Ambulatory Surgery Centers are becoming an increasingly popular choice for minor medical procedures like knee surgery and tissue biopsies. Often, they're cheaper and more convenient than hospitals.
But problems at one such center in Little Rock have garnered national attention, and it's uncertain whether it's indicative of a larger issue.
On July 18, 2014, Faye Watkins got a colonoscopy; a fairly routine, elective procedure that screens for colon cancer. She went to Kanis Endoscopy Center in Little Rock, where its medical director, Dr. Alonzo Williams, performed the procedure.
But when she woke up, she wasn't at the clinic; she was down the street, at Baptist Health Medical Center. Watkins had stopped breathing almost immediately after her procedure. She was revived, but suffered a brain injury from the lack of oxygen.
Like in most colonoscopies, Watkins underwent conscious sedation—a type of anesthesia where you breathe on your own.
An August 13 article published in USA Today tells the story of Watkins and two others who got colonoscopies from Dr. Williams at Kanis Endoscopy. All three underwent the same procedure within four months of each other back in 2014, and all three stopped breathing just after the procedure ended. The two others, Clarence Creggett and Ronald Smith, died from complications due to the anesthesia.
Watkins, Creggett and Smith all had similar medical histories; advanced age, obesity, and in the case of Watkins and Smith, obstructive sleep apnea. Watkins' lawyer Lamar Porter says she was unaware of the increased risk of complications her health problems posed.
"Sleep apnea, during somebody's night-time hours while they're asleep, they can just stop breathing. Well, the odds of a person having apnea after conscious sedation when they have sleep apnea is much increased," Porter said.
Porter also filed lawsuits on behalf of the families of Creggett and Smith. The suits allege Dr. Williams didn't screen patients properly, and that the way anesthesia was given contributed to the complications.
Instead of going to court, lawyers for both the patients and the clinic settled all three lawsuits for undisclosed amounts of money.
Kanis Endoscopy is what's known as an ambulatory surgical center; a clinic that performs same-day, low-risk surgeries, with a doctor on staff to supervise nurses and physician's assistants.
Nationwide, ambulatory surgical centers outnumber hospitals; though in Arkansas there's 63 centers to 111 hospitals.
Arkansas, along with 16 other states, doesn't require surgical centers to report deaths at their facilities to the state Medical Board or any other agency.
This means death statistics aren't available through open record laws, and officials only know about deaths at surgery centers through complaints and lawsuits. But, associations like the one representing surgery centers could change that, says Becky Bennett, chief of Health Facility Services at the Arkansas Department of Health.
"There are associations out there that have very strong voices. It would be maybe the [Arkansas] Hospital Association, or the Association of Ambulatory Surgery Centers," Bennett said. "We take their opinions into consideration when we're writing rules. So it's not just us sitting behind a desk, 'Oh, let's write this rule!' We gather a lot of information to be able to write those rules."
Bennett says mandatory death reporting would likely only come about if the state legislature or a special interest group brought it to the Department of Health.
Following the incidents at Kanis Endoscopy, it's unclear if any practices changed. Porter says that information isn't available to the public.
"Nobody knows whether in fact they're going through these quality-assurance proceedings to try and keep something from happening. But you wonder, when you have three events like this that were so close in time, why, right after the first event, some big light didn't go off over somebody's head and there be an immediate investigation."
Bennett says her office only handles complaints about the medical facility. Complaints against a doctor go to the state Medical Board.
Dr. Williams' file with the Medical Board has 13 complaints against him, stretching as far back as the early 90s.
Some complaints later became lawsuits, but in all 13 cases, the Medical Board took no disciplinary action against Williams.
Arkansas Public Media reached out to Dr. Williams and Arkansas Diagnostic Center, the clinic owned by Williams where Kanis Endoscopy is housed. The center's director said she had no comment on the USA Today story or for this report. Subsequent emails to Arkansas Diagnostic Center were not returned.
The Ambulatory Surgery Center Association publicly disputed the USA Today report, saying it didn't include the number of safely completed procedures at surgery centers. But without credible numbers on deaths and injuries from procedures done at ambulatory surgical centers, there's no way to know whether the incidents at Kanis Endoscopy are part of a larger problem or not.
This story is produced by Arkansas Public Media. What's that? APM is a nonprofit journalism project for all of Arkansas and a collaboration among public media in the state. We're funded in part through a grant from the Corporation for Public Broadcasting, with the support of partner stations KUAR, KUAF, KASU and KTXK. And, we hope, from you!