Lax oversight and safety nightmares burgeon with boom in surgical centers

kprobes-300x167An innovation in medical treatment — which was supposed to offer more affordable, accessible, and even convenient care — instead may be getting swamped with safety problems that long have plagued hospitals and academic medical centers.

USA Today and Kaiser Health News Service deserve credit for digging into patients’ nightmares with specialized surgical centers, not only those performing “routine” procedures but also those handling increasingly longer, more complex, and difficult operations. The many surgeries, once the province only of big and well-staffed hospitals, put patients at risk, the newspaper reported, saying:

[Our] investigation found that surgery centers operate under such an uneven mix of rules across U.S. states that fatalities or serious injuries can result in no warning to government officials, much less to potential patients. The gaps in oversight enable centers hit with federal regulators’ toughest sanctions to keep operating, according to interviews, a review of hundreds of pages of court filings and government records obtained under open records laws. No rule stops a doctor exiled by a hospital for misconduct from opening a surgery center down the street.

USA Today and Kaiser have collected information on deaths and patient harms that have occurred in some of the 5,600 free-standing, specialized surgical centers nationwide. Such centers have burgeoned because they can be nimbler than the hospitals and academic medical centers they now outnumber. The centers can be set up without hospitals’ high overhead costs, including for staff and equipment that may be unnecessary for a specialty practice. The facilities also can be set up closer to patients, theoretically offering them greater access and convenience, including with easy navigation and parking.

But regulators have been slow to adapt, leaving critical oversight to organizations that are retained by doctors and the centers themselves to certify crucial safety and quality measures.

In 17 states, reporters found, regulations are so lax that surgical centers may not be required to report to any authorities their significant problems, up to patient deaths. At one center, two patients died and a third had to be rushed to a hospital for emergency care. None of these events were publicly disclosed.

The news organizations found that, due to regulatory gaps, doctors who could not practice at local hospitals due to licensing or other challenges, instead, partnered with spouses, peers, and friends so they could operate in surgical centers.

Even the once-potent oversight provided by Medicare inspection and qualification may not be optimal at surgical centers, due to legal flaws in what the facilities must report on and how often over-stretched inspectors can review them.

In my practice, I have represented patients with life-ruining injuries from surgical shortcuts in these surgery centers. I also regularly see the harms that patients suffer while seeking medical services and their struggles to access and afford safe, efficient, and even excellent medical care. Experience has shown how staggering the damage that doctors and hospitals inflict on patients every single day, whether through institution-acquired infections or avoidable error. Medical errors claim the lives of roughly 685 Americans per day — more people than die of respiratory disease, accidents, stroke and Alzheimer’s. That estimate comes from a team of researchers led by a professor of surgery at Johns Hopkins. It means medical errors rank as the third leading cause of death in the U.S., behind only heart disease and cancer.

Major campaigns have failed to significantly reduce medical errors, including harms caused in hospitals and academic centers. As specialized surgical centers rise, especially as they become alluring to profit-seeking doctors and insurers — and, yes, to the hospitals that often have a stake in them, too — they’re performing not only more procedures but also more complex surgeries.

It’s unclear, USA Today and Kaiser Health News reported, that patients who get in trouble while getting operated on in specialized centers would be better off, if they experienced their problems in a hospital or an academic medical center. But will patients and the health care system be penny wise and pound foolish to push over complicated surgeries, without increased support for the worst-case instances, into specialized centers?

With the two news organizations also reporting previously on the growing doubt by Medicare officials about allowing seniors to undergo serious, same-day spinal procedures in specialty surgical centers, it may be past time to rethink and more significantly regulate these facilities, taking into account their safety as much as their utility and possible savings.

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