Mendoza: a sponge count does not end the surgeon’s duty

Facts and context

After undergoing hysterectomy and myomectomy, the patient experienced recurring pain, fever, and abnormal discharge. She had no intervening operation. Another physician later removed a foul-smelling rolled gauze from her cervix. The original surgeon denied leaving it and relied on the operating-room record showing a correct sponge count.

The patient’s account, clinical course, extracted gauze, and absence of another surgical procedure placed the documentary count in dispute. The case asked whether responsibility for closure could be satisfied by accepting the recorded count without reconciling it with the evidence of a retained object.

Issue

Did the recorded sponge count overcome the physical and circumstantial evidence that gauze had been retained, and could the surgeon discharge the duty of safe closure by relying entirely on the count performed by others?

Ruling and doctrine

The Court upheld liability and added exemplary damages. The patient’s history and the later extraction supported the finding that the gauze had remained from the operation, while the written count did not conclusively displace that evidence. The surgeon’s responsibility included personally ensuring, before closure, that the operative field did not contain a retained sponge.

The decision does not reject team counts or documentation. It holds that the safety process and record must be acted on with professional vigilance; a checked box is not an automatic defense when persuasive clinical evidence shows the count was wrong.

Practice implications

Parao Law practice guidance

For physicians

• Complete the applicable accounting checks before closure and clarify the surgeon’s responsibility for verification.
• Escalate a discrepancy and document the action taken; do not treat a count entry as a substitute for resolving the concern.
• If postoperative findings suggest retained material, reassess and arrange appropriate investigation instead of relying only on a previous “correct count.”
• Keep operative, count, and later treatment records consistent with the facts actually observed.

For lawyers

• Obtain the operative record, counts, intervening-treatment history, and evidence of later discovery or removal.
• Test the count entry against the physical and testimonial evidence; neither accept it as conclusive nor disregard it without analysis.
• Connect the retained material to the earlier procedure and address alternative explanations.
• Identify the evidence supporting each category of damages separately from proof of negligence.

Limits of the ruling

Mendoza concerns the retained gauze and the operative responsibility established in this case. It does not mean every inaccurate record proves malpractice, or every postoperative symptom proves a retained object. The evidence linking the material to the earlier operation remains central to the reasoning.