The Florida Agency for Health Care Administration has prohibited the Fort Myers Endoscopy Center from treating patients after 19 regulatory violations were discovered during a recent inspection.

The infractions were discovered during a Jan. 19 recertification and license survey.

The center has until Feb. 13 to comply with the citations or risk losing its Medicare certification and its state license. Some of the violations cited in the 17-page inspection report include:

Laparoscopic surgeons often stand in awkward positions as they maneuver their instruments through fixed ports for long stretches, making them prime candidates for work-related injuries, according to a recent survey conducted by researchers at the University of Maryland School of Medicine in Baltimore.

Out of 317 board-certified gastrointestinal and endoscopic surgeons surveyed, 272 (87%) report that they've experienced discomfort during surgery, including eye strain, neck, back and leg pain, headaches, finger calluses, disc issues, muscle spasms and carpel tunnel syndrome.

While 84% of the respondents say they've changed positions during surgery and 30% swap instruments in attempts to avoid aches and pains, 40% have ignored ergonomic issues. More than half were unaware of the recommendations made by surgical ergonomic experts, according to the survey, which will appear in the March issue of the Journal of the American College of Surgeons.

David B. Renton, MD, MPH, an assistant professor of surgery at Ohio State University in Columbus, says he knows surgeons who have had tendon problems in their hands due to the instruments they use, which was a major complaint of 74% of the surgeons involved in the survey. It doesn't have to be this way, says Dr. Renton. "We keep squeezing an instrument tightly to hold a piece of tissue in retraction, even though the instrument locks and holds it if we just squeeze lightly."

The survey's lead author, Adrian E. Park, MD, chief of general surgery at the University of Maryland Medical Center and professor of surgery and vice chair of the school's department of surgery, says surgeon injuries need to addressed before healthcare experiences "a shortage of surgeons as well as shortened career longevity among surgeons who enter, or are already in, the field."

Daniel Cook

Were a drug maker's packaging and instructions partially to blame for the hepatitis C outbreak that emerged from Nevada endoscopy centers between 2004 and 2008? Lawyers for some exposed patients plan to make that case at trial.

Las Vegas attorneys Will Kemp and Robert Cottle argue that a statement made by an executive at Irvine, Calif.-based Teva Parenteral Medicines, a division of Teva Pharmaceutical Industries and the manufacturer of the propofol used at the now-closed Endoscopy Center of Southern Nevada, implies that the company shares some of the liability for the center's unsafe injection practices.

In a deposition given in May 2009 and recently made available, they say, Vice President of Marketing Craig Lea noted that while a veterinary version of the drug included instructions to draw a vial's entire contents into a single sterile syringe, the human propofol did not.

Compounded with the company's discontinuation of 10-milliliter vials of the drug - a suitable amount for the average endoscopy case - in favor of 20- and 50-milliliter vials, as well as the center staff's aversion to wasting drugs, the single-use vials encouraged reuse.

The civil trial against the endoscopy center, which may have exposed 63,000 patients to hepatitis C, is scheduled to begin in April.

David Bernard

Your surgeons are probably pretty content with how your facility is run. But if you had to identify the one aspect that's most underwhelming to them, what would it be? Scheduling? The anesthesia team? Your staff's know-how? The equipment? The lounge? Parking? Tell us in this week's InstaPoll. We'll report the results in this space next week.

Last week, nearly two-thirds (64%) of the 85 respondents to our online poll said they'd been victims of sexual harassment during their healthcare careers.

Dan O'Connor