In our last post, we examined the motivations of so-called rogue medical practitioners— physicians, nurses and other medical personnel responsible for causing multiple patient injuries. For the most part, such bad actors may be described as either reckless, financially motivated, attention-seeking or purely evil. But occasionally we encounter examples that seem to defy categorization.
In December 2017, a stretcher bearer in Sicily was arrested on suspicion of killing terminally ill people in return for cash payments linked to the mafia. The 42-year-old is alleged to have injected air into the veins of three people being driven from the hospital in a mafia-related case. It’s difficult to see why the mafia – or anyone for that matter – would wish to kill terminally ill patients in this way, unless they were about to turn witness against them. But in this case surely they would have had other means of silencing their opponents? Perhaps more details will emerge with time.
Leaving their trademark
Another puzzling case reported in the British media is that of surgeon Simon Bramhall, who branded his initials into at least two of his patients’ livers. This highly unusual practice might have gone completely unnoticed, but for the fact that another surgeon discovered Bramhall’s handiwork when performing follow-up surgery on one of the patients in 2013.
Apparently, Bramhall used an argon beam coagulator, a procedure used to control bleeding or mark areas of the liver to be operated on, to leave his trademark. The marks usually fade quickly as the beam only penetrates surface tissue. However, in these two reported instances the livers were in poor condition so the marks didn’t fade, leaving the initials “SB” visible to any subsequent surgeons.
While Bramhall pled guilty to two counts of “assault by beating,” he avoided a more serious charge of assault occasioning actual bodily harm, and it appears that no physical “injury” resulted, although in court it was claimed that at least one of the victims was left feeling violated and suffering from ongoing psychological harm.
The court was told that Bramhall’s actions were an attempt to relieve tension in the operating theatre while he was tired and stressed, and the judge accepted that this may have affected the surgeon’s judgment. So it may simply have been a case of overwork. However a nurse who saw the initialling questioned what had happened and Bramhall was said to have replied “I do this.” While speaking after the hearing the Crown Prosecutor refused to be drawn on whether Bramhall had carried out the practice on other patients.
On further review, it turns out that Bramhall isn’t the first surgeon to be caught branding his patients. In 1999, a doctor apparently carved his initials onto his patient’s abdomen following a C-section, while in 2010, a gynaecologist was sued after he lasered his initials onto a uterus he removed from a 47-year-old patient.
Repercussions for risk managers and (re)insurers
Why do we share these stories of medical malpractice? On the principle that loss avoidance is preferable to actual loss, an understanding of what has occurred in the past – and why – can assist healthcare risk managers, and their insurers, do to prevent similar situations from arising again. Equally it’s important to recognize that even the most comprehensive risk management program cannot entirely prevent adverse outcomes, and that appropriate (re)insurance arrangements are in place for when they do.