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How Safe are Ambulatory / Outpatient Surgical Centers?

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The first Ambulatory Surgical Center (ASC) opened its doors in 1970. The healthcare business magazine Modern Healthcare reports that there are now over 5,500 such facilities that have been certified by the Centers for Medicare and Medicaid Services as meeting the minimum standards required to receive payment directly from Medicare. While the majority of ASCs have patient safety records that equal or exceed those of hospitals located in the same geographic area, some facilities have exposed patients to unnecessary risks.

On this page the medical malpractice lawyer at The Doan Law Firm will begin a series of articles presenting an overview of why surgical procedures performed at ASCs may pose an unnecessary risk of serious complications or, in extreme cases, untimely deaths. In a companion article, he will review specific circumstances that could suggest medical malpractice.

What is an “Ambulatory Surgical Center”?

The Ambulatory Surgery Center Association defines an ASC, also known as an Outpatient Surgical Center (OSC), as:

"… a public or private facility, not a part of a hospital, which provides surgical or obstetrical treatment performed under general or regional anesthesia in an operating room environment to patients not requiring hospitalization."

The majority of ASCs / OSCs are privately-owned, for-profit, corporations that depend on referrals from the local medical community as their primary source of income. Since the physicians who perform procedures at a given ASC are typically shareholders in the facility, there is always concern that a physician’s choice of surgical or related diagnostic procedures could be influenced by his or her “return on investment.”

Collecting reliable data on the number of medical malpractice lawsuits where an ASC / OSC is named as a defendant or co-defendant is difficult because, until relatively recently, there was no legal requirement that these facilities report such data to a central agency or “clearinghouse.” In fact, as of December 2018, 17 states do not require ASCs / OSCs to report “adverse events” such as complications of surgery that require hospitalization or complications resulting in a patient’s death!

Despite this lack of readily-available data, earlier this year (2018) a study sponsored by Kaiser Health News and USA Today found that:

  • between 2013 and 2017 there were at least 260 deaths that were due to complications of procedures that were performed in “freestanding” (not physically connected to a hospital) ASCs / OSCs;

  • despite the fact that at least 14 patients had died from complications directly caused by their surgery, in 2015 and 2017 Medicare approved payment for many types of outpatient cervical spinal (neck) operations that had previously required at least an overnight hospital admission;

  • although sound medical practice principals and regulatory agencies require that ASCs /OSCs meet certain minimum standards regarding emergency care of surgical complications, there were many instances where ”emergency care” consisted of a call to 911 and transfer of a medically-unstable patient to a nearby Emergency Room, and

  • physicians who had a financial interest in an ASC/OSC tended to perform more diagnostic and/or surgical procedures than did physicians who utilized hospital-based outpatient services.

How can I learn about an ASC’s / OSC’s patient safety record?

In all honesty, the answer to this question is either 1) “You can’t” or 2) “Only with difficulty.” The reason for these answers is that there is no federal law or regulation requiring ASCs / OSCs to keep a record of surgical complications that are either treated “on site” or require emergency admission to a hospital. Even in those states that closely monitor the activities of ASCs / OSCs, this information is rarely available online or by written request.

Our advice is that you should first ask the health care provider who will be performing the procedure for information on the ASC/OSC’s safety record. If he or she is unable or unwilling to provide a satisfactory answer to your question, you should consider asking for a second opinion or postponing the procedure until you are satisfied that you will not be exposed to any additional risk of complications by having the procedure performed outside a hospital.

Contacting a medical malpractice lawyer

We have seen that, although the majority of ASCs / OSCs are just as safe as those operated by a hospital, there are some facilities (and physicians) that seem to be more concerned about profit and loss than with the well-being of their patients. Unfortunately, proving that an injury was the result of malpractice can be difficult and will require the services of an experienced medical malpractice lawyer.

If you suspect that you or a family member may have been a victim of medical malpractice that involves an ASC / OSC, we invite you to contact the medical malpractice lawyer at The Doan Law Firm, a nationwide medical malpractice and personal injury law practice with offices located in major cities throughout the country.

When you contact our firm to arrange a review of your potential medical malpractice lawsuit, your first consultation and review of the legal options that may be available to you is always free of charge and does not obligate you to hiring our firm. Should you later decide to file a lawsuit and that you would like for us represent you in court, we are willing to assume full responsibility for all aspects of preparing your case for trial in exchange for a percentage of the final settlement that we will win for you.

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