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Anesthesiologist: Overlapping Surgeries Led to Safety Issues and Medicare Fraud

Former employee says Massachusetts General Hospital endangered patients and inflated anesthesia charges.

Published: June 9, 2017

LISA WOLLMAN, MD, says surgeons were incentivized to schedule as many as 3 overlapping surgeries.

Research suggests that overlapping surgeries — those in which a single surgeon is responsible for 2 or more surgeries, portions of which are performed simultaneously — can be done safely. But where do you draw the line?

Anesthesiologist Lisa Wollman, MD, filed a False Claims lawsuit this week against Boston's Massachusetts General Hospital and its parent company, Partners HealthCare System. The suit claims that between 2010 and 2015, orthopedic surgeons at the hospital, where she worked at the time, frequently kept patients under anesthesia longer than necessary — sometimes much longer — because they were incentivized by the hospital to do as many procedures as possible. Surgeons routinely scheduled 2, or even 3, overlapping cases, she says.

One result was that at least 5 surgeons defrauded the government, the suit claims, by billing for surgeries in which they were absent from the OR during key portions of the procedures. Surgeons are required by Medicare and Medicaid billing regulations to be present for all "critical portions" of surgeries.

Patients, she says, were never told that about the practice. Amid growing controversy about overlapping surgeries, the American College of Surgeons last year sanctioned the practice under what it considers appropriate circumstances, but said patients need to be informed when surgeons plan to perform simultaneous surgeries.

Responding to the suit, Mass General, which has been a center of controversy over the practice because of a Boston Globe "Spotlight" report, says it "continues to believe that its practices comply with all applicable laws and regulations, and the hospital will defend the claims accordingly."

Dr. Wollman, who worked at Mass General for more than 20 years and now works at New England Baptist Hospital in Boston, says patients were often "left fully anesthetized — unconscious, paralyzed, intubated, dependent on a ventilator to breathe — for longer than medically necessary, often in the care of trainees, without the backup of a properly qualified surgeon, despite legal requirements."

One one occasion, she says, an unnamed surgeon scheduled 2 long shoulder operations to start within 15 minutes of each other. As a result, the suit claims, a 65-year-old patient on blood pressure medication was under anesthesia for 90 minutes before the surgeon arrived in the OR. But the surgeon initially wrote on the patient's operative note that he'd participated in the entire surgery and corrected his report only after Dr. Wollman complained, she says.

Another surgeon, she says, "never appeared in the room" for an operation for which he was supposed to be the attending physician. The patient, says the suit, suffered a serious airway crisis with only a senior trainee present. When she complained about the incident, hospital officials did not respond, "except to threaten her by saying that she had violated patient privacy and could face legal action," she claims.

In all, the suit lists 16 times when orthopedic surgeons performed at least 2 operations simultaneously for hours, keeping patients anesthetized longer than was warranted, and thereby increasing risks and inflating anesthesia charges.

Dr. Wollman initially filed a sealed lawsuit in 2015, but U.S. attorneys declined to join as plaintiffs. After filing the revised federal suit this week, she said she was pursuing the case "because my ethical obligation is to patients — past, current and future — who are unknowingly scheduled for concurrent surgeries."

Under provisions of the False Claims Act, Dr. Wollman stands to receive 25% to 30% of any money recovered as a result of the suit.

Jim Burger

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