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Single-Room Surgeries to Operate Under Same Rules as Hospitals, Ambulatory Centers

Lawmakers approve legislation that gives health department control over licensing.

The Legislature on Monday approved a bill giving the state Department of Health oversight over all surgeries performed in New Jersey. The health agency already licenses and inspects operating rooms in hospitals and ambulatory surgery centers. By wide margins, lawmakers voted to include single-room surgical practices under the purview of the agency.

The measure has the support of the large ambulatory surgery centers -- outpatient surgery facilities with more than one operating room -- and hospitals already subject to licensure, as well as physicians whose single-room surgical practices will now come under the control of the health department.

Tens of thousands of surgical procedures, from plastic surgery to joint replacement that once were only performed in hospitals, are now being done as same-day surgeries in outpatient surgery centers and in the offices of physicians with an office equipped with an operating room.

The legislation, S 2780 sponsored by Sen. Joseph F. Vitale (D-Middlesex) and A 4099 sponsored by Assemblyman Herb Conaway (D-Burlington), puts every surgical venue under the same health department license and inspection regime. Previously, the one-room surgical practices were overseen by the state Board of Medical Examiners. Under the new law, the one-operating-room surgical practices will be inspected by the state health department every two to three years.They have been subject to less frequent inspection by the Centers for Medicare and Medicaid Services.

The legislation was supported by the New Jersey Hospital Association, the New Jersey Association of Ambulatory Surgery Centers, and the Medical Society of New Jersey.

Putting all surgical venues under uniform regulation by the health department addresses concerns raised a year ago by a study of outpatient surgery by the New Jersey Health Care Quality Institute, a nonprofit foundation. The foundation analyzed reports compiled by the health department from a special project that inspected both ambulatory surgery centers (ASCs) and surgical practices in physicians' offices.

Catherine Purnell, a former emergency room nurse and now director of clinical and policy advocacy for the foundation, said the results of that analysis suggested there were more safety issues at single-room surgery practices that were not licensed by the health department, than at large ASCs licensed by it.

"We read 91 inspection reports from 2009 and 2010," Purnell said, explaining that about half were large ASCs that were already licensed with the health department, and the other half were one-room surgical practices overseen by the state Board of Medical Examiners. "What we found is that of the licensed facilities, only 15 percent were noncompliant with certain serious safety requirements." But the one-room surgical practices had a 45 percent rate of noncompliance with serious safety procedures. "That is a pretty big difference," she said. Violations included failure to have life-saving medications on hand, and the use of a vial of medication on more than one patient.

"This is a landmark piece of legislation," said Larry Trenk, president of the New Jersey Association of Ambulatory Surgery Centers. "It creates a level playing field with a universal and uniform set of standards. Everyone will be subject to licensure, so there will be consistent standards and quality assurance goals."

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