This story is about Iowa, but it should serve as a warning to everyone that when the government does not regulate healthcare providers, there is a chance that patients will suffer. This article ran in the Des Moines Register recently, and is excerpted here:
Iowa is home to dozens of outpatient surgical centers, but none of them is licensed and many are uninspected by the state.
They often deal in volume, each day performing dozens of operations – including spinal surgery, cosmetic surgery, hip replacements, hysterectomies and other complex procedures – that don’t require overnight hospitalization.
Federal officials are concerned about rising infection rates in surgical centers, which they say are a major problem attributable to unsafe medical practices and failure to follow basic patient-safety guidelines.
But Iowa is one of only of seven states that don’t license the so-called ambulatory surgical centers, which represent one of the fastest growing, but least regulated, segments of the health care system.
The centers are another segment of Iowa’s health care system that’s almost entirely unregulated by the state, leaving consumers with little or no information on the quality of care that’s being delivered.
In addition, hospice providers that care for Iowans in the final stages of terminal illnesses are now being inspected by the state on a schedule of one visit every 20 years. Also, the state exercises no oversight of privately run home health agencies, cannot impose fines on hospital-owned nursing homes and is years behind in the inspection of dialysis treatment centers.
There are now 5,000 outpatient surgical centers nationwide, handling almost half of all same-day surgeries in the United States. They perform 20 million operations annually.
Iowa has 26 Medicare-certified surgical centers that are being inspected once every three years, but there are an unknown number of centers in Iowa that aren’t part of the Medicare system. Those surgical centers aren’t tracked or monitored by the federal government. And because Iowa doesn’t require them to be licensed, the state doesn’t track them, either.
“We know they’re out there,” said David Werning, spokesman for the Iowa Department of Inspections and Appeals. “But they don’t have to report to anyone, so we don’t know where they are. There’s no way to count them, and currently no way to license them.”
Kevin Hamers of the Iowa Association of Ambulatory Surgical Centers said his organization would probably oppose legislation that simply required surgical centers to be licensed and subject to state inspection.
Figuring out which surgical centers have problems and which have a good record of meeting minimum standards of patient care isn’t easy in Iowa.
The state inspections department’s website has no inspection information on 12 of the 26 Medicare-certified surgical centers. As for the 14 others, many of their inspection reports are at least seven years old. One dates back to 1995.
The accrediting agencies don’t offer much in the way of information, either. For example, the Accreditation Association for Ambulatory Health Care will confirm a center’s accreditation, as well as its name, address and phone number – but that’s about it.
Last year, a U.S. Centers for Disease Control and Prevention study of surgical centers in three states found that two-thirds of them had problems with infection control. More than 28 percent of them had failed to follow the standard infection-control procedures for preparing surgical equipment, even though they knew they were being observed by researchers at the time.
That study was conducted in the wake of a public uproar over a health scare in Nevada. State health officials had discovered that three former patients of the Endoscopy Center of Southern Nevada had contracted hepatitis C, a potentially life-threatening disease of the liver.
After learning that doctors at the center had been routinely reusing syringes and vials of anesthetic on different patients, state and federal health officials contacted 50,000 clinic patients to warn them of potential health risks. More than 100 of the patients tested positive for hepatitis.
Public health officials later issued a report that said the outbreak, testing and investigation had cost taxpayers at least $16 million and could have been prevented if the surgical center had adhered to “common-sense” practices.