Specialty hospitals, surgery centers call 911 in emergencies

By Morgan Loew
KPHO-Phoenix

During the past decade, the number of so-called "specialty hospitals" and surgical centers has risen dramatically in many major American cities. Supporters say these facilities ease crowding at full-service hospitals and provide a top-notch alternative, by using staff that focus on just a few types of procedures. Web sites for the facilities tout gourmet meals and "spa-like" treatment for patients. But critics warn: Don't be fooled. These are not full-service hospitals. That means if you experience a complication during your stay, real emergency treatment may be a 911 call and an ambulance ride away.

At least 150 patients were transported to Phoenix-area emergency rooms over the past seven years after undergoing procedures at specialty hospitals and surgical centers. All of the patients we spoke to said they assumed the facilities would be able to handle any complications that could arise during those surgeries.

After our story aired, the U.S. Senate Finance Committee sent letters to the CEOs of the specialty hospitals and surgical centers named in the story, asking them to explain the circumstances of each of the 911 calls and patient transfers. One senator was quoted as saying, "When hospital patients need emergency care, they absolutely should not have to be transported across town to receive it."

While interviewing a man for an unrelated story two years ago, he told me the story about how his back surgery at a local hospital resulted in a 911 call and a transport to another hospital that had an emergency room. At the time, the story seemed a little odd, so I filed it in the back of my mind and continued with the story I was working at the time.

In April, I read an article in The New York Times that reported on problems with specialty hospitals in Texas, and how many times they had to call 911 following complications during operations. I remembered the story I had heard two years before and decided to find out if this was a problem in the Phoenix area.

The first step I took was to find out how specialty hospitals are regulated and how they differ from full-service hospitals. I discovered that any facility that uses general anesthesia and keeps patients overnight is regulated by the state. I requested the database containing all of the hospitals and surgical centers registered in Arizona.

The list was quite large, so I narrowed it down. I removed all of the full-service hospitals and surgery centers that were connected to those hospitals. I removed eye surgery centers and endoscopy centers because those procedures are more traditionally viewed as "outpatient." I was left with a list of about 50 facilities across Maricopa County.

I ended up choosing about a dozen of the best-known and most high-profile specialty hospitals and surgical centers in the area. I sent a public records request to the City of Phoenix Fire Department, asking for a printout of the 911 calls placed from those facilities. I specified that the list should include, but is not limited to the time and date of the call, the nature of the call, the type of response, and any other information that was available.

We had our response in about a week and a half, and it appeared that there were hundreds of calls from these facilities. Not all of them involved problems with patients. The list included fire alarms, false alarms, something called "miscellaneous service," as well as "ALS" and "BLS" calls. We focused on the last two, which stand for "Advanced Life Support" and "Basic Life Support."

After reviewing our data, we removed several more facilities from our list because they shared their addresses with other medical facilities and it was impossible to distinguish where the calls originated with our tight deadline approaching. We ended up with seven of the facilities calling 911 emergency services 150 times over a seven-year time frame. The numbers are most likely much higher if you include the facilities we weeded out.

I contacted the man I had spoken to two years earlier and he agreed to an on-camera interview about his ordeal. I contacted the hospitals and surgical centers and interviewed a doctor. At that point, my deadline was up and the story hit the air.

Here are some tips I would suggest if you're trying to do this story in your area:

• Look into the ownership of the specialty hospitals and surgical centers in your area. Most are owned by the doctors who perform the surgeries in them. This brings up a question of whether they have a financial incentive to perform the procedures in their own facilities.

• Look into the physical condition of the patients who have their surgeries performed at these facilities. Most doctors will tell you these places are viable alternatives to the full-service hospital if the patient is in relatively good condition. When you add risk factors, such as obesity, age, heart, kidney or other conditions, you end up with a patient who may be more suitable for a procedure in a facility with an emergency room or intensive care unit. The patients I spoke to (I talked to four in total) all had risk factors that appeared to exceed what doctors I spoke to deemed as acceptable for a surgical center or specialty hospital.

• Look into the effect these hospitals are having on the full-service hospitals in your area. These facilities typically perform only the most lucrative procedures, such as joint replacement and spine surgeries. Full-service hospitals use those procedures to make up for other parts of the hospital that don't make money, such as the neo-natal ICU or ER. If the knee replacements start disappearing, the full-service hospitals may find themselves in a big financial crunch.

Here are some difficulties you may face:

• It's going to be difficult to find a victim, because of the medical privacy issue. You may have some luck if you request the actual taped 911 calls. I've found that they sometimes contain information the paperwork does not, including names. Try getting to know a medical sales representative in your area. These people are in the operating rooms, they hear stories from other reps and doctors, and are more likely to talk to you about what they hear and see than a doctor would. You also may want to check the lawsuits filed against the facilities.

• The representatives from the facilities may downplay the transports by saying they routinely transport patients to other hospitals after surgery. Remember, these companies have contracts with ambulance services for non-emergency transports. They only call 911 if they have to!

Morgan Loew is an investigative reporter for KPHO-Phoenix.