There are certain types of surgical procedures that don’t require long hospitals stays. Biopsies and colonoscopies are a good example, because they’re same-day procedures that don’t require an overnight stay; tonsillectomies, X-Rays, and cataract removals are also same day procedures. As a result, they are often performed at stand-alone surgery centers – not hospitals. These centers often cost less money, and are more conveniently located than hospitals, making them popular alternatives.
Right now, there are more than 5600 surgical centers located across the U.S. – far more of them than there are hospitals. A USA TODAY/Kaiser Health News investigation in March uncovered more than 260 patient deaths at these centers in the last 5 years.
One of those deaths was a 12-year-old boy. CBS Evening News tells his story:
The latest investigation by USA TODAY has found that 17 states have “no mandate to report patient deaths after surgery center care. So no facility oversight authority has examined whether the deaths were a statistical anomaly or cause for alarm.” Furthermore:
[These] 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. (emphasis ours)
A doctor who has had his or her privileges revoked from a hospital due to misconduct can simply open up a surgical center of his or her own, no questions asked. And that doctor doesn’t have to tell anyone, it seems.
When a patient dies in a hospital, that hospital may be required by law to report that death. In some cases, hospitals may be required to report a death to the Centers for Medicare and Medicaid Services, to the county Medical Examiner (if there is a need for an autopsy), or to the state health department. Not all deaths need scrutiny, but the unexpected ones do – like a 12-year-old boy dying from a tonsillectomy, or anyone dying after a colonoscopy, which is one of the safest procedures a person can have.
Incomplete reports are not limited to deaths
Understand, too, that this incomplete reporting is not limited to deaths. Per the USA TODAY investigation, “Medicare allows surgery centers to report data for as few as half of just their Medicare patients, ignoring most patients under age 65 who do not yet qualify for Medicare. In practice, that has allowed surgery centers to report as many hospital transfers as they choose – unless more than half of their patients leave by ambulance.”
What this means is, when you do your research into surgical centers, you might see that the Kentucky Surgery Center in Lexington, or the Ohio Surgery Center in Columbus, shows that fewer than half their patients have been transferred to hospitals because of complications. What you don’t see is any explanation for why the numbers present the way they do. In a 2013 study published by the National Institutes of Health (NIH), researchers looked at patient’s “acute care needs after care” at ambulatory surgical centers. They reviewed records (July 2008 through September 2009) of 3,821,670 surgical patients who were treated at 1,295 ambulatory surgery centers in three states, to determine:
- How many were transferred to hospitals at the time of their discharge from the centers; and
- How many people needed hospital-based or Emergency Room care within 7 days of that discharge.
They concluded that “Among adult patients undergoing ambulatory surgery center care, hospital transfer at discharge is a rare event. In contrast, the hospital-based, acute care rate is nearly 30-fold higher, varies across centers, and may be a more meaningful measure for discriminating quality.”
In short, despite low levels of transfers to hospitals, the number of adult patients who sought additional care from the E.R. or through hospital admittance was about 30 times higher than those who did not.
Perhaps most telling, however, is that the transfer rates at the surgical centers across all three states varied very little. Because of this, researchers found, the data “may offer little in a patient’s or payer’s ability to determine which ambulatory surgery centers are providing ‘better’ care.”
What can be done to protect surgical center patients?
The NIH study’s authors recommend penalties and rewards to incentivize centers to do better. Medicare can issue sanctions, too, for facilities with serious safety lapses. But instead, in July of 2018, Medicare proposed ending its collection of transfer data altogether – after all, transfer rates vary so little from facility to facility, and from state to state.
That means it is up to us, as patients and advocates, to force changes for the better. One of the reasons Medicare does not always send officials to investigate problems at surgical centers is that they rely on consumer complaints. Therefore, we must take it upon ourselves to report problems we, or our loved ones, have at these centers. This is especially true for cases concerning minors, as Medicare collects no data on that at all.
The other thing we must do is contact our local and state representatives, and demand that more oversight and regulation be put in place for surgical centers. The owners and operators of these facilities must be held accountable for the mistakes they make, and for their medical negligence. If Medicare and the facilities won’t do it, then we need to ensure that other authorities or governing bodies will.
At Crandall & Pera Law, we will continue to fight on behalf of individuals and families whose lives have been turned upside because of medical malpractice. If you or your family member were harmed while undergoing a procedure at a surgical center, we can help. Please call 877.686.8879 or fill out our contact form to schedule a free consultation with an experienced medical malpractice lawyer in Ohio or Kentucky.
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