Oxygen and heat or flames makes a dangerous and explosive combination. In the health care environment, this is so well known that The Joint Commission, and accrediting agency, requires hospitals and surgery centers to take special precautions in operating rooms (OR).
When there’s a fire, it’s considered a reportable sentinel or never event. That means the hospital or facility administrators are required to conduct a thorough investigation and root cause analysis aimed at identifying why the OR fire happened and how it can be prevented in the future.
Despite the well-recognized risk of operating room fires and requirements to protect patients from them, they still occur. In fact, just this week, a patient sued a Pennsylvania hospital and doctors over an OR fire that left him with third-degree burns.
The underlying surgery itself was rather straightforward. The patient went to the hospital for surgical removal of basal cell carcinoma on his face and chest.
What is basal cell carcinoma
Basal cell carcinoma is the most common type of skin cancer, with over 4 million cases a year being diagnosed in the United States. It’s also distinguished as the most common of any form of cancer. That’s probably the case because medical experts believe they are most often caused by damage to the DNA from exposure to sunlight or tanning beds, specifically ultraviolet (UV) radiation.
Primary care providers often are the first to spot a suspicious area, leading to a referral to a dermatologist, a physician who specializes in diseases of the skin.
Basal cell carcinomas can take on any of several appearances:
• An open sore that doesn’t heal.
• A reddish, irritated, or crusty patch of skin that may itch or be painful.
• A white, yellow, or waxy-looking scar.
• A shiny bump or nodule on the skin.
Fortunately, when a basal cell carcinoma is identified early, the treatment is generally a short surgery to remove the tumor, with clean margins around it. Some dermatologists perform basal cell carcinoma surgery in a hospital operating room setting, while others handle them as an in-office procedure. There are different surgical options, but I’m a fan of Mohs Surgery, which allows confirmation that the entire tumor was removed before the patient is discharged.
How did the fire occur?
Getting back to what happened in the Commonwealth of Pennsylvania, the lawsuit alleges that an anesthesiologist and certified registered nurse anesthetist (CRNA) used local monitored anesthesia, rather than general anesthesia. According to the anesthesia report contained in the patient’s medical records, anesthesia providers sedated him and administered 30% oxygen via a face mask.
The surgeon used Bovie cautery—an electrosurgical instrument that projects intense heat to destroy tissue in the area of treatment—while performing the basal cell carcinoma surgery on the patient’s right temple. The lawsuit alleges that the anesthesia providers and other defendants violated the standard of care by administering a higher supplemental oxygen level than is allowed when Bovie cautery is used.
According to a case management note that was part of the patient’s medical record, the surgical drapes on the patient’s face caught on fire. A fire emergency was announced in the room, and staff disconnected the oxygen and put out the fire with water. In the medical malpractice lawsuit, the patient makes a claim for damages from the first, second, and third degree burns to his face and chest, blistering to two fingers, and an eye injury.
The complaint clearly identifies multiple issues with the way the hospital, anesthesia providers, surgeon, and operating room staff handle themselves with regard to standard fire prevention practices. The allegations include:
• The surgeon didn’t warn other operating room providers before starting the Bovie cautery procedure. If that had been done, oxygen should have been disconnected or turned down.
• The nursing operating room staff didn’t properly drape the patient’s face. Based on the improper technique, it allowed accumulation of oxygen that leaked out of the non-sealed facemask.
• The anesthesia team administered excessive oxygen.
If you’ve been seriously injured by an operating room fire in Texas, then contact a skilled, top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.