Most patients, when scheduling any type of surgery or medical procedure, do their due diligence. They ask their specialist or primary care physician to recommend the surgeon best suited to perform their specific surgery. They reach out to family and friends who have undergone the same procedure and ask for the name of the surgeon they used – and if they recommend them. Patients check surgeons’ credentials and look to see if a surgeon has enough expertise and experience performing the type of surgery they need. They do all of this in an effort to choose a surgeon who is unlikely to make a mistake – and who will be prepared to adjust and complete the surgery successfully even if unexpected challenges arise during the procedure.
In 2015, the Boston Globe’s team of investigative reporters, known as Spotlight, exposed a common practice among surgeons in hospitals and medical centers across the United States: concurrent surgeries.
Concurrent surgeries are surgeries that involve the surgeon running two or more operating rooms at the same time – simultaneously performing two or more surgeries, on two or more patients, in two or more separate operating rooms. In one case documented by the Boston Globe, a surgeon performed two surgeries at hospitals approximately eight miles apart – at the same time.
During a concurrent surgery, the primary surgeon performs the aspects of the surgery that require their specialized skills, while leaving the more routine tasks, such as making incisions and closing wounds, to surgical trainees.
However, there is little consistency in the practices surrounding concurrent surgery. Regulations vary between institutions, with some requiring the primary surgeon to be present for the pre-surgery huddle and others allowing the surgeon to join by phone from another location. Even the term “concurrent surgery” is inconsistent. Some call the practice “simultaneous surgery,” while others refer to it as “staggering,” “sequential,” “overlapping,” or “double-booking.”
Are surgeons required to tell their patients about concurrent surgeries?
Prior to 2016, most hospitals and medical centers did not require surgeons to proactively disclose to patients if they would be splitting their time between more than one operating room during the patient’s surgery. Critics say that the failure to share such vital information deprives patients of their right to give informed consent.
Following the publication of the Boston Globe’s 2015 Spotlight article exposing the frequency of concurrent surgeries nationwide, numerous hospitals announced that they would review their policies regarding the practice.
Likewise, the American College of Surgeons (ACS) – the world’s largest surgeons’ organization – announced the formation of a committee to review the practice of concurrent surgeries. The committee, which included critics and supporters of concurrent surgeries, was tasked with creating guidelines designed to help ensure patients are kept safe and informed when surgeons run two operating rooms simultaneously.
The ACS issued guidelines in 2016 that made a distinction between concurrent, or simultaneous, surgeries and overlapping surgeries. Per the ACS, the former occurs when “the critical or key components of the procedures for which the primary attending surgeon is responsible are occurring all or in part at the same time.” The ACS considers a primary surgeon’s involvement in concurrent or simultaneous surgeries to be inappropriate.
Overlapping surgeries, per the ACS, occur when either “the key or critical elements of the first operation have been completed, and there is no reasonable expectation that the primary attending surgeon will need to return to that operation,” or “the key or critical elements of the first operation have been completed and the primary attending surgeon is performing key or critical portions of a second operation in another room.”
However, the ACS states that it is up to the primary surgeon to determine which elements of a surgery are “key or critical.” It does recommend that surgeons inform their patients prior to surgery if they will be absent from the operating room at any point during the procedure.
It should be noted that the ACS guidelines are not legally binding. As a result, many believe that the guidelines are inadequate.
Why do most surgeons support the practice of concurrent surgeries?
Many surgeons feel that overlapping surgeries allow them to focus intensely on the portion of the surgery that is their specialty, while leaving the less complicated parts of the procedure to other doctors or surgical trainees. This is especially true in teaching hospitals, where surgical trainees are often entrusted with making the initial incision and stitching the wound closed at the end of the surgery.
Hospital leaders and other advocates of concurrent or overlapping surgeries do not believe the practice puts patients at any additional risk. They consider the practice to be an efficient use of surgeons’ time. It is not necessary, they say, for the surgeon to be present while the rest of the surgical team prepares a patient for surgery.
Do concurrent surgeries put patients’ lives at risk?
While there are no guarantees, patients typically take the selection of a surgeon seriously as they are, quite literally, putting their life in that doctor’s hands. To later learn that the surgeon so carefully chosen was not even in the room for the entire procedure and may not have performed certain portions of the surgery can be shocking. At the very least, it can be viewed as a breach of trust between the surgeon and the patient. At worst it could result in serious medical errors that leave the patient suffering from severe complications, or worse, dead.
Those who oppose the practice of concurrent surgeries cite the overall risk of not having the surgeon in the room and focused on the patient throughout the entire surgery. They also cite instances when patients were left under anesthesia for longer than planned due to timing issues with another surgery.
Critics of concurrent surgeries say that, ultimately, the danger to patients depends on the surgeon’s ability to multitask; some are simply better at it than others. While some doctors may be fully capable of quickly switching gears as they transition from one patient to the next, that is not the case for all.
Of course, the experience and expertise of the rest of the medical team is also crucial, as they are with the patient throughout the entire surgery and must alert the surgeon to any potential complications that may occur when the surgeon is not present – and address those complications if the surgeon is in transit between operating rooms.
If you or a loved one recently underwent surgery that involved complications which you think may be due to the surgeon performing overlapping surgeries, you may have a medical malpractice suit. The experienced Richmond medical malpractice attorneys at Phelan Petty represent patients in medical malpractice claims throughout Virginia. Contact us today for a free consultation. Call 804-980-7100 or fill out our contact form.