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Joan Rivers's Clinic May Lose Certification

Yorkville Endoscopy, the Manhattan-based surgery center where Joan Rivers suffered fatal complications, will lose its CMS certification on Jan. 7, 2015, if it fails to adequately address 4 deficiencies cited by Federal investigators, according to news reports.

The investigation, which started Sept. 5 — the day after Ms. Rivers died — and ended Oct. 9, found a lack of compliance with governing body and management, surgical services, medical staff and patient rights issues.

No specifics were disclosed, but a spokeswoman for the federal Department of Health and Human Services told the New York Daily News that the full report will be released publicly either in November or when the clinic provides an acceptable plan of correction, whichever comes first.

Ms. Rivers's procedure took place in a licensed surgical center. But New York state health officials say her death underscores the need for greater scrutiny over surgeries performed in doctors' offices, according to a report in Crain's New York Business. A study undertaken before Ms. Rivers's death found that out of 2,202 adverse events occurring after surgeries in doctors' offices, 257 resulted in deaths. However, those numbers are preliminary and the state doesn't know the total number of procedures that were performed in offices.

Geoffrey Keyes, MD, president of the American Association for Accreditation of Ambulatory Surgery Facilities, cautions against overreaction, telling Crain's: "Joan Rivers's case is one in a million. She is in a spotlight, so the reaction is 'Oh my God, people are dying in outpatient surgery centers,' but the actual incidence is very, very low."

Ms. Rivers died after sustaining brain damage resulting from insufficient oxygen, while undergoing a laryngoscopy to evaluate changes in her voice and an endoscopy to determine whether she had acid reflux, according to the New York City medical examiner.

Jim Burger

Post-op Pain Decreased Over Past Decade

The severity of the pain that patients report after surgery has decreased 24% since 2003, says a study presented during the American Society of Anesthesiologists' annual conference last week.

Researchers attribute the drop to providers' awareness of their options for managing post-op pain. "During the last 10 years, there have been significant changes in hospitals to support better pain management post-surgery," says Asokumar Buvanendran, MD, of Rush University Medical Center in Chicago.

He and his colleagues surveyed 441 patients before they were discharged from the hospital, then once every week for 3 weeks. Their survey asked patients to grade their levels of pain intensity on a scale from no pain to extreme pain and to rate their satisfaction with their pain medications.

The data from the survey was then compared with data from a similar study published in 2003. The number of patients who reported moderate-to-severe pain 2 weeks after surgery decreased from 63% in the 2003 study to 39% in the 2014 study. In both studies, the number of patients reporting no pain stayed the same at 22%.

Another factor that remained the same: patients' satisfaction with their pain management. The researchers noted that, in both studies, most patients said they were "satisfied" or "very satisfied" with the treatment.

Kendal Gapinski

Laser Spine Institute Accused of Incentivizing Patients

Did the Laser Spine Institute of Tampa, Fla., cover patients' travel expenses in order to get them into the facility for surgery?

The Bonati Institute, a rival spine surgery center, has accused the Laser Spine Institute of incentivizing patients with such illegal perks in a lawsuit, according to a report in Bloomberg Businessweek.

In e-mails obtained through the lawsuit's discovery process, the report says, one of LSI's patient educators allegedly told a co-worker that he scheduled a procedure after comping a hotel stay for a Medicare patient. The educator reportedly told the patient to put the room in the name of her escort, which suggests the educator was aware that inducing Medicare patients with financial incentives crossed the medico-legal line.

According to the report, LSI is also accused of paying "secret shoppers" to gather information about the Bonati Institute and using the intel to badmouth the rival's services to patients considering having surgery there.

The Bonati Institute's attorney did not immediately respond to a request for comment. Chris Knopik, chief trial counsel at LSI, says, "We strongly assert that the claims in the lawsuit are unproven allegations that haven't been reviewed by a court of law and are only being asserted by a competitor, nothing more."

Mr. Knopik says LSI's employees interact with patients on a daily basis and are extensively trained on procedures and protocols to ensure they comply with state and federal requirements.

"As an additional step to ensure quality, our compliance team monitors all patient communications and takes corrective action as appropriate," he adds. "Our patient satisfaction results show that the overwhelming majority of our patients agree with our approach."

Daniel Cook

InstaPoll: Do You Reuse Surgical Skin Markers?

Could surgical skin markers used on multiple patients be a source of cross-contamination? Tell us if your "single-patient-use" policy extends to skin markers in your facility in this week's InstaPoll, then check back next week for the results.

Last week we asked whether it's better to sterilize or high-level disinfect the complex channels in duodenoscopes. Our 447 respondents were split right down the middle. The results:

Should upper GI endoscopes be sterilized instead of high-level disinfected?

  • Yes 50%
  • No 50%

Dan O'Connor

News & Notes
  • Hospira recalls IV bags The possibility of leaky IV bags has led Hospira to voluntarily recall certain lots of several products in its LifeCare line. According to the company, a post-manufacturing inspection found puncture marks in the flexible containers and their overwraps, which could lead to contamination, waste, spillage and dosage errors. The affected lots were distributed between September 2013 and October 2014.
  • Court halts sale of ultrasonic shears A federal court in Connecticut has issued a preliminary injunction against Ethicon Endo-Surgery, prohibiting the company from manufacturing, marketing or selling its Harmonic Ace+7 ultrasonic shears. The injunction stems from a lawsuit filed in June by Covidien, which claims that Ethicon's device infringes on Covidien's patents.
  • California scrub tech bill vetoed California governor Jerry Brown blocked legislation that would have required surgical facilities to hire only certified scrub techs. While the current workforce would have been exempt, new graduates would have had a year to complete training. Mr. Brown argued that the bill created an employment hurdle. The state's 9,000 surgical techs are the only OR personnel who aren't required to meet a minimum level of education.