I think for anyone preparing for surgery is scary. There is a lot of changes to your diet, what type of medications you can take and preparing your home for post-operative care – all of which can be overwhelming. A recent article that I came across reminded me to make sure of another factor – what you should get clear about your surgeon’s schedule before the procedure occurs. Unfortunately, we see this happen litigating medical malpractice cases. Consequently, I thought it was important to make this issue known to our clients and potential clients. You need to know whether the surgeon supervising your procedure could be operating on another patient in another room, while your surgery is underway. Whether we like it or not, it happens all the time and in some cases – something can go terribly wrong.
In an effort to stop the medical errors that can occur from coinciding surgeries, the American College of Surgeons (ACS) put on new guidelines recently saying patients should be informed if the surgeon who’s doing a procedure is planning to manage another overlapping surgery. Even though these guidelines are persuasive, they’re not the law. Therefore, many say it’s common practice for patients to be unaware if the supervising surgeon is going to be out of the room for at least part of the procedure, performing surgery on another patient.
Although Centers for Medicaid and Medicare Services rules deal with procedures that overlap, the new ACS guidelines explicitly state “the patient needs to be informed” if an overlapping procedure is planned. The guidelines also distinguish between so-called overlapping procedures versus s coinciding surgeries in which the “critical” or “key” components of procedures a surgeon is managing overlap. “That’s not appropriate,” says ACS Executive Director Dr. David Hoyt. “Concurrent surgeries [are] something that should not be occurring.”
The critical components of a heart bypass surgery, for instance, would include sewing the arteries together, Hoyt says, while the initial incisions or final sutures of the procedure might not be considered critical. Similarly, placing a prosthesis would be a key component of joint-replacement surgery. Ultimately, the ACS guidelines say it’s the surgeon’s responsibility to determine what is and isn’t a critical component of the procedure, though, which has drawn criticism from some surgeons as well as Sen. Chuck Grassley, R-Iowa. He’s questioned publicly how the status quo would be changed by the new ACS guidelines, since they still allow the surgeon to determine what’s considered the critical part of the procedure.
CMS rules prohibit surgeons from overlapping critical parts of procedures. But some experts say surgeons have too much discretion in determining what’s critical – potentially leaving patients on the operating table in harm’s way.
Countering criticism that ACS guidelines don’t go far enough to provide guidance on what are key or critical components of surgery, Hoyt says most hospitals define parameters that surgeons have to practice within, and he reiterates that longstanding CMS rules forbid surgeons from managing operations where the critical parts overlap. “The American College of Surgeons cannot write a definition for the critical portion of every operation that exists, and there will be some variability depending upon who you’re working with,” he says – noting that a supervising surgeon will consider the level of training of a surgeon assisting in the procedure, for example. Ultimately, he adds, it’s the responsibility of the surgeon to take care of the patient. “So that can’t be relinquished,” Hoyt says.
Experts recommend that patients clarify what parts of the operation their surgeon will – and won’t – be in the room for. They think it is important for the physician who plans to essentially be two places at once to explain it to the patient, and make the patient comfortable, and make sure the patient’s knowledgeable about what’s going on. Then if a patient feels uncomfortable and would like the surgeon to be in the operating room for a greater portion of the procedure or the entire surgery, experts say the patient should voice those concerns and, if necessary, find another surgeon.
If you or a loved one has been injured as a result of medical negligence, contact us at Edwards & Ragatz for a free consultation. (904)399-1609, toll free (800)366-1609 or via our website at https://www.edwardsragatz.com
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