Overlapping surgeries to face US Senate inquiry
The chairman of a powerful US Senate committee has asked 20 hospital systems, including the parent company of Massachusetts General Hospital, to provide detailed records about the controversial practice of allowing surgeons to operate on more than one patient at a time.
Senator Orrin G. Hatch, a Utah Republican who heads the Finance Committee, has requested the information, including 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.
Committee staffers have already met with representatives of the American College of Surgeons, the world’s largest surgeons’ organization, which is drafting new guidelines to regulate double-booking of surgeries in the wake of a recent Globe Spotlight Team report on the practice.
“We are concerned about reports of patients not being informed that they may be sharing their surgeon with another patient, and we are especially concerned by reports that, in some cases, steps have been taken to actively conceal this practice from patients,’’ Hatch wrote in a copy of the Feb. 16 letter to hospitals obtained by the Globe.
The request, described as a “fact-finding exercise” by a committee staffer, comes after US Attorney Carmen Ortiz launched a federal investigation into concurrent surgeries at MGH last year.
An aide to the Finance Committee declined to identify who received the letter, but a spokeswoman for Massachusetts General Hospital confirmed Friday that its parent company, Partners HealthCare, got it. The Spotlight report last October focused on a fierce internal debate at MGH over the propriety and safety of concurrent surgeries, a yearslong controversy that led to the dismissal of the leading critic of the practice.
Hatch’s letter was addressed to Partners chief executive Dr. David Torchiana, according to MGH spokeswoman Peggy Slasman.
A spokeswoman for the American Hospital Association, which represents nearly 5,000 hospitals, said it was aware of the letter and is trying to “educate the committee staff about this very complex issue.’’
Hatch’s review is already underway. Dr. David Hoyt, executive director of the American College of Surgeons, said he and other representatives of his organization met with Senate committee staff members for about an hour Thursday.
“The staff people that we met with are very much trying to understand this issue,’’ Hoyt said Friday. “They’ve come to understand that there’s a lot of different opinions on definitions of things, and they’re trying to get clarification.’’
Hoyt said the Globe series on concurrent surgeries “shined a light on a problem’’ and “it has had the desired effect of getting people to take a look at it.’’ He said the panel that is writing new guidelines for simultaneous surgeries will be finished soon, and the organization expects to unveil them in about a month.
Hoyt declined to say what the guidelines will say. But one panel member said the rules will not support surgeons conducting two surgeries that overlap for significant periods of time.
“Having concurrent surgery — truly concurrent surgery with substantial overlap — that is not acceptable,’’ said Dr. L.D. Britt, a past president of the surgeons’ organization who teaches at Eastern Virginia Medical School. “I don’t care what the institution is.’’
Disputes over surgeons running more than one operating room have erupted at hospitals across the country in recent years. But the conflicts were viewed as isolated events, and simultaneous surgeries remained largely unknown to much of the public, until the battle within the orthopedics department at MGH spilled out into the open.
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 Globe report said.
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 suffered 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 non-overlapping cases.
They described overlapping surgeries as an extension of the teaching hospital’s team approach, pairing senior doctors with residents — surgical trainees — and fellows, who have completed their general orthopedic surgery residency and are training in a subspecialty.
However, a number of patients interviewed by the Globe said they were not told beforehand that their surgeon planned to perform a second operation that overlapped with theirs, sometimes for hours.
Tony Meng, a Westwood father of two, was surprised to learn that he had been “double-booked” after he emerged paralyzed from an 11-hour spine operation in August 2012. His operation overlapped for seven hours with another patient’s spine surgery by the same physician, Dr. Kirkham Wood. Meng has sued Wood, saying he feels betrayed.
Wood, who left MGH in November to become a professor of orthopedic surgery at Stanford University, has denied wrongdoing in court filings.
There is no evidence in the medical records that the overlap played a role in Meng’s sudden paralysis, a known risk of the surgery, but concerns over his case prompted a prominent orthopedic surgeon at MGH, Dr. Dennis Burke, to alert state regulators. Burke was dismissed by the hospital last August for allegedly violating patient privacy by providing the Globe with redacted copies of his own surgical case records. He is appealing his dismissal.
The controversy has prompted several federal and state investigations, including the one by Ortiz.
Hatch’s Senate committee has gotten involved because it oversees federal health care programs, including Medicare.
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.
Senator Charles Grassley of Iowa, a Republican member of the Finance Committee who has targeted health care fraud, said he was disappointed at the answers he got last week from Medicare officials about their regulation of simultaneous surgeries.
The acting administrator of the agency that runs Medicare told Grassley that his office “does not have national fraud activities related to the concurrent surgery issue” and has not investigated double booking at MGH, according to a letter obtained by the Globe.
Grassley accused the agency, the Centers for Medicare & Medicaid Services, of stonewalling and deferring too much to hospitals.
Although the aide to the Senate Finance Committee stressed that Hatch’s inquiry was not a full-blown Senate investigation, Dr. Gerald Healy, a member of the American College of Surgeons panel drafting new surgery guidelines and past president of the organization, said an investigation might be in order.
“If the government sees the need to investigate this, so be it,’’ said Healy, a former surgeon-in-chief at Children’s Hospital of Boston. “If hospitals did nothing wrong, they should have nothing to fear in an investigation by the federal government.”
Healy said he hopes the new guidelines will improve transparency with patients, who are too often unaware that their surgeon is overseeing a second procedure. “That’s the crux of informed consent. If I tell you one thing and do another, that’s unethical,” he said.
Britt, another surgery panel member, said the new guidelines will allow for small overlaps, such as when an OR team is closing a surgical wound in one room and the attending surgeon is starting a second operation in another room, but not simultaneous surgeries.
Although defenders of concurrent surgeries say the practice makes the most efficient use of skilled and coveted surgeons, Britt said some hospitals have taken it too far and “will get in line’’ under the new guidelines.