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carelessly cut into a healthy organ, who is also obligated to go into
exile. This is perhaps one way of explaining the words of Tashbetz.
However, the Minchas Yitzchak (Part 3 #104) explains the words
of Tashbetz in a different way, and that is that the difference between
a surgeon and a physician who heals with medications and laxatives is
that the surgeon causes the patient’s death with his hands, but the in-
ternal medicine doctor causes the patient’s death indirectly (gerama).
Thus the surgeon is exiled, while the ordinary physician is exempt
from exile. In our case, then, the surgeon who mistakenly operated
for appendicitis would have to be exiled because he cut the patient
with his hands.
However, the Tur and the Shulchan Aruch (Yoreh Deah #336:1)
write: “If he caused the patient’s death and he became aware that he
caused the death, [though] unintentionally, he is exiled for what he
did.” And the Perishah explains the words “he became aware” as im-
plying that only if the patient died immediately after the treatment
is the physician exiled. If he died later, one can argue that the patient
caused his own death by eating and drinking or by moving around.
According to this, in our case, if the child did not die immediately
after the surgery, the surgeon may be exempt from exile.
It says in the Shulchan Aruch (Yoreh Deah #336:1): “One should not
practice medicine unless one is an expert, and there is no greater phy-
sician than he there, for if it is not so, he is shedding blood.” According
to this, if the physician on duty who operated on the child could have
consulted with a physician greater than he but did not do so, then
although his error was one of judgment, his mistake is considered
“close to intentional,” and we can only hope that exile will serve as
an atonement for him, for if a physician was able to consult with a
greater physician but did not do so, he is viewed as having shed blood.
One should not, Heaven forbid, avoid consulting with a greater
physician because it is not pleasant, is a bother or is embarrassing. As
it says in maseches Berachos (4a):
King David said… My hands are soiled by the blood of
menstruation and fetal membranes, in order to declare a
120 1 Medical-HalacHic Responsa of Rav ZilbeRstein
#
A PHYSICIAN LEFT AN
INSTRUMENT IN THE
35 PATIENT’S ABDOMEN
1 Question
I would like to hear the Torah view on the following case:
A patient underwent abdominal surgery. During the course of the
surgery, a hemostat was mistakenly left inside the abdomen. (This
is an instrument used to stop bleeding, 8 to 10 centimeters long,
resembling a pair of scissors.) The instrument was discovered sev-
eral months later when the patient sought treatment for pain he had
endured since the surgery. It was removed by additional surgery. The
hospital administration blames the surgeon and wants to fire him.
Are they justified in doing so?
We sent this question to Dr. Devir, an expert physician and sur-
geon in Jerusalem, and asked him: Who is to blame in this case? Here
is his answer:
To the honorable Rav… shlit”a,
During the surgery, the surgeon is handed dozens of instruments
and swabs. Before he closes the abdomen, he checks with the nurse
that the instrument count is correct, examines the site of the surgery
and certifies that there is no bleeding. Only then does he close the
abdomen.
If there is an apparent discrepancy in the number of instruments
that were in the operating room at the beginning of the surgery and
the number of instruments at its conclusion, or between the instru-
Left instrument in abdomen 2 20818_efi-ab - 20818_efi-ab | 4 - B | 18-08-20 | 13:29:01 | SR:-- | Cyan 20818_efi-ab - 20818_efi-ab | 4 - B | 18-08-20 | 13:29:01 | SR:-- | Magenta 20818_efi-ab - 20818_efi-a
# 20818_efi-ab - 20818_efi-ab | 4 - B | 18-08-20 | 13:29:01 | SR:-- | Magenta #20818_efi-ab - 20818_efi-ab | 4 - B | 18-08-20 | 13:29:01 | SR:-- | Yellow