Concurrent surgeries cause conflict at MGH: 10 things to know

The Boston Globe's Spotlight Team recently reported on an ongoing controversy at Boston-based Massachusetts General Hospital — one that has spurred several investigations, changed patient lives and fueled both terminations and resignations of top physicians.

The years-long debate at MGH is over concurrent surgeries, or when a surgeon runs two operations at the same time. The controversy calls patient rights and surgeon rights into question.

Here are 10 things to know about the Boston Globe report on MGH's battle over concurrent surgeries.

1. The report stems in large part from a former leading hip and knee replacement specialist at MGH, who has led the opposition against double-booked surgeries at his own expense. After nearly 10 years challenging the practice, he provided The Globe with copies of internal records — with patient names and identifying information removed — and was dismissed from his position in August.

2. The story closely follows several surgeons who performed concurrent surgeries. One such surgeon performed complex spine procedures concurrently. One surgery — of a 41-year-old father — resulted in paralysis, and another — of former Red Sox pitcher Bobby Jenks — ended the baseball player's career, Mr. Jenks says. Both surgeries overlapped significantly with other cases — for Mr. Jenks, a second case completely overlapped his surgery — and neither patient was aware of the overlap, according to the report.

3. The practice of double-booked surgeries is not unique, according to the report. It is used by many other hospitals as a way to most efficiently use its top specialists. Boston-based Brigham and Women's, a sister hospital to MGH, engages in the practice, but limits overlap to an hour max, according to the report. Boston Medical Center allows overlap as well, but limits it to certain procedures or certain physicians.

4. Only about 3 percent — or 1,000 cases — annually at MGH involve at least one patient with an open incision while a second case is going on, according to the report. Hospitalwide the case overlap is 15 percent, but in the orthopedics department about 25 percent of cases overlap, according to the report.

5. MGH policy requires patients to know the involvement of the attending surgeon, but they are not required to disclose concurrent surgeries, according to the report. The hospital revised its policy in 2012 to limit concurrent surgeries from spanning three rooms simultaneously, or two cases and one patient in a clinic. It also called on hospital leaders to define what parts of a surgery are critical and should not overlap. Physicians are still not required to inform patients of an overlap, according to the report.

6. MGH said it conducted a review of 25 concurrent surgeries that resulted in complications following the Globe investigation and found none of the complications were due to double booking, according to the report.

7. The former MGH surgeon who led the opposition to double booking reached out to a trustee for the Massachusetts General Physicians Organization and David Torchiana, MD, CEO of Boston-based Partners HealthCare, the hospital's parent organization, in late 2010 and met with both officials in 2011. The surgeon said Dr. Torchiana did not budge at the meeting and reminded him MGH is a teaching hospital which gives residents graduated levels of responsibility during surgery. Dr. Torchiana later said the surgeon's account was not accurate, according to the report, but he did not provide additional information.                                                                            

8. Shortly after the meeting between the surgeon and Dr. Torchiana, MGH called on former U.S. attorney Donald Stern to investigate concerns raised by the surgeon. After months of investigation, Mr. Stern's report showed the practice of double-booking was safe, according to the report. However, the hospital has not shared Mr. Stern's document with state regulators or even its chief surgeon, who is responsible for the hospital's new concurrent surgery policy.

9. After learning of the 41-year-old father's paralysis from a spine surgery at MGH, the surgeon leading the opposition alerted state agencies of the issue. The Massachusetts Department of Public Health investigated in February and said nothing was wrong at the hospital, according to the report. However, investigation of several surgeons, including the one who operated on the paralyzed father and Mr. Jenks, is ongoing.

10. MGH claimed 10 percent of the surgeries performed by the hip and knee surgeon who led the opposition overlapped in 2014. In response, the surgeon gathered 15 months of records to give to The Globe and showed the average overlap was just a few minutes, and that he never overlapped patients with open incisions, according to the report. Providing these documents led to his removal from the hospital.

Read the full report and access hospital emails regarding the matter here.

 

Editor's Note: This article was updated Oct. 29 at 9:51 a.m. CT.

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