Significant media attention has bee...

Significant media attention has been paid to the 90-day ban lately issued in Florida of all office-based flat III (ie, requiring anesthesia and preoperative sedation) surgeries. As a spring health and safety issues of patients undergoing surgery in office settings now are gaining the attention of state legislators and regulators from head to foot the country.

Improvements in surgical and anesthesia technology and the demand to be cost-effective have driven the explosion in the number of surgeries performed in office settings. undivided source estimates that 20% of surgical conducts in 2001 will be performed in physicians' offices.(1) These measures are becoming increasingly complex as technology advances. State and federal legislators now are grappling with the question of what of the same height of regulation is necessary to render certain patients' health and safety. National associations whose members work in office-based facilities also are taking a closer await at their professional standards and practices.

STATE OVERSIGHT OF OFFICE-BASED SURGERY

Six states (ie, California, Florida, strange Jersey, Pennsylvania, Rhode Island, Texas) generally have laws or regulations pertaining to office-based surgery These regulations differ from legislation that requires the licensing of ambulatory surgery center which has been passed in 43 states.

Connecticut is in the proces of developing regulations for freestanding outpatient surgical facilities. recent York and Ohio have issued voluntary statements or guidelines regarding performing surgery in office settings. In Illinois, the state medical board is adopting guidelines for administering anesthesia in office settings.

CALIFORNIA

in succession Sept 30, 1994, Gov Gray Davis (D-Calif) signed AB 595 which defines outpatient settings as any facility, licensed or unlicensed clinic, center office, or other setting that is not part of a general acute care facility and that administers anesthesia in doses that can place a patient at risk. The bill prohibits physicians from performing surgery in any outpatient setting that is not accredited by dint of an accrediting agency approved from the Division of Licensing of the Medical Board of California.

Five years later, in October 1999 Gov Davis approved couple more laws affecting outpatient surgery Senate Bill 450 requires the Medical Board of California to adopt extraction and postoperative care standards for liposuction managements not performed in general acute care hospitals.

The other bill, AB 271 the Cosmetic and Outpatient Surgery Patient Protection Act, requires tighter regulation of outpatient surgery settings. The bill states that like settings must have two staff members forward the premises to perform procedures--one of whom must be a licensed surgeon or a licensed health care professional with passing from hand to hand certification in advanced cardiac life support. The act also requires that any measure that results in the death or a transfer of the patient to a hospital or juncture department be reported to the Medical Board.

FLORIDA

The Florida Board of Medical Examiners has been businessed about office-based surgery since the early 1990 In 1994 the Board added [sections] 64B8-9009 Standard Care for Office Surgery to the Florida Administrative digest The section includes several significant components First, it defines three evens of surgery: level I, even II, and level III. inferior the section outlines personnel required for each level

flat I defines minor procedures that require topical or local anesthesia. In of the same height I procedures, the surgeon must be assisted by way of a physician, osteopathic physician, RN licensed practical succor (LPN), or surgical technologist. An RN may assist with anesthesia induction. A physician, physician assistant, or RN with postanesthesia care unit (PACU) experience must be available to monitor patients in the PACU.

even II defines more complex transactions in which perioperative medication and sedation are used intravenously, intramuscularly, or rectally. In plain II procedures, the surgeon must be assisted by the agency of a physician, physician assistant, RN or LPN A physician, physician assistant, or RN must be available to monitor patients in the PACU.

flat III procedures involve the use of general anesthesia or major conduction anesthesia and preoperative sedation. In flat III procedures, the surgeon must be assisted at a physician, osteopathic physician, RN LPN physician assistant, or surgical technologist. A physician, physician assistant, or RN with PACU experience must be available to monitor patients in the PACU.

of recent origin legislation (ie, Florida Statute [sections] 458351) went into force March 2000 requiring that adverse surgical incidents occurring in office practice settings be reported. After receiving the first incident reports, onward Aug 10, 2000, the Florida Board of Medical Examiners issued a 90-day moratorium forward all level III office-based surgeries. The moratorium was issued to

* guard the lives of patients undergoing on a level III procedures in physician office settings and