Guest Op-Ed: Rectifying Surgical Patient Safety

You and your doctor decide you need surgery. As you are lying on the operating room (O.R.) table looking up at the ‘many faces behind the masks,’ do you ask yourself, “did everyone here graduate from an accredited program before being hired?”

As a healthcare consumer, chances are that you expect all healthcare professionals, regardless of specialty area or discipline, to have received a formal education.

Surgical technologists (STs), aka ‘operating room technicians’ are a hidden profession. STs are allied health professionals that work in surgical settings doing tasks such as passing instruments, draping the patient, counting instruments and handling medications and specimens on the field. (Think surgery scene in “Grey’s Anatomy.”)  Most assume that STs are registered nurses. However the majority in this profession are not. In Washington, to work as a ST a person must first ‘register’ with the Department of Health (DOH). After filling out forms, paying the fee, showing proof of AIDS training and submitting to a background check, a person becomes “registered” thus allowing surgical settings such as hospitals and ambulatory surgical centers to hire these folks.

Notice which requirement was left out of the DOH’s registration process: a minimum education requirement.  The reality is this: yesterday’s high school graduate or last week’s barista, construction worker or custodian (insert any occupation here) can work in surgery TODAY because they do not need to meet any minimum educational requirements.  And I mean no disrespect to the aforementioned job classifications. Surgical HR departments reserve the right to hire these individuals based on their needs.

Senate Bill 5049 / House Bill 1596 would close the loophole by doing three things: 1) it would require newly practicing STs to have graduated from a nationally-recognized, accredited program; this would include military-trained O.R. techs; 2) a ‘grand-father’ clause allows those not meeting the previous prerequisite to continue working regardless of how, when they received their on-the-job training; and 3) includes a ‘waiver’ which compels surgical facilities to first make a ‘reasonable effort’ to recruit school-trained techs but can hire and train their own if none can be found.

Senator Jan Angel, R-Port Orchard, is prime sponsor of SB 5049. To her, this bill is personal. She signed onto the patient safety effort because her daughter had a retained sponge after a surgery. While she has fully recovered and doing well today, “Kara’s bill” would correct a course-of-action that the public assumes already exists.

This bill has opposition from the state’s powerful behemoths: WA State Medical Association, WA Ambulatory Surgery Centers Association and WA Hospital Association. To be fair, the hospital association has unveiled their reason for resistance; however, the former organizations have not been as forthcoming. Another power player is Senator Randi Becker, R-Eatonville, chair of the Senate Healthcare Committee who has given the bill a hearing but has not scheduled it for executive session.  At this point, it is slated to die quietly, for the fourth year in a row. These Goliaths have once again flexed their political muscles on the subject, stymieing this legislation.

Some reasons for opposition include costs, wages in particular. The Bureau of Labor statistics has data showing that wages have not spiked upward in those states that have passed some version of this law (8 so far). Others are concerned about the availability of STs. There are seven community colleges that teach surgical technology (located on both sides of the Cascades) and graduate more than 100 students a year, ready-for-employment. These programs can require up to 2 years to complete and includes intensive clinical and didactic surgical training. On the flip side, surgical site wound infections can add pain and suffering to a patient and their pocketbook, adding more than $25,000 to consumer’s medical bill.  Advances in surgical techniques and use of sophisticated medical equipment make formal education a no-brainer. Simply put: an educated person has the critical thinking skills needed to circumvent adverse events, thus increasing overall patient safety.

Interestingly, the common denominator in this argument is patient safety. However, if that were the case, this bill would be ready for the governor’s signature. Instead, it appears that patients continue to be highly regarded – long after this bill has died ‒ by a CFO’s daily accounts receivable report.  So the next time you are in the operating room drifting off to sleep, ask yourself: is everyone in is this room really qualified to be here?

Sandra Manwiller is a certified surgical technologist and member of the Washington State Assembly of the Association of Surgical Technologists. She currently works at a local hospital. Ms. Manwiller is a former public information officer for WA State Senate and former policy analyst for WA State Employment Security Department.

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