Was discussing a case in Grand Rounds.
Pt was on Coumadin therapy for a previous coronary sent. Now had to undergo non-cardiac surgery(shoulder). The surgeon instructed the patient to continue his Coumadin therapy all the way up to surgery.
On pre-op assessment, MDA noticed that the INR was noticeably elevated and refused to perform the anesthesia. Surgery was eventually cancelled. Pt came back in about a week (now off his coumadin), had an MI in the OR and died.

Who's to blame?