Two CRNAs have filed a whistleblower and retaliation lawsuit against a California gastroenterology center and the physicians who own it, claiming they routinely ushered patients into the OR without performing adequate histories and physicals or pre-surgical assessments. The CRNAs say they were fired after repeatedly expressing concerns about the physicians' failure to comply with safe practices and CMS guidelines.

Tennessee-based AmSurg, which is affiliated with more than 200 ASCs nationwide and which owns a majority stake in the defendant Redding (Calif.) Surgery Center, is also named in the suit, along with Gaddam Naresh Reddy, MD, Piyush Kumar Dhanuka, MD, and B. Nicholas Namihas, MD.

CRNAs Douglas Dalitz and Randy Gray cite 4 examples in their complaint. "Patient A," they say, was prepped for a colonoscopy despite no H&P having been done. When Mr. Dalitz, having done his own evaluation, determined that treatment in an ASC was inappropriate and refused to administer anesthesia, Dr. Namihas reportedly replied, "We did the prep and that's what we're paying you for." He then allegedly went ahead with the colonoscopy without anesthesia.

In the case of "Patient B," Dr. Reddy is accused of signing an H&P at 7:42 a.m. for a procedure that began at 6:51 a.m. The same day, he allegedly signed an H&P for "Patient C" at 7:45 a.m. and started Patient C's procedure at 7:45, indicating that there had been inadequate time for a comprehensive H&P.

Dr. Reddy also allegedly failed to perform a comprehensive H&P or pre-surgical assessment on "Patient D," an endoscopy and colonoscopy patient. When Patient D told Mr. Gray he'd gone to the ER with heart palpitations the night before, Mr. Gray expressed concern to Dr. Reddy, who allegedly insisted on proceeding. Once anesthetized, Patient D experienced a sudden onset of profound bradycardia, and the procedure was halted.

Mr. Gray and Mr. Dalitz say they first expressed their concerns in September 2010 and that they continued to express them on multiple occasions to both the physicians and to AmSurg's regional vice president (whose name doesn't appear in court papers). They were assured corrective action would be taken, they say, but none was. Shortly after a December meeting with AmSurg management in which Mr. Gray again expressed concern that the center wasn't complying with CMS regulations, both he and Mr. Dalitz were fired.

Legal maneuvering by the defendants in an attempt to have the case dismissed was rejected last month in the U.S. District Court for the Eastern District of California.

In a filing with the Securities and Exchange Commission in late 2013, AmSurg noted that both the United States and the state of California had declined to intervene in the case. "[AmSurg] believes the claims in the lawsuit have no merit, and intends to vigorously defend the lawsuit," says the company. When reached by Outpatient Surgery Magazine, Brian D. Roark, the lead attorney representing all of the defendants, declined to comment.

Jim Burger