More than 5,600 outpatient surgery centers operate in the U.S. today. While many of the patients who undergo operations at these centers return home and recover safely, an alarming number suffer severe and even fatal complications. This raises serious questions about training, protocols, and medical mistakes at these surgery centers.
The Shift Toward Outpatient Surgery Centers
The number of outpatient surgery centers has grown in recent years as both health insurance companies and government Medicare and Medicaid programs seek to save money. Entrepreneurial physicians and surgeons also began steering patients toward surgery centers in which they own stakes.
The U.S. passed laws many years ago that prohibit doctors from referring patients to other businesses they own without disclosing their interests. So, if a patient appears to need an MRI, the doctor is legally obligated to tell that person they’re sending them to an MRI scanner at their own facility.
However, Congress granted an exception several years ago for surgery centers. A doctor can tell a patient they’ve scheduled a gallbladder surgery at their own center, and the patient doesn’t get a say in where the surgery takes place — nor do they know that the surgeon will benefit financially from scheduling the operation there.
The Wrong Patients at the Wrong Surgery Centers
On the face of it, conducting simple, routine procedures at outpatient centers appears to make sense. However, increasingly complex surgeries are being done at outpatient centers, and that raises the risk of complications. Historically, most surgeries occurred at hospitals so patients could spend the night or several days under observation during the critical post-operative period.
In many cases, the procedure being done at surgery centers is straightforward but the patient’s case is not. The sicker someone is and the more complicated their medical history, the greater the chance of post-operative challenges. Patients with underlying conditions require higher degrees of care, but they’re less likely to receive those at outpatient surgery centers.
Patients with underlying conditions require higher degrees of care, but they’re less likely to receive those at outpatient surgery centers.
Unlike hospitals, these centers close at night, which means patients must go home. Based on these constraints, there’s a tendency to cut corners and overlook potential problems. If someone can use the bathroom and keep down food, they’re often cleared for release. Then they’re in the care of their family members who have no medical training. While relatives may be loving and dutiful, they don’t know the signs of medical crises or how to deal with them.
It’s alarming how many times people die after coming home because no one understood the severity of their conditions. Often, family members say they knew the patient would be in pain, so they assumed their recovery was progressing normally despite their excruciating discomfort. Or they believed it was normal to be extraordinarily drowsy after anesthesia, so they let them sleep, never realizing something was wrong.
When surgery patients recover in hospitals, professionals are available around the clock and they are available to monitor when someone is in an inordinate amount of pain or shows abnormal post-op symptoms.
A Lack of Training and Equipment Leads to Tragedy
Another concern with outpatient surgery centers is the lack of appropriate training. Staff must be prepared to deal with post-op issues immediately, particularly related to anesthesia and bleeding. Unfortunately, most are poorly trained and end up calling 911 because they don’t know how to respond to routine post-op crises.
Patients are no better off at the surgery center than they are at home because they’re relying on 911 anyway. That’s a deeply disturbing fact that would likely horrify patients and their families, especially because it causes life-threatening delays in care.
If someone isn’t breathing, they need treatment immediately. By the time EMS personnel arrive at the surgery center, they might be dead or brain dead due to a lack of oxygen. But in a hospital, an attendant or nurse will call over the intercom for a crash cart team that can intubate patients who can’t breathe on their own.
That immediacy can make all the difference. We are currently representing patients who coded on the operating room table at outpatient surgery centers and the staff called 911. One patient died and the other suffered severe brain damage. Had they been at a hospital, the outcomes might have been different.
Surgery centers should always have arrangements with nearby hospitals so there’s a plan in place in case an emergency occurs. If a surgery center is three blocks from a hospital, the patient has a better chance of receiving life-saving treatment in time. But sometimes surgery centers are much farther from hospitals, and that distance, combined with poor training and a lack of proper equipment, can lead to tragic consequences for patients and their families.
Do You Have Grounds for a Legal Case Against an Outpatient Surgery Center?
To reiterate the core issues, there are two chief concerns with outpatient surgery centers: the lack of appropriately trained staff and equipment to resuscitate patients; and the tendency to “turn and burn” patients, sending them home despite early warning signs of potentially fatal complications.
If you or a family member suffered traumatic injuries due to substandard care at an outpatient surgery center, you’ll want to speak with an experienced legal team to find out if you have a case. The types of compensation you may be eligible for depend on the severity of the situation, and it’s wise to seek good counsel to help you work through the process.
The types of compensation you may be eligible for depend on the severity of the situation, and it’s wise to seek good counsel to help you work through the process.
Someone who survived an anoxic brain injury from a lack of oxygen is likely completely incapacitated and will require a lifetime of medical care, whether through home care or an institution. Others may have suffered mild brain injuries that leave them with diminished capacities, but they still may be able to care for their children or work part-time.
Getting compensation in either case is a complex process, because your lawyer will need to determine the extent of the injury’s impact. When we take on these cases, we seek input from neutral, highly qualified experts who create economic models of what a patient lost due to the injury. They also develop projections for what the person will need financially for the rest of their life. In wrongful death cases in which the victim was the family breadwinner, we look at economic models for how to replace the wage-earner and appropriately compensate the family.
Here’s how Van Wey, Metzler & Williams, PLLC approaches these cases:
- Understand the surgery center. We begin by looking at the type of surgery center and its certification. Different surgery centers are held to different regulatory standards, so we need to know which ones apply and what services they offer. Based on the types of procedures conducted at a center, it may be required to have certain numbers and types of personnel on staff, particular pieces of equipment, and other key safety measures in place. The first step is gathering this information to determine if the center was in compliance.
- Identify who owns the facility. We want to know whether the physicians involved in the procedure hold financial stakes in the surgery center.
- Collect patient medical records. We’ll then request that an appropriate expert review the patient’s records to determine what went wrong and whether it amounted to negligence.
- Explore legal options. In some cases, an out-of-court settlement is the most appropriate approach. However, sometimes proceeding directly to litigation and preparing for trial is the clear option. This stage depends on the circumstances of each case.
If a family member died from complications following surgery at an outpatient center, you should request an autopsy. The surgery center or doctor may refuse to do one, in which case you should arrange for a private autopsy. As the plaintiff, you carry the burden of proof in a wrongful death case. Your legal team must know the cause of death to determine whether you have a case and to build the suit on your behalf. However, requesting an autopsy should be your number-one priority, even before contacting a lawyer.
Once you’ve ordered the autopsy, you’ll want to contact a firm with a high degree of expertise in medical malpractice litigation. Most lawyers won’t charge you to investigate your case if they determine that potential negligence was involved in the injury or death. But it’s very important that you seek out lawyers with experience in the field because these cases are complex. A generalist will not know how to handle a medical malpractice case, so look for a firm with a proven record of pursuing and winning these cases.
By: Kay Van Wey | June 20th, 2018