There are just over 5,600 federally accredited, Medicare-approved, surgical centers in the United States. Considered a more affordable, less-hassle option than having surgery performed within a hospital, patients should be aware of the risks involved, including the inability of their medical team to save their life in case of an emergency.
Without a federal database that tracks the number of adverse events or number of deaths during or immediately following procedures at these facilities, little is known about the outcome of surgeries performed there. In years past, the only negative chatter surrounding surgical centers seemed to be news stories of botched procedures performed at plastic surgery centers by unskilled medical professionals or those masquerading as one. It wasn’t until 2014 and the death of Joan Rivers at a New York City surgical facility that many realized these facilities were often ill-equipped to handle medical emergencies, despite numerous doctors and surgeons being on site. This month, a joint Kaiser Health News (KHN) & USA Today investigation revealed that at least 260 people have died since 2013 after having a routine procedure performed at a surgical center in the United States.
Joan Rivers Case Highlights Surgical Center Flaws
The key differences between having a surgery performed within a hospital is the training of staff in CPR and life saving techniques, as well as the availability of critical life saving equipment, such as defibrillators and equipment needed to open a patient’s airway. Hospitals and outpatient surgical centers are required to have crash carts stocked with a routinely monitored inventory of critical life saving drugs and equipment. Regulatory agencies require hospital staff who work on many units to be fully trained in the use of such equipment, but the same rules do not apply to surgical centers. So while the equipment to save a patient’s life might be physically available while having an outpatient surgery, a surgeon or anesthesiologist may not feel comfortable actually using it. In fact, the standard protocol for outpatient surgical centers is to dial 911 in case of emergencies. In a hospital, a code would be called and within seconds a team of trained clinicians would be in the room attempting resuscitation of a patient.
In the case of Joan Rivers and Yorkville Endoscopy, she was undergoing a routine endoscopy after complaining of hoarseness in her voice. Her personal specialist, an Otolaryngologist (or ENT), was in the room, as well as the surgeon (the owner of the clinic) and an Anesthesiologist. According to the clinic’s own policy, Joan Rivers’ personal doctor was not licensed to perform procedures at Yorkville Endoscopy, yet was permitted to start a different procedure than Joan Rivers had consented to. After the unauthorized procedure was finished, her personal doctor went on to perform the initially agreed upon laryngoscopy, despite objections from the anesthesiologist, who was having trouble controlling some of Ms. Rivers’ vitals. She eventually coded, with none of the staff attempting CPR or other life saving measures because they didn’t feel comfortable doing so. They called 911, and an ambulance arrived in less than 15 minutes. However, at that point Ms. Rivers had gone without oxygen for too long and ultimately died of complications from cardiac arrest a week later.
Had Joan Rivers had her endoscopy performed within a hospital, she would not have had her personal physician performing an unauthorized surgery, but instead a skilled, highly-trained surgeon with extensive experience in laryngoscopies. She also likely would not have been forced into a second procedure, the one she actually consented to, after being under anesthesia for so long with obvious complications. In the extremely unlikely event that she still coded, she would’ve been immediately attended to by experts in CPR and advanced cardiovascular life support measures.
Riskier Surgeries Equal Bigger Profits
USA Today/KHN point out that there are other shortcomings to surgical centers than just staff minimally trained in life saving techniques. Journalists found multiple instances of deaths arising from going ahead with procedures on those with underlying conditions that made surgery an even riskier proposition than it already is. Several cases uncovered by KHN and USA Today found that some patients were visibly in distress post-procedure and were still sent home with little, if any, post-op instructions, including one who had to travel hours home in a car across isolated roads. The patient died on her ride home.
According to many experts, surgical centers are taking on more and more procedures, including those that are difficult, because riskier, more complicated surgeries are often worth more. In fact, many of the surgeons at these facilities are actually co-owners, meaning in addition to a nice salary, they are also earning money per procedure, something many physicians would argue poses an ethical dilemma. Nancy Epstein, a board-certified Neurosurgeon at NYU Winthrop Hospital who specializes in spine surgeries told USA Today that surgical centers performing spinal surgeries and allowing a patient to be discharged the same day is “pretty revolting.”
With any surgery, the benefits should always outweigh the risks. A thorough pre-op examination should address any underlying health issues that may complicate a typically routine surgery performed under anesthesia. In these instances, we rely on our doctors to let us know if it is in our best interests to have a procedure. If the procedure is advised, we also seek our doctor’s counsel on where it should be performed – either at a surgical center or within a hospital, surrounded by those trained to handle complications that may arise. Still, since 1993 it has been legal for doctors to guide patients to surgical centers in which they have a vested interest. You must always take your doctor’s advice under consideration while acting as your own advocate. It’s important to ask yourself: Does convenience matter more than anything else? If something were to go wrong while you were under anesthesia or upon waking from the surgery, would you be comfortable knowing you’d be waiting for an ambulance to transport you to a hospital?
Chicago’s Surgical Error and Medical Malpractice Attorneys
Since 1992, we have become one of the most widely-known and respected medical malpractice law firms in Illinois, achieving multiple million dollar verdicts and settlements for those who have been injured and killed as the result of medical and surgical errors. If a loved one has sustained serious injuries or death resulting from an anesthesia error, surgical error, or other medical oversight, you may be entitled to compensation.
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