RGJ.com: = In-office surgery ignored by state

NEWS

Local = News Weather Obituaries Nation and World Today's=20 Photos Decision 2008 Special=20 Reports

COMMUNITIES

Neighborhoods=20 Announcements / = Weddings Cars= on=20 Times Spar= ks=20 Today Truckee = Times=20 Fall= on Star=20 Press Mason Valley = News Fernley Leader Dayton Courier Douglas Times

SPORTS

Toda= y's=20 Sports = High School=20 Sports Wo= lf Pack=20 NEW=20 Skiing Sports = Columnists

BUSINESS

Today's= =20 Business Stocks eTechnology=20

VOICES

Today'= s=20 Voices Your Voice Columni= sts Blo= gs Send = Letter to the=20 Editor

ENTERTAINMENT

Today's= =20 Entertainment Events = Calendar=20 Comics Sudoku Eatin= g Out=20 Movies = Music=

LIVING

Today's= Living=20 Food = &=20 Drink Heal= th RENO Magazine

OUTDOORS

Fi= shing and=20 Hunting

CUSTOMER SERVICE

MOBILE NEWS & EMAIL

Email = Editions = RSS=20 Headline Feeds RGJ.= com=20 Mobile Mobile Text Alerts =

=20

Back = one=20 page Email a friend Del.icio.us Printer=20 friendly version

In-office surgery ignored by state

FRANK X. MULLEN JR. = AND JASON=20 HIDALGO
RENO GAZETTE-JOURNAL =
Posted: 3/9/2008 =

3.0 earthquake shakes Mogul area Battle brews over beer ban at Mackay Stadium Opera house ready for another rebirth Four arrested after fights at Tahoe high school Trial allowed to proceed in rape, killing of Sparks girl = Family, friends mourn death of Nevada soldier, wife =

Most free-standing surgical centers go six years between state = inspections.=20 In some cases, Nevada falls far short of even that federal goal.

Even when a center is inspected and deficiencies are found, = inspectors=20 usually don't return to the facility to make sure changes have been = made.

And unlike some other states, Nevada doctors who do surgical = procedures in=20 their offices don't need office surgery licenses and face no health = inspections=20 at all.

Some doctors and other health care experts say that's an invitation = to the=20 kind of unsafe practices now under scrutiny in Las Vegas, where a = surgical=20 center using unsanitary anesthesia practices allegedly caused at least = six=20 patients to contract hepatitis C. Since then, state officials found that = three=20 surgical centers in Northern Nevada also were using unsafe = practices.

They said the lack of regulation is a prescription to allow unsafe = practices=20 to fester for years before they are discovered. That leaves thousands of = patients at risk.

About 40,000 patients of the Las Vegas clinic have been notified that = they=20 should be tested for hepatitis and HIV.

"We hope the state becomes more involved in providing oversight," = said=20 Jovanna Lee, who serves on the boards of the Nevada Ambulatory Surgery = Center=20 Association and the national Ambulatory Surgery Center Association. "We = welcome=20 that. What's happened (in Las Vegas) really hurts our image. The reality = is=20 that, nationwide, the infection rate is less than 1 percent.

"What happened is unfortunate. We don't really understand how = somebody puts=20 practices like that into place."

Inspections rare in state

State records show the Endoscopy Center of Southern Nevada, which was = shut=20 down two weeks ago for reusing vials of anesthetic and plastic syringes, = had not=20 been inspected by state officials since 2001. Other ambulatory surgery = centers=20 contacted last week said they had not seen a state inspector in more = than six=20 years.

Nearly all of Nevada's stand-alone surgical centers are approved for = the=20 Medicaid/Medicare programs, and so the federal government, not the = state, makes=20 recommendations about how often they should be inspected.

"This year, the federal recommendation is for inspections every six = years,"=20 said Martha Framstead, spokeswoman for the Nevada Division of Health. = "They make=20 recommendations yearly based on funding."

In Nevada, as in 24 other states, ambulatory surgical centers must be = accredited by a national accrediting organization. Most are certified by = the=20 Accreditation Association for Ambulatory Health Care, records show.

The AAAHC does on-site "surveys" of centers every three years unless = previous=20 violations require a more frequent schedule.

"The AAAHC usually arrives unannounced and it's a pretty rigorous = survey,"=20 Lee said.

Dr. John F. Gray of Gastroenterology Consultants in Reno and Carson = City,=20 whose facilities were inspected by the state last week and passed = without=20 violations, said the AAAHC conducts an "intense reaccredidation process" = that=20 acts as an extra quality-assurance program.

"Inspection is good for us," he said. "Our first obligation is to do = no=20 harm."

He said the industry would welcome more oversight if it were offered, = but=20 said he doesn't think the lack of state inspections affects the quality = of most=20 surgical centers.

"To me, the real problem that goes unrecognized is endoscopy and = other=20 procedures that happen in some doctors' offices, and those aren't even = being=20 looked at by the state," Gray said. "Medicare also provides financial = incentives=20 to doctors to do endoscopies and colonoscopies in their offices.

"I think that's a perverse incentive."

Some states, such as New York, require doctors to obtain a = "certificate of=20 need" to do such procedures in their offices. Those states regulate = office=20 surgeries the way free-standing surgical centers are now regulated.

The need for strengthened quality oversight for office-based surgery = has=20 grown as the number of increasingly complex surgical and invasive = procedures=20 performed in doctors' offices has more than doubled in the last decade, = with=20 nearly 10 million surgical procedures performed annually in office-based = settings nationwide since 2000, according to the Joint Commission, a = health care=20 facilities accreditation agency.

Problems fester for years

In Nevada, the surgical centers are almost ignored by state = officials.

The Nevada State Health Division's Bureau of Licensure and = Certification is=20 supposed to do one initial inspection for a new ambulatory surgical = facility,=20 followed by routine surveys every three years. The rules are different, = however,=20 for ambulatory surgical centers that accept Medicare patients. Based on = an=20 agreement with Medicare, such centers only need to be inspected every = six=20 years.

According to the bureau, only three of the 19 ambulatory surgery = centers in=20 Northern Nevada don't take Medicare patients: Reno Orthopedic Surgery = Center,=20 Eye Surgery Center of Northern Nevada in Reno and New River Surgical = Arts in=20 Fallon.

That means the overwhelming majority of ambulatory surgical centers = in=20 Northern Nevada are only inspected every six years based on guidelines = set by=20 Medicare.

"These facilities basically aren't surveyed unless CMS (Centers for = Medicare=20 and Medicaid Services) asks us to do so," said Pat Andrews, a health = facilities=20 surveyor for the Bureau of Licensure and Certification. "It's a matter = of=20 funding, and Medicare sets up the criteria for how often they need to be = inspected. Since we have a contract with Medicare, we have to follow = what they=20 say as far as what time to go back (to survey these facilities)."

The length between inspections makes it difficult to determine = whether=20 deficiencies that are found are part of an ongoing trend.

"If a deficiency involves standard procedure and they've been doing = it wrong,=20 that usually means that they've been doing it for a long time," Andrews = said.=20 "But it could also mean it's a one-time thing. You just don't know."

Besides the long gap between inspections, facilities that get cited = for=20 deficiencies usually don't get a return visit. In most cases, centers = with=20 deficiencies are given 10 days to come up with a plan to address the=20 deficiencies. Even if the bureau approves the plan, it doesn't require = surveyors=20 to return to the facility to verify that it's being followed.

The only exception involves deficiencies that either require = documentation or=20 are so egregious that they directly affect patient safety, Andrews said. = One=20 example is infection because of failure to ensure that equipment is = being=20 sterilized properly.

"That would likely lead to a cease and desist and some sort of = sanction,"=20 Andrews said.

Centers not a priority

"From a licensure standpoint, they're not one of the higher priority=20 facilities that we're required to go in on an annual basis," Andrews = said.=20 "Nursing homes are inspected on an annual basis. Intermediate Care = Facilities=20 for the Mentally Retarded are also required by the federal government to = be=20 inspected annually. Annual inspection of group care facilities is = mandated by=20 the Legislature.

"But we do go in and inspect (ambulatory care centers) if there's a = complaint=20 or if something happens like what just happened in Las Vegas."

The situation in Las Vegas, potentially affecting up to 40,000 = patients, has=20 made headlines around the world.

State officials in part blame limited funding for their failure to = meet even=20 the six-year goal, but critics said putting patients at risk for = financial=20 reasons isn't acceptable anywhere.

Lawrence F. Muscarella, director of research and development and = chief of=20 infection control for The Q-Net Monthly, Custom Ultrasonics, Inc., said = money=20 woes and personnel deficiencies promote poor health care practices.

"This debacle in Nevada is another example of failed oversight by = regulatory=20 authorities," he said. "... It will probably turn out that the state of = Nevada=20 will claim, too, that it was unable to inspect the facilities in = question more=20 often, as patient safety requires, due to limited resources.

"These are not legitimate excuses. Either do the job right, or get = out of the=20 business."

Muscarella said the only guarentee of patient safety in health care=20 facilities is fair and balanced oversight.

"My experience suggests that the organizations and agencies that = perform=20 these inspections are often biased and act more according to political = pressure=20 and legal maneuvering than to hints that something may be amiss and a = disaster=20 is about to happen," he said.

In Nevada, disaster brought quick action.

Staff members of some northern Nevada surgical centers said they = welcomed=20 last week's emergency inspections.

"We haven't seen a (state) inspector in six or seven years," said = Mable=20 Guerrero, administrator at the Great Basin Surgical Center in Elko. = "When we=20 heard about the Las Vegas situation, we couldn't see how that could = happen."

She said the news made her center re-examine all its procedures.

"We found that we're clean, but one thing we decided is to no longer = use=20 multi-dose vials," Guerrero said, referring to the larger vials of = anesthetic=20 that the Las Vegas clinic workers were using with reused syringes and = thus=20 spreading infection from patient to patient.

"We weren't doing what they were doing, but we decided to go with the = single-dose vials so that could never happen here," she said. "It's a = little=20 more expensive, but what's more important, saving a few dollars or a = patient's=20 health?"

Story Chat

This = article does=20 not have any comments associated with it

Back = one=20 page Email a friend Del.icio.us Printer=20 friendly version

Try=20 home delivery of the Reno Gazette-Journal & get your FREE 20% off = dining=20 card.

CLASSIFIEDS

=20

Jobs	=BB=20 Find a Job =BB=20 Resumes http://www.careerbuilder.com/Jo= bs/Company/C8C3N46156QF1084MBZ/Reno-Gazette-Journal-Reno-NV/?lr=3Dcbga_rg= j

Cars	=BB New = Cars =BB Used = Cars =BB=20 Car Dealers

Real=20 Estate	=BB=20 Classifieds =BB=20 6,585 Active Agent Listings

Apartments	=BB=20 Apartments =BB=20 Homes & All Other Rentals

Shopping	=BB = Shop=20 Locally =BB=20 Coupons

Classifieds	=BB=20 Classified =BB Ad = Builder

Calenda= r	=BB Things to=20 do =BB = Movie=20 Listings

Dating	=BB Search=20 =BB My=20 Profile

=20

YELLOW PAGES

Keyword

Business Category
Agriculture =20 = Community & Recreation Construction & Materials Education Finance =20 = Personal Care & Services Real Estate Shopping

Popular Searches =

Restaurants=20

Coffee=20 joint=20

Family=20 dentist=20

Shopping=20
=BB All=20 Yellow Pages

NEWS

COMMUNITIES

SPORTS

BUSINESS

VOICES

ENTERTAINMENT

LIVING

OUTDOORS

CUSTOMER SERVICE

MOBILE NEWS & EMAIL

TOP 10 EMAILED ARTICLES

CLASSIFIEDS

YELLOW PAGES

=A9 Copyright Reno=20 Gazette-Journal, a Gannett Co. = Inc.=20 Newspaper.
Use of this site signifies your agreement to the Terms of = Service and=20 Priv= acy=20 Policy, updated June 7, 2005.

NEWS

COMMUNITIES

SPORTS

BUSINESS

VOICES

ENTERTAINMENT

LIVING

OUTDOORS

CUSTOMER SERVICE

MOBILE NEWS & EMAIL

TOP 10 EMAILED ARTICLES

CLASSIFIEDS

YELLOW PAGES

=A9 Copyright Reno=20 Gazette-Journal, a Gannett Co. = Inc.=20 Newspaper.Use of this site signifies your agreement to the Terms of = Service and=20 Priv= acy=20 Policy, updated June 7, 2005.

=A9 Copyright Reno=20 Gazette-Journal, a Gannett Co. = Inc.=20 Newspaper.
Use of this site signifies your agreement to the Terms of = Service and=20 Priv= acy=20 Policy, updated June 7, 2005.