Wisconsin Bill: Cameras in the OR

A legislator in Wisconsin is proposing a bill that would require facilities to record both video and audio of any operation requiring general anesthesia if requested by a patient. The focus is apparently on the actions of personnel in the OR and not the procedure itself.

The bill was drafted in response to a campaign by the family of a woman who died after a cardiac arrest in an operating room in 2003.

It’s a tragic case, and the family has every right to be upset and want to do something to prevent a similar incident happening to someone else.

However, this law is not the answer. Here is why.

The woman, who was 38 years old when she died, underwent breast augmentation surgery by an oral and maxillofacial surgeon who was both a dentist and an M.D. He was not board-certified in plastic surgery or anything else. He billed himself as a Fellow of the American Academy of Cosmetic Surgeons–an entity not recognized by the American Board of Medical Specialties.

The operation took place in the doctor’s office in Sarasota, Florida. According to a recent article on the Outpatient Surgery magazine website, the patient had been given a massive overdose of propofol—a short-acting intravenous anesthetic, the physician’s office manager [not a medical professional] was monitoring her pulse, and after she suffered a cardiac arrest, the doctor waited several minutes to begin chest compressions.

The Florida Board of Medicine revoked the doctor’s license, but he is now practicing in Pennsylvania.

Most of those facts were omitted from the Milwaukee Journal Sentinel story about the new law.

Questions about the plan include: would the actual surgery be recorded or just the actions of the people in the OR; how many cameras would be necessary to cover all of the participants in a typical operation; would the videos be part of the medical record; and how long would they have to be kept?

There are at least 130 hospitals in Wisconsin. There are probably more than 800 ORs in the state, not including outpatient facilities that do surgery under general anesthesia. Who would pay for the installation, maintenance, and operation of the cameras and the collation and storage of the videos?

The sad truth is that if the law passes, it would not prevent a non-board-certified oral surgeon from practicing plastic surgery in his office with his office manager monitoring the patient. If a doctor is going to break some of the rules, he probably would break a video recording rule too.

This recalls the famous Libby Zion case. In 1984, a young woman in the early morning hours died on a medical floor at a prestigious New York City hospital. In the aftermath, the State of New York established regulations limiting the work hours of residents. But the case had more to do with supervisory issues than fatigue. Ironically, the regulations permitted housestaff to work more than 24 hours when, in fact, the residents taking care of Ms. Zion had been on duty for less than 24 hours.

We are now feeling the unintended consequences of similar rules limiting the work hours of residents nationwide.

It is understandable that a family would want to do something positive in memory of their loved one, but is this proposed law the way to go? I don’t think so.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.