A Florida surgery center that voluntarily shuttered its ORs after a patient went into cardiac arrest has reopened following a state-mandated plan of corrective action.

The Gladiolus Surgery Center in Fort Myers stopped performing surgeries after surveyors from the Florida Agency for Health Care Administration issued immediate jeopardy citations during a 3-day complaint survey that concluded on July 30.

State investigators discovered that several safety violations had occurred during a decompression of the peripheral nerve performed on a patient's right foot on July 23. Members of the surgical team who were interviewed by health inspectors agreed that the patient's breathing became labored about 30 minutes into the case. The patient was flipped to the supine position and began to "perk up" after being intubated and "hand-bagged," according to a circulating nurse, who says the anesthesiologist turned down several offers for the crash cart because he believed the patient would be "OK."

"I just wish he hadn't waited so long to do something," the procedure's scrub tech told investigators. "The nurses finally brought the crash cart in. Wish I had gone and got it myself earlier."

The facility's pre-op manager reportedly tried to shock the patient using a defibrillator, but it didn't discharge. She says CPR did not begin until EMS personnel arrived to transfer the patient to a local hospital, about 45 minutes after the trouble began. Health officials report that the malfunctioning device had not yet been replaced when they inspected the center 7 days after the emergency event.

They also say the anesthesiologist failed to adequately maintain the patient's airway during the procedure. Investigators found that audible alarms on the anesthesia monitoring equipment were turned off and not activated because the anesthesiologist claimed that "the equipment was old and he did not know how to turn the alarms on."

One of the facility's circulating nurses told investigators that the director of anesthesia is known to leave the OR when patients are anesthetized; another claimed she has watched the vital signs monitors for the director, but was uncomfortable doing so. The director of anesthesia told health officials that he occasionally leaves the OR for short periods to go to the bathroom or check on patients in the PACU, but said he does not assess other patients while a procedure is underway.

The health inspectors concluded that the facility failed to have monitor alarms set to audible levels, failed to have policies and procedures in place that ensured anesthesia presence in ORs during procedures and failed to ensure staff were able to recognize when a patient's condition deteriorates enough to necessitate an intervention.

A spokeswoman for the Agency for Health Care Administration says the surgery center is free to resume operating, but health officials will revisit the facility to ensure staff continue to comply with the plan of corrective action.

The center's administrator did not immediately respond to a request for comment.

Daniel Cook

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