Kerala tightens surgical protocols after two shocking incidents

Thiruvananthapuram, April 20 Kerala’s public health system has moved to restore confidence after two disturbing incidents in which surgical instruments were left inside the abdomens of women patients during separate procedures, only to be discovered and removed later.

The back-to-back lapses triggered public concern and prompted swift action from the Health Department.

In response, the department has issued a comprehensive set of guidelines aimed at eliminating surgical errors and tightening accountability across hospitals.

A key directive mandates that every patient be fitted with a wristband carrying complete surgical details.

In addition, the specific body part to be operated on must be clearly marked in advance to avoid any ambiguity in the operating theatre.

The guidelines also impose a strict ban on the use of mobile phones inside operation theatres, citing the need for undivided attention and adherence to sterile protocols.

Importantly, the new norms apply uniformly to all procedures, irrespective of their scale, covering both minor and major surgeries.

A detailed pre-operative verification process has been made mandatory.

Doctors and nurses are required to ensure that the patients’ inpatient numbers and case records are fully completed.

The ward doctor and nurse in charge must fill out and sign a pre-operative checklist, which is then to be reviewed and countersigned by the nursing officer overseeing the operation theatre.

Only after these steps are completed can the patient be moved in for surgery.

The guidelines place strong emphasis on instrument accountability.

Hospitals must conduct a thorough count of all surgical instruments and consumables before and after every procedure.

The names and quantities of instruments must be displayed on a whiteboard prior to surgery and verified post-operation again, with the checklist submitted to the concerned authority.

Officials say the new framework is designed to ensure clarity of responsibility, making it difficult for lapses to be overlooked or blame to be shifted.

In a glaring case of medical negligence, a surgical scissor was found inside the abdomen of a 51-year-old woman nearly five years after she underwent a hysterectomy at the Medical College Hospital in Alappuzha.

Usha Josephkutty, a native of Punnapra, had the procedure on May 10, 2021. Since then, she had been suffering from persistent abdominal pain and episodes of blood in her urine. The cause of her distress remained undetected for years until, in February, when an X-ray taken on the advice of a urologist revealed a Metzenbaum scissor lodged inside her body. The instrument was subsequently removed through a follow-up surgery in February, bringing to light a serious lapse in surgical protocol.

Kerala’s first widely reported case of a surgical instrument being left inside a patient’s body had emerged earlier through the ordeal of Harshina, a native of Kozhikode.

The incident dates back to November 30, 2017, when Harshina underwent her third Caesarean section at the Kozhikode Medical College Hospital. During the procedure, a pair of surgical forceps was allegedly left inside her abdomen. For years, she endured severe physical discomfort and complications before the instrument was finally detected and removed in September 2022.

Harshina continues to pursue legal recourse, seeking accountability and justice for the prolonged suffering caused by the lapse.

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