Kaiser Health & USA Today recently reported how medical errors that often lead to injuries and deaths at many ambulatory surgery centers are not being reported to government oversight agencies. They reported a series of recent procedures that had tragic outcomes at centers across the country. Roughly 17 U.S. states have no mandated reporting requirements, even in the event of a patient fatality. This is particularly disturbing because these centers are primarily conducting what are intended to be outpatient procedures.
Ambulatory Surgery Centers (ASCs)
There has been an emergence of ASC fatalities in recent years that largely focus on outpatient surgical procedures, diagnostic testing, and wellness care. They are currently estimated to provide care for over 4 million individuals annually as a potentially better option than a hospital. Their patient volume has continued to rise and between 1996 and 2006 they saw a 300% increase. In Maryland, there are approximately 345 such facilities and three in Washington D.C.
Differing State Requirements
Bill Prentice, executive director of the Ambulatory Surgery Center Association, describes the current ASC reporting requirements as a “patchwork system” that lacks any “consistency”. Many of the states simply do not have an established duty to report fatalities. In states where reporting mandates applying to ASCs exist, often they require much less detailed data regarding surgical results compared to hospitals.
Leah Binder, an executive with the Leapfrog Group, referred to the lack of ASC data being reported as “disgraceful”. Additional concerns include how the oversight of their physicians is being handled. For example, in many states, it is possible that a surgeon who was dismissed from a hospital for misconduct or a history of medical malpractice could resume practice at an ASC without the public or regulators knowing it.
Lack of Federal Standards
The federal government reports performance to the public through a “Hospital Compare” web forum. It is obvious that ASC data such as rates of mortality and procedural complications are largely absent. Hospitals increasingly are accountable now to report data such as those relating to infections that patients acquire at the facility and patient approval ratings. Medicare also has similar reporting requirements for medical facilities that perform surgeries; however, they are predominately focused on concerns of those over the age of 65—the age for Medicare eligibility.
Patients Transferred to Hospitals Unreported
Often when these surgical procedures have complications patients are transferred to a local hospital. Many of these also are going unreported. One more well-known such case involved Joan Rivers who underwent a procedure on her vocal cords and was rushed to the hospital and died one week later. The Kaiser Health & USA Today report cited several ASCs which showed zero hospital transfers.
Local Maryland Surgeon
In 2001 Dr. Paul Mackoul, a Maryland OB/GYN surgeon, had his privileges at Washington Hospital revoked for what a staff committee said was “competence or conduct”. Mackoul later said that he had not been given a proper chance to defend himself. He has been a named defendant is approximately 14 lawsuits, where settlements were paid on his behalf at least four times. Dr. Mackoul and his wife later opened an ASC called Innovations Surgery Center in Rockville, Maryland which obtained Medicare approval—yet another oversight.
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