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A stitch in time costs doctor dearly

Recently at Beth Israel Deaconess Medical Center, Dr. Joseph Upton was performing a 12-hour surgery reconstructing a patient's hand. During a "clinically required break," though, he apparently got a bit twitchy and went for a walk. He ended up at another nearby hospital, where he helped reattach a boy's partially-severed finger (from a skiing accident), then ambled back to his own patient and concluded that surgery successfully.

Now, this kind of dedication would normally be laudable. But Dr. Upton was required to either be available to his patient or arrange for another doctor to cover for him -- neither of which he did during his little jaunt to Children's Hospital. Had an emergency arose with his first patient during his absence, the rest of his surgical team would have had to either find another doctor on the spot, or handle it themselves.

Dr. Upton has been suspended from his practice for two weeks, and a state investigation is pending.

Dr. Upton is 62, and has been on Beth Israel's staff since 1989 and Children's Hospital since 1977.

From all accounts, Dr. Upton is a fine doctor and well-regarded. But this looks like a case of his own self-confidence developed into overconfidence and arrogance, and that overwhelmed his own common sense.

I predict a hefty fine in Dr. Upton's future. And with luck, it'll be a wake-up call to him and any other doctors who might make such errors in judgment in the future.

J.


Comments (16)

Interesting that the Dr, al... (Below threshold)
Red:

Interesting that the Dr, although not within medical guideleines, manages to do a good thing while breaking the rules, maybe bending them. Which is more than I can say for most.

To bad the Healthcare systems does not go after the Dr's who mabe physically in the buliding are way too drunk or stoned to operate. Don't get me started on Hospital cover ups for impaired physicians.

Dr. Upton is an excellent s... (Below threshold)
kayla:

Dr. Upton is an excellent surgeon. I know that because he IS my hand surgeon. It upsets me that people are comparing him to the doctor who left during an operation to cash a check. Dr. Upton went to go help a little boy, by reattaching his "partially severed finger". I think this is being blown way out of proportion.

Oh Jay, I think youre way o... (Below threshold)

Oh Jay, I think youre way off base here.


Cindy

This doctor is an angel!</p... (Below threshold)

This doctor is an angel!

If there was an emergency, ... (Below threshold)
John A:

If there was an emergency, particularly during a hand case, there would be little, if anything, that the surgeon could or would do. The patient was being cared for by another physician - the anesthesiologist, who was more than able to take care of any emergency.

The surgeon leaving to take care of another patient would be a bit of a pain, but certainly did not put the patient at any particular risk. We balance the needs of more than one patient at once all the time. This example is a somewhat extreme, but not particularly out of the ordinary.

Nothing in the text indicat... (Below threshold)
Ken:

Nothing in the text indicates he is over-confident or arrogant. He was required to take a break and he did. He was required to be available if an emergency arose but it did not; if something didn't occur how do you know he didn't handle it?

But the guy ambled. I hate dem guys. Some doctors are so evil they saunter (hope I typed that right, my fingers tremble when I think about sauntering). I have seen others meander!

Pull his license. Fine him into poverty. Cut off his hand and see how he likes saunterite surgeons.

I don't know that this is a... (Below threshold)
Just Me:

I don't know that this is all the bad.

Also, these hospitals are pracitcally right on top of each other, it isn't like he was across town or anything.

I would say it would have been a good idea to make arrangements in case of an emergency, but I can think of worse things a doctor can do than this.

Speaking from personal obse... (Below threshold)
DaveD:

Speaking from personal observations, experienced residents and fellows routinely start surgeries without the attending being present. They may perform the less technically challenging aspects of surgery under the eye of the attending or sometimes even when an attending is in another room working on another case. The attending is only steps away if not in the room. If the attending had to be present from the initial incision to the final suture placement at closure - well, good luck getting your elective surgery scheduled in a timely fashion. If the patient has systemic issues - blood pressure problems, cardiac arrythmias, etc. its the anesthsiologist and "crash" team who handle that aspect of the case. That is their expertise. The surgeon sounds like he went to where his own expertise was needed the most at that point in time. These hospitals are indeed right there next to each other.

Sounds like he should have ... (Below threshold)
epador:

Sounds like he should have arranged coverage when he left the grounds - for whatever reason. And didn't. If that is truly the case, he was in error and deserves some sort of penalty. If someone was covering for him, and he informed that doc of his actions, then there is no foul.

He may indeed be a fantastic and well intentioned surgeon.

He's also a human, and capable of errors, if even in this case no bad came from it, it deserves some recognition and evaluation.

But the litiginous atmosphere surrounding medicine will undoubtedly lead to exaggerated responses and posts on both sides of this issue.

If I was the father of the ... (Below threshold)
Mark A:

If I was the father of the boy who's finger was saved by this doctor, I would be paying the doctor's fine.

Administrative punishment f... (Below threshold)

Administrative punishment for not following protocol? Fine... Anything more is over the line.

Let's face it. If more doctors were like this guy, it would be a very good thing. Too bad he's going to retire pretty soon (perhaps immediately after this situation).

Anyone want to bet the real... (Below threshold)

Anyone want to bet the real issue is Medicare billing? If the first operation was being done with a resident, then he as the attending would have to be present for the important parts of the surgery, and can't be doing other things.

If this was a habit, it could be a tremendous fine for the hospital.

So if I understand what mos... (Below threshold)
t. z.:

So if I understand what most posters are saying is they want NO coverage for hand surgery, because they want to punish the Doctor & the hospitals.
This will result in no physician available, they don't have to sign up for "call". This type of thinking is exactly what is causing women to drive long distances to get OB services in the South & Vegas.

I had the pleasure of seein... (Below threshold)
Tracey:

I had the pleasure of seeing Dr. Upton on a weekly basis for the 8 1/2 months that my son was alive. As a result of a congenital defect of my son's lymphatic system, his right limb resembled a football. Dr. Upton saved the function of my son's arm, and performed an amazing surgery that restored the limb to a normal size and shape.

To imply that Dr. Upton is arrongant, cocky, etc...really frosts me! When my son passed away (just over three months ago) he was only one of two doctors (my son had many)that contacted me personally to offer his condolences. He went to bat with my insurance company, and treated my son with the highest level of expertise, humility and respect.

One only has to sit in his clinic waiting room for ten minutes to see what a gifted and devoted physician he is.

It is easy to glom onto the... (Below threshold)
Tom Upton:

It is easy to glom onto the fantastic. And ignore the hidden. Joe is not arrogant. Nor is he a dumbass. The hospital required him to take a break, so being a person of high standards he went to help a kid. He had 45 minutes to reattach a finger, three blocks away. Ambled my ass, have you been drinking with Jason Blair? He is the kind of guy that you want reattaching your fingers, after pulling them out of a septic environment like your keyboard. This gaffe is not a gaffe; he will be exhonerated, but IS politically motivated, as you will see when hundreds of people rise to his defense. You took the bait hook line and sinker dude. So now why don't you find who is holding the fishing pole...

Even months later, I find y... (Below threshold)
Carol:

Even months later, I find your comments so offensive. Dr. Upton saved our daughter's face after being attacked by a dog. This wonderful man can do no wrong in our book. We should be happy a person of his talent and expertise in in this world. We will be forever grateful




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