ST. LOUIS Severe mistakes happen, even at hospitals that receive high marks from federal health officials. And consumers usually never learn the details of these errors.

In a very small percentage of surgeries, doctors operate on the wrong knee or breast, and in rare cases amputate the wrong body part.

But when a neurosurgeon operates on the wrong side of a persons brain, as happened last month at an SSM Health Care hospital in the St. Louis area, it is a unique event and a medical mistake of the highest order.

A wrong-site surgery on the brain of which only about one a year has been documented since the mid-1960s can rob a person of cognition, emotional strength and ability to interact with others, as well as traumatize and scar a patients family, caregivers and the medical professionals who made the error.

According to national experts, it is usually a signal that the institutions quality control processes systems that are designed to safeguard the lives and limbs of patients are insufficient.

In a public apology issued Tuesday, Chris Howard, president and chief executive of SSM Health Care-St. Louis, admitted that one of the health systems neurosurgeons operated on the wrong side of a 53-year-old womans skull and brain.

This was a breakdown in our procedures, and it absolutely should never have happened, he said.

The case of Regina Turner, a former paralegal who lived in St. Ann, is a significant crisis for not only St. Clare Health Center in Fenton, where the brain surgery took place on April 4, but also for Creve Coeur-based SSM Health Care, a Catholic nonprofit health system that runs 18 hospitals in Missouri and three other states.

The case also points to weaknesses in federal and Missouri law that leave patients as consumers with a limited view of hospital performance. Unless litigation about a hospital error is reported by news media, Missourians rarely learn about these surgical mistakes. And without this data, consumers have less information to help them make choices about medical care.

Missouri is among the minority of states that do not require hospitals to report serious errors and also among those states that do not operate a public database of information about these occurrences. Such events normally remain hidden from public scrutiny.

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Botched brain surgery prompts extensive review at SSM Health Care