Report: worrisome deaths in non-hospital surgery centers

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Kaiser Health News just came out with this fascinating and worrisome report on surgery centers:

It appears to me that much of the report is based directly on Medicare reports.

In one case, for instance, “[…] a Medicare inspection report describing the event says that nobody who remained on duty that evening at the Northern California surgery center knew what to do. […] In desperation, a nurse […] dialed 911. By the time an ambulance delivered [the patient] to the ER, [she] was lifeless, according to the report. If [she] had been operated on at a hospital, a few simple steps could have saved her life.”

The core of the article:

Thousands of times each year, these centers call 911 as patients experience complications ranging from minor to fatal. Yet no one knows how many people die as a result, because no national authority tracks the tragic outcomes. An investigation by Kaiser Health News and the USA TODAY Network has discovered that more than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. Dozens — some as young as 2 — have perished after routine operations, such as colonoscopies and tonsillectomies.

An example of how things can go wrong:

Pedro Maldonado, 59, went to Ambulatory Care Center in New Jersey to have his upper digestive tract scoped. He was discovered unresponsive 10 minutes after the seven-minute procedure, according to his widow’s lawsuit.

It took surgery center staff 25 more minutes to start CPR, according to a lawsuit that Philadelphia attorney Glenn Ellis filed on behalf of Maldonado’s widow. Twenty-seven more minutes passed before Maldonado was wheeled into an ER, the widow’s ongoing suit alleges. Maldonado never regained consciousness.

One sentence that particularly shocked me in that report:

Thousands of times each year, these centers call 911 as patients experience complications ranging from minor to fatal.

I am not ready to believe every conclusion of this report until I read more information. But, until then, I will be very careful about getting any procedures in a surgery center.

The same report as published by USA today:

Mention in Becker’s Hospital Review:

https://www.beckershospitalreview.com/quality/kaiser-health-news-report-questions-safety-of-ascs-5-things-to-know.html

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Just some perspective. This is a bit alarmist and is really different from state to state. The vast majority of surgery centers in most states are co-located with a full service hospital. A few states allow these centers to exist anywhere they want.

Red flags for me are physician owned surgery centers and not being co-located with a hospital.

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Why are physician owned surgery centers more concerning?

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Because the physician has an incentive to do things in a minimal way to increase their profit. i.e. use the least trained staff possible, or use re-sterilized single use items so that they make more money. I prefer my physician to be happy with the profit from doing the procedure only. Keeps things clean,

Edit, clarification: If the physician doesn’t have any profit motive in the surgery center, they are also more likely to fight for the patients rights.

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Also, for more minor procedures done by specialists (such as plastic surgery), if something goes wrong in a hospital, you have other doctors and surgeons right there who can save your life, as well as nursing staff well trained in a broader range of emergency protocols. In a non-hospital center, you might need to be loaded into an ambulance and taken to a hospital before you can get, say, a cardio specialist trying to figure out what’s going wrong suddenly with your heart.

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What shocked me most in the story was the thousands of times nurses in these surgery centers called 911 when something went wrong.

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They have to—they often don’t have the training or sometimes even the equipment often to deal with serious problems there and need to get the patient to a real hospital ASAP. That’s the main reason it’s so risky.

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It should also be noted that there are approximately 5500 hospitals, and most have a surgery center co-located, so the number of non-collocated surgery centers isn’t large, but in some states they are prevalent.

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