscussedthismatterwiththeparents beforediscussingitwithourlegalcounsel?

2. Whatwouldyoudototheprivileges ofthegeneralsurgeonwhomadethesurgicalerror?

3. Whatnewprocedureswouldyoudevelopinyouroperatingroomtoprevent thisfromhappening again?