Policyholder Services

Do You Operate a Surgery Center?

By Betsy Kelley, OMIC Underwriting Manager

Digest, Spring 2003

Why does OMIC want to know? Quite simply, we want to help protect you, your staff, your facility, and your patients from liability associated with surgical procedures. As is often the case, it took some widely publicized patient deaths following procedures at surgery centers and other outpatient settings to remind physicians and patients alike that there are risks inherent in surgery, regardless of where it is performed.

In order to be licensed and accredited, acute care hospitals must have trained anesthesia and nursing staff, emergency equipment, and procedures in place to treat life-threatening complications when they develop. In the past, outpatient settings and surgery centers often were not subject to the same oversight and as a result, patient safety was compromised. Surgeons performed procedures for which no hospital had credentialed them; sedation was administered without monitoring for cardiopulmonary complications; staff had no training in Basic or Advanced Cardiac Life Support; unlicensed staff were given authority to administer medications, and monitor and discharge patients on their own; and centers had no procedures for handling emergencies or transferring patients. In response to poor patient outcomes, some states passed laws to govern outpatient surgical settings.

Areas of Potential Liability

Outpatient surgery is not just a threat to patient safety. It also creates significant malpractice risks for surgeons, their staff, and the facilities where the surgery takes place. Just like acute care hospitals, surgery centers can be held vicariously liable for the negligent acts or omissions of the surgeons who utilize the facility. Moreover, the center can be held directly liable for its own acts and omissions. Plaintiffs may allege that the surgery center failed to appropriately credential a surgeon or failed to take reasonable or prompt action against a problematic utilizer. Injuries may result if equipment is not properly maintained or calibrated or if conditions are not sufficiently sterile; in such cases, the facility likely will be held accountable. Furthermore, employees who provide professional services or assist utilizers may be a source of exposure.

Definition of a Surgery Center

OMIC’s underwriting process is designed to enhance patient safety and reduce liability risk by ensuring that the same standard of care applies to the practice of surgery, regardless of where it takes place. For underwriting and liability purposes, OMIC defines a “surgery center” as: 1) any freestanding surgical or laser refractive facility; 2) any surgical facility (including an in-office surgical suite or in-office laser equipment) utilized by physicians other than the owners and their employees; or 3) any in-office surgical suite used for the performance of surgical procedures other than minor surgical procedures that are routinely done in a physician’s office.

Underwriting Review Required

Because of the increased exposure, OMIC performs additional, thorough underwriting review prior to extending professional liability coverage to surgery centers. (Coverage is not “automatic” and applies only if the surgery center is specifically named in the policy declarations.) OMIC reviews a range of issues, including operations, licensure/accreditation, credentialing, peer review, risk management, anesthesia, and emergency protocols as well as prior insurance and claims history. Before extending coverage, reviewers want to be satisfied that physicians who use the facility are properly trained, licensed, credentialed, and insured; that they and the facility are fully equipped and able to promptly and effectively handle emergency situations as well as routine surgeries; and that the center operates in such ways as to limit its exposure.

Eligibility Criteria for Coverage

To qualify for coverage, a surgery center must first meet OMIC’s eligibility criteria. Ophthalmologists or ophthalmologist-owned entities must hold at least 50% ownership in the facility, and at least one owner, partner, or shareholder must be insured with OMIC. Ideally, the OMIC-insured owner(s) should hold at least 50% ownership in the facility.

The surgery center should be used primarily for ophthalmic procedures. Other specialists may use the facility, but coverage is not available for surgery centers at which certain high-risk procedures, such as abortions, cardiac surgery, laminectomy, pain management, or surgical weight control, among others, are performed. The surgery center also must meet other OMIC underwriting guidelines.

If approved, the surgery center will be named as an insured under the owner’s policy or may be issued a separate policy. The facility may share liability limits with the owner or may maintain separate limits of liability. Premiums are based on the volume and category (ophthalmic, laser refractive, or non-ophthalmic) of procedures performed. The premium may be waived if the facility is used exclusively by the owner-insured and shares liability limits with that insured.

If you operate a surgery center and would like to verify or apply for coverage of the facility, please contact your OMIC underwriting representative at (800) 562-6642.

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