Quick Summary: The nurses did not make a note of a second or third sponge count on the form in the chart. The Court of Appeal of Louisiana approved a lower court verdict apportioning negligence 60% to the surgeon and 40% to the operating room nurses, for a surgical sponge left inside the patient during a hernia repair.

   The hospital had a standard procedure to insure correct sponge counts, the court noted. Prior to surgery, the nurses set up the instruments, sponges and other supplies needed for the procedure. For a hernia repair, only ten sponges would have been laid out for use during the procedure.

   At the start, the nurses are to count the unused sterile sponges that have been laid out, and are required to note the number on the hospital’s standard sponge-count form.

   Later in the procedure, as the surgeon is completing the operation, the nurses are to do a second sponge count by adding together the number of unused sponges they still have on the field with the number of sponges they have counted being removed from the patient.

   The court noted that the number of unused sponges left and the number that have been removed from the patient has to equal the number that were laid out at the start. If there is any discrepancy, the court said, that obviously means the number of sponges in the discrepancy is equal to the number of sponges still inside the patient.

   At this point if there is a discrepancy the nurses have an absolute legal duty to notify the surgeon, the court stated, that is, before the incision is closed.