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New eye on office surgeries
Regulations increase scrutiny on procedures such as plastic surgery and colonoscopies

By CATHLEEN F. CROWLEY, Staff writer  
First published: Saturday, January 26, 2008

ALBANY -- Until now, office surgeries like face-lifts, tucks and colonoscopies were largely unchecked by state regulation.
But starting this month, doctors and some medical personnel who perform surgical procedures outside the hospital must report adverse events to the state and in 2009, office-based practices must receive accreditation from a national organization.
     
"There was a concern that some of the group practices were substandard and there were issues related to poor outcomes," said Dr. Robert Kennedy, a Schenectady ophthalmologist who served on the state commission that designed the regulations.
"This should really raise the level of care," Kennedy said.
The new law, which went into effect Jan. 14, affects plastic surgery, colonoscopy and any invasive procedure that uses moderate to deep sedation in an office setting. Other procedures that may fall under the law include needle biopsies and contrasting imaging studies.
Laser eye surgery generally uses local anesthesia so would not be regulated by this law, and dentists and podiatrists are exempt because they are regulated by the state Education Department.
"In the last 20 years, we've gone from doing virtually nothing in the office other than the most minor skin tag or skin biopsy to now doing significant surgery," said Dr. John Morley, medical director of the Health Department's Office of Health Systems Management. "And we are evolving toward being able to safely do more and more in the office."
Morley said the law will affect about 2,000 facilities in New York, but it's only an estimate because nobody knows how many surgical centers there are.
The new law requires office-based doctors, physician assistants and surgical assistants to report adverse events to the state, just like hospitals. They could face charges of professional misconduct if they do not comply. If patients end up in the hospital after an office surgery, the hospital is required to report the incident to the state.
Adverse events include patient deaths, unplanned hospitalizations and any serious or life-threatening event.
The state's Patient Safety Center will collect the information and, if it is serious enough, will pass the case on to the Office of Professional Medical Conduct or the appropriate DOH office for investigation, Morley said.
The law also requires office-based surgery centers to get accreditation from one of three national associations by July 2009. Some practices already have it.
"We wanted to provide the highest standard of care possible," said Dr. Kevin Herlihy, a gastroenterologist at Gastroenterology Associates of Northern New York in Glens Falls.
It took years for the six-doctor practice to prepare for the accreditation process, Herlihy said. Accreditation sets standards for doctor training, equipment, cleanliness, medical procedures and many other patient safety issues.
Accreditation will weed out the offices that have weak safety standards, and it will force them to improve or stop offering invasive procedures, Morley said.
"I genuinely believe that the vast majority of offices have quality services and are very safe, but I do think there are some outliers," he said. "We are setting a bar, a minimum standard that they all must achieve."
Cathleen F. Crowley can be reached at 454-5348, or by e-mail at ccrowley@timesunion.com.

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The law also requires office-based surgery centers to get accreditation from one of three national associations by July 2009. Some practices already have it.

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"In the last 20 years, we've gone from doing virtually nothing in the office other than the most minor skin tag or skin biopsy to now doing significant surgery," said Dr. John Morley, medical director of the Health Department's Office of Health Systems Management. "And we are evolving toward being able to safely do more and more in the office."