It is a nightmare for both the patient and the surgeon. The surgery is successful and the patient recovers well, except that she has odd pain symptoms that seem to persist, sometimes for years. Eventually, it is discovered that a surgical item, such as a sponge, was left behind when the patient was closed.

Surgery to remove the item may be successful, but in some cases scar tissue that formed around the item can cause permanent injury. In a few cases, the item left behind become a site for infections that can wax and wane and can even result in sepsis and death of the patient.

Medical people often refer to such items as “retained objects,” but most medical malpractice lawyers do not like that term. It implies that the patient somehow “retained” the item, as opposed to the providers leaving it behind. After all, the patient is anesthetized and completely unaware of what happens.

Every year, there are an estimated 4,000 cases of such “left behind surgical items.” Although gauze-like sponges are the most common, there have been cases of clamps, scalpels, and even scissors left behind. In some cases, too, a piece of an instrument, needle, or catheter can break and unknowingly be left in the patient when the procedure is completed.

Hospitals primarily deal with this problem in an old-fashioned way: having nurses do numerous “sponge counts” during a surgical procedure. But in the busy atmosphere of an operating room, errors can be made and the manual count can be inaccurate. New methods have been devised, including the use of radio-frequency tags and even bar codes, to ensure that all medical devices are accounted for and removed before the patient is closed up.

One estimate is that this would add about $10.00 to the cost of the procedure, and about 12 additional seconds at the end of the procedure. Yet, most hospitals have been reluctant to use such methods, and fewer than 1 percent employ them. Cost is a factor, but some doctors say it is primarily a matter of “operating room culture.” Manual sponge counts have been used for so long that operating room personnel are comfortable with them and are reluctant to try totally new methods.

Who is legally responsible for an object being left behind by mistake? It used to be that the surgeon was considered the “captain of the ship” and ultimately responsible for any errors made by nurses in the manual count. The trend now is to focus on the person who actually made the mistake, which is usually an operating room nurse.

In Washington state, there is a special statute of limitations (time limit to file a lawsuit) for cases of “left behind” surgical items: “ the time for commencement of an action is tolled upon proof of . . . the presence of a foreign body not intended to have a therapeutic or diagnostic purpose or effect, until the date the patient or the patient’s representative has actual knowledge of the … presence of the foreign body; the patient or the patient’s representative has one year from the date of the actual knowledge in which to commence a civil action for damages.”