A pain management specialist decides to perform a provocative discogram on a 49-year-old woman suffering from long-standing back pain. In the hopes of facilitating a diagnosis, he'll attempt to replicate the patient's pain by manipulating her lumbar disks under minimal sedation.

The pain doctor rents office space from, and shares an occasional round of golf with, one of the physician-owners at the local ASC, who vouches for his friend's skills and experience when he urges the credentials committee to grant pain management and surgical privileges. It turns out that three different ASCs within the past two years have granted the pain doctor privileges - and subsequently relinquished them.

Despite being uncomfortable with this history, the committee approves his privileges, largely at the behest of the shareholder. None of the three docs on the committee is an anesthesiologist or pain management specialist.

Unusually tentative
The provocative discogram goes uneventfully. It shows that the disc at L4-5 is responsible for the patient's chronic low back pain. The pain management doc tells the patient he'd like to perform a percutaneous lumbar discectomy. Having already put herself in the hands of the specialist, the patient consents to the procedure, scheduled for a week later.

The scrub technician would later say that she thought that the surgeon seemed unusually tentative during the procedure, but that she chalked the hesitancy up to a surgeon working in an unfamiliar environment.

In PACU, the patient complains of numbness and paresthesia in her right leg. Staff notifies the surgeon, who examines the patient and reassures her that the symptoms are transient. The patient is discharged home after three hours, but she can't bear weight on her right leg. Two male aides have to assist her to her car.

Consult with a neurosurgeon
Over the next six weeks, the patient's symptoms persist. A neurosurgeon believes that a nerve root was damaged during the procedure - an opinion EMG and imaging studies confirm.

Unhappy at how the specialist treated her, the patient seeks out an aggressive plaintiff's lawyer. The lawyer discovers that the ASC never credentialed the surgeon to perform percutaneous lumbar discectomy and that the surgeon was never formally trained in the procedure.

He brings suit against the surgeon and the ASC alleging, in addition to malpractice, that the ASC had negligently credentialed and supervised the surgeon. Unfortunately for the surgery center, the lawyer discovers that the surgeon had multiple suits against him and had lied about having malpractice insurance on his application to the ASC. Faced with the prospect of multiple judgments against his personal assets, the surgeon sells everything and flees to Europe. Efforts to locate him fail, leaving the ASC as the sole defendant.

To see if this was an expensive lesson for the ASC and its shareholders, meet me to discuss this case at writeOutLink("www.outpatientsurgerymall.net",1).