A Pompano Beach, Fla., surgery center was ordered closed and barred from treating new patients after state inspectors discovered serious mismanagement during an emergency survey.

Officials from the Florida Agency for Health Care Administration visited the Atlantic Surgery Center on Feb. 5 in response to complaints about a December incident in which a patient fell into a coma while under anesthesia.

According to a published report, Dan Whyte, 33, was undergoing a joint manipulation procedure for which he'd been sedated when he stopped breathing. He was taken to North Broward Medical Center in Deerfield Beach, where he remains unresponsive.

Not only did attending physician Basil Mangra, MD, and anesthesiologist Thomas Rodenberg, MD, fail to monitor the patient's oxygen level, reported the inspectors, but the room in which the procedure took place did not have a working oxygen supply.

In addition, the center's managers were lax in verifying its physicians' credentials, it had no written patient safety protocol and its medical director position had been vacant since October, the report says.

David Bernard

In the wake of last year's hepatitis C outbreak, the Joint Commission, the Accreditation Association for Ambulatory Health Care and other healthcare industry authorities plan to report patient safety breaches to the Nevada Department of Health and Human Services.

For its part, the Joint Commission will report patient safety issues within two days of discovery and share its schedule of unannounced visits with the health department, according to a published report.

The outbreak, which was traced to the reuse of syringes and other unsafe practices at the Endoscopy Center of Southern Nevada in Las Vegas, sickened eight patients and led the state to recommend hepatitis C and HIV tests for more than 50,000 more.

Consequently, the state health department has asked ten accrediting bodies to report any patient safety issues they uncover during their surveys. So far, six agencies in addition to the Joint Commission and the AAAHC have agreed to work with the state.

Kent Steinriede

Recognizing the growing trend of treating chronic non-cancer pain with opioids, a panel of pain management experts has published a comprehensive set of recommendations to help clinicians navigate patient selection, addiction risk, potential adverse events and other difficult issues associated with this therapy.

The panel, whose members represent the American Pain Society and the American Academy of Pain Medicine, based their 25 recommendations on a review of more than 8,000 abstracts and studies. They published their clinical practice guideline in the February issue of the Journal of Pain.

The recommendations deal heavily with patient selection and management. For example, the panel suggests that "clinicians should conduct a history, physical examination and appropriate testing, including an assessment of risk of substance abuse, misuse, or addiction" before initiating chronic opioid therapy (COT).

The authors note that a personal or family history of alcohol or drug abuse is the factor "that appears to be most strongly predictive of drug abuse, misuse, or other aberrant drug-related behaviors after initiation of COT." Other recommendations deal with initiation and escalation of COT, adverse events related to opioid use and the monitoring of patients undergoing COT.

Irene Tsikitas

Slightly more than half (53 percent) of the 32 readers who answered last week's online poll say their facility typically uses a smoke evacuator when doing electrosurgery or cautery.

Our poll results mirror those of a much broader 2007 Web-based survey. Analyzing data from 623 individuals from healthcare facilities across the United States and Canada, Duke University Medical Center researchers found that "effective engineering controls" such as local exhaust ventilation systems "are being used in fewer than half of the facilities represented by the survey respondents for most laser procedures and in very few facilities for most electrosurgery, electrocautery or diathermy procedures." Researchers concluded that "personnel at most healthcare facilities are not adequately protected from exposure to surgical smoke."

This week's poll asks whether the economy has forced you to lay off any staff. Go to our front page to participate in the poll and view real-time results.

Dan O'Connor