From Rhonda Rowland
CNN Medical Correspondent
JACKSONVILLE, Florida (CNN) -- Florida has joined just a handful of states to try to regulate what has become a flourishing growth industry in American medicine -- surgery done in a doctor's office.
"The public is accustomed to the regulation of the hospital industry," said Dr. John Neeld, a former president of the American Society of Anesthesiologists. "They presume those regulations (that) are in place to protect them and to ensure good care extend to the offices (but) the system does not go there."
In the past six months, five people have died after surgeries performed in doctor's offices. That's as many deaths as took place in all of 1999 because of operations done in the state's ambulatory surgery centers, even though center surgeons outnumber office surgeons by 17 to 1.
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Critics point to physicians certified in non-related specialties, such as dermatology or ophthalmology, who "branch out" into more lucrative cosmetic-surgery procedures, lesser-trained nurse anesthetists responsible for administering general anesthesia, inadequate monitoring of patients and preparedness for emergencies as reasons for closer regulation of the industry.
The American Society of Anesthesiologists estimates that within five years, as many as 10 million surgical procedures could take place each year in doctor's offices.
For Phyllis Scott, however, it is already too late.
The Jacksonville woman told a plastic surgeon that she wanted a few "touch ups" before moving back to her hometown. The procedure lasted for six hours, and then something went wrong.
"She was sort of recovering, and everybody left her side," her daughter, Rhonda Morgan, believes. "She wasn't properly monitored and she went into cardiac arrest."
Her mother "actually flat-lined" before medical personnel called 911 and began resuscitation efforts, Morgan said.
"I remember someone saying, 'That's it. She's dead,'" added Scott, who suffered severe brain damage from the episode. "I wasn't dead."
Now, however, Scott's mental function is equal to that of a first-grader.
California, New Jersey, New York, Texas, Ohio, Rhode Island and the District of Columbia have adopted safety standards to address surgeries in an office-based setting. Some laws ban the use of general anesthesia in a doctor's office, while others require that a physician -- not a trained nurse -- administer sedation. Florida's 90-day moratorium gives legislators a chance to consider stronger regulations.
The action by the Florida Board of Medicine requires that such surgeries be done only in a hospital or ambulatory-surgery center.
"I think the moratorium was not necessary and (is) unjustified at this time," protested Dr. Reza Samiian, a former president of the Florida Society of Plastic and Reconstructive Surgeons. He defends the practice, saying patients get to save money and enjoy more privacy and comfort.
One patient paid $350 more just in anesthesiology costs when her surgery was done in an ambulatory-surgery center rather than Samiian's office, he said.
"Everybody in my office is certified to do the basic life-support resuscitation," he added.
While Samiian acknowledges that more regulation might be needed, he insists that his clinic is safe. And even supporters of stronger laws agree that some office surgeries can be safe.
"I believe general anesthesia can be done safely in the surgeon's office, and I believe those surgeons want to make sure that their patients are taken care of safely," said Dr. David Mackey of the Florida Society of Anesthesiologists. "But there are surgeons out there who want no regulations."
The lack of regulations means that in most states, any kind of doctor can perform any kind of surgery in his or her office.
The key for patients, doctors say, is to check credentials carefully. Is the doctor board-certified to do the procedure he or she is advertising? Who will be administering the anesthesia -- a certified anesthesiologist or a nurse anesthetist? Are there procedures in place to deal effectively with emergencies?
"I feel if my mom had been in a hospital, she would have been properly monitored," said Morgan, who settled a lawsuit with the clinic and personnel who operated on her mother.
"Let everyone know that they should think twice before they do something like this," added Scott.
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American Society of Anesthesiologists
American Society of Anesthesiologists - Recommended standards for office procedures
Florida Society of Plastic and Reconstructive Surgeons
Florida Board of Medicine - 90-day moratorium ruleNote: Pages will open in a new browser window
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