Multi-tasking is popping up everywhere, some of it is good, but in other instances it is dangerous.
For instance, Texas is one of the few states where it is legal to “text and drive.” I hardly ever drive for more than a few minutes without seeing drivers weave in and out of traffic lanes because they are busy looking at mobile phone screens. I am happy that a law will go into effect later this year that imposes some restrictions on this dangerous multi-tasking behavior.
Another dangerous multi-tasking practice that few people know about, though, happens in the operating room—or, rather, I should say in operating rooms. It is a common practice called overlapping or double-booked surgeries.
Many hospitals allow surgeons to operate on two patients in different operating rooms at the same time. The practice works by having senior attending surgeons delegate parts of one surgery to less-experienced trainee surgeons, like residents and fellows. Then the senior surgeon leaves and goes to another operating room, or even goes to see other patients on the floor.
The law leaves it up to each hospital to decide whether to allow it in their operating rooms. As for Medicare, its billing rules permit a surgeon to participate in overlapping surgeries, so long as the senior attending surgeon is present during the “critical portion” of each operation. But, guess what—Medicare leaves it up to the surgeon to decide what the critical portions are.
As a Texas medical malpractice attorney, my experience is consistent with studies that show that double-booking of surgeries happen most frequently in heart/cardiac, neurosurgery, and orthopedic surgery procedures, but can occur with any type of surgery.
Bait and switch
Many people who are facing a surgery research potential surgeons and even look for recommendations before settling on one. That is a rather worthless effort, though, if the surgeon whom they have researched ends up leaving the operating room before the procedure is done.
I consider the double-booking practice to be a bait and switch. The Washington Post recently quoted James Ricket, an orthopedic surgeon and president of the Society for Patient-Centered Orthopedics, “The only reason it has continued is that patients are asleep.”
Any time that I handle a medical negligence case for a surgical client, I specifically investigate whether the main surgeon was in the operating room during the whole procedure. During depositions, I ask questions to every surgeon who was in the operating room to find out who actually did what.
What you can do
Unfortunately, there is no database or public source of information for patients to use to find out which hospitals allow surgeons to double-book surgeries. Of course, hospitals do not advertise or want to talk about topic either.
As the patient, though, you can get answers by asking some direct questions.
First, when you meet with your surgeon before an operation, ask if he or she participates in double-booked or concurrent surgeries.
Second, during the informed consent process at the hospital, read the paperwork to make sure there is no language stating that you consent to your surgeon participating in overlapping surgeries, while you are under his or her care in an operating room. Also specifically ask the nurse and surgeon whether your surgeon will be in your operating room during the entire procedure—from the moment you are put to sleep to the moment you wake up.
Another bait and switch
A similar situation occurs with anesthesia care during surgical procedures.
Hospitals and anesthesia groups have learned that it is cheaper to use certified registered nurse anesthetists (CRNAs) to provide anesthesia care, instead of anesthesiologists, who are medical doctors with extensive residency training.
In my experience as a medical negligence attorney, this is also something that is rarely discussed before a patient is taken to the operating room. Instead, an anesthesiologist often meets with the patient for the purpose of going over the informed consent paperwork and to discuss the anesthesia plan. After that, a nurse anesthetist takes over and performs all the anesthesia care.
This procedure is also allowed by insurance companies and Medicare, and it is left up to each hospital to decide how to staff their operating rooms with anesthesia providers.
As a patient, I recommend having a discussion with the anesthesiologist before your surgery to find out if he or she will be providing your care, of if it will be a less-trained certified registered nurse anesthetist.
We are here to help
Many hospitals, surgeons, and anesthesia providers are constantly looking for new ways to multi-task, treat more patients, and make more money. Unfortunately, that sometimes comes at the significant expense of patient safety.
If something goes wrong during a surgery, I believe a patient will be better off if the senior attending surgeon and an anesthesiologist are in the room to deal with it—rather than less experienced providers who need to call for help.
If you or someone you care for has been injured during a surgery, by anesthesia care, or any other type of medical mistake, call Painter Law Firm’s Houston, Texas office, at 281-580-8800, for a free consultation with an experienced medical malpractice lawyer.
Attorney Robert Painter represents plaintiffs in medical malpractice and wrongful death cases at Painter Law Firm PLLC, in Houston, Texas. He has a background in hospital administration, and began his legal career at a large law firm, where he defended doctors and hospitals. Robert Painter puts his know-how of how hospital, doctors, and insurance companies approach medical malpractice cases to work for his clients.