Patient Dies After Surgical ‘Blade’ Is Left Inside, Spurring $1M Malpractice Lawsuit

The operating room is a place where precision and care are paramount. Yet, a disturbing reality persists: surgical instruments are sometimes left inside patients, leading to severe consequences. In a recent case, a 58-year-old man died after a surgical blade was left in his abdomen following a minimally invasive procedure, resulting in a $1 million malpractice lawsuit. This incident underscores the devastating impact of retained surgical items (RSIs) and raises critical questions about patient safety and accountability in the healthcare system.

The Tragic Case: A Preventable Error

Jeffrey Alan Fulcher, a 58-year-old father of three, underwent a procedure to remove part of his esophagus at the Medical University of South Carolina (MUSC) in June 2022. During what was intended to be a minimally invasive surgery, a retractor blade, a sharp object, was left inside his abdominal cavity. Despite Fulcher’s complaints of pain in the days following the surgery, doctors initially dismissed his concerns, stating that he was recovering normally. An X-ray eventually revealed the retained blade, but tragically, Fulcher died six days after the initial surgery due to sepsis, peritonitis, and colonic perforation, all stemming from the RSI.

Fulcher’s family filed a wrongful death lawsuit against MUSC, alleging gross negligence and willful violation of duties. The case was settled out of court for $1 million, with the state of South Carolina compensating Fulcher’s wife and children. While the settlement provides some measure of justice for the family, it doesn’t erase the fact that Fulcher’s death was a preventable tragedy.

Retained Surgical Items: A “Never Event” That Still Happens

The National Quality Forum (NQF) and other healthcare organizations classify RSIs as “never events” – errors that should never occur in a modern healthcare setting. Despite this classification, RSIs remain a persistent problem in hospitals across the United States.

What are Retained Surgical Items?

RSIs encompass a range of objects unintentionally left inside a patient’s body after surgery. Common examples include:

Sponges and gauze
Surgical instruments (scalpels, forceps, clamps, needles, retractors)
Sutures and staples
Guidewires and catheters
Device fragments

Why Do RSIs Occur?

Several factors can contribute to RSIs, including:

Human error: Mistakes in counting instruments and sponges are a primary cause.
Lack of communication: Poor communication among surgical team members can lead to oversights.
Failure to follow protocols: Inadequate adherence to established procedures for counting and tracking surgical items increases the risk.
Rushed procedures: Emergency surgeries or hurried operations can create an environment where errors are more likely.
Complex surgeries: Procedures involving multiple instruments and a large surgical team can increase the chances of an item being left behind.
Fatigue: Overworked and fatigued surgical staff may be more prone to making mistakes.

How Common are RSIs?

While deemed “never events,” RSIs occur more frequently than many might expect. According to the Association of periOperative Registered Nurses (AORN), RSIs occur in approximately 1 in every 10,000 surgical procedures. A study of over 198 million surgical procedures from 2016 to 2023 found an overall RSI incidence of 1.34 per 10,000 surgeries. While the study noted a decline in RSI incidence from 2016 to 2023, the numbers still highlight the need for continued vigilance and improved prevention strategies. In 2024, The Joint Commission (TJC) reported 119 incidents of unintended retention of a foreign object, which accounted for 8% of the 1,575 sentinel events reported.

The Devastating Consequences of Retained Surgical Items

The consequences of RSIs can be severe, leading to a range of complications, including:

Infection and sepsis: Foreign objects can introduce bacteria into the body, leading to serious infections.
Pain and discomfort: RSIs can cause chronic pain and discomfort at the surgical site.
Organ damage: Sharp instruments can puncture or damage internal organs.
Intestinal blockages: Retained items can obstruct the bowel, leading to blockages and other digestive issues.
Abscesses and hematomas: The body may react to a foreign object by forming abscesses or hematomas.
Blood poisoning: In severe cases, RSIs can lead to blood poisoning (sepsis), which can be life-threatening.
Death: As seen in the Fulcher case, RSIs can be fatal.

Legal Recourse for Victims of Retained Surgical Items

Patients who suffer harm due to RSIs have legal rights and may be able to pursue a medical malpractice claim. A successful malpractice lawsuit can provide compensation for:

Medical expenses: Covering the costs of corrective surgeries and ongoing treatment.
Lost wages: Reimbursing for lost income due to the inability to work.
Pain and suffering: Compensating for physical pain, emotional distress, and diminished quality of life.
Punitive damages: In cases of egregious negligence, punitive damages may be awarded to punish the responsible parties.

To establish a medical malpractice claim, the injured patient must demonstrate that:

The healthcare provider owed a duty of care: This is generally established by the doctor-patient relationship.
The healthcare provider breached the duty of care: Leaving a surgical instrument inside the patient is a clear violation of the standard of care.
The breach caused injury: The RSI directly led to the patient’s harm.
The patient suffered damages: The patient incurred measurable losses, such as medical bills, lost income, and pain and suffering.

Preventing Retained Surgical Items: A Multi-Faceted Approach

Preventing RSIs requires a comprehensive approach involving strict protocols, advanced technology, and a culture of safety within the surgical environment. Key strategies include:

Standardized counting procedures: Implementing and consistently adhering to rigorous counting procedures for all surgical items before, during, and after surgery.
Team communication: Fostering clear and open communication among all members of the surgical team to ensure everyone is aware of the count and any discrepancies.
Technology-assisted counting: Utilizing technologies such as barcoded sponges and radiofrequency identification (RFID) systems to improve the accuracy of counts.
Postoperative imaging: Employing postoperative X-ray screenings, particularly in high-risk procedures, to detect any retained items before the patient leaves the operating room.
Root cause analysis: Conducting thorough investigations of all RSI events to identify contributing factors and implement corrective actions.
Mandatory reporting: Establishing mandatory reporting systems for RSIs to track incidence and identify trends.
Continuous training: Providing ongoing training and education to surgical staff on RSI prevention strategies.

Seeking Justice and Promoting Patient Safety

The case of Jeffrey Alan Fulcher serves as a stark reminder of the devastating consequences of retained surgical items. While financial compensation can provide some relief to victims and their families, the ultimate goal is to prevent these “never events” from happening in the first place. By raising awareness, advocating for stricter safety protocols, and holding negligent parties accountable, we can work towards a healthcare system where patient safety is truly paramount.

If you or a loved one has been injured due to a retained surgical item, it is crucial to seek legal advice from an experienced medical malpractice attorney. An attorney can help you understand your rights, navigate the legal process, and pursue the compensation you deserve.