Boston Globe: Surgeons Double-Booked to Cut Costs at Nation’s Hospitals

Picture this: You’re in the hospital about to undergo a risky surgery. The nurse places a breathing mask over your mouth and nose and asks you to count backwards from 100. 100… 99… 98… Then the surgeon casually mentions they’ll be performing another, separate surgery at the exact same time as yours.

How would that make you feel? Pretty angry, right? Well, this practice is not unusual for surgical departments across the United States. And in most cases, the patients are never even told about that second, concurrent operation. Why would hospitals do this?

To save money, of course – and because for-profit hospitals are, in fact, big businesses. And maybe not just big businesses, but huge businesses. At the end of the day, what this means is that it’s all about the business’s bottom line; investors want to see profits soar.

It’s a controversial practice to say the least, but it’s one that is finally being brought to light. For years, surgeons at Massachusetts General Hospital (MGH) in Boston have been in the habit of “double-booking” their operations, meaning they’ll occasionally perform 2 surgeries – 2 different patients in 2 different operating rooms – at the exact same time. MGH adopted the practice as a cost-saving way to schedule their top surgeons and medical specialists.

How Double-Booking Came to Light

The practice of concurrent surgeries was revealed in an investigation by the Boston Globe. Since then, the controversy has rippled across the country, sparking inquiries at medical institutions in Chicago, Milwaukee, Nashville, and Syracuse, as well as MGH’s sister hospital, Brigham and Women’s. This month, a U.S. Senate committee was formed to inquire about the extent of concurrent surgeries. Still, many hospitals, including MGH, have refused to admit to any wrongdoing.

If you’re tempted to view the practice of concurrent surgeries as mere multitasking by some of the most highly skilled medical professionals in the world, think again. Because when things go wrong, it’s not the doctors and board-members who suffer the consequences – it’s the patients.

Back in 2012, Tony Meng, a 41-year-old father from Massachusetts, was paralyzed after a complicated surgical procedure had been double-booked alongside another, equally complex operation. The surgeon was scrambling back and forth between 2 patients. Although Meng was duly informed of the risks involved with the specific surgery, he was never informed that his surgeon would be performing another operation simultaneously. Understandably, Meng is now suing the hospital for malpractice.

The Controversy at Massachusetts General Hospital

It seems obvious that patients should be informed about the possibility of their operations being double-booked, and that they should be given the opportunity to postpone or back out of the procedure once they’re informed.

An MGH spokeswoman told the Globe that surgeons are merely “encouraged and expected” to tell patients that they’ll be absent for part of an operation; they are not required to do so.

As is the case with most controversial medical practices, it’s the extent of the policy that is perhaps most alarming. This isn’t a one-off thing. Concurrent surgeries make up 3 percent of all MGH operations in a given year. If the hospital performs 37,000 surgeries a year, that figure adds up to 1,110 double-booked surgeries a year.

Where Does It Start, Where Does It End?

The whole concept of double-booking surgeons for 2 procedures at the same time points to a much larger problem with the entire healthcare industry: malpractice. Since 1990, roughly 1.25 million doctors are recorded to have practiced medicine in the U.S. Among them, 15 percent — about 192,000 — have had at least 1 malpractice payout.

That figure is worrisome, but it fails to convey the toll such medical errors take on patients and their loved ones. For something as risky and dangerous as a surgical operation, “luck” is not something patients should have to rely on.

Most dangers stem from doctors themselves. One estimate from the Journal of Patient Safety claims that, every year, at least 210,000 hospital patients suffer some kind of preventable harm that contributes to their death. And that makes medical error the third-leading cause of death in America.

The Right to Know

Sadly, a lot of problems could be prevented if hospitals required their doctors to be more open with patients about their practices.

There’s no more room for secrecy. Patients should expect and even demand the disclosure of information about their doctors. They have a right to know if a surgeon is performing 2 operations at once, and they have a right to know about past misconduct. They have a right to know if, for example, their urologist was charged with a DUI, or if their surgeon was disciplined for forging prescriptions; or if their pediatrician was found guilty of “sexual misconduct” — all cases that were revealed in a recent Consumer Reports investigation.

For patients at MGH, the grounds for malpractice seems to lie in the failure to disclose this kind of information to patients — and now it’s gotten the attention of Congress. In a letter addressed to hospitals obtained by the Globe, Senator Orrin Hatch (R-UT), chair of the Senate Finance Committee, wrote:

We are concerned about reports of patients not being informed that they may be sharing their surgeon with another patient, and we are especially concerned by reports that, in some cases, steps have been taken to actively conceal this practice from patients.”

Gerald Healy, a member of the American College of Surgeons (ACS), told Becker’s Hospital Review that this is “the crux of informed consent.”

"If I tell you one thing and do another,” Healy said, “that's unethical.”

Sokolove Law Team

Contributing Authors

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Last modified: September 29, 2020