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This is in reference to Scrubs season 5 episode 20 - "My Lunch".

At the end of the episode, all three of Dr. Cox's transplant patients die. This happens because the donor from whom those organs were taken was found to be infected by rabies (as per autopsy). That infection spread in the transplant patients' bodies.

Later in a conversation J.D. consoles Cox:

J.D.: There's no way you could have seen that coming. I mean, rabies? Come on, there's, like, three reported cases a year. In fact testing for it would have been irresponsible. You would have wasted time those people didn't have.

Dr. Cox: I was obsessed with getting those organs.

J.D.: You had to be. The fact is, those people were going to die in a number of hours and you had to make a call. I would have made the same call.

This was true for first two transplant patients. But eventually, when the last kidney transplant dies, Cox confesses:

Dr. Cox: He wasn't about to die, was he, Newbie? Could have waited another month for a kidney.

This was a clear case of medical negligence and malpractice by Dr. Cox. Despite that, there is no mention of him being sued/questioned/fired for such a gross mistake. Instead, the whole hospital staff was taking care of the depressed Cox by consoling him continuously.

I understand it is a comedy drama show so they are not even obliged to portray everything accurately in such matters (though the show is known to be quite accurate). So one good possibility is - writers chose to show the sentimental/depressed part of Dr. Cox's story rather than focusing on the suing/malpractice/investigation part which is obviously too boring for the show. After all it's not a legal drama.

Question: Am I missing something here? How does it happen in reality? Are doctors not held responsible? Is it normal that doctors and the hospital get away with such mistakes?

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    It was an accident through no one's fault. No one is getting away with anything. – cde Sep 18 '16 at 2:29
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Three patients dying would certainly trigger a hearing at the very least, and based on the families, lawsuits. But that is what Malpractice insurance is for, and medical waivers, and any number of procedures in the hospital for how the donor would be tested prior to the transplants. If they crossed their Ts and doted their Is, there would be no reason for any sanctions or anything. Patients routinely die in many operations or after-operation complications.

The increase in organ transplants from drug-overdose victims may raise questions about safety. But organ transplants from drug users have been deemed acceptable for decades.

Such donors are labeled as "high-risk" because their behavioral history. According to U.S. Public Health Service guidelines, recipients have to give specific consent to transplants from high-risk donors.

Organ donors are screened for HIV, Hepatitis B and Hepatitis C, and high-risk donors receive additional scrutiny, Klassen said.

But lets look at the whole situation.

Dr. Cox is not a surgeon. The Surgeon would be the first person they would look into for routine negligence or cause of death. Then any lab workers or the Organ harvesting and testing company for routine negligence in checking the donor. Then maybe Dr. Cox for gross negligence if any. The recipients know that there is a higher risk from a drug-death donor, and accepted that before the transplant, limiting liability. A physician's involvement here is mostly:

  • Doctor's Patient is sick.
  • Doctor requests Transplant based on Patient's needs.
  • Doctor provides After Transplant Care.

The physician would have little direct involvement in choosing the donor, testing, the operation, etc.

As mentioned, human victims of Rabies are rare. At the highest, 60k deaths a year, with 57k being in 3rd world Africa and Asia. US rates are in fact 2 deaths a year. Testing for rabies is not quick or accurate except for a brain biopsy. Tracy, the donor, did not exhibit typical symptoms of Rabies, which tend to be aggressive behavior.

Had they tried to test for an extremely rare virus, with no visible signs after examination, which takes so long that the organs will go bad in the mean time, would have meant no one would receive the organs anyway.

There really wouldn't be liability for Dr. Cox. It was unfortunate but there was no malpractice here, no negligence. The outcome was so remote that no reasonable professional could foresee it. The only one that would blame the Dr. Cox, is Dr. Cox...

Of course, a malpractice lawsuit would be pretty much automatic and routine, but no professional consequences for what is essentially just bad luck.

That said, there is a real life case that the episode seems to draw on.

On admission, a urine toxicology screen was positive for cocaine and marijuana, and computed tomography of the brain demonstrated a subarachnoid hemorrhage. The hemorrhage progressed, and the neurologic symptoms, including seizures and coma, worsened. The patient was declared brain-dead within four days after presentation. Donor-eligibility screening and testing performed by an organ-procurement organization, including a review of premortem blood, urine, and sputum bacterial cultures, did not detect any signs or symptoms of infection precluding solid-organ donation.

As the trivia section of the wiki you link to says:

The plot is based on the true story of three patients who died in June 2004, due to rabies contracted by organ transplants. However, as the commentary on the Season Five DVD mentions that the episode took some dramatic license, as the organs from one donor do not usually all go to the same hospital.

The story follows the real life event.

  • Fantastic explanation. Excellent points covered especially the real life case. "The recipients know that there is a higher risk from a drug-death donor, and accepted that before the transplant, limiting liability." - I had totally missed this point. Thanks for taking time in writing such a detailed answer. As a sidenote - this particular episode is very intense and indeed makes me bit emotional. – Pale Blue Dot Sep 18 '16 at 6:29

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