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Massachusetts medical board approves rules on simultaneous surgeries

The Lunder Building at Massachusetts General Hospital.
Globe Staff/File 2015
The Lunder Building at Massachusetts General Hospital.

WAKEFIELD — Surgeons will have to document each time they enter and leave the operating room, and who took over in their absence, under a rule approved Wednesday by the state medical board amid controversies over doctors who perform more than one surgery at a time.

The Massachusetts Board of Registration in Medicine unanimously passed that rule and another requiring that patients be told the names of junior doctors who will participate in their operations.

Massachusetts is the first state to approve such requirements, according to board members. A spokesman for the Federation of State Medical Boards, which represents the nation’s 70 state medical and osteopathic regulatory boards, said it was unaware of any other states with similar regulations.

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The regulations come more than three years after the board gave preliminary approval to them, and are expected to go into effect next month.

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Dr. Candace Lapidus Sloane, chairwoman of the board that regulates the state’s roughly 42,000 licensed physicians, said before the vote that the goal is “to ensure that patients have knowledge about who’s going to be operating on them.”

After the meeting, she said, “As a doctor and as a patient, I know that when you undergo a serious surgery, or your loved one undergoes a serious surgery, you find the best doctor you can. You’re going there for that surgeon’s skill. And if it’s not going to be that surgeon [who actually does the operation], the patient has a right to know.”

The board first endorsed the proposed requirements in January 2016 after a series of Globe Spotlight Team stories about surgeons at teaching hospitals around the country who operated on more than one patient at a time without their consent.

A bitter disagreement about the practice by several orthopedic surgeons at Massachusetts General Hospital led to the 2015 dismissal of the hospital’s leading critic of so-called double-booking, and also prompted a federal whistle-blower lawsuit by a former MGH anesthesiologist and a national debate on patient safety.

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But the proposed rules then went to the state’s Executive Office of Health and Human Services. That agency reviewed those measures and continues to scrutinize dozens of other proposed revisions to state regulations that govern how doctors practice medicine.

The Massachusetts Medical Society, the statewide association for physicians and medical students, declined to comment on Wednesday’s vote, saying it needed to review the matter further. In written testimony two years ago, it was one of several groups — including the Conference of Boston Teaching Hospitals — that criticized the proposals as burdensome and impractical.

“Surgeons often need to step away from a lengthy procedure to take a break, use the rest room or get a drink,” John Erwin, executive director of the conference of teaching hospitals, wrote to the board. “They may also need to take care of clinical tasks related to the surgery outside the OR, such as reading a radiology or a pathology report.”

But when the medical board recently received the proposed rules after they had been considered by Health and Human Services, they were essentially left intact, according to George Zachos, executive director of the board.

Among those who told the Globe they welcomed the rules is former Boston Red Sox pitcher Bobby Jenks. Two months ago, Jenks settled a claim against MGH that he suffered a career-ending spine injury in 2011 when a surgeon at the renowned teaching hospital operated on his back while overseeing another operation at the same time. Jenks received $5.1 million in the out-of-court settlement.

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Jenks, 38, said in brief phone interview Wednesday that he hopes other states follow Massachusetts’ lead.

‘It’s actually pretty sad to hear that the hospitals need to put in effect this new thing. Your surgeon shouldn’t be leaving your room in the first place.’

“It’s actually pretty sad to hear that the hospitals need to put in effect this new thing,” he said. “Your surgeon shouldn’t be leaving your room in the first place.”

MGH said after the settlement with Jenks that his spine surgeon, Dr. Kirkham Wood, provided “high-quality and appropriate care” and didn’t enter the operating room of a second spine patient until Wood had completed the pitcher’s surgery. Overlapping surgeries, the hospital said, played no role in Jenks’s case.

Under the new rules, a surgeon seeking written consent from a patient to perform any “diagnostic, therapeutic or invasive” procedure must inform the patient who will be in charge and the names of any participating “physician extenders.’’ Those include surgical residents, fellows, physician assistants, and advanced practice registered nurses.

If, during an operation, the attending surgeon is “absent for any part of the procedure,” the medical record must specify the time of the absence and who was in charge when the lead surgeon was gone.

Though many surgeons at teaching hospitals in the United States schedule operations to overlap by a few minutes — letting trainees close the surgical wound of the first operation while the surgeon moves on to the second — the controversy at MGH focused on surgeries that overlapped for hours.

Dr. James Rickert, an Indiana surgeon who is president of The Society for Patient Centered Orthopedics, said that if hospitals in Massachusetts allow concurrent surgery, the new rules are “the blueprint for doing it.”

“There’s actually going to be a written record of when the surgeon is absent or present,” he said.

The federal Centers for Medicare and Medicaid Services already require surgeons overseeing operations to specify whether they were there for the “critical parts” of the procedure. But doctors themselves determine what is considered critical.

The Massachusetts Medical Society had complained that the requirement to identify all “physician extenders” was nearly impossible. Patients often agree to procedures weeks or months before they take place, and surgical teams, especially those at teaching hospitals, “can be fluid and shift at a moment’s notice,” the society said in a letter two years ago.

But Sloane and another board member who approved the rules, Dr. George Abraham, said patients can be informed of personnel changes shortly before the procedure and then say whether they want the doctor to proceed.

Jonathan Saltzman can be reached at jsaltzman@globe.com