We all read the sensational news of Joan River's passing.  While she may have not been your comic cup of tea, one had to admire her energy, work ethic, and longevity.

Her tragic death had its roots in a procedure that occurred in an outpatient surgery center.  The plan was for her to undergo an endoscopy—a procedure where a camera is threaded down the esophagus and into the stomach and beginning of the small intestine – by a gastroenterologist – a doctor that specializes in diseases of the digestive tract.  Typically, this type of procedure evaluates whether a patient suffers from a problem with their stomach or esophagus. Because it is uncomfortable, patient receive sedation or, less commonly, general anesthesia.

It was not planned that she undergo any procedure on her throat.  By some unknown series of events, however, Ms. Collins long time ear, nose, and throat doctor was allowed access during the procedure.  He purportedly took a biopsy of her vocal cords during the procedure.  Thereafter, she suffered a complication, and her heart stopped.  911 was called, and emergency medical responders found her unresponsive and in cardiac arrest.  After some unknown period of time, she was resuscitated.   It appears her heart remained stopped for too long, and she suffered irreversible injury.  She was transported to Mt. Sinai Hospital where she remained in a coma until she passed away.

In today's medical world, patients are often pushed toward outpatient surgery centers.  There are several reasons for this. First, they are cost effective for insurance companies.  Because they do not possess all the equipment and staff of a full service hospital, they can provide surgical support services at a lower cost.

Another reason is the doctors that perform the surgeries often have an ownership interest in the surgery centers.  Decades ago, doctors asked themselves, “Why shouldn't we, instead of a hospital, make a profit off each surgery they perform?”  In response, doctors joined together and started their own surgery centers where they could perform more routine surgeries, such as orthopedic or plastic surgery.  This way, the physicians retained that portion of the fee the patient previously paid the hospital for hosting the surgery.  This economic model exploded to the point that all sorts of surgeries once performed in hospitals are now performed in surgery centers.  Now, general, orthopedic, plastic, podiatry, ENT, eye, colon, and even heart procedures are frequently done in surgery centers.

Make now doubt about it, this lowered cost and often improved convenience comes at a cost.  The risk is if a patient has a severe complication, a surgery center may not have the personnel or equipment to address it.  Be it a stroke, heart arrest, airway complication or other problem, a patient will need to transport the patient to a full service hospital where they can receive care from specialists and additional equipment.  When this happens, critical time is lost.

The lesson to be learned, is elderly patients and patients with heart or other significant risk factors should think long and hard before having their surgery performed at a surgery center.  You always have the right to insist your surgery or procedure be done at a hospital.  That way, if you do have a complication, you can obtain the necessary emergency care.