Letters & Emails

1. SMG Quintiles, 2001

Safety Standards on Office-Based Suites Re: "How We Made Office Surgery Safer" (May, page 24). The anesthesia machine pictured on the cover and the article is an outdated piece of equipment. Back in 1979, this equipment was disallowed for use in ORs and today is only used for veterinary anesthesia. Additionally, the equipment, with two large 8-cylinder containers of oxygen, violates National Fire Protection Agency (NFPA) fire safety standards. Dr. Almeyda equates being accredited with having a safe facility. That is not necessarily the case. Here in Tennessee and in many other states (including New York), an office surgery facility can be accredited without state licensure. Although Dr. Almeyda points to the "strict" physical requirements required by AAAASF, safety standards related to physical layout often do not measure up to the requirements expected for facilities that pass through state licensure. While those involved in this story may not intentionally be cutting safety corners and presenting a less-than-diligent standard of safety for their patients, ignorance of current safety standards is a poor excuse for non-compliance. And it is certainly not license to trumpet how your facility made office surgery safer. Mark Pepper, CRNA Nashville, Tenn. markjpepper@comcast.net Dr. Almeyda replies: I applaud Mr. Pepper's professional concerns for the safety standards of office-based surgical suites. His comments need to be addressed. The anesthesia machine in our office is a Narkomed 2A. Mr. Pepper is correct that it is an older model. Narkomed has "de-certified" the machine, meaning that it no longer manufactures the machine or its associated parts. Parts are widely available as it is still used in many ORs. Narkomed says the equipment does not violate the Z79 standards. The machine may still be used for human, as well as veterinary anesthesia. The difference between the 2A model and the current generation of Narkomed anesthesia machines is that the 2A does not have a pressure limit control mechanism - an additional safety feature. The NFPA standards Mr. Pepper cites in regard to the oxygen tanks apply only to in-wall gas systems. New York fire standards require the oxygen tanks on the floor be secured either to the floor or by a chain to the wall. Although not visible in the photographs in the article, a metal bracket secures our tanks to the floor. As an office-based surgery center, we are not an Article 28 facility as a hospital or a freestanding ASC would be. In other words, accreditation, which is strictly voluntary, is our benchmark for safety. I maintain that by seeking AAAASF accreditation, we took a strong step toward assuring that our surgical facility is safe for our patients. Elizabeth Almeyda, MD, FACS New York, NY info@nycwomanplasticsurgeon.com