Today, we had the privilege of conducting an interview with Dr. Robert MacArthur, a prominent orthopedic surgeon situated in California. Throughout the interview, we delved into his personal encounters with instances of wrong-site surgery and intraoperative burns. Additionally, we explored the broader subject of "never should happen events" in the medical field.
Dr. Robert MacArthur achieved a dual major in Biochemistry and Physiology at the University of California, Berkeley. During his time there, he garnered recognition as a skilled athlete, actively participating in both boxing and rugby as part of their respective teams.
Subsequent to his undergraduate education, Dr. Robert MacArthur pursued further studies at the Columbia College of Physicians and Surgeons. Notably, he was elected as the president of the institution, which has since been renamed the Vagelos School of Medicine. Following his time at Columbia, Robert MacArthur successfully completed his orthopedic residency at Harbor UCLA.
Statistically, wrong-site surgeries are typically a rare occurrence, happening once in the career of the average orthopedic surgeon. However, this rate increases to four times per career for specialists in sports, hand, and spine surgeries. Regrettably, many of these specialists opt not to report or openly discuss such incidents. In contrast, Dr. MacArthur stands out for his proactive approach to addressing and confronting these unfortunate events.
Instead of trying to hide the incident, Dr. MacArthur responded in a unique and distinctive manner.
Dr. Robert MacArthur conducted thorough investigations into the root causes of the two incidents he encountered and subsequently published multiple works outlining strategies for preventing similar occurrences. His efforts earned him recognition as an expert in the field of preventable accidents. He authored two articles in the prestigious orthopedic journal, The Journal of the American Academy of Orthopedic Surgeons.
In the first article, he meticulously outlined the specific errors that had led to the wrong-site event, offering a valuable guide for fellow doctors to prevent similar incidents in the future.
In his second paper, co-authored with Dr. David Ring, Chairman of the AAOS, Dr. MacArthur addressed the issue of the "shame and blame game." He stressed that assuming responsibility for such incidents is a rare occurrence, as the prevailing tendency is to attribute blame to others. Dr. MacArthur underscored that this inclination not only discourages surgeons from reporting their own incidents but also impedes the crucial analysis of root causes, which is essential for preventing future occurrences.
When discussing the intraoperative burn incident, Dr. Robert MacArthur demonstrated the same unwavering commitment to investigation that characterized his approach to researching wrong-site events. For example, he proactively reached out to the manufacturer of the problematic clamp to inquire about any similar burn incidents. The manufacturer's response indicated that the clamp in question had been "discontinued," leaving room for interpretation.
In his efforts to address the issue of uneven heating in large hinged clamps, Dr. MacArthur conducted an extensive investigation into its root causes. His findings pointed to flash sterilization as a potential contributor to uneven heating. It's worth noting that nursing associations strongly advise against the use of flash sterilization except in emergency situations, such as sterilizing a dropped component. Further investigation revealed that St. Joseph's Hospital frequently utilized flash sterilization to streamline consecutive surgeries without the need to acquire additional equipment trays.
In a proactive move to prevent future burn incidents, Dr. MacArthur informed St. Joseph's Hospital about the risks associated with the continued use of the specific clamp and the routine application of flash sterilization. Instead of assigning blame to the clamp itself, he took responsibility for the situation and made it clear that he had made a surgical error. Even when informed that the clamp was hot, he handled it without discomfort, distinguishing himself from some surgeons who might hastily use a towel to handle an excessively hot clamp.
Dr. MacArthur addresses the issue of the "shame and blame game" by highlighting a common misconception between the "captain of the ship" concept and root cause analysis, prevalent in both the legal and general public communities. According to the "captain of the ship" perspective, surgeons are deemed responsible for any adverse events that happen to a patient under their care, making it tempting to attribute wrong-site events solely to the surgeon's actions.
However, Dr. MacArthur emphasizes that this approach contradicts the core principles of root cause analysis, which seeks to deeply understand the underlying causes of wrong-site events and ideally prevent similar incidents in the future. Resorting to shaming and blaming not only hinders the proper conduct of root cause analysis but also discourages other surgeons from reporting their own wrong-site events due to fear of potential consequences.
In the specific incident where Dr. MacArthur failed to recognize the excessive heat of the clamp's large hinge, resulting in a burn when applied to the patient's leg, he was under supervision for case privileges at CHOC. Neither the proctor nor Dr. MacArthur immediately detected the burn. It was only after he had dictated the operative report that a recovery room nurse identified a small red area on the patient's leg, and even then, the severity of the burn was not initially apparent.
Dr. MacArthur points to the aviation industry as an exemplary model of effective root cause analysis. Since its inception, the airline industry has striven to thoroughly comprehend the causes of adverse aviation events rather than assigning blame solely to the pilot. This commitment to understanding root causes has contributed to the industry's impressive safety records.
However, Dr. MacArthur expresses disappointment that the medical community has encountered challenges in fully adopting root cause analysis due to prevailing legal and public perceptions linked to the "captain of the ship" concept. The unfortunate consequence is that preventable medical errors continue to occur at a high rate, and the careers and reputations of many medical professionals are unfairly marred.
The incidence of wrong-site surgery remains alarmingly frequent, with one event occurring per surgeon per career and up to four events per surgeon's career for specialists in hand, spine, and sports subspecialties.
In 2023, it has become feasible to level false accusations against individuals, which can tarnish their reputation and name without the accuser facing significant consequences. Whether the accused person is innocent or guilty, simply making an accusation can lead to enduring harm to a professional's reputation.
Dr. Robert MacArthur shared a disconcerting personal experience in which he chose to leave a workers' compensation clinic due to concerns about possible illicit activities within the clinic. In what appears to be an act of retaliation, the clinic manager allegedly collaborated with a patient to fabricate a false claim against him. The accusation involved an assertion that Dr. MacArthur had "stripped naked in the middle of the clinic and requested sex in exchange for a favorable workers' comp report."
Notably, he only became aware of this accusation more than a year after he had left the clinic. In response, he insisted on taking a lie detector test to demonstrate his innocence. However, the accuser declined to participate in such a test. To Dr. MacArthur's disappointment, he later discovered that both his lie detector test results and the accuser's refusal to take the test would not be admissible in court.
The mediating attorney cautioned him that the jury would likely be composed of individuals sympathetic to the accuser, rather than his peers. This situation could potentially lead to a devastating loss in court. Despite the absurdity of the claim made against him, he was advised to settle the matter by paying $29,000, illustrating the unfortunate impact of false accusations in damaging reputations and compelling individuals to enter unwarranted settlements.
The Medical Board of California conducted a thorough examination of the claims made by the accuser and determined them to be "non-credible." This assessment suggested the possibility of an ongoing investigation into the clinic implicated, although Dr. MacArthur did not explicitly confirm whether the clinic had been indicted.
Despite the presented facts and the Medical Board's findings, Dr. MacArthur encountered a significant challenge when attempting to remove the accuser's claims from search engine results on the internet. This meant that, despite his innocence, the slanderous campaign against him had effectively tarnished his reputation.
It's important to note that the claim itself did not assert that Dr. Robert MacArthur was found guilty; rather, it functioned as a summary of a complaint that remained publicly accessible.
Dr. MacArthur strongly advocates for penalties that align with the consequences of falsely made accusations. In his perspective, individuals who make false accusations should face penalties equivalent to the severity of the events they falsely claimed. He suggests that his false accuser should be categorized as a sexual predator and felon, underlining the gravity of such actions.
Dr. MacArthur concluded by contemplating the coexistence of both good and evil in the world, expressing the hope that those who come across his account would never have to encounter individuals capable of inflicting such damaging false accusations, as he himself experienced.
Dr. MacArthur is a distinguished orthopedic surgeon celebrated for his profound expertise in diagnosing, treating, preventing, and rehabilitating musculoskeletal disorders and injuries. His extensive knowledge encompasses a profound understanding of bones, joints, ligaments, tendons, muscles, and nerves, enabling him to deliver comprehensive care within this specialized field of medicine.
Diagnosis: Dr. MacArthur sets himself apart with his exceptional diagnostic abilities. He employs a combination of comprehensive physical examinations, advanced imaging studies, and precise laboratory tests to adeptly and swiftly identify a diverse array of musculoskeletal conditions with great precision.
Treatment:
Non-surgical Approaches: Dr. MacArthur firmly adheres to the principle of first exploring non-invasive alternatives before considering surgery. His repertoire of options includes medications, physical therapy, and a variety of other non-surgical treatments, underscoring his commitment to a holistic approach to patient care.
Surgical Mastery: When surgery becomes the essential path to follow, patients can place complete trust in Dr. MacArthur's expertise. His surgical proficiency covers a wide range of procedures, including joint replacements, fracture repairs, and ligament reconstructions, guaranteeing comprehensive care and treatment for his patients.
Rehabilitation: Recognizing that treatment is only one facet of the healing journey, Dr. MacArthur places substantial emphasis on post-treatment rehabilitation. He often collaborates closely with physical therapists to expedite the recovery of his patients, with a strong focus on restoring strength, mobility, and function in a rapid yet safe manner.
Prevention: Dr. MacArthur is a committed advocate of preventive healthcare. He frequently conducts workshops and community sessions to educate individuals on injury prevention and emphasize the importance of maintaining musculoskeletal health.
Specialized Focus: Among his many achievements, Dr. MacArthur is particularly renowned for his notable contributions to the field of Pediatric Orthopedics. He has dedicated a significant portion of his professional career to addressing musculoskeletal issues in children, with a relentless commitment to ensuring that they grow up with optimal physical health and well-being.
Dr. MacArthur's steadfast commitment to excellence has not only reinstated the health but also significantly enhanced the lives of countless individuals, solidifying his status as a distinguished figure in the field of orthopedics.