This Just In

Not long after the Florida board of medicine imposed new regulations on office surgeries, two more patients died, according to a report in the Florida Sun Sentinel. A 38-year-old social studies teacher stopped breathing while undergoing a breast-reduction procedure in the office of Coral Springs plastic surgeon Bose Yalamanchi, and a 54-year-old Naples computer consultant died of a blood clot one day after a "tummy tuck" and liposuction of the hips and outer thighs in the office of Ft. Myers surgeon Joseph F. Mazza. Both patients were overweight; the first also had asthma. Two months earlier, the board had restricted the time of surgery to eight hours, limited the amount of fat removal during liposuction to 9 lbs., required physicians to seek accreditation of their office surgery suites and also required the presence of physician anesthesiologists when general anesthesia was to be used.

A trial in Westlake Village, Calif., over another office surgery death began. Tania Pfefferman, 25, suffered a cardiac arrest while recovering from breast augmentation and liposuction in the office of Theodore R. Corwin, MD, according to the Ventura County Star. She died two weeks later. The husband and daughter sued, claiming that the anesthesia was improperly administered and that Ms. Pfefferman was unattended for five to 10 minutes in the recovery room. Dr. Corwin's attorney contends that Ms. Pfefferman's death was due to an adverse drug reaction. The attorney said Demerol reacted with St. John's Wort and an over-the-counter supplement called "Formula I."

An April "Dateline" feature detailed two office surgery deaths. One was that of Kami Favors, a nine-year-old from Odessa, Tx., who underwent a tympanoplasty in the office of surgeon Ralph Cepero in 1997. The death was blamed on a leaky Halothane vaporizer in the 30-year-old anesthesia machine Dr. Cepero had in his office. The incident led to the passage of office-surgery regulation in Texas. The second was that of Wendy Haigh, a 45-year-old New York woman who died after undergoing a hysteroscopy in her physician's office secondary to a carbon-dioxide embolism. Her husband settled out of court for $1.1 million, according to the report.

Currently, five states regulate office surgery, according to the AAAHC:

California. Requires licensure, Medicare certification or accreditation in all outpatient settings where any form of anesthesia except local or peripheral nerve blocks is used. Physicians must have liability insurance, two staff persons on the premises, and written discharge criteria.

Florida. A new law requires either licensure or accreditation, and regulates anesthesia, procedure length, aspects of liposuction and several other items.

New Jersey. The state requires anesthesiologist supervision of CRNAs, regulates surgical equipment and monitoring procedures, and requires that all sedation-related office deaths and injuries be reported to the state Department of Health within 24 hours.

Rhode Island. A new law provides for licensure and regulation of surgery performed in physicians' offices.

Texas. A new law regulates physicians providing general or regional anesthesia, or monitored anesthesia, in any outpatient setting.

State Act on CON

Two of the 36 states with certificate of need laws - the regulatory processes used to approve new health care facilities and expansions - may be on their way to eliminating them. However, the laws won't go away anytime soon:

Virginia legislators voted to phase out the state's certificate of need law over the next four years. Another law passed this session will force that state's health department to process applications in a more timely fashion, says Rep. John H. Rust, Jr., a sponsor of one of the bills.

A bill on Illinois Governor George Ryan's desk would raise to $6 million the amount facilities could spend per year on expansions without applying for a certificate of need. Currently, the limit is $2.7 million.

The bill also attempts to reinforce state laws prohibiting secret deals and payoffs. It reminds the controversial Health Facilities Planning Board that it is subject to the state's open meetings act and gift ban act, and also significantly restricts lobbying efforts by prohibiting any private communication between board members and applicants. Some have charged that the board is corrupt, says an Illinois Senate staffer who asked not to be named.

The bill would not otherwise make it easier to start a new ambulatory surgery center. However, it would sunset Illinois's CON law in 2003, giving lawmakers an opportunity to do away with the entire process then.

Gov. Ryan had until the end of June to make a decision about the bill. It was not known what his decision would be.

A bill in that would have partially deregulated the certificate of need process and caused a sunset of the law in South Carolina died in committee, says the sponsor of the bill, Rep. Mike Fair. "There are so many powerful interests opposed to reform," he says.