Does a surgical 'black box' open the floodgates for malpractice suits?
- A team of Canadian researchers led by surgeon Teodor Grantcharov are developing a surgical "black box" that analyzes surgeons' performance in real time and provides instant feedback on errors. According to Grantcharov, doctors make approximately 20 errors per surgery, but those errors are rarely recognized.
- Although the concept of the black box has been around for years, the technology was never sophisticated enough to interpret all of the complex activity that goes on in an operating room. Grantcharov's device includes room cameras and microphones and is capable of synthesizing information on how surgeons stitch and how they handle organs, as well as physician-staff communication.
- Despite the obvious benefits of the black box as a learning tool and a real-time monitor, some surgeons are concerned that it may be used against physicians in malpractice suits. The Health Care Quality Improvement Act does not allow courts to consider information that hospitals use for peer review and self-regulation—but cases where surgeries are recorded but not used for review purposes would be fair game.
Industry experts are split on the issue: Allowing recordings from the black box to be used in court would "open the floodgates to a new wave of malpractice concerns," surgeon Chethan Sathya wrote for CNN. And according to Teodoro Dagi of the American College of Surgeons Perioperative Care Committee, it would have a negative impact on patient outcomes because the constant monitoring for legal purposes would make physicians "nervous." According to Dagi, "the black box needs to be used solely by surgeons for their own education."
Meanwhile, Richard Epstein of New York University School of Law and William McMurry, president of the American Board of Professional Liability, are both in favor of immediate utilization of the technology. Epstein notes that being prevented access to information about their own care causes patients to distrust their surgeons.
If Epstein and McMurry get their way, it may happen sooner rather than later: The technology has been tested on approximately 40 bariatric weight-loss patients and is entering a test phase in hospitals in Canada, Denmark and South Africa. And if the technology comes to the U.S., according to Sathya, integration will likely be quick: The black box is not considered a medical device and therefore will not need to be approved by the FDA.
- Advisory Board The case for a surgical 'black box' to prevent mistakes