MARCH 2, 2018
The surgery went
fine. Her doctors left for the day. Four hours later, Paulina Tam started
gasping for air.
Internal
bleeding was cutting off her windpipe, a well-known complication of the spine
surgery she had undergone.
But a
Medicare inspection report describing the event says that nobody who remained
on duty that evening at the Northern California surgery center knew what to do.
How a
push to cut costs and boost profits at surgery centers led to a trail of death.
A team
of journalists based in California, Indiana, New Jersey, Florida, Washington, D.C., and Virginia worked to tell this
story in a partnership between Kaiser Health News and USA TODAY Network.
Christina
Jewett is a senior correspondent for Kaiser Health News. Mark Alesia is an
investigative reporter for the Indianapolis Star.
Reporters
pored through thousands of pages of court records and crisscrossed the U.S. to
talk to injured patients or families of the deceased.
For
more than a year, using federal and state open-records laws, reporters gathered
more than 12,000 inspection records and 1,500 complaint reports, as well
as autopsies and EMS documents and medical records, together forming the
foundation for this report.
In
desperation, a nurse did something that would not happen in a hospital.
She
dialed 911.
By the
time an ambulance delivered Tam to the emergency room, the 58-year-old mother
of three was lifeless, according to the report.
If Tam
had been operated on at a hospital, a few simple steps could have saved her
life.
But
like hundreds of thousands of other patients each year, Tam went to one of the
nation’s 5,600-plus surgery centers.
Such
centers started nearly 50 years ago as low-cost alternatives for minor
surgeries. They now outnumber hospitals as federal regulators have signed off
on an ever-widening array of outpatient procedures in an effort to cut federal
health care costs.
Thousands
of times each year, these centers call 911 as patients experience complications
ranging from minor to fatal. Yet no one knows how many people die as a result,
because no national authority tracks the tragic outcomes. An investigation by
Kaiser Health News and the USA TODAY Network has discovered that more than 260
patients have died since 2013 after in-and-out procedures at surgery centers
across the country. Dozens — some as young as 2 — have perished after routine
operations, such as colonoscopies and tonsillectomies.
Reporters
examined autopsy records, legal filings and more than 12,000 state and Medicare
inspection records, and interviewed dozens of doctors, health policy experts and
patients throughout the industry, in the most extensive examination of these
records to date.
The
investigation revealed:
·
Surgery centers have steadily expanded their business by taking
on increasingly risky surgeries. At least 14 patients have died after complex
spinal surgeries like those that federal regulators at Medicare recently
approved for surgery centers. Even as the risks of doing such surgeries off a
hospital campus can be great, so is the reward. Doctors who own a share of the
center can earn their own fee and a cut of the facility’s fee, a meaningful sum
for operations that can cost $100,000 or more.
·
To protect patients, Medicare requires surgery centers to line
up a local hospital to take their patients when emergencies arise. In rural
areas, centers can be 15 or more miles away. Even when the hospital is close,
20 to 30 minutes can pass between a 911 call and arrival at an ER.
·
Some surgery centers are accused of overlooking high-risk health
problems and treat patients who experts say should be operated on only in
hospitals, if at all. At least 25 people with underlying medical conditions
have left surgery centers and died within minutes or days. They include an Ohio
woman with out-of-control blood pressure, a 49-year-old West Virginia man
awaiting a heart transplant and several children with sleep apnea.
·
Some surgery centers risk patient lives by skimping on training
or lifesaving equipment. Others have sent patients home before they were fully
recovered. On their drives home, shocked family members in Arkansas, Oklahoma
and Georgia discovered their loved ones were not asleep but on the verge of
death. Surgery centers have been criticized in cases where staff didn’t have
the tools to open a difficult airway or skills to save a patient from bleeding
to death.
Most
operations done in surgery centers go off without a hitch. And surgery carries
risk, no matter where it’s done. Some centers have state-of-the-art
equipment and highly trained staff that are better prepared to handle
emergencies.
But
Kaiser Health News and the USA TODAY Network found more than a dozen cases
where the absence of trained staff or emergency equipment appears to have put
patients in peril.
Rekhaben
Shah trusted her care to a surgery center.
It may
have cost her her life, her family’s lawsuit contends.
And in
cases similar to Tam’s, upper-spine surgery patients have been sent home too
soon, with the risk of suffocation looming.
In
2008, a 35-year-old Oregon father of three struggled for air, pounding the car
roof in frustration while his wife sped him to a hospital. A Dallas man
collapsed in his father’s arms waiting for an ambulance in 2011. Another Oregon
man began to suffocate in his living room the night of his upper-spine surgery
in 2014. A San Diego man gasped “like a fish,” his wife recalled, as they waited
for an ambulance on April 28, 2016.
None of
them survived.
Spinal
surgery patient McArthur Roberson, 60, lost more than a quart of blood during
the operation and struggled to breathe after surgery, his family claimed in a
lawsuit. He died on the way home.
If he
“had been observed in a hospital overnight,” said Dr. Daniel Silcox, an Atlanta
spine surgeon and expert for the family in their lawsuit, “his death would not
have occurred.”
The
surgery center denied wrongdoing in the case, which reached a confidential
settlement in 2017.
https://khn.org/news/medicare-certified-surgery-centers-are-expanding-but-deaths-question-safety/?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=61068105&_hsenc=p2ANqtz-_fI5BYZ-O79HjlYKkqx7ZaEpm5n_oRz2FVYwfI_biH3vt4qp-Eqvm598CY5vAfeDIvWzA_2FEKRIw7s37wkUcPZ_I_CA&_hsmi=61068105
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