Outpatient Surgery Procedures Have High Death Rate
27 Jul 2007
Statement By The Florida Society Of Anesthesiologists On The Florida Board Of Medicine's Office Surgery Rule
Statement Issued by The Florida Society of Anesthesiologists, Inc.
Tallahassee, FL - Aug. 7, 1999 - The Florida Society of Anesthesiologists opposes the office surgery rule because it fails to protect patient safety. Patient safety must be ensured by requiring the same high standards for surgery performed in physicians' offices as the state requires for surgery performed in hospitals and ambulatory surgical centers. This rule fails to do that, and that is inexcusable.
The patient safety issue was called to the public's attention when the Fort Lauderdale Sun-Sentinel published a series of articles in December 1998 that documented an unacceptably high rate of deaths and injuries resulting from cosmetic surgeries performed in physicians' offices. The newspaper reported that at least 34 people have died following cosmetic surgery in Florida since 1986. There have been at least 18 deaths since 1997.
In acting on its rule, the board failed to investigate the deaths that have occurred. That puts it in the untenable position of proposing solutions without understanding the causes of the problem, an effort that's doomed to failure. Amazingly, the board failed to consider during its rule-making process cases in which it had initiated disciplinary proceedings against two cosmetic surgeons involved in patient deaths. The rule would set weaker standards than the standards the board adopted in those disciplinary cases. The FSA reviewed nine recent deaths and determined that five were attributable to anesthesia-related complications. The national rate for anesthesia-related deaths in outpatient surgery is about 1 in 400,000. But in Florida the rate is about 1 in 8,500 office surgeries.
The proposed rule fails to require adequate safeguards when anesthesia is administered in office surgeries. In fact, it would result in a double standard, strict safeguards when surgery is performed in hospitals and ambulatory surgery centers and minimal standards that fail to protect patients during office surgery. The strict standards the state enforces when a patient undergoes cosmetic surgery in a hospital disappear when a patient undergoes the exact same procedure in a cosmetic surgeon's office. This is not only illogical; it's dangerous. Anesthesia is anesthesia, and strong patient safety standards should be required wherever it is used.
In hospitals and ambulatory facilities anesthesia is administered either by or under the direct supervision of an anesthesiologist who has at least 12 years of post-secondary education and has extensive medical training in his or her specialty. When cosmetic surgery is performed in a physician's office it is frequently administered by a nurse anesthetist under the supervision of the operating surgeon who may have no training or experience in the administration of anesthesia. Nurse anesthetists have typically completed a two-year training program after they receive their nursing credentials. Most hospitals do not permit cosmetic surgeons to supervise administration of anesthesia because they are not adequately trained for that responsibility. The rule should require anesthesia in office surgeries to be administered either by or under the supervision of a fully qualified physician, preferably an anesthesiologist, who is trained to respond to medical emergencies. Instead, it jeopardizes patients by failing to ensure the presence of properly trained personnel and appropriate equipment to respond to emergencies during office surgeries.
Because the rule fails to deal effectively with patient safety issues, the FSA has challenged it before the Division of Administrative Hearings. The FSA is seeking a declaration that the rule is invalid. Florida's three major hospital associations have also challenged the rule because it fails to protect the safety of patients. Instead of enhancing patient safety, the hospitals said, the rule would result in poorer care and less oversight.
For additional information contact John C. Van Gieson, 850-681-6505 or 850-566-6423.
