The more we looked into the case of Jeanne Holden, the 86-year-old surgical fire burn victim on the cover, the more confused we got. This much we know: Ms. Holden is suing an Oregon surgical center for $1 million, alleging that her face caught fire during a temporal artery biopsy.

We first reported online that the fire was due to a wet surgical skin prep, even though the lawsuit blamed it on an "anesthetic" (perhaps mistaken for "antiseptic?"). When we called Ms. Holden's legal team, a representative told us that the OR team didn't let the chlorhexidine gluconate skin prep that had been applied to her face dry before they closed the incision with an electrosurgical cauterizing probe.

But when we followed up again to get more details for "Did Skin Prep Fuel This Fire?", Ms. Holden's lawyer told us "there's a level of uncertainty" as to what caused the fire and could not confirm that the skin prep was involved. Ms. Holden's family and a national expert who has researched the causes and prevention of surgical fires for more than 40 years strongly suspect that the fire was caused by supplemental oxygen.

"You never, ever cauterize an incision with oxygen on for obvious reasons," says Katrina Staigle, Ms. Holden's daughter.

Whatever the reason, you have a wholly preventable surgical fire from which to learn. Even though only a fraction of surgical fires involve alcohol-based skin preps, Michael Barts, CRNA, of Havre, Mont., was around to witness one early in his career (not his case, he says). In 1983, a Canton, Ill., surgeon was removing skin tags with a cautery pencil.

"The circulator told the surgeon no, but the surgeon did his own skin prep and plugged the cautery stick back into the machine," he says. "A low blue flame consumed the paper drapes. The fire department responded in turnout gear dragging a charged hose."

Someone sent the National Enquirer a Polaroid of the burn victim. "Woman Burned in OR" screamed the front page.

On the banishment of the surgeon's cap. Lauren Kosinski, MD, a colorectal surgeon in Chestertown, Md., sums up the debate over surgical attire perfectly in her piece in General Surgery News. "What is at the source of the potency of feeling and argument about what we wear? Behind the rhetoric about patient safety and infection control is a power struggle between doctors and nurses, which is still fundamentally a struggle between men and women, and resentment of the asymmetry of authority, respect and value. Cloaking the issue of appropriate attire in the untouchable topic of patient safety is a Trojan horse for penetrating the fortress of physician authority and dominance, of getting inside the walls and exercising control over the most personal physical space: what we put on our bodies and how we present ourselves and visually manifest our identity. It is about how we distinguish ourselves."

Giant insurer buys giant surgical center chain. Did you see where UnitedHealth, the nation's largest insurer, is spending $2.3 billion on Surgical Care Affiliates' national network of more than 200 ambulatory surgery centers? Analysts are applauding the acquisition for its shrewdness. UnitedHealth would obviously prefer to pay for surgeries at its own lower-cost centers. Now it can encourage its enrollees to consider a surgical center for a procedure before a higher-priced hospital. "UnitedHealth is attacking surgeries, which are a very large portion of the healthcare spend," one analyst wrote. Another said, "We view surgery centers as high-value providers, defined as facilities that provide high-quality care at a price that is lower than the rate that hospitals receive for comparable services." OSM