View as “PDF version”
Patient Safety Tip of the Week
July 9, 2024
Overlapping
Surgery Proves Costly
We’ve argued the
many issues surrounding overlapping surgery in our many columns listed below.
Now, overlapping surgery has proved very costly to a renowned Texas cardiac
surgery center. The Department of Justice announced that Baylor St.
Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM) and Surgical
Associates of Texas P.A. (SAT) have jointly agreed to pay $15 million to
resolve claims they billed for concurrent heart surgeries in violation of
Medicare teaching physician and informed consent regulations (DOJ
2024).
The investigation began in 2019 after a whistleblower complaint
that 3 surgeons routinely performed multiple procedures simultaneously over a
7-year period from 2013 through 2020. The suit alleged the surgeons often ran
two operating rooms at once and failed to attend the surgical “timeout” in some
cases. Additionally, surgeons would allegedly enter a second or occasionally a
third operation without designating a backup surgeon. It also alleged the
surgeons falsely attested on medical records they were physically present for
the “entire” operation and that medical staff did not inform patients the
surgeon would be leaving the room to perform another operation.
The Washington Post notes that, while the federal
investigation focused on three doctors, the complaint alleges that at least 10
other cardiovascular surgeons at Baylor engaged in varying levels of surgery
overlaps “as a standard practice” (Somasundaram
2024).
The $15 million recovery is the largest settlement to date
involving concurrent surgeries. The whistleblower apparently will receive about
$3 million from the settlement.
We hope that
hospitals performing or considering overlapping surgery review our “Overlapping
Surgery Checklist”. That checklist contains many items that hospitals often
fail to consider in their decisions to allow overlapping surgery. Also, our December 19, 2017 Patient Safety Tip of
the Week “More on Overlapping Surgery” had our detailed comments on the following
considerations for overlapping surgery:
·
The
“Critical Part of the Surgery”
·
Timeouts
·
Post-Procedure
Debriefing
·
The
Pre-op “Huddle”
·
Duration
of surgery
·
Other
Infection Control Issues
·
Definition
of “Immediately Available”
·
Multitasking
·
The
educational/training mandate
·
The
Ethical Issue(s)
·
Who
Should Be Allowed to Perform Overlapping Surgery?
·
Monitoring
Overlapping Surgery
It’s obvious we are
not fans of overlapping surgery. We recognize that part of our job in teaching
hospitals is to train surgeons and other physicians to be able to practice
independently. That obviously requires graded autonomy. But the issue comes
down to transparency. If a patient is expecting that the attending surgeon will
be performing the entire surgery or at least be present in the OR for the
entire surgery, the informed consent must clearly specify anything to the
contrary.
See our previous
columns on double-booked, concurrent, or overlapping surgery:
·
November
10, 2015 “Weighing in on Double-Booked Surgery”
·
November 29, 2016 “Doubling
Down on Double-Booked Surgery”
·
December
13, 2016 “More
on Double-Booked Surgery”
·
May 2017
“The
Concurrent Surgery Debate Continues”
·
December
19, 2017 “More
on Overlapping Surgery”
·
March
12, 2019 “Update on Overlapping
Surgery”
·
December
3, 2019 “Overlapping Surgery Back in
the News”
·
April
2022 “Overlapping Surgery Back in
Focus”
And our “Overlapping
Surgery Checklist”
References:
DOJ (Department of Justice). Texas medical center
institutions agree to pay $15M record settlement
involving concurrent billing claims for critical surgeries. Press Release U.S.
Attorney's Office, Southern District of Texas 2024; June 24, 2024
Somasundaram P. Heart surgeons left ‘unqualified’ trainees
alone during operations, DOJ says. Washington Post 2024; June 27, 2024
https://www.washingtonpost.com/nation/2024/06/27/texas-baylor-surgeons-concurrent-surgeries/
Print “PDF version”
http://www.patientsafetysolutions.com/