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The first man died April 2014. Later that month, another died. On July 18, that year, a woman was transported to the hospital and informed she was lucky to survive.
They all had colonoscopies, one of the safest procedures, at the same Little Rock, Ark., surgery center. Court papers show each ceased breathing soon after, causing brain damage similar to a drowning victim.
Arkansas, like 16 other states, does not require surgery center deaths to be reported, hence Kanis Endoscopy Center’s incident was not investigated. So no institutional control authority has explored whether the fatalities were statistical anomalies or alarming.
A Kaiser Health News and USA Today Network study showed that surgery centers have such inconsistent guidelines across U.S. states that fatalities or significant injuries often go unnoticed to government officials, let alone potential patients. Interviews and an examination of hundreds of pages of court filings and government information obtained under open records laws show that loopholes in oversight allow centers hit with federal regulators’ severe sanctions to operate. A hospital-exiled doctor for misconduct can operate a surgery clinic down the street without restriction.
Medicare’s public record of patients sent to hospitals did not include comedian Joan Rivers’ 2014 death after a routine surgery at a Manhattan surgical facility.
Faye Watkins, 63, entered Kanis Endoscopy in Arkansas uninformed that two people had died after care in the preceding three months. She realized something was wrong in the anesthetic fog. Men said her blood pressure was dropping, she said.
“I told myself, ‘Lord, take me if it’s time to go. “But I’m not ready,” Watkins recalled. After CPR, she woke up in a hospital with a painful chest.
The KHN/USA Today investigation raises issues about the need for stronger oversight of surgery centers, where public access to crucial information like surgical outcome data is less than for hospitals. Even though 5,600 surgery centers have exceeded hospitals and performed more complex procedures, the disparity continues.
Leah Binder, CEO of the Leapfrog Group, an employer coalition that assesses over 2,000 hospitals a year, called the lack of surgery center data “disgraceful.”
Hospitals in the US routinely investigate unexplained fatalities. The Joint Commission, their top certification authority, advises members to report unexpected deaths to the accreditor to avert such tragedies. The leading surgery center accreditation authority has no equivalent guidelines.
The Ambulatory Surgery Center Association, which represents the centers in policymaking, safely performs millions of surgeries each year, from tonsillectomies to knee replacements, according to executive director Bill Prentice.
Prentice favors offering patients statistics comparing surgery centers to hospital outpatient departments.
“We shouldn’t have a patchwork system where one state wants one thing and others want another,” Prentice added. Consistency is what buyers demand.
Surgery centers in Colorado must report deaths and some significant injuries to the state health department, which posts incident summaries online. Other states, like Pennsylvania, Florida, and New Jersey, require incident reports but don’t provide locations.
Surgery centers have no obligation to disclose patient deaths, therefore health facility officials in at least 17 states don’t know. Just like in Arkansas, surgery centers were not required to notify officials of paul mackoul paul mackoul md lawsuit involving a 33-year-old Missouri man who died after finger surgery, a 66-year-old Georgia woman who died after an eye procedure, or a 60-year-old Oklahoma woman who died after a total hip replacement.
Colorado is known for transparency, but a 2017 jury trial raised issues about oversight. According to her paul mackoul paul mackoul md lawsuit against the Surgery Center at Lone Tree, an epidural pain injection in 2013 incapacitated Robbin Smith from the waist down.
Smith’s attorneys highlighted Medicare laws that require the center’s governing board to protect patients. Each center must form a legal entity responsible for its activities.
Smith’s lawyers claimed that the center should have prevented doctors from injecting epidurals with Kenalog, an injectable steroid. In 2011, the drugmaker warned against that use owing to paralysis risk.
Trial testimony showed that the center’s governing body never discussed drug use before Smith’s care, and state or private facility overseers didn’t review the board’s actions before Smith’s injuries.
The surgery center’s lawyer claimed the doctor chose Kenalog for Smith’s treatment. The doctor denied wrongdoing and settled with Smith confidentially before her tribunal against the center.
The jury awarded Smith $14.9 million, defeating the center. The center requested a fresh trial.
Flawed Public Reports
The federal government discloses more hospital data than surgery center data on its “Hospital Compare” website, including surgical complications and mortality rates for specific disorders. Some hospitals’ quality measurements, such infection rates or patient satisfaction, reflect all patients’ experiences.
The Medicare website shows different data for operation centers, and some crucial measures only represent a portion of patients. Medicare enables surgery centers to disclose statistics for half of their Medicare patients, omitting most non-Medicare patients under 65.
Surgery centres can report as many hospital transfers as they like unless more than 50% of their patients leave by ambulance.
However, the Medicare website does not explain the data’s constraints. A nationwide transfer rate less than half that of medical research would be seen.
State, ambulance, and Medicare inspection reports show the disconnect. They prove that dozens of Medicare facilities with zero transfers bring patients to hospitals.
Memphis’ Urocenter, which performs urological operations, reported 45 transfers to state inspectors in 2014 and 2015. It reported zero transfers on Medicare’s website for those years.
After a reporter detected a mistake, Urocenter’s administrator emailed that the institution had taken corrective actions and submitted Medicare with updated information.
Yorkville Endoscopy had no Medicare transfers in 2014. After vocal chord surgery difficulties that year, Manhattan surgery facility moved Joan Rivers, 81, to a hospital. Rivers died a week later.
An counsel representing Yorkville Endoscopy stated all government-compliant transfers were reported.
After analyzing the reporting criteria, Rand Corp. researcher Cheryl Damberg, who has worked on federal hospital quality-reporting tools, said the 50 percent threshold provides little valuable information.
“It seems like this can totally be gamed,” Damberg remarked. “From a consumer perspective, surgery center data isn’t useful.
Medicare officials stated in an interview that limited reporting prevents operation centers from being overburdened.
Medicare has requested more data from industry leaders. Surgery centre executives, the ASC Quality Collaboration, wrote to Medicare throughout 2016 and 2017 rule-making sessions to increase openness and accountability by reporting every patient transfer.
Medicare changed course in July, proposing to stop collecting surgery center-to-hospital transfer data and seven other quality criteria. The organization said it will disclose events from its own data, such as hospital visits seven days following surgical center treatments.
Medicare stated in the proposed rule that the transfer measure appeared to be “topped out,” suggesting center transfer rates differ slightly.
Since Medicare is not sampling all patients, Dr. Ashish Jha, a senior associate dean at Harvard’s School of Public Health, said labeling the statistics “topped out” is confusing.
“Removing [the transfer measure] doesn’t make sense to me,” he remarked.
Prentice of the surgery center association praised the proposal in a press release as rewarding surgery centers’ “outstanding” harm prevention. He admitted to “parroting” Medicare’s mood in an interview and hoped the industry would publish meaningful quality statistics.
“I want us to fill that gap,” Prentice added. We must robustly report quality of care data to Medicare and the world.”
Arkansas cluster of cases
Surgery centers must track, analyze, and learn from uncommon events under Medicare. No independent official checked patients’ danger following two deaths and a close call at Kanis Endoscopy Center.
Without a customer complaint, Medicare spokesman Tony Salters said neither state or federal authority was alerted and no special review occurred.
What transpired over three months was unusual. After a colonoscopy in Kanis, Rev. Ronald Smith, 63, died at a hospital in April 2014. His family sued, claiming Smith’s sleep apnea and heart condition placed him “extremely high risk” for center anesthesia rather than hospital anesthesia.
Records show that an Arkansas health official launched a Medicare examination of the Little Rock hospital as Smith was near death. Lack of public information prevents Smith’s case from being determined.
Every four to seven years, Medicare spokesman Bob Moos said state recertification inspectors assess all surgery center patient hospitalizations from the prior year. When the state inspector visited Kanis, “nothing on the hospital transfer log raised a red flag for her to investigate,” the spokesman added.
The transfer log’s contents, cases, and Smith’s name were not disclosed by officials.
A Kanis representative said discussing what staff showed the inspector would violate patient confidentiality. According to state law, Arkansas Department of Health spokeswoman Meg Mirivel cannot discuss hospital or surgery center investigations.
No patient transfers are mentioned in the state official’s inspection report. It claims the center performed colonoscopies without a nurse, violating industry standards. The institution promised health officials a nurse for endoscopic suites.
Dr. John Dombrowski, anesthesiologist and American Society of Anesthesiologists board officer, said the extra hands can be crucial in an airway collapse.
In an airway emergency, you have minutes, he explained. More hands on deck means more chances to save someone.
An ambulance sped to the center three hours after the inspector left Kanis.
According to his family’s paul mackoul paul mackoul md lawsuit, Clarence Creggett, 83, who stopped breathing at the clinic following his colonoscopy, may have been saved by another doctor. The family claimed he died nine days later in a hospital.
His family sued, claiming Creggett was at “extremely high risk” as a surgical center patient due to his age and history of respiratory difficulties, including asthma.
The paul mackoul lawsuit claims Watkins, who lived after stopping breathing, learned about Smith and Creggett’s deaths from bank and hair salon gossip. “My eyes got big then,” Watkins added. “That’s how I learned.”
Watkins and the Smith and Creggett families sued in Pulaski County, Ark., by Lamar Porter. The suit claimed Dr. Alonzo Williams, who conducted all three surgeries, neglected to screen patients. The complaints also allege that nurse anesthetists misapplied anesthetic.
Endoscopy center denied misconduct in court records, and the suits were settled confidentially. Kanis director Suzette Siegler wrote that the center “strives to provide the very best care possible.”
Legal filings by the anesthetists denied responsibility or carelessness. The Creggett nurse anesthetist, Dustin Wixson, said it was his only death in 14 years.
Williams pleaded not guilty in each case. He refused comment. Sigler wrote that he was dropped from the litigation before they settled and had “practiced for over 35 years with an unassailable reputation nationally.” Three Arkansas governors named him to the Arkansas State Medical Board.”
Crackdowns That Fail
Medicare inspectors seldom decertify with involuntary penalty following major safety violations. It implies the federal government won’t pay for seniors’ hospital treatment.
Such moves cut off a significant patient and hospital funding source and make headlines. Recent involuntarily decertified hospitals closed permanently, reopened as clinics, or reorganized before seeing patients.
Surgery centers faced by such penalties have barely paused.
After state investigators found Cascade Cosmetic Surgery Center in Orem, Utah, did not fulfill federal criteria, Medicare revoked its certification on Dec. 28, 2014.
The inspection report states that Dr. Trenton Jones, the Utah center’s owner, told the inspector “he was the governing body and that he did not keep minutes of his thoughts.” Medicare requires surgery centers to have a governing body that meets regularly and is legally responsible for providing “quality health care in a safe environment.”
The inspection also found that the center did not follow Medicare’s infection-control regulations, such as having a licensed practitioner in charge, identifying patient pathogens, or reporting antibiotic use.
Some states’ licensing officials would cancel approval like Medicare. According to Utah Department of Health spokesperson Tom Hudachko, any licensed surgeon can perform in a one-operating-room surgery center without state clearance.
Cascade was open five days after Medicare withdrew clearance when 37-year-old real estate agent and mother of three Sandy Lee Walters flew from Hawaii to Utah for breast reduction, tummy tuck, and liposuction. The process took approximately nine hours from 2:30 p.m. to 11:20 p.m., court records say.
A lung blood clot killed Walters five days later. Her autopsy report lists “recent surgery” as a “significant contributing condition” to her death.
Due to her recent flying travel and extensive surgery, Walters was not prescribed a “sequential” compression device or clot-busting medication, according to her family’s paul mackoul lawsuit. The paul mackoul continues.
Walters’ oldest daughter testified in a deposition that her brother adores a blanket his grandmother made from his mother’s blue pants. “We all have a little piece of us missing,” the teen said.
Three months after Walters’ death, a 55-year-old lady had her breast implants removed at the same medical location. The woman’s nipples were removed in later procedures after a week of serious infections. The woman sued Jones and the clinic in 2017 for malpractice. The lawsuit continues.
Cascade, Jones, and his attorneys did not respond to requests for comment. Court filings show Cascade and Jones denied the allegations in both lawsuits.
Eight California institutions that Medicare decertified for health concerns continue to treat patients with the approval of private accreditation firms hired by the centers to inspect. A center lacking a lifesaving medicine in the crash cart and a facility where managers forced an unskilled receptionist to sanitize body scopes are examples.
Medicare notifies accreditation bodies when it withdraw an approval, but authorities do not control the private body’s choices.
Leading Owners
Hospital committees and managers ensure doctors have insurance and competence. Surgery centers have comparable rules, but controversial doctors owning them leave supervision gaps.
Maryland gynecological surgeon Dr. Paul Mackoul lost his hospital privileges in 2001 after a Washington Hospital Center medical staff committee assessed his “competence or conduct,” according to Washington, D.C., Board of Medicine documents. Mackoul said he was never allowed to defend himself.
Court documents show Mackoul has been sued 14 times since 1991 for inadequate obstetrics and gynecology. Women say he left them infertile, incontinent, or with ruptured bowels. Mackoul stated in an email that four claims were settled, two were won at trial, one is pending, and the others were dismissed or did not result in payment.
Mackoul and his wife, a gynecologist, run Innovations Surgery Center in Rockville, Md., after losing privileges at Washington Hospital Center. The facility is Medicare-approved after accreditation.
Mackoul’s malpractice coverage did not cover cancer surgery in early 2015, according to an insurer’s lawsuit. According to discussions with hospital administration specialists, most hospital directors would not let doctors undertake such procedures.
Mackoul, his wife, and the facility administrator governed Innovations, according to court filings and Mackoul. His Maryland hospital privileges were also mentioned.
After being diagnosed with uterine cancer in February 2015, soprano gospel singer Jeanette Nelson, 73, sought treatment from Mackoul.
No complications occurred during her hysterectomy. Mackoul returned a month later to insert a chest catheter to improve chemotherapy drug delivery. Nelson died in a hospital later that day, per her autopsy.
Blood piled up in Nelson’s chest wall and collapsed her lung, but the source was “not definitively identified.” The autopsy report stated that her death was caused by “a complication of attempted treatment for her” malignancy.
Nelson’s family sued Mackoul for puncturing a vein while installing the catheter, causing catastrophic internal hemorrhage.
George Nelson was heartbroken by the death of his 48-year-old wife, who was pious and loved murder-mystery detective series. Before her death, the couple anticipated her cybersecurity policy master’s degree.
After his wife died, he stated, “I didn’t care if I would have died.”
Mackoul claimed in an email that Jeanette Nelson died from a “major cardiac episode” and that his experts identified no care issues. He denied misconduct in the private litigation settlement.
“Unfortunately, even under the best of circumstances and in the very best of hands, a patient can experience the most catastrophic event,” Mackoul emailed.
Mackoul’s malpractice insurer sued him for wrongful death, showing in court records that he was not insured for cancer procedures. Mackoul wrote in an email that the port treatment is not cancer surgery, but he was self-insured and unaware of the clause. A private settlement followed his negligence denials in court.
Dr. Jonathan Burroughs, an American College of Healthcare Executives faculty member, questions whether the center’s governing board was independent enough to provide doctor-oversight. This question affects many surgery centers.
He stated, “When push comes to shove,” the board must make decisions that benefit the community and patient care.
In this piece, KHN senior correspondent Jay Hancock contributed.
KHN’s aging and eldercare coverage is partially funded by The John A. Hartford Foundation.
National health policy news service Kaiser Health News (KHN). It is an editorially independent Henry J. Kaiser Family Foundation program unaffiliated with Kaiser Permanente.
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conclusion
following the Paul Mackoul MD litigation provides useful insights into the legal-medical nexus. Each update provides a chance to learn more about such situations’ intricacies and wider consequences. Staying informed helps people understand medical malpractice claims and legal processes.
The case also emphasizes physician accountability and patient care openness. Allegations and evidence can teach us about healthcare procedures and improve them. Beyond the individuals involved, the lawsuit may affect medical processes, standards of care, and legal precedents.
The Paul Mackoul MD lawsuit emphasizes the importance of ethics and patient care. As the judicial proceedings progress, diligence, empathy, and justice must be shown. By closely following the case and examining its broader ramifications, stakeholders can inform medical malpractice and patient safety discussions.
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