State Turns Blind Eye to Appalling Conditions at Unlicensed Surgery Centers
The body count is mounting. California journalists have been documenting harrowing tales of patient harm and chaos in surgery centers that have been operating in a regulatory vacuum since mid-2007.
More than three years ago, a state appeals court handed a momentous victory to a doctor. He argued that he already had a license to practice medicine, so why should he need a second license to open a surgery center? The court ruled that he did not.
The state Department of Public Health interpreted the decision to mean that they will no longer accept complaints, undergo investigations or conduct inspections of hundreds of surgery centers in the state. That means the state no longer takes a close look at nursing services, infection control and other managerial standards in all but 45 of the state's outpatient surgery centers.
State authorities say they know of 715 such unlicensed facilities that perform plastic surgery, colonoscopies and knee surgery. Yet more might operate without the state's knowledge, public health spokesman Ralph Montano said. (Here is a list of those 45 licensed and 715 certified facilities. Further explanation below.)
The big question is this: Is it more dangerous to undergo surgery in a free-standing facility or in a hospital? Accidents happen everywhere. And state data that could answer the question is no longer being collected.
But there is mounting evidence that the state has a problem on its hands.
Molly Hennessy-Fiske of the Los Angeles Times wrote yesterday about Maria Garcia, a 39-year-old who bled to death after a procedure at an Anaheim Hills surgery center. The Medical Board of California later examined the case and accused Garcia's doctor of gross negligence.
Investigative reporter William Heisel also explored the same case in a series of columns published on the Reporting on Health website.
Hennessy-Fiske’s colleague, Michael Hiltzik, dedicated several columns earlier this year to the story of Willie Brooks Jr. Brooks, 35, died after seeking weight-loss surgery at a Beverly Hills surgery center. A coroner found that contents of Brooks’ stomach had leaked around his lap band and found that his death was caused, in part, by complications from the surgery, Hiltzik reported.
The San Diego Union-Tribune recently highlighted other alleged problems linked to a cosmetic surgeon working in a stand-alone facility. Dr. Jeffry Schafer, a Coronado cosmetic surgeon, is on probation with the medical board following accusations of gross negligence. The accusation says Schafer let a physician assistant perform surgeries and refused to see some patients who had complications.
Here is a startling excerpt from the state medical board accusation:
(Schafer’s) surgical suites and offices are cluttered and filthy and patients complained about this. (Schafer) walked around in bloody scrubs and there would be blood all over the floors and carpets. Food is left in areas where there are tubs of fat, and in areas where surgical dressing is applied on post-operative patients.
One of Schafer’s attorneys responded to the Union-Tribune, saying the allegations were "unproven claims of disgruntled former employees."
"Dr. Schafer continues his state-of-the-art practice at New Image Cosmetic Surgery Center, having performed thousands of cosmetic surgical procedures since 1978 using the best and most advanced technologies available," the attorney said.
A state inspection or two might shed more light on the claims about blood and tubs of fat, but that won’t happen anytime soon.
Despite the state Public Health Department’s effort to sponsor legislation [PDF] to fix the problem, lawmakers have not moved to restore the state’s legal authority to regulate surgery centers.
The hundreds of centers that are owned by doctors have also stopped, by and large, sending data to the state hospital finance agency. That department tracks whether patients die within 24 hours of a surgery. It also is used to collect data on whether they are transferred from a surgery center to an emergency room, another telling measure.
Surgery centers never sent quality data to Medicare officials, a standard expected of hospitals, nursing homes and even dialysis facilities. And the centers are not covered by state laws that mandate reporting of surgical errors.
As others have reported, many surgery centers are overseen by accrediting groups such as the Joint Commission. But as Hennessy-Fiske’s report says, those groups have no obligation to provide detailed information to the public. And if a center loses the seal of approval from one group, it can turn to another accreditation agency seeking a gold-star rating.
This Google document contains a spreadsheet that the California Department of Public Health provided to California Watch. The facilities with FAC_STATUS showing "licensed" are facilities that the state oversees, accepting complaints, conducting inspections and asking facilities to fix any problems.
Those that are "certified only" are not subject to state oversight. If you scroll to the right, you can see whether those facilities are accredited, and if so, by which agency. The Joint Commission is a Chicago-based group, the AAAHC is the Accreditation Association for Ambulatory Health Care, and AAAASF is the American Association for Accreditation of Ambulatory Surgery Facilities.