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Hole in the Head Error, 2nd Offense

A Bradenton neurosurgeon who cut a hole in the wrong side of a patient's skull felt the full wrath of the Florida Board of Medicine on Friday. And so did the Department of Health, which had been willing to settle the case with just a fine and "letter of concern."

Dr. Philip Tally, who came to the Jacksonville meeting without a lawyer, left without the settlement that he had counted on. Instead, he has to decide whether to accept a reprimand or go through a full evidentiary hearing before an administrative law judge,  a lengthy and expensive process.

Tally has 10 days to decide. After the hearing, he declined to discuss his plans.

What made the board angry at the Health Department was that its prosecutors had offered a settlement with a minor penalty for a  second offense on wrong-side surgery, when the guidelines call for at least a reprimand.  State records show Tally came before the board in a similar case in 1994.

"You're supposed to know what part of the body you're operating on," said Dr. Robert Nuss, a board member from Tallahassee.  Before beginning surgery, physicians are required to take a "time out" to make sure they have the right patient on the table, have identified the correct body part, and are planning the correct procedure.

Dr. Zach Zachariah, chairman of the medical board, called the case "abominable," indicating that adjective applied to both the surgeon's error and the prosecutors' proposed settlement.

"This is the second time for the same thing, a burr hole in the wrong side of the head. Anything less than a reprimand is unacceptable."

Doctors greatly prefer to receive a "letter of concern" rather than a reprimand, because the latter triggers an automatic report to the National Physicians Data Bank. Hospitals, health plans and others who hire or grant privileges to physicians are supposed to check the data bank. 

Tally told the board that operating-room staff contributed to the mistake, but that argument didn't help.

Zachariah said, "He can blame anyone he wants -- even his mother-in-law -- but it was preventable."

State records indicate the incident occurred a year ago at Manatee Memorial Hospital, when Tally was to cut open the left side of the skull of a 65-year-old woman to relieve pressure on her cranial nerve. According to the state complaint, he cut open the right side instead.

Such openings are often called "burr holes."

The board's counter-offer to Tally includes a reprimand, a $7,500 fine, a course in risk management and a requirement that he give a lecture to other health professionals on wrong-side surgery.

This was only one of many cases on Friday in which the medical board told Health Department prosecutors the penalty in the settlement agreement was too lenient. Prosecutors said they did so when they lacked enough solid evidence to feel assured they could prevail at a hearing.

-Health News Florida, an online news service at www.HealthNewsFlorida.org, is a service of WUSF Public Media. Contact Carol Gentry at 813-974-8629 (desk) or 727-410-3266.