In recent years, there has been a significant increase in the number of surgeries conducted in private medical offices or surgical centers located outside of hospitals. This is especially true for surgeries that are minimally invasive. These surgeries are performed without hospitalization and with both local and general anesthesia. Such surgeries include everything from dental procedures to cosmetic surgery.
The procedure may not always be performed by a physician. It may be performed by a physician assistant or specialist assistant, in any location other than a hospital or ambulatory surgery center. Minor procedures and procedures performed with minimal sedation are not surgeries, so are not included in most definitions of office-based surgery.
Minor procedures are those that can be safely performed relatively easily and with minimal discomfort. In addition, complications that might require hospitalization are not likely. Procedures performed with only local or topical anesthesia, i.e. anesthesia applied only to the skin and not under the skin, are minor procedures.
Some of the medical procedures that are commonly done in a physician’s office are colonoscopies, endoscopies, knee arthroscopies, abortionss, micro laparoscopies, transvaginal retrievals of oocytes for in vitro fertilization, breast augmentations and reductions, abdominoplasties, liposuction, and other cosmetic plastic surgeries. Many of the procedures are for diagnostic purposes
Any person who is considering an office-based surgery should be careful about selecting the right provider for their surgery. In most states, office-based procedures conducted by physicians, dentists, or podiatrists are not subject to the same regulatory standards as in-patient procedures, even if the scope or complexity is the same.
Are There Any Advantages to OBS?
Some significant advantages to OBS have been identified. Some experts note the following benefits:
- Cost Savings: Additional costs or fees are added to hospital surgery, such as an operating room fee, an anesthesiology fee, medication fees and the like. These can quickly mount up making hospital surgery as much as 70% more costly than OBS;
- Time Savings: Scheduling a surgery in a hospital can be difficult and delays are a fact of life. This is why many doctors turn to OBS to perform the procedures they need to accomplish to serve their patients;
- Less Exposure to Infectious Diseases: One in 25 patients acquire infections while in hospitals each year. These infections may involve antibiotic-resistant bacteria and can be very harmful if not fatal to a patient. In-office procedures involve less risk of exposure to the bacterial infections that patients can acquire in hospital settings.
What Should I Look for In Choosing an Office-Based Surgery Provider?
Following California’s lead, a few states, including Georgia, Florida, New Jersey, New York and Texas have established mandatory accreditation requirements to ensure that the same safeguards exist for office-based surgical facilities as exist for in-patient surgical facilities in hospitals.
For example, New York state has enacted an “Office-based Surgery Law.” This law defines office-based surgery, so the type of surgical procedures to which it applies is clear. It requires private physicians’ offices in which OBS is performed to maintain accreditation from an accrediting agency sanctioned by the New York Commissioner of Health.
Accreditation is a voluntary evaluation process through which a person or institution is assessed and found to be qualified for some purpose. For example, colleges and universities seek accreditation from various institutions in order to assure students, and their parents, that the college or university is qualified to provide students with a college education.
It requires offices in which OBS is performed to report when patients who have had OBS in their offices experience negative consequences. Podiatrists must comply with the OBS law under certain circumstances. Physicians’ offices that want to perform OBS must comply with the OBS law as well as all other applicable statutes and regulations
To ensure that a person receives the highest level of treatment in terms of safety and quality, a person should ask their doctor for their accreditation information. Or, a person may contact an accreditation agency to confirm that their doctor has met all the requirements for accreditation. They can also contact their state’s department of health, or equivalent agency, to find out if the state regulates OBS and if so, how.
What If My State Does Not Regulate Office-Based Surgeries?
The American Medical Association and numerous state agencies have established factors that a person should consider when selecting an office-based surgery provider:
- General or Local Anesthesia: It is important for a person to know whether general or local anesthesia is to be used. Having a procedure that involves general anesthesia poses a greater risk than a procedure in which a local anesthetic is used, although some experts say that currently, even a general anesthetic is not highly risky;
- The Provider’s Level of Disclosure and Patient Consent: It is preferable to have a provider who discloses risks and asks a patient for consent to the procedure;
- Information Sharing: The information that the provider has given the person about the procedure is important. The more information a provider gives, the better. A patient should have the opportunity to ask questions and get answers;
- Accreditation in Resuscitation: A person wants to know whether the provider has advanced accreditation in resuscitative techniques. “Resuscitation” is a kind of medical procedure for correcting the physiological problem of a person who is in medical distress.
- For example, it could be restoring breathing in a person who is not breathing or restoring the heartbeat of a person who lacks a heartbeat. It is an important part of emergency and intensive care medicine. Examples are cardiopulmonary resuscitation to restore a person’s heartbeat and mouth-to-mouth resuscitation to restore a person’s breathing. Clearly, a person wants the provider of their surgery to have accreditation in resuscitation;
- The Provider’s Education and Training: A person wants to know what kind of education their provider has and what kind of training and experience in the specific procedure the person is going to have.
Even in states that do not have specific regulations for office-based surgical procedures, the practitioner must be licensed to practice the profession, e.g. medicine, and perform the specific procedure that a person is going to have.
It is important for a person considering this type of surgery to evaluate the qualifications of the person who is to perform the surgery. Specifically, a person would want to know their qualifications and accreditation.
For example, a person would want to ask if the surgery is going to be performed by a licensed physician who specializes in surgeries of the type to be performed. A person might reasonably hesitate to have a surgical procedure that is to be performed by someone who is not an experienced surgeon.
What If I Have Been Injured as a Result of an Office-Based Procedure?
Every health care provider owes a duty of care to their patients. Their care must meet the accepted standards of medical practice. This is the case whether or not a person’s state has established regulations for office-based procedures.
The health care provider must ensure their patient’s safety. Failure to meet these standards can be considered medical negligence and serve as grounds for a lawsuit for medical malpractice. If a person is injured as a result of the healthcare provider’s negligence, the person can sue.
Do I Need an Attorney?
If you or a loved one suspect that you have been injured by medical malpractice during an office-based surgery procedure, you should speak to a personal injury attorney immediately. Your attorney can analyze the facts of your case and determine whether a health care provider’s negligence caused the injury and how to obtain compensation for your losses.
