Senate Committee Investigates Concurrent Surgeries

Boston hospital at center of controversy

Senator Orrin Hatch (R–Utah), chairman of the Senate Finance Committee, has asked 20 hospital systems to provide detailed records about the controversial practice of allowing surgeons to operate on more than one patient at a time, according to an article in the Boston Globe. Hatch has requested the total number of “concurrent surgeries,” broken down by specialty, at each hospital from 2011 to 2015, and policies about whether patients are informed beforehand.

The requests come after U.S. Attorney Carmen Ortiz launched a federal investigation into concurrent surgeries at Massachusetts General Hospital (MGH) last year. A series of articles published in the Boston Globe in October focused on an internal debate at MGH over the propriety and safety of concurrent surgeries, a years-long controversy that led to the dismissal of the leading critic of the practice.

Dr. David Hoyt, executive director of the American College of Surgeons (ACS), said the Globe series “shined a light on a problem’’ and “it has had the desired effect of getting people to take a look at it.’’ The ACS is drafting new guidelines to regulate double-booking of surgeries, which the college expects to unveil in about a month. A panel member told the Globe that the rules will not support surgeons conducting two surgeries that overlap for significant periods.

Simultaneous surgeries remained largely unknown to much of the public, the newspaper said, until the battle within the orthopedics department at MGH came to light. Over the last decade, a small group of medical staffers at MGH complained about at least 44 alleged problems involving concurrent surgeries, most of them orthopedic operations. The alleged problems included cases in which surgeons performing concurrent surgeries didn’t respond when an urgent need arose in the second room or didn’t show up at all, leaving the surgery to a resident or fellow.

There were also cases in which patients waited under anesthesia for the surgeon to arrive and others in which patients experienced complications, prompting malpractice lawsuits.

MGH disputed the importance or validity of almost every allegation about concurrent surgeries and said internal studies found no significant differences in complication rates between overlapping and nonoverlapping cases.

Hatch’s Senate committee has gotten involved because it oversees federal health care programs, including Medicare, the Globe article points out.

Medicare allows surgeons to perform concurrent operations but requires them to be present for the “critical or key portions” of each surgery, although the program leaves it up to physicians to decide what is critical. Medicare rules do not require surgeons to tell patients when their cases will overlap with those of others.

Source: Boston Globe; March 13, 2016.