The Limits of Multitasking: California Surgeon Facing Review After Appearing For Trial While Doing Surgery

I have taught medical malpractice as part of my torts course for decades but I have never seen anything quite like this. Dr. Scott Green is accused of appearing in Sacramental Superior Court for a trial of a traffic violation during a surgery.  While Green was willing to continue, the court was not.  He will now have to appear before the Medical Board of California, presumably not in scrubs and in mid surgery. While we have discussed past cases like a doctor hip-hopping on videos around patients, this is the first doctor appearing as a surgeon and a litigant at the same time.

According to the Sacramento Bee, Dr. Green appeared dressed in surgical scrubs in a surgery room with a patient undergoing a procedure.

The court clerk is heard saying “Hello, Mr. Green? Hi. Are you available for trial? . . . It kind of looks like you’re in an operating room right now?”

“I am, sir,” Green replied. “Yes, I’m in an operating room right now. Yes, I’m available for trial. Go right ahead.”

The clerk helpfully reminded Green that he and the trial were being livestreamed but it did not seem to faze Green who said that he understood but kept on working with his head down.

Court Commissioner Gary Link then entered the chamber and balked at the idea of Green dividing his time and attention between a trial and a surgery. Green however pushed for the court to proceed: “I have another surgeon right here who’s doing the surgery with me, so I can stand here and allow them to do the surgery also.”

The judge refused and Green appears to start to apologize:  “Sometimes, surgery doesn’t always go as…”

Link was supportive and said “It happens. We want to keep people healthy, we want to keep them alive. That’s important,”

It is not clear if Green was trying to say that the surgery went longer than anticipated. However, the answer is not to proceed with a trial. Green could have had a staff member go on to ask for a delay or he could have foreseen that he had scheduled a surgery in potential conflict with the trial. If, for example, there was an unpredictable complication in a surgery, it would have not only warranted more time but the continued attention of Green. If Green was no longer needed in the surgery, he could have left. His continued work in the surgery indicated that he was in fact needed. Indeed, many procedures dictate two surgeons.

One of the nine core principles of medial ethics is “A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”

There is also the duty to put a patient’s interest before your own as a physician:

The relationship between a patient and a physician is based on trust, which gives rise to physicians’ ethical responsibility to place patients’ welfare above the physician’s own self-interest or obligations to others, to use sound medical judgment on patients’ behalf, and to advocate for their patients’ welfare.

The problem for Dr. Green is multifold. First, the most serious consequence is if there were any complications or problems with the patient.  Second, there is the potential violation of the patient’s privacy (though the patient remains off camera). Third, there is the obvious medical practice and ethics issue. On the ethical issues, it is not just the Board but the hospital that will have to review the matter. I would be surprised if Green would keep his privileges at hospitals active during the review. While some of the circumstances of the surgery must be determined (like an unforeseeable delay), the key facts are open and obvious. He elected to appear in trial while doing surgery. Most hospitals would be leery of the potential liability in continuing privileges for a physician with such a lack of judgment. If he were later involved in another malpractice case (particularly involving a lack of focus or attention), this case would be raised in court.

The other question is the responsibility of the second surgeon.  There may also be a duty of that surgeon to object to a colleague who wants to appeal for trial while assisting in a surgery. Such reporting is expressly mandated by the American Medical Association.

What is particularly striking is that any legal action will be based on evidence derived from an actual court. Moreover, that record will show a court intervening in real time to stop a presumptively unethical act.  Courts have long asserted the authority to determine what is reasonable in terms of medical practice (and other professional fields) even when such findings contradict long held customs. As noted in The T.J. Hooper, 60 F.2d 737 (2d Cir. 1932) “Courts must in the end say what is required; there are precautions so imperative that even their universal disregard will not excuse their omission.” Here a court was not dealing with any long established practice or custom  of multitasking surgeons. It was however acting to stop a practice that was facially improper involving both an appearance as a surgeon and a litigant.

 

22 thoughts on “The Limits of Multitasking: California Surgeon Facing Review After Appearing For Trial While Doing Surgery”

  1. Reminds of a line in the movie MASH : “IS this guy an officer or an enlisted man”.

  2. My guess is he regularly takes phone calls during surgery, which perhaps he does by voice command, and it has become such an ingrained habit it never occured to him the court might object.

  3. Ha, I can beat this story easily. A surgeon i know excused himself to use the lavatory (it happens, and you don’t want a surgeon working fast because she has a weak pelvic floor or he has diarrhea).

    Instead, he got in his car and drove to another hospital because they needed him to complete some paperwork for his patient scheduled there. There was another surgeon who was going to start the case and then this guy was supposed to come in and do the second phase. The OR would not let the first surgeon start without the second surgeon’s paperwork completed.

    Then he came back and finished the procedure. I think it went to Peer Review but not to the Board or the NPDB.

    1. I spent a great of time working in top-flight surgeries.
      In my experience good (not necessarily great) are well able to milt-task well ahead the current condition of a single patient.
      The multi-tasking ability is second nature to anyone who worked with multiple patients that required immediate treatment that was not available due to multiple wounds and other nasty problems. These abilities are due many doctor-patients successfully treated.
      Every patient deserves quality care, but sometimes all problems that overwhelm ability. These problems become the hours spent by all the people who who toss in bed asking “Why. What could have done?”
      These experiences are what builds a doctor’s ability to multi-task. No great rah! rah! but the ability to keep track of a patient’s well being flies high.

      1. This is egotistical macho BS. “Anonymous” is basically talking about meatball surgery like you would see in a field hospital (eg MASH, or an ER after 9/11). The idea of multitasking in those conditions is not to do the best job but to do what’s expedient to save life or limb as fast as possible. It’s basically running from fire to fire doing what you can in the moment. No one is expected to have stellar outcomes. It’s understood that there are unavoidable distractions and limitations. Being able to do that is not an indication of superior ability. It induces a false sense of superiority, exactly what I warned my residents about. Perhaps the appropriate term would be hubris. If I can do meatball surgery it must mean that I can do a great job even while doing a video call about a traffic ticket.

        As Mr Turley pointed out, a physician has a fiduciary duty to place the patient’s well-being first and foremost, including above the physician’s own interests. This case was a controlled situation. There was no reason to attend to personal business. The needless interruption and distraction this surgeon introduced by addressing his personal business while performing surgery is inexcusable and a textbook example of breach of fiduciary duty to the patient.

  4. Give it a rest! The good doctor was merely making a point. This was a court appearance for a traffic violation, not a murder case. Traffic violations take less than five minutes, usually with the accused pleading guilty and paying a fine. If the accused pleads not guilty, then the judge sets a date for a trial but who wants to go to trial and spend thousands on an attorney when they can pay the fine and be done with it. This is a non-issue.

    1. You simply don’t do this. This guy had a big ego. I taught residents for 8 years and when they asked me the most important thing to remember I told them “Never bend the rules because you think you’re better than the rest, even if you are. Murphys Law loves it when you do that.”.

      I’ve been practicing for over 40 years and I’ve seen so many problems happen because some fool thought he was better than everyone else – in this case, operating while trying to simultaneously perform an unrelated intellectual task.

      If I need surgery I want my surgeon’s undivided attention. I don’t want them watching Oprah or arguing in traffic court.

  5. The most puzzling aspect of this story is that the subject apparently had the intellect and wherewithal to become a surgeon, while simultaneously lacking the foresight and judgement to realize combining surgery and his court case would not fly. Maybe the key word above is the past tense verb “had.”

    I suspect this surgeon should prepare for a new permanent or long term temporary career. If he was searching for more spare time prior, maybe he found it.
    Or maybe he unconsciously wished for a way out of a high stress career, and found it.

    Strange doesn’t begin to describe this story.

  6. I have a more basic question: what was a camera with Zoom capabilities doing in the OR in the first place? What about the privacy rights of the other health care participants, like the anesthesiologist, scrub and circulating nurses, OR techs, etc and their responsibilities toward the patient.? If I were a patient at this hospital and knew other licensed health care providers stood by and allowed this, I would be outraged. Did the patient consent to his/her surgeon appearing in court while simultaneously performing surgery? I seriously doubt it. There is a growing body of law and cases dealing with doctors doing whatever they please after the patient is rendered unconscious, and not just sexual assault sorts of things or invasions of privacy, like what happened to Joan Rivers, but other things, like bringing in EMT students to practice intubation, and medical students and residents allowed to perform parts of the procedure without first obtaining the patient’s consent. I am aware of an Indiana case in which a woman patient was asked to consent to students being allowed to participate in her surgery, and on the consent form, she specifically said “no”. Nevertheless, an EMT student was brought into the OR and allowed to attempt an intubation. The student lacerated the woman’s esophagus, resulting in a very serious complication that could have been fatal. The patient made clear her wishes, but it happened anyway. The surgeon was not held liable, nor the student, but the hospital was. The moral of that story was that hospital staff had a duty to prevent this from happening. The OR nursing supervisor should have been on top of this and stopped it.

    1. What happened to Joan Rivers? (“and not just sexual assault sorts of things or invasions of privacy, like what happened to Joan Rivers”)

  7. Reminds me of asking what the number in the upper right corner of a medical bill that came too late to pay using the coverage approval by three or four months. I sent a rebuttal stating failure to bill in a timely manner constitutes cancellation, The number in the corner indicated other bills being sent out. At the same time reading x ray charts was combined with stand by surgeon for the hospital across the street. There was a time stamp. I was number twenty something, For fun checked on the surgery involved. It had been canceled Thats up their with billing 48 hours in one day.

    As it happened the office billing clerk was limited to certain number of hours a day. Neither the MD or the Clerk knew they could add the cost of billing to the bill. I wonder how much more was grafted by that bit of news.

    Mine was cancelled.

  8. Just a suspicion, but I wonder if the surgeon chose to do surgery during the trial to show the court how important he was. Police officers have told me that when they stop doctors for some traffic violations one of the first things they hear is, “I’m a doctor.” There is an expectation they will be treated differently and perhaps sometimes they are but generally not. For that you need to be a current or former police officer or prosecutor. But to get away with murder you need to be a Democrat.

    1. Reminds me of the Surgeon and God joke:

      What is the difference between a Surgeon and God?

      God doesn’t think he’s a Surgeon.

    2. I had a similar thought. It’s traffic court, so what was his motor vehicle violation? I would not be surprised if the doctor told the officer he was speeding or reckless driving because he was called into emergency surgery. Appearing in court during surgery was to demonstrate he is a surgeon and so vital that he can’t even spare the time for court.

      1. The fact that they had a Zoom meeting arranged suggests this was no coincidence.

        If this is really the case it was a stupid move by the surgeon. If you have ever been in court you’ll know that even a traffic court magistrate is like a little god in his own little world.

        Imagine being in court standing before the judge and texting on your cell phone while discussing the case. The text message might be important but the message you’re sending the judge is one of the stupidest things you can do.

  9. California, not Florida? The doctor is just lucky there was no HIPPA violation. Hope that the patient recovered without complication

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