By Pat Shannahan, The Arizona Republic, for USA TODAY Doug McCoy of Chandler, Ariz., still has a tumor in his right ear because he's nervous about having surgery again. DON'T BECOME A VICTIM • Bring a family member or friend to act as your advocate. • Remind the surgical team,  nurses, surgeons, anesthesiologists and perhaps others,  what operation you are expecting. • Get the doctor to mark the correct surgical site. • Ask the doctor to take a "time out" to confer with the surgical team before the operation begins. This pause inside the operating room allows the team to confirm that the procedure, the patient and the surgical site all are correct. Source: Joint Commission on Accreditation of Healthcare Organizations

"It's getting worse," says Dennis O'Leary, who heads the non-profit Joint Commission on Accreditation of health care Organizations, which inspects more than 15,000 hospitals and surgical centers nationwide and sets patient safety requirements and guidelines.

Last year, health care facilities reported 84 operations to the commission that involved the wrong body part or the wrong patient. While some states require hospitals to report such blunders, many hospitals across the nation are not obligated to account for them publicly.

"I can assure you that this is just the tip of the iceberg," O'Leary says. "Some hospitals are reporting everything and some hospitals don't report anything at all."

A new study documents cases in which surgeons operated on the wrong arm, the wrong rib and in one case the wrong person, among other mistakes.

The study of 2.8 million operations over a 20-year period, published in today's Archives of Surgery, suggests that the rate of "wrong site" surgery anywhere other than the spine is 1 in every 112,994 operations. The study excludes the spine, the authors explain, because surgical sites on the spine are verified with X-rays, in contrast to the apparent simplicity of marking the correct knee or ear in advance.

The study, funded by the federal Agency for health care Research and Quality, concludes that the rate is "exceedingly rare" but "unacceptable."

Patient safety experts say more vigilance is needed. "We're trying to get the number down to zero," says Donald Palmisano, a New Orleans surgeon on the non-profit National Patient Safety Foundation's board of directors. "It is such a catastrophe when this happens."

Since 2004, doctors have been required by the joint commission to mark the spot they plan to cut while consulting with their patient before surgery. The commission also encourages patients to insist on such a mark.

Nurses are supposed to call a "time out" in the operating room, according to commission protocol, calling everyone's attention to a final safety check in an effort to ensure that the right procedure is performed on the right patient.

But some surgeons, particularly those who believe they would never make such a stupid mistake, often ignore the safety protocols, says one chief surgeon. "They think this is useless," says Glenn Rothman, chairman of surgery at Banner Desert Medical Center in Mesa, Ariz. "Doctors fight it because they are the captains of the ship. There is a lot of resistance to standardized conduct."

Doctors and nurses spar over the safety checks. Rothman says some surgeons make a tiny, mole-sized mark on a patient instead of a big, bold "X."

"I call them passive-aggressive marks," Rothman says. He is working to develop a standard stamp to put an end to such conflicts in his hospital and in others nationwide.

Some surgeons all but ignore the nurse's call for "time out" before the operation begins, Rothman says. "Doctors think nurses are just trying to torture them," he says.

Both Rothman and O'Leary say the way doctors and hospitals are paid contributes to the problem. There is no financial incentive for practicing safer medicine, O'Leary says, because hospitals want operating-room staff to move patients through quickly.

It can be "dangerous" if speed is a measure of operating-room performance, Rothman says.

Doug McCoy is no stranger to the inner workings of a hospital. And the 43-year-old medical-device repairman was completely at ease in September when co-workers at Maricopa Medical Center in Phoenix wheeled him into an operating room.

But instead of removing a tumor from McCoy's right ear, the team operated on his left ear — which had no tumor. He reached a settlement with the hospital and the surgeon, agreeing not to disclose the doctor's name or the amount of money he received.

Peter Crowley, the risk manager for Maricopa County who spoke on behalf of the medical center, suggests that it's important to have perspective, noting that the McCoy operation was just one of 6,400 surgical procedures performed last year at the hospital.

While Crowley could not discuss specifics of the McCoy case, he said that "a very thorough analysis was conducted" and that "procedures to avoid a recurrence were immediately implemented."

The researchers in the new study note in a prepared statement that, "No protocol will prevent all cases. Therefore, it will ultimately remain the surgeon's responsibility to ensure the correct site of operation in every case."

But McCoy is afraid to return to the operating room to have the benign growth removed. "My doctor couldn't apologize enough," McCoy says. "But if he can't even do the right ear, how is he going to do the procedure right?

"There are so many mistakes that can be made," he says. "I don't trust them."