newlawsregulatesurgeryindoctorsoffices

New Law Regulates Ambulatory Surgery in Doctors’ Offices

The public may be surprised to learn that the circumstances under which doctors can perform surgery and provide anesthesia in their private offices is generally unregulated, allowing serious harm to go unreported. All that will soon change in New York State, which recently passed one of the nation’s toughest laws regulating surgery performed in private doctors’ offices.

I served as the consumer member of the state task force that proposed this new law. It requires all offices where surgery involving more than minimal anesthesia (e.g., local, topical anesthesia) is performed to be accredited by one of several national organizations selected by the commissioner of health. Such organizations develop and oversee safety standards and practices for office-based surgery. Among other things, these standards require an office to have appropriately trained personnel and the equipment to deal with emergencies.

Harm Must be Reported

Another important change brought by New York State’s new law is the requirement that surgeons report all serious adverse events related to surgery done in their office to the state health department. A growing number of other states, including Florida, California and New Jersey, have a similar requirement.

Mandating that doctors report serious patient harm is long overdue because there is almost no data on the comparative safety of the ten million (and growing) office-based surgeries estimated to occur each year. Some years back, a rash of disastrous office-based liposuctions was front page news in Florida and led to that state’s requirement of reporting of patient harm.

A 2003 analysis of these reports found the risk of patient harm was ten times greater for the same surgery done in private doctor offices, compared to outcomes in regulated surgery centers.

From a patient’s perspective, having surgery performed in a doctor’s office may appear to offer advantages. A private office may provide more attractive surroundings, greater convenience and for procedures not covered by insurance, less expensive. Furthermore, given what we know about medical errors and deadly infections running rampant in hospitals, avoiding an inpatient stay may sound like a good thing.

Those advantages pale, however, if patients cannot be assured that their surgeon’s office meets the same safety standards required of licensed hospitals and surgery centers. In the absence of such standards, for example, there may not be resuscitation equipment or trained personnel to deal with an emergency.

While no guarantee of a good outcome, hospital- based surgeons are at least required to provide some evidence of their training and competency to do specific procedures before they are permitted to operate in a hospital. And, in a licensed facility the administration of anesthesia and the monitoring of patients is normally the responsibility of a trained anesthesiology staff, not a surgeon doing double duty.

If you are considering having surgery in a private doctor’s office, check with your state health department to see if there are any laws regulating such practices and ,if so, that the office is in compliance. You should also ask your doctor if her/his office is accredited by a national accrediting body; if they have admitting privileges at a nearby hospital; and if they are currently permitted to perform the specific procedure you have scheduled at that hospital.