At the present time, 25% of all surgery in this country is done in an office setting. According to experts, it will continue to rise in numbers. We are not just talking about cosmetic and dental surgery that has been done in offices for 20 plus years. Already, surgical procedures as inguinal hernia repairs, hemorrhoidectomies, liposuction, and breast augmentations are done in office settings. In the near future this list is expected to broaden to include abdominal and vaginal hysterectomies, laparoscopic gallbladders, diagnostic laparoscopic surgery, mastectomies, lumbar and cervical diskectomies, anterior cruciate ligament repairs, and ENT procedures to name a few.
What makes office-based surgery potentially a high risk is that, as of this writing, only 23 states have any type of standards or guidelines in place to attempt to ensure that the quality of care in office-based surgery will be equal to that in an ambulatory surgery center or a hospital. These states include, AL, AZ, CA, CO, CT, FL, IL, KS, LA, MA, MS, NJ, NY, NC, OH, OK, OR, PA, RI, SC, TN, TX and VA.
Once the office door is closed, what goes on behind closed doors is the sole business of that surgeon. Consequently, there is no ongoing quality control or peer review processes taking place in that office similar to what are required in every hospital and outpatient surgery center in this country. Without these two processes, the state and national accreditations that are required for these medical facilities to operate would be withheld.
Three particular areas of concern for office-based surgery standards seem to be creating the most controversy at the present time. Even states with standards already in place may not have properly addressed these issues. These areas are the following:
1. Requiring surgeons to have privileges in a nearby hospital or outpatient surgery center to do the same procedures that will be done in the office setting. (Inadequate training, improper competency, or difficulties with the surgery and/or patient care are reasons why privileges may have been either withheld or put on probation.)
2. Requiring surgeons' offices to be accredited by one of the three national accrediting organizations or certified by Medicare. (The common objection given here is cost. Physicians don't want to spend the money to bring their offices into compliance with national accrediting standards.)
3. Requiring an Advanced Cardiac Life Support (ACLS) certified physician, not just a practitioner, to remain in the office setting until the last patient is ready for discharge from the facility. In November 2003, the American Medical Association's (AMA) Board of Directors unanimously passed 10 Core Principles governing office-based surgery to ensure quality of care. Three of these principles included the above three requirements.
As a medical consumer, it is important that you ask key questions and receive complete, respectful answers before you EVER sign a consent for office-based surgery. You do not have to have your surgery in an office-based setting. You have other options. These are your patient rights! Your medical condition may make you a very poor risk for surgery in an office setting. At the present time, insurance companies cannot force you to have your surgery in an office setting. Know your rights! Know the risks involved for your surgery in an office setting.
KNOWLEDGE IS YOUR BEST DEFENSE TO HELPING PREVENT A MEDICAL DISASTER FOR THIS TYPE SURGERY!
Posted February 26, 2008 by Frederick W. Ernst, M.D.
A graduate of the University of Michigan, Dr. Ernst received his medical degree from Ohio State University, is certified by the American Board of Anesthesiologists and has been a practicing Anesthesiologist for over 40 years. Most recently, he has worked for 15 years as Medical Director at two Alabama outpatient surgery centers.
For the past 12 years, Dr. Ernst has served as a legal consultant and an expert witness for both plaintiff and defense counsel in medical malpractice cases.
He is a renowned national speaker discussing medical consumer issues that go to the heart of America's health care system and the co-author of Now They Lay Me Down To Sleep--What You Don't Know About Anesthesia and Surgery May Harm You and his new book Truth, Lies, and the O.R. - The Good, The Bad, and the Realities.
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