Horrific medical error in Hungary: saline solution switched with disinfectant, patient dies

The Szigetvár District Prosecutor’s Office has filed charges against three people. The persons used disinfectant instead of saline solution during an operation. This horrible medical error caused the death of the patient, the prosecutor’s office said in a statement.

Two of the defendants work as surgical assistants in the hospital where the surgery was performed. The third defendant works as a specialist, Telex reports.

The fatal error

Back in May 2020, they were preparing for a gynaecological surgery at the hospital. Before the surgery, the two accused operating room assistants brought disinfectant into the operating room to clean the room. However, only 5-litre jerrycans of disinfectant were found in the storage room. Therefore, the two assistants decided to transfer it to a smaller bottle: a top-labelled bottle originally containing saline solution.

After the exchange, the two men put the saline bottle containing the disinfectant in the operating room lobby. They placed it on the table where the surgical instruments were stored. They both forgot that the bottle was there. They only found out the next day, during the operation, when they needed to use saline solution, but used the switched bottle, which was actually containing disinfectant.

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The nurse noticed, but the surgeon decided to cover up

One of the operating theatre nurses noticed the strange consistency of the drug. After the operation, she let the doctors who performed the operation know. The surgical assistant remembered that the fluids had been switched before the operation. This was also told to the surgeon who decided not to tell the head physician and not to recommend another operation. He chose to cover up the mistake.

The next day, the patient became unwell. Another operation was performed, but the specialist did not point out that they had made a mistake earlier. The patient eventually died.

The prosecutor’s office charged the specialist with the crime of intentional endangerment in the course of his work. Meanwhile, the two surgical assistants were charged with the crime of negligent endangerment causing death in the course of their work.

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Source: telex.hu