A bill has been introduced in the Wisconsin state legislature that would mandate medical practitioners to offer patients the option of having all operative and dental procedures done under general anesthesia to be audio-video recorded in color. This bill, AB 255, would require that each entrance to the room be covered so that all coming and goings of staff are date and time stamped. Additionally it would require that all set-up and preparatory time be recorded. All patient’s would be required to be offered this option, except in the emergent setting. The recording devices would need to be installed and maintained by the facility, one copy of the recording must be provided to the patient and one must be maintained within the medical record. This bill was introduced by Rep. Sinicki of Milwaukee on April 26, 2015. It has been referred to the health committee. To date only five other representatives have signed on to the bill. Both the Wisconsin Hospital Association and The Wisconsin Medical Society have stated their opposition to the bill.
This bill raises many areas of concern. The potential for misinterpretation of events within the operating room is great and specific and important events of the operative procedure and anesthetic care are unlikely to be recorded by such wide-view video. The potential for increased medical malpractice litigation is likely. The highly specialized and complex environment of the operating room partially captured on the video recording could be interpreted and misinterpreted by lay persons without the expertise or the lengthy training of the professional medical participants. Significant activity occurs within the operating field that would not be captured on a wide view camera and a field focused camera would not meet the goals of the bill to record all entrances and exits to the room. The audio video recording would also be unlikely to capture the complex communications and interaction amongst the various separate but inter-functioning team members.
This bill introduces undue and unnecessary onus upon surgeons and will interfere with the all important physician-patient relationship by introducing distrust and oversight into a highly functioning, advanced and professional environment. Many current laws exist to appropriately deal with unprofessional or malignant behavior on the part of medical professionals. This bill will only introduce additional confusion, cost and distrust within a venerable profession.
However, the technology of audio visual recording can be harnessed in targeted, productive and professional ways to improve the quality of surgical care delivered to patients. Highly specific and professional review of technical surgical skills leads to improved individual technical performance and is currently under scientific study to be utilized in coaching programs. The idea is to apply very specific and controlled audio and/or visual recording to surgical practice in much the same way professional athletes use video review to improve their performance. It is also used to evaluate team based communication and improve team skills in high stress settings such as trauma evaluation and code situations both within and outside of the operating room. Introducing the potential of legal discovery and punishment will hinder these ever so important activities in the ongoing process of healthcare continuous quality and system improvement.
The drafting and introduction of Bill 255 was spurred by the death of a Wisconsin family’s loved one after undergoing a breast augmentation in Florida in 2002. This procedure was performed in a day surgery center by an oral surgeon who was not board certified. There was no anesthesia professional nor licensed nurse present. It is reported that the patient received an excessive dose of propofol and that there was a delay in CPR after cardiac arrest likely caused by respiratory depression. The patient’s family was Wisconsin and eventually transferred back to Wisconsin where she died in a nursing facility three months later. The physician who was performing the procedure was stripped of his Florida medical license and has since been reported to have moved to the state of Pennsylvania where he is currently in practice.
This is a tragic story and an event that should never have occurred. However, the events of this case would not have been prevented by the presence of an audio and/or video recorder. States do need to ensure that appropriate laws are in place for medical licensure, surgery center oversight, and punitive actions for the very few medical practitioners who place revenue above patient care. However, imposing additional bureaucracy upon medical centers and medical professionals that already practice to a high standard of care is unnecessary. If instead, audio video recording is protected legislatively the potential for great improvement and advancement in surgical care is great.