The rising cost of health care in America is a big concern. Small, relatively routine surgeries that are performed in a hospital can greatly increase those costs. Thus, many patients are directed toward ambulatory or same-day surgery centers. In 1970, the first freestanding surgery center was started in Phoenix to combat rising health care costs and provide more convenient, timely care for patients. The number of ambulatory surgery centers (ASCs) in the United States has exploded since, surpassing 5,600 today.

As the number of surgeries performed in these centers has risen into the millions, so have the risks of medical complications. A new joint investigation by USA TODAY and Kaiser Health News sheds light on centers plagued by poor oversight, unqualified or ill-equipped staff, and little to no accountability.

Poor Training, Equipment and Procedures Endanger Patients
Since 2013, more than 260 patients have died after “in-and-out” procedures at surgery centers across America. At Kandis Endoscopy Center in Arkansas, two people died and one suffered brain damage in the span of four months after complications during anesthesia. Arkansas is one of 17 states that does not have a mandate for ASCs to report deaths after a procedure.

Medicare reporting qualifications aren’t strong either, allowing ASCs latitude on reporting the number of patients that are transferred to a hospital unless more than half leave by ambulance. A hospital transfer indicates that a surgery center could not handle a serious issue that occurred during a procedure. Only one-third of ASCs voluntarily disclose how often patients are sent to an emergency department. Even the ASC Quality Collaboration, an advocacy organization run by leaders in the industry, requested that Medicare require better reporting. It also publishes a voluntary quarterly quality report.

And what happens when the doctors working at a center are also the owners? In large hospitals, committees and administrators are in place to oversee doctors. However, many surgery centers are partially or fully owned by the physicians who work there. This creates a conflict of interest between a doctor-owner’s financial interests and his/her willingness to report mistakes.

In 2001, gynecologist Dr. Paul Mackoul lost his hospital privileges after a committee reviewed his “competence or conduct” as a physician. He now runs his own surgery center with his wife. In 2015, a uterine cancer patient died after Dr. Mackoul installed a catheter into her chest, even though he was not certified to perform any type of cancer surgery. Her family sued, alleging that the doctor punctured a vein during installation, causing blood to build up in her chest and her lung to collapse. Dr. Mackoul is still performing surgeries today.

Guide to Vetting Surgery Centers
With millions of procedures or more performed each year, you or a loved one could be referred to a surgery center in the near future. What can you do to reduce the chance of complications?

• Choose a center that has accreditation. The Centers for Medicare and Medicaid provide a list of approved accrediting organizations.
• Talk to trusted friends and family about their experiences. If you know someone who has had the same procedure, ask them about the surgery center they utilized.
• Look for a facility and surgeons that perform your procedure on a regular basis.
• Customer reviews are your friend! Do your due diligence and look for patient reviews online before you book your surgery.
• Make sure your center is close to a hospital just in case an emergency arises.