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Yes.When I was a second-year resident I was performing a hysterectomy with a private attending. Private attendings were not employed by my residency program or the hospital (they had their own private practices) but many of them would allow us to come operate with them as an assistant during their surgeries.The surgeon I was operating with was widely regarded by the residents as borderline incompetent. This person had a very charismatic and friendly personality and was well loved by patients. We had a running joke that no matter what this person did, this attending would never get sued. Unfortunately patients often confuse “good bedside manner” with “good physician”.In contrast, one of my residency attendings, despite being a careful, safe and excellent physician has been sued multiple times because some patients do not like this individual personally.I was assisting with an abdominal hysterectomy. During the procedure, the attending decided to use a new surgical device designed to seal and ligate blood vessels and tissue.Using the new device, the attending completely transected a ureter. The ureter carries urine from the kidney down to the bladder. The ureter runs very close to the uterus and cervix and the ovaries and is in danger during hysterectomies. I watched a stream of urine shoot from the bladder straight up into the surgical field after the injury.I pointed this out to the attending. I showed what I thought happened and I indicated the newly disconnected ureter leading to the bladder.The attending disagreed.At this point I had recently been trained in cystoscopy (looking through the urethra into the bladder with a camera) and I offered to perform this to prove the injury. My offer was declined.At this point the hysterectomy was completed, and I uneasily helped to close the abdomen.A few weeks later the patient became extremely sick and underwent a large abdominal surgery by urology to repair the injury. The attending did seek me out to let me know what happened and to tell me that I had been right.Injuries happen, and happen consistently at a certain rate no matter how skilled the surgeon. This is why we discuss these risks when consenting patients for surgery. But the very best time to discover the injury is at the time it was made not weeks later.Your pride isn’t going to keep the patient from getting sick.I perform routine cystoscopy at the completion of every hysterectomy, and I think this case is why.

I am not a lawyer but am a law student. I spent sometime as an assistant researcher dealing with medical malcpractice issues.I dont think the doctor is liable for anything from his actions. What is key to understand here is, you gave him consent to operate. You did not sustain injuries during the course of the procedure as a result of the doctor doing /not doing what he was supposed to do professionally. Also, if there are deviations by the doctor during the procedure from what is universally accepted within the medical profession as professional standards but the deviation is not substantial enough, so that the doctor can be said to be acting outside those accepted standards then the doctor has no case to answer.What you need to ask yourself is, would you consider using staples instead of stitches a substantial deviation from universally accepted medical standards? Did using staples cause you any body injury? Is it even a deviation? Were any of your constitutional rights violated as a result? Like right to life, right to access medical services? I would think not.It is probably best to sit down with the doctor and discuss with him/her why they made those decisions, if there was a good reason for doing so and listen to their views and express yours too and reach a middle ground where you both have a consensus.

This and some earlier questions assume that there is a casualness in the way surgeons go about their job. The questioners are in error. What surgeons do have a considerable effect on the life of their patients. They take their responsibilities very seriously. The closest students come to surgical operations is watching from the student’s gallery. At times the surgeon may invite them to the floor to watch from a closer (but not too close) distance. Even that only with the consent of the theatre nurse. The nurse has a say because she will have to answer if wounds get infected and it is well documented that more the persons inside the theatre greater the instances of operation wound infection.Internees can operate but only after temporary registration. A senior assistant, gloved and draped, is by his side to assist him at every stage of the procedure. He often takes over during the critical stages of the operation. If anything should go wrong it is not the internee’s responsibility. It is not the assisting senior who would be called upon to answer either. The unit chief is the one who will have to bear the responsibility even if he was at a different table, and even if he was not in the theatre at all. He is responsible because everything that happens in the unit is under his direction and control.The event I relate below happened when I was unit chief of surgery in one of the teaching hospitals in Madras (now called Chennai). A middle-aged cyclist was knocked down by a lorry and was admitted into my unit late at night. He had a fracture of a lower limb but had no visceral injury. The duty assistant ordered for a transfusion and when I saw the patient on rounds the next morning the patient’s condition was stable. We transferred the case to the orthopaedic department for management of the fracture.Two days later I was called to the orthopaedic ward to see the patient. He was deeply jaundiced and was in critical condition. On clinical examination, there was no sign of visceral injury. Ultrasound was not available in the hospital at that time. I could not make out any surgical condition that could account for jaundice. The patient was a chronic alcoholic. That being the case I suspected liver failure and wanted the physician to see the case. The patient was transferred to the care of the physician. The patient died the next day.It appeared that the patient was a prominent worker of the party ruling the state at that time. Some top party functionary seems to have been severe on the health minister for not being able to save the life of their own loyal worker. Spurred to action by criticism of his department the health minister decided to conduct the enquiry himself. The next morning, he visited the hospital with the health secretary and the director of the department in tow. He was fully armed for punishing those responsible there and then.Unaware of all this I was demonstrating cases to students when I was called to the Dean’s office. The minister coming to investigate an event of this sort was most unusual. I was surprised to see the health secretary as well as the director of the department with the minister. Given the nature of the case, their presence was ominous. I was introduced to the minister as the surgeon in whose unit the patient was first admitted. The minister pushed, rather threw, the case-sheet of the patient in my direction.‘You have killed my patient,’ he said in angry tones.I explained how we had attended on the patient and stabilised him with blood transfusion and sent him to the orthopaedic department for further treatment. As for the jaundice I said I could not connect the jaundice to the injury. The cause most likely was medical. The minister would not accept my explanation but once again repeated that I had killed his patient. There was more discussion in which the director of the department took part. The raging minister would not be placated. Then for the third time the minister said that I had killed his patient. I had to respond.‘A responsible person like you should not assert that a doctor has killed a patient without knowing anything about the case,’ I said. That is my recollection of what I said anyway. This incidence went viral. Later several versions of what I supposedly said was in circulation. Some of it containing words I never employ. During the entire proceedings the minister was beside himself with anger. I might have also lost my cool. Soon after he left with his entourage.That afternoon the forensic professor performed the post mortem of the case. I must confess that I was not without anxiety about what the post mortem might reveal. Post-mortems are notorious for throwing up unexpected findings. To my relief there was no visceral injury. The case was one of liver failure owing to chronic alcoholism.There were consequences for me which were not serious and lasted for but a very short while.As illustrated by this case the unit chief is the one responsible and no other. The assistant is some cases may face departmental action. The dean and the secretary may be answerable if an administrative flaw was responsible, and as happened in this case the minister may have to face criticism, but when the axe falls it is on the neck of the unit chief.Law courts may apportion responsibilities differently but in the unenlightened days I was functioning it was not the practice of patients to drag their doctors to court. I hence cannot say how courts will handle these cases.