How to make surgery centers accountable

Herman Gordon, Las Vegas

Sunday, April 6, 2008 | 2:02 a.m.

Nevada is undergoing a crisis of how to regulate endoscopic centers involved in practices that are hazardous to public health. It seems the first and most obvious excuse is that state and local governments do not have the inspection resources necessary to visit and check up on the 50 or so ambulatory surgical centers in the state, not to mention the hospitals.

There are never enough inspectors to ensure compliance with rules and regulations, whether it be for food or drug manufacture, restaurant sanitation or a thousand other legal requirements that need to be monitored. Our officials have to devise different ways to cope with the growing complexity of compliance to rules in an increasingly permissive society. I have a suggestion.

Forget about increasing the inspection and licensing staff and making more regular and frequent visits to the ambulatory surgical centers — we’ll never be able to afford enough trained people to keep constant vigil.

The government inspector probably has a checklist to cover to determine whether compliance with the code is in place. Why not give the checklist to the ambulatory center and require its people to periodically perform their own inspection according to a handbook written by the government?

The requirement could be that both the owner of the establishment and the director of operations attest that the appropriate inspection took place and that deviations from code, if any, were noted and corrected.

Nothing concentrates the mind so much as when the signer of a document realizes that if he is caught lying, he is subject to additional criminal charges beside the original violation, such as reusing a one-time syringe or vial. He is now obstructing justice and colluding or conspiring with another party to defraud.

When the owner and operator know there is a possibility of exposure, either through some future whistleblower or an infrequent checkup by a government inspector that results in showing that the signers deliberately falsified the self-inspection, I think you will get much better compliance than we do now under the current system of inspectors never or rarely getting around to visiting surgery centers.