Surgery at an Ambulatory Surgery Center—Know the Risks

By Aitken Aitken Cohn

Until about 50 years ago, surgery took place in a hospital. The first Ambulatory Surgery Center or “ASC” opened in 1970 in Phoenix, AZ. Also known as an outpatient or same-day surgery centers, there are now more than 5,600 Medicare-certified ASC facilities nationwide.

ASCs offer several advantages for patients in terms of cost, convenience, and comfort. Designed as an alternative to hospitalization for minor, routine procedures that don’t typically require an overnight stay, these centers can provide financial savings, greater freedom in scheduling, and the opportunity to recover at home.

Most operations at outpatient surgery centers are thriving and without complication. And it’s important to note that all surgery, no matter where it’s performed, carries some risk.

However, recent investigations of ASCs, including a 2018 joint report by Kaiser Health News and USA Today, have turned up some significant safety concerns for patients.

Surgery centers may be less prepared than hospitals to handle an emergency.

ASCs don’t have the same legal requirements as hospitals concerning staffing and equipment. While hospitals are well-equipped for a crisis, skilled in handling trauma, and can respond rapidly, not all surgery centers are prepared to manage emergencies.

Each year, thousands of 911 calls are made from surgery centers when a patient has complications, from minor to life-threatening, and the center cannot handle the situation.

Although Medicare requires that ASCs have hospital transfer arrangements for such emergencies, it may be 15 or more miles away. Even in cities, 20-30+ minutes can elapse between the 911 call and arrival at an ER.

The Kaiser/USA Today report found that 260 patients—most having routine procedures, and some as young as 2-years-old—had died under such circumstances between 2013 and 2018.

More troubling still, the actual number of fatalities is unknown due to lack of reporting and uneven regulation—in 17 states, ASCs are not required to report deaths.

Same-day surgery centers often keep regular business hours.

Unlike a hospital staffed 24/7, surgery centers often run like a standard “9-to-5” office. Patients who are seen later in the day may be at greater risk of being sent home without thorough observation, and those who run into post-op trouble after hours may be unable to return to the center.

The ASC model has exploded partly through practices that some medical professionals find worrisome.

Advances in surgical procedures, anesthesia, and pain management have broadened the scope of outpatient surgery. In recent years, ASC services have expanded to include inherently riskier procedures such as complex spinal surgery.

Further, in some cases, it appears that ASCs do not turn away patients who, due to underlying health concerns, are at higher risk for complications and, therefore, not good candidates for surgery outside a hospital setting.

Many surgery centers are physician-owned, and federal law allows doctors to refer patients to surgery centers where they have a financial interest. Having a financial incentive may encourage surgeons to take on more patients and procedures at their facilities.

The study reveals concerns about standards.

In 2019, an analysis of state surveys of ASCs by the US Department of Health and Human Services’ Office of Inspector General found that 77% had at least one violation and a quarter had serious deficiencies; the most frequently cited issue was infection control.

So, what should you do if you’re considering an Ambulatory Surgical Center for an upcoming procedure?

Be an informed patient. Ask questions about your procedure. Read reviews of the center. Don’t hesitate to get a second opinion and comparison-shop facilities. Does the surgical center have emergency equipment such as a crash cart? What happens in the event of complications? What is the procedure? Should you need to be transferred to a hospital? You have the right to know your surgeon’s credentials— are they board-certified in the specialty? (Your insurance company should have basic physician information).

It’s also essential to understand your risk factors. Discuss your medical history with your doctor, including medications, allergies, and any underlying health issues.

 You may be better off having surgery at a hospital if you have any of the following conditions:

  • Overweight/obese BMI
  • Obstructive pulmonary disease
  • Hypertension
  • History of heart attack or stroke
  • Previous cardiac surgery
  • Complications in a past surgery

If you or someone you love may have suffered injuries due to medical negligence at an Ambulatory Surgery Center, you should contact an attorney with expertise in the practice area. At Aitken Aitken Cohn, we have a track record of success in recovering significant settlements and judgments for our clients in medical malpractice cases.

Most recently, we obtained a $1.5 million settlement for the husband and family of a woman in her 70’s who went into a surgery center for a routine cosmetic filler procedure. During the procedure, an unsupervised nurse anesthetist (not a doctor) provided the anesthesia. She negligently monitored the patient’s oxygenation and did not have on hand a simple carbon dioxide monitor that the American Association requires of Ambulatory Surgery Centers. Upon realizing the patient was having problems, 911 was not called for at least an hour, while the patient was left on room air without additional resuscitation or emergency care. She passed away tragically, and the surgery center was found to have violated its certification requirements and its written protocols and procedures.

Our firm won a $15 million jury verdict on behalf of a young student who went blind after an anesthesiologist failed to monitor his oxygen and ventilation levels during routine outpatient surgery to fix his broken ankle. We also secured a $1.2 million settlement for a mother of four who went in for gallbladder surgery and died of internal bleeding. We achieved a $750,000 settlement on behalf of a client whose doctor failed to diagnose breast cancer for two years. And our legal team recovered a $650,000 wrongful death settlement on behalf of the family of a high school principal whose surgeon nicked his bowel during surgery, which led to a fatal infection.