They are the slam dunks of medical malpractice lawsuits: anesthesia awareness, surgical fires and wrong-site surgery. Inexcusable and indefensible and, as you'll see in our fourth annual safety issue, in the news in a big way.

Let's begin with anesthesia awareness. A first-person story about awakening during surgery and feeling excruciating pain but being unable to make a sound or move a muscle might have as much of an impact on jurors as a car accident victim wearing a neck brace and a black eye to court. As you'll see on page 10, the uncommon, largely unrecognized and often psychologically devastating experience known as anesthesia awareness is the surgery center's newest malpractice risk.

We already know of two cases of patients who woke up during surgery that went to trial in Virginia and resulted in jury awards of $150,000 and $350,000. The lawyer for a woman who wasn't even under general anesthesia during her IOL exchange tried to hang his case on anesthesia awareness. A jury awarded her $500,000.

Jurors can hear the silent screams of patients and imagine being buried alive or entombed in a corpse, but there's no case unless there's proof in the medical record that shows the anesthesiologist breached the standard of care. "Either he did not give the right medicine at the right time or in the right quantities," says medical malpractice lawyer Douglas Hornsby, Esq., of Newport News, Va. "Our anesthesia experts have to find something where they can say, ?That's where it is, that's where the patient had awareness.'"

Only about 100 to 200 operating room fires are reported each year. You'll find some expert advice on preventing them in "Lessons Learned from Three OR Fires" on page 46. And on page 14, you'll read about a surgical fire that was implicated in an 86-year-old woman's death. A shoulder roll supporting her neck caught fire, possibly sparked by a cautery device, according to a malpractice suit the woman's lawyer filed against the hospital, her cardiothoracic surgeon and her anesthesiologist ... a week before she died.

Rounding out this lawyers' delight is wrong-site surgery. SurgiChip, a radio frequency ID tag that patients can affix like a bandage to ensure doctors perform the right surgery on the right site on the right person, has won FDA approval. The tags, scanner and software will cost $20,000 to $60,000 dollars. Compared to the cost of defending and perhaps losing a medical malpractice suit, that might be a wise investment.

Enjoy the issue. And from our staff to yours, we wish you happy holidays.