Amateur Hour

Anyone for surgery?

When a Long Island, N.Y., service-station operator named Franklin Mirando checked into a suburban hospital in July 1975 for the implanting of an artificial hip joint, he had little reason for concern. Such operations are routinely performed more than 100,000 times a year in the U.S., and have kept countless people on their feet who might otherwise be left permanently crippled by arthritis and other ailments. But Mirando's surgery turned into a permanent nightmare. He was left in constant pain, with a right leg two inches shorter than his left and unable to walk without crutches. Now Mirando's private agony has become a public scandal as well, with possible repercussions for surgeons elsewhere.

Last week New York authorities charged that critical phases of Mirando's hip implant were done not by his surgeons but by a medical-equipment salesman who had no more than an eighth-grade education. Calling it "the most scandalous case it has ever been my duty to prosecute," the Suffolk County, N.Y., district attorney has already obtained indictments against the two doctors, as well as the anesthesiologist, supervisory nurse and hospital, charging them with second-degree assault and the attempted cover-up of a crime. The four individuals have pleaded not guilty. But state investigators say that the case is only a beginning, and that there will be similar revelations of surgical wrongdoing in other places.

Mirando's surgery was performed at Smithtown General Hospital, a private, 274-bed doctor-owned institution about 40 miles from Manhattan. According to the investigators, the operation started out smoothly enough. It was only after Mirando was wheeled into the recovery room that the doctors discovered the artificial joint had popped out of place.

Still unconscious, Mirando was taken back to the operating room, where his femur (thigh bone) cracked as the surgeons tried to remove the dislocated prosthesis. Unwilling or unable to proceed further, the doctors sent out a rush call to the sales representative for the device, William MacKay, 34, who was playing golf at the time.

Arriving at the hospital, the investigators continued, MacKay was told by the doctors to scrub up quickly and lend them a hand in the crisis. Despite his lack of medical education, MacKay is described as something of a mechanical whiz. He regularly demonstrates products for doctors' groups, reads medical journals diligently, spends hours in his garage practicing surgical procedures with animal bones--and has "ghosted" for surgeons in the past. MacKay agreed not only to repair the cracked bone but also to replace the artificial joint. As he told the Long Island newspaper Newsday: "I kept repeating in my mind, 'Let's get this guy's hip back together right.' He had been under anesthesia since 8 a.m., and could have stopped breathing any time." Indeed, before Mirando left the operating room again, he had been out for more than ten hours. Says MacKay, who has been granted immunity from prosecution for his cooperation with investigators: "After it was over, I never wanted to touch a patient again."

Doctors at other hospitals vigorously deny that such an event could happen in their operating rooms. But they concede that medical-supplies salesmen do occasionally act as technical advisers and sometimes even help set up the complicated instruments and equipment that have become essential in today's intricate surgical procedures. Attorney Matthew Lifflander, chief of the New York State Assembly task force that uncovered the Mirando case on a Newsday tip, disagrees.

He insists that salesmen all too often participate in the actual operations because some surgeons refuse to take the trouble to become familiar with new equipment or techniques. He says that his investigators have information implicating a dozen other salesmen in illegal surgery, including one case in which the factory representative had to remove a drill that became stuck in a patient's skull during brain surgery. Adds Lifflander: "What we found is that the level of incompetence among surgeons is a lot greater than anyone imagined."

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