The Medical Gestapo

In Haleakala Crater - photo by JoAnn Sturman

by Scott Sturman
fliesinyoureyes.com

It is when power is wedded to chronic fear that it becomes formidable.

Eric Hoffer, The Passionate State of Mind, 1954

“The inspectors are here, and they want to observe this operation!” The nursing director announced, as she stuck her head into the operating room. All of us knew the score. The inspection had little to do with surgery and anesthesia but everything to do with paper work and procedure. These situations border on farce. The operation room is not where most inspectors like to be. They invariably pull an ill fitting coverall over their street clothes, but despite their best efforts they look like a fish out of water. Hair hangs out from beneath their OR hats and clothing and well fed body parts cannot be hidden by temporary apparel.

The case proceeded uneventfully while the inspector and a nervous nursing director sat in the corner and poured over the chart, oblivious to any other activity in the room. Toward the end of the case the inspector approached me and stated she liked the way I labelled my syringes with dates, initials, and drug concentrations. Hardly a compliment since there were only two syringes in view, the drugs only come in one concentration, and I had prepared them 30 minutes ago at the beginning of the case. But in the inspector’s mind, this was real medicine. Having no idea of the patient’s condition, in her mind I had passed the test.

We in the medical profession are experiencing what the business community has for a long time. Every year a barrage of regulations comes our way which in most cases hampers efficiency and does little to correct problems they are intended to solve. Perhaps the most difficult aspect is the sense of helplessness when dealing with bureaucrats who enforce these rules, and short of knowing a politician who can intervene, there is no recourse - their word is law.

JCAHO is the tool the government uses to force hospitals to comply with policies and procedures. The organization was discussed in a previous posting, but essentially if JCAHO does not accredit a hospital, then the hospital receives no Medicare funds, and virtually no hospital can survive without Medicare. No hospital official will defy the most inane JCAHO ruling, since to do so undermines the hospital's solvency and the administrator's career.

Remember the days when a traffic policeman could use discretion when deciding whether a ticket or warning was issued? At least the violator felt he was dealing with a human being rather than a mindless robot. JCAHO is the cop who gives a ticket for every infraction and knows there is no traffic court to appeal the decision. To say that JCAHO's charter and ability to micro manage has expanded is an understatement. Good ideas or bad ideas are enforced in the same monotonous fashion – comply or else.

Professions function under different time constants. A lawyer's reaction time can be measured in months or years. A bureaucrat's in weeks or months, but for an anesthesiologist seconds matter. In some cases a patient’s well being depends on near instantaneous intervention. Traditional anesthesiology training programs preach this philosophy. All equipment is checked and emergency drugs are drawn up in syringes and made readily available to save time in case of an emergency. In most instances this level of response is not required, but just as in the case of US Airways Flight 1549, one never knows when a crisis will occur. It is with this in mind that every case is approached as if a catastrophe could occur at anytime.

Now this time honored approach is under fire. This level of preparation is considered to be a safety hazard. Rules and regulations demand all drugs, not just controlled substances, be locked away in the anesthesia cart or some other secure location at all times.

Regulators are masters of the what if ? game, where every conceivable scenario is considered irrespective of its likelihood. Their words are incontestable and when leaving the hospital well before cocktail hour, they must be consumed with a sense of self importance and power, knowing those on the front lines are subject to their every whim. Safely tucked in bed for a long night’s sleep, these regulators will never know if an avoidable injury was due to a drug that was not immediately available. That’s the patient’s and doctor’s problem.