There is no dispute about the unusual, horrifying and incomprehensible facts in the story that took place at Assuta Ramat Hachayal Hospital in Tel Aviv. During a private surgery designed to depressure the spinal disc, the wooden handle of the surgical instrument (the impact) was broken when the surgeon hit it with a hammer. The malfunction immediately caused damage to the patient's spinal cord, leaving him severely disabled and in a nursing condition.
The serious and unusual malfunction, which is revealed here for the first time (which, according to the Ministry of Health, is the first documented case in Israel and around the world), occurred on June 14, 2021, during surgery performed by Prof. Eyal Yitzhak, head of the spine surgery department at Beilinson Hospital in Petah Tikva and one of Israel's leading doctors in the field. He chose to perform the surgery in Assuta Shalom Eshel, 53, a father of six who lives in a moshav in central Israel. The surgery was mostly paid for by Maccabi's supplementary insurance.
Assuta Ramat Hachayal Hospital, Photo: Liron Almog
"I chose to perform the surgery specifically at Assuta Hospital and with a private surgeon, knowing full well that this is a private hospital with all that this entails - advanced medicine, state-of-the-art devices, personal attention and maximum comfort," Eshel explained. "At least that's what I thought, but I came out paralyzed from the waist down, and my life changed beyond recognition in one day because the hospital acted carelessly. No one prepared me for such a thing. My world was destroyed, and the lives of my family members were also destroyed. It is clear to everyone that a device should not break in an operating room, and that I should not leave with such a serious injury from such an operation. It's not a risk I've been told or should have considered using old, crumbling surgical instruments, and now my life has changed drastically. My life became complicated, very difficult physically and mentally, I became dependent."
"The circumstances of the case are under investigation"
Assuta Tel Aviv is the largest private hospital in Israel, and is part of the Assuta chain, which is owned and fully responsible by Maccabi Health Services.
In an unusual internal document written by Assuta Hospital Director Dr. Hadar Marom about the affair and transferred to Shalom Eshel patient, she admitted all the details of the case and wrote that "this was an incident of a fracture of the handle of the device during surgery, which caused spinal cord injury and paralysis of the patient's lower body. The case was reported to the Ministry of Health and a meeting was held with the family, in which the details of the incident were transparently provided and the broken device was presented.
Surgeons // Photo illustration: GettyImages,
"In examining the conduct of the surgeon, the operating room staff and the imaging team, we found that the teams acted quickly and professionally as required, and we did not identify a deviation from the accepted medical standard."
Dr. Marom also noted that the broken device was made by a German company, represented by Zemel, one of Israel's largest importers of medical devices, and that the circumstances of the case are under investigation by the manufacturer.
Internal screens in the case show that the device was purchased more than 14 years ago, and that in the year and a half before the operation it was used in about 30 surgeries. Today, this type of device is made from a different material.
The factor that was surgically broken,
"However," noted Dr. Marom, "an examination of the procedures of the medical equipment company and the Ministry of Health did not find guidelines for the shelf life validity of such devices. We deeply regret the incident and promise that we have taken all the necessary steps to learn and ensure that such an incident does not happen again."
However, contrary to the self-compliments of Assuta's manager, in the medical malpractice suit filed by Shalom Eshel and his wife against Assuta and the Lloyds insurance company, which insures the hospital, to the Tel Aviv District Court by attorney Ilit Nevo-Rafael, many very serious allegations are raised against them in the case. The lawsuit is still ongoing.
"The testing requirement is high"
According to the lawsuit, "The disaster for which Shalom was injured could have been avoided had Assuta Hospital acted in accordance with its obligations to operate and supervise the devices used in the operating room, and also acted to correct them and prevent the use of old devices or those that could endanger the operating public.
"Assuta is well aware that negligence on its part regarding the equipment may cause harm to the operating public under its responsibility, and it has an obligation to ensure that the surgical instruments are in good working order, especially when it comes to spinal surgery."
The statement of claim was accompanied by the opinion of Prof. Menashe Zaaror, who headed the neurosurgical department at Rambam Hospital in Haifa. "There is no dispute that such a case should not happen. A person is left severely disabled because of a fracture in the surgical device, even more so that it is a device that must be knocked on with a hammer, meaning that the obligation to check that the device is in good working order and resistant to the force exerted on it is higher."
He said that given the fact that the device was broken, "there was a manifestly unreasonable irregularity in the examination of the device. As the photos indicate, this is an old device, which was clearly not replaced in time and not properly tested. Had the hospital provided a proper device, Shalom Eshel's spinal cord would not have been damaged and his serious condition would have been prevented."
"Miss wandering in the garden"
Shalom told Israel Hayom, "I haven't worked for two years because I'm still in an intensive rehabilitation program on a daily basis, and it's also clear to me that I won't be able to return to work. For two years I didn't pour a cup of coffee, I didn't shower alone, two years I can't be alone with myself and just wander around the garden or on the street. Apart from damages that are a direct result of disability, there are damages that are the result of sitting in a wheelchair all the time, sitting and immobility. The paralysis in my lower body means I can't feel my legs – I have no feeling in them and I can't move my fingers."
Ministry of Health, Photo: Oren Ben Hakon
Shalom added, "In principle, everything that was damaged doesn't work as it did before or doesn't work at all. There are wounds, pressures, lack of control in certain areas and in basic daily activities. What's worst is the fact that you become completely dependent. Everything needs to be helped. I was robbed of my independence, my privacy, my freedom of movement taken away. I am a prisoner in a wheelchair. Rolling into the toilet and engaging in the bathroom in general becomes the main issue of the day."
Shalom said of the Health Ministry: "I demand that the Health Ministry thoroughly examine what exactly happened in the operating room at Assuta, and what exactly happened with the broken device. This is very important because it is literally human life. Unfortunately, we will no longer be able to prevent my case, but we must and can try to prevent future cases. It is the duty of the Ministry of Health to do so. I feel a strong sense of mission to make it really happen."
Reject the claims
Attorney Ilit Nevo-Rafael, who represents Eshel, told Israel Hayom that "admitting responsibility has become a 'dirty word,' which is very sad. We must remember that beyond the legal aspect, there is a human case here, alongside a moral obligation. When such a disaster occurs, which should not have happened under any circumstances, the hospital must bear responsibility in all aspects and behave humanely and morally, while doing everything possible to ensure that such a disaster does not happen again. It was also expected that the hospital would act as it promised and do everything possible to alleviate his condition, and not drag him into an arduous legal campaign with one goal – attrition. There are right, fair, just, and even more economical ways."
Adv. Ilit Nevo-Rafael, Photo: Yehoshua Yosef
In the statement of defense, Assuta rejected all the claims against it, arguing, inter alia, that the hospital "serves only as a hostel for back surgery, and it bears no responsibility, including for the actions of surgeon Prof. Yitzhak," and that according to the opinion of Dr. Oz Golan, head of the Center for Materials Engineering at Afeka College, the fracture that occurred in the device is "of the type of fatigue without prior warning, and an ordinary user has no practical way of predicting the process that will lead to the device breaking."
"The doctor is not responsible"
The statement of defense relies on the opinion of Dr. Nachshon Knoller, who managed the spine surgery unit at Sheba Hospital, and according to him, the device that broke is "common and common in many spinal surgeries, and an identical device is found in all operating rooms I know. These are reusable devices and do not have expiration validity. The surgeon receives the device, and is never involved in its maintenance."
Prof. Yitzhak told Israel Hayom: "There was justification for the operation, and the operation went well until the last part, when the handle of the device broke. Since then I think a lot about what happened, it is impossible to forget it. After the incident, we conducted ourselves in full transparency with Mr. Eshel and his family, and we did everything in our power to ensure that he received the best treatment to achieve improvement in spinal cord function."
Masuta said in response: "The lawsuit is still ongoing. Assuta's response can be found in great detail and full transparency in the letter of the director of Assuta Hospital."
The Ministry of Health said: "According to the information available in the ministry, the device involved in the incident was not sent by the medical institution for examination by the manufacturer, and therefore the manufacturer cannot determine with certainty the source of the malfunction. Like the rest of the world, the shelf life of surgical equipment is determined by the manufacturer and/or the professional staff at the hospital."
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