When I saw the summary of this article, I thought to myself, "What?!" I've never worked at a teaching hospital so the thought of a surgeon performing two surgeries at once seemed more like a magical act than something that should be a reality. What do you think? Would that bother you if your surgeon was operating on you and someone else simultaneously? Supposedly there is no higher incidence of issues when concurrently running two ORs; see if a patients of dual operating rooms feels the same.
CLASH IN THE NAME OF CARE
It was a battle pitting a star surgeon against a great hospital, MGH. The question: Is it right or safe for surgeons to run two operations at once? Is it right that their patients may have no idea? The conflict went on for years. And it isn’t over yet.
To learn more about concurrent surgeries, visit our home for Globe coverage of the issue.
Dr. Kirkham Wood arrived in the operating room at Massachusetts General Hospital before 7 one August morning with a schedule for the day that would give many surgeons pause.
Wood, chief of MGH’s orthopedic spine service at the time and a nationally renowned practitioner in his specialty, is a confident, veteran surgeon. He would need all of his talent and confidence this day, and then some, as he planned to tackle two complicated spinal surgeries over the next many hours — two patients, two operating rooms, moving back and forth from one to the other, focusing on the challenging tasks that demanded his special skills, leaving the other work to a general surgeon, who assisted briefly, and two surgeons in training.
In medicine it is called concurrent surgery, and the practice is hardly unique to Wood or MGH. It is allowed in some form at many prestigious hospitals, limited or banned at many others. Hospitals that permit double-booking consider it an efficient way to deploy the talents of their most in-demand specialists while reducing wasted operating room time.
For patients, however, it can come as an unsettling surprise — especially when things go wrong.
Waiting for Wood in operating room 72 that day in 2012 was Tony Meng, a 41-year-old father of two from Westwood who had been diagnosed that summer with a serious degenerative condition that constricted his spinal cord, causing pain, tingling, and numbness. To relieve the symptoms, the surgeon would have to slice through the front of Meng’s neck, navigate around arteries that supply blood to the brain, and remove parts of his vertebrae.
Then, he would turn Meng over onto his abdomen and operate some more.
Wood later testified that he performed this particular procedure only once or twice a year, working in a delicate space where the difference between recovery and ruin is sometimes a scalpel’s width. The risks are real; the benefits can be huge.
Down the hall in room 64 was Wood’s other patient, an elderly woman awaiting her own complex surgery, a spinal fusion that would also require precise work spanning much of the day.
Wood’s cases were scheduled to start within minutes of each other. Great skill and stamina would be required for the long hours of medical ballet ahead, as Wood timed his moves between the two ORs to match the ordinary progress of each procedure and both patients’ needs.
Wood was known among his peers for taking on some of the most challenging cases, sometimes as the surgeon of last resort for suffering patients who had been turned down by other doctors. That’s exactly why Meng had brought his troubles to MGH: He wanted a star surgeon, someone who could help him put aside his pain medications and comfortably play soccer again with his two young children.
Tony Meng had no idea he was sharing Wood with another patient that morning. Double-booked surgery patients often didn’t at the time, and sometimes still do not. Surgeons are “encouraged and expected” to tell patients when they’ll be absent for part of the surgery, an MGH spokeswoman said, but they are not explicitly required to do so. Some doctors, Wood among them, consider disclosure of double-booking a case-by-case call.
Meng wouldn’t know until long after he woke up in a recovery room following the 11-hour operation to hear a medical resident say, “Mr. Meng, can you move your arms or legs, or squeeze my fingers or wiggle your toes?”
He could not.
All Meng could do, when the resident asked, was “wince.”
No one knows why it happened to Tony Meng, or how, or even exactly when. Nothing in the medical record indicates that Meng’s sudden paralysis — a known risk of the surgery — had anything to do with Wood’s decision to juggle his care with another patient’s for about seven hours. Wood said he did nearly all of Meng’s surgery himself and did not even scrub in for the second part of the other patient’s procedure, leaving it to the surgical fellow.
MGH officials declined to comment directly on the Meng case, saying federal patient privacy laws forbid their doing so. Hospital attorneys, however, strongly defended Wood in court documents filed in Meng’s malpractice suit, saying he broke no rules and “acted appropriately” within the accepted standard of care.
More broadly, MGH officials say their analysis of hundreds of orthopedic cases from 2013 and 2014 found no significant difference in complication rates between overlapping and non-overlapping cases. They describe the practice as an extension of the teaching hospital’s team approach, pairing senior doctors with residents — surgical trainees — and fellows, who have finished their general orthopedic surgery residency and are training in a subspecialty. In one of the few scientific studies of simultaneous surgeries, a University of Virginia researcher found no increase in complications in operations that overlapped by up to 45 minutes.
“We haven’t found a single case where the concurrency has caused harm, so I don’t think patients should be alarmed about it,” Dr. Peter Slavin, Mass. General’s president, said during an interview in the hospital’s historic Bulfinch Building.
Still, the Spotlight Team found that the 2012 Meng case reignited an extraordinary, long-running controversy at one of the nation’s top-rated hospitals over the propriety and safety of a fairly common but little studied practice that goes to the heart of a doctor’s obligation to his unconscious patient. Is it right, some MGH medical staff asked, for surgeons to divide their attention between two operating rooms — especially when the patients don’t know? Can they really do two overlapping operations equally well?
What began as an internal discussion about safe surgical practice long ago turned personal and bitter, pitting top medical figures against one another. So far, the controversy has spawned state and federal inquiries and led to the summary dismissal in August of a star surgeon, Dr. Dennis Burke, who fought a multi-year battle against double-booking. MGH officials assert that Burke violated hospital rules and possibly federal privacy laws by supplying the Globe with copies of some internal records.
It is a struggle few outside MGH and its parent company, Partners HealthCare, know anything about. This is a realm where patient privacy and business information is, by law and habit, guarded zealously. But the Globe, through dozens of interviews and a review of hospital records, court filings, and hundreds of e-mails shared by current and former medical staffers, pieced together a portrait of this remarkable and revealing episode, one which changed surgical practice and procedure at the hospital and resulted in double-booking being raised as an issue in malpractice lawsuits.
Burke and a small but determined cohort of anesthesiologists and other Mass. General employees complained about at least 44 alleged problems involving concurrent surgeries, and raised concerns to their superiors and colleagues, sometimes through official channels, other times in court testimony or ordinary e-mails about what they considered substandard patient care or medical practice between 2005 and 2015, the Spotlight Team found.
Stoking their anxiety, they alleged, were cases of patient complications, including two that ended with the deaths of elderly patients; cases where surgeons were out of the operating room attending to another patient when an urgent need arose; cases where surgeons didn’t show up to operations, leaving the work to a resident or fellow; cases of patients lying under anesthesia for prolonged periods waiting for a doctor to arrive or return; cases where operating room staff were confused about who would do the operation.
MGH officials dispute the validity and importance of almost every complaint, saying many are based on inaccurate information, turf fights, or misunderstandings in a busy hospital. They also privately question the motives of some who made them. “Each and every one of these allegations of a potential incident was investigated,” a hospital spokeswoman said in a statement to the Globe, adding that federal privacy law and hospital personnel policies prevent the hospital from saying what investigators found or what action, if any, was taken. Patients would have to authorize such comment by the hospital, and only one of those who spoke to the Globe agreed to do so.
Certainly, at a hospital where 37,000 surgeries are performed each year, concurrent operations make up a small minority. Cases with “procedural overlap,” involving at least one patient with an open incision while the second case is underway, account for 3 percent of the total — about 1,000 cases a year. Overall, patients at MGH share their surgeon for some part of the case 15 percent of the time, figures provided by the hospital show.
Dr. Kirkham Wood stopped double-booking surgeries some time after the Meng case in 2012, when a revised hospital policy sharply limited concurrent complex spine cases, according to Dr. Harry Rubash, MGH’s chief of orthopedic surgery. Wood, Rubash said, “chose to step down” from his hospital leadership position the following year amid concerns about his communications skills.
Rubash, in written statements, said there was no connection between the Meng case and the leadership change.
Now, attorneys for three of Wood’s patients say that double-booking will play a prominent role in their malpractice lawsuits against the surgeon, including one filed by Meng and another by former Red Sox pitcher Bobby Jenks, who blames Wood for what he alleges was a botched back surgery in 2011 that ended his career.
The handful of orthopedic surgeons best known for double-booking cases were reluctant to be interviewed, though Wood spoke briefly to a Spotlight reporter in a Boston courtroom after a hearing on one of his malpractice cases.
“Our hospital is being crucified for something that happens at hospitals across the globe,” Wood said. “Everyone in America has done it at some time.”