When Doctors Fall Asleep in the Operating Room: Lessons from the Dr. Herbst Case


In September 2022, a news story sent shockwaves through the medical community: Dr. Thomas Herbst, a consultant anaesthetist (anesthesiologist) in the United Kingdom, was suspended for six months after falling asleep during a patient’s shoulder surgery. This incident not only raised concerns about patient safety but also sparked broader discussions about the demanding work schedules and potential for fatigue faced by medical professionals.

This article delves into the details surrounding Dr. Herbst’s case, exploring the potential consequences of such an event, the factors that may have contributed to it, and the ongoing efforts to ensure patient safety in the operating room.

The Incident and its Consequences

According to reports from the Medical Practitioners Tribunal Service (MPTS) in the UK, Dr. Herbst allegedly dozed off shortly after administering anesthesia to a patient undergoing shoulder surgery. He was reportedly observed in a deep sleep and required colleagues to physically wake him by tapping him on the shoulder “at least twice.”

Following the incident, Dr. Herbst initially denied falling asleep. However, he later attributed his fatigue to a combination of factors, including long working hours, an undiagnosed illness, and stress related to completing his tax returns the night before the surgery.

The MPTS, after a thorough investigation, found the allegations against Dr. Herbst proven. They highlighted the potential risk posed to the patient due to Dr. Herbst’s condition and his incoherent responses after being woken up. This raised concerns about his ability to continue practicing safely.

Consequently, Dr. Herbst was suspended for six months and ordered to undergo a fitness-to-practice review. This case serves as a stark reminder of the critical role vigilance plays in ensuring patient safety during surgery.

Public Reaction and Industry Concerns

The case of Dr. Herbst sparked public outrage and raised concerns about the working conditions and fatigue faced by medical professionals, particularly anaesthetists. The demanding nature of their work, often involving long hours and high-pressure situations, can lead to fatigue and potentially compromise patient care.

The Dr. Herbst case generated considerable public interest and sparked important conversations around several key issues:

  • Patient Safety: The most significant concern relates to the potential safety risks posed to patients when a medical professional responsible for their well-being falls asleep during a critical procedure.
  • Fatigue in Medical Professionals: The incident highlights the demanding work schedules and potential for fatigue experienced by medical professionals, particularly those in specialties like anesthesia, which involve long hours and high-pressure situations.
  • Work-Life Balance and Well-being: This case also raises questions about the impact of work-life balance and personal well-being on a healthcare professional’s ability to perform their duties effectively.
  • Regulatory and Oversight Mechanisms: Finally, the Dr. Herbst case underscores the importance of robust regulatory and oversight mechanisms within the healthcare system to ensure patient safety and address potential misconduct.

These concerns go beyond Dr. Herbst’s individual case and have broader implications for the entire medical profession, prompting discussions about potential solutions and preventive measures.

This incident also brought to light the importance of robust safeguards and monitoring systems within hospitals to ensure patient safety and hold medical professionals accountable for their actions. Public discourse focused on various questions:

  • How common is it for anaesthetists to fall asleep during surgery?
  • What are the factors that can contribute to such an incident?
  • What measures can be taken to prevent similar incidents from happening in the future?

While the incident involving Dr. Herbst remains an isolated case, it serves as a stark reminder of the potential consequences of fatigue and lapses in professional conduct.

Prevalence of Sleep in the OR:

It’s crucial to understand that closing eyes briefly during surgery, particularly during longer procedures, might be observed in some anaesthetists. However, a clear distinction exists between experiencing brief moments of drowsiness and falling into a deep sleep, as was the case with Dr. Herbst. The latter poses significant risks to patient safety.

Factors Contributing to Fatigue:

While the specific reasons behind Dr. Herbst’s case may never be fully known, several factors can contribute to fatigue and potential lapses in vigilance among medical professionals:

  • Long working hours: Extended shifts, especially during on-call periods, can lead to significant fatigue and impair judgment.
  • Demanding work environment: Operating rooms can be stressful, fast-paced environments with high stakes. This pressure can contribute to emotional and physical exhaustion.
  • Lack of sleep hygiene: Poor sleep habits outside of work can compound the effects of fatigue experienced during long shifts.
  • Underlying medical conditions: In Dr. Herbst’s case, he claimed an undiagnosed illness contributed to his fatigue. Undiagnosed or untreated medical conditions can significantly impact energy levels and focus.
  • Work-life imbalance: Difficulty maintaining a healthy work-life balance can lead to chronic stress and exhaustion, impacting a professional’s ability to function at full capacity.
  • Lack of breaks: The nature of surgery may not always allow for breaks, further compounding fatigue issues.

Preventing Similar Incidents:

The Dr. Herbst case serves as a stark reminder of the importance of patient safety and the need for robust safeguards within the healthcare system. It compels us to consider the pressures medical professionals face and work towards creating sustainable work environments that prioritize well-being while maintaining the highest standards of patient care.

To prevent similar incidents in the future, several measures can be taken:

  • Limiting working hours: Implementing stricter regulations on working hours, including breaks and mandatory rest periods, can help reduce fatigue and improve alertness among medical professionals.
  • Promoting sleep hygiene: Encouraging and supporting medical professionals in prioritizing healthy sleep habits outside of work, including stress management techniques, can significantly improve their overall well-being and performance.
  • Mental health awareness: Fostering a culture of open communication around mental health issues and providing access to appropriate support can encourage healthcare professionals to seek help when needed.
  • Improving work-life balance: Addressing workload management and creating better work-life balance for healthcare professionals can help reduce stress and improve overall well-being.
  • Advanced monitoring systems: Implementing technological solutions for monitoring alertness levels in the operating room could offer an additional layer of safety and prompt interventions if fatigue is detected.
  • Open communication: Fostering an open environment where anaesthetists feel comfortable reporting fatigue and seeking help when needed.
  • Continued research: Investing in research to better understand the factors contributing to fatigue among medical professionals and develop effective prevention strategies

Beyond Dr. Herbst: A Look at the System

The Dr. Herbst case also brings into focus the importance of a robust and supportive system for medical professionals. This includes:

  • Peer support programs: Providing access to peer support programs can help anaesthetists manage stress and fatigue and create a sense of community.
  • Mental health resources: Ensuring accessible mental health resources to address potential underlying issues contributing to fatigue.
  • Hospital policies and reporting mechanisms: Implementing clear policies and procedures addressing fatigue and encouraging reporting concerns related to potential lapses in alertness.

Lessons Learned and Ongoing Efforts

The Dr. Herbst case highlights the delicate balance between patient safety and the well-being of healthcare professionals. While individual actions can play a role, a systemic approach is crucial to prevent similar incidents in the future.

Dr. Herbst’s Appeal and Outcome:

Following his suspension, Dr. Herbst appealed the MPTS decision. He argued that his actions were an isolated incident and did not pose a risk to future patients. However, the appeal was dismissed, upholding the initial six-month suspension and the requirement for a fitness-to-practice review.

The Medical Community Responds:

The Dr. Herbst case sparked debate within the medical community. Many healthcare professionals expressed concerns about the demanding work environment and the potential impact on patient safety.

Professional organizations, such as the Royal College of Anaesthetists (RCoA), emphasized the importance of prioritizing sleep and well-being for all medical professionals. They also called for stricter regulations on working hours and better support systems for managing fatigue and stress.

Impact on Regulatory Landscape:

The incident led to increased scrutiny of working practices within the healthcare sector. Regulatory bodies like the General Medical Council (GMC) in the UK reviewed their guidelines and emphasized the importance of fatigue management within their ethical standards.

Furthermore, the incident has spurred discussions around the potential use of technological solutions in the operating room. Some experts suggest exploring the use of wearable devices to monitor fatigue levels in real-time, allowing for timely interventions if necessary.

Looking Forward: Building a Culture of Safety and Well-being

The Dr. Herbst case serves as a stark reminder of the importance of prioritizing both patient safety and the well-being of healthcare professionals. By implementing the following measures, we can create a safer and more sustainable healthcare environment for everyone involved:

  • Collaboration and Open Communication: Fostering open communication between healthcare professionals, regulators, and policymakers is crucial to identify and address challenges related to fatigue and well-being effectively.
  • Investing in Well-being Programs: Healthcare institutions should actively invest in and promote well-being programs for their staff, including resources for sleep hygiene, stress management, and mental health support.
  • Flexible Working Arrangements: Exploring flexible working arrangements and workload management can help reduce stress and improve work-life balance for medical professionals.
  • Continuing Education and Training: Ongoing education and training programs can equip healthcare professionals with skills and strategies for managing fatigue and maintaining alertness during demanding work situations.

FAQs about the Dr. Thomas Herbst Case:

1. What happened to Dr. Thomas Herbst?

Dr. Thomas Herbst, a consultant anaesthetist in the UK, was suspended for six months in 2024 after falling asleep during a patient’s surgery.

2. How did this incident come to light?

The incident was reported to and investigated by the Medical Practitioners Tribunal Service (MPTS) in the UK.

3. What are the potential risks associated with a medical professional falling asleep during surgery?

This can lead to delayed responses, impaired judgment, and potential harm to the patient.

4. What factors might contribute to fatigue among medical professionals?

Long working hours, demanding work environments, lack of sleep hygiene, and underlying medical conditions can all contribute to fatigue.

5. What steps are being taken to address fatigue and ensure patient safety?

Some measures include stricter working hour regulations, promoting healthy sleep habits, improving work-life balance, and exploring technological solutions for monitoring fatigue levels.

Dr. Herbst’s appeal against his suspension was dismissed, and he remains subject to a six-month suspension and a fitness-to-practice review.

7. What are the ethical considerations surrounding this case?

Patient confidentiality and privacy remain crucial aspects to be upheld in such situations.

8. What can be learned from the Dr. Herbst case?

This case highlights the importance of prioritizing both patient safety and the well-being of healthcare professionals. It emphasizes the need for collaboration, well-being programs, flexible working arrangements, and ongoing education to create a safer and more sustainable healthcare environment.

9. Is Dr. Herbst currently practicing medicine?

No, Dr. Herbst is currently under a six-month suspension and has not been cleared to return to practice yet.

10. What resources are available to help healthcare professionals manage fatigue?

Several resources exist, including professional organizations offering guidance and support, and individual strategies like maintaining good sleep hygiene and seeking stress management techniques.

These FAQs aim to address the most common questions people have regarding the Dr. Thomas Herbst case and provide concise, informative answers based on publicly available information.


In conclusion, the Dr. Herbst case serves as a critical case study highlighting the complex interplay between patient safety, healthcare professional well-being, and the demanding work environment of the medical field. This case serves as a wake-up call for the medical community. It highlights the critical need to address the issue of fatigue among anaesthetists and implement safeguards to ensure patient safety. By implementing the various measures outlined above, we can strive towards creating a future where both patient safety and the well-being of healthcare professionals are consistently prioritized and protected.

It is important to note that this article is for informational purposes only and should not be taken as medical advice. Always consult with a qualified healthcare professional for any questions or concerns you may have.

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About the author

Adeline Darrow
By Adeline Darrow


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