The Joint Commission and the Indiana Department of Health are only two regulatory bodies that recently have implemented and/or expanded requirements that ambulatory surgery centers (ASCs) take a more active role in community disaster preparedness. It has been historically demonstrated that acute care hospitals have a definitive role and obligation to assist their community in times of emergency. Nearly all have mission statements that specify they are to meet the needs of the regional population and most receive tax exempt status to encourage/require their assistance. Even the for-profit hospitals usually consign to some form of duty of providing for their service area’s healthcare requirements, especially during untoward events. Therefore, hospitals have an acknowledged commitment to their community in a disaster situation.
Most ASCs, on the other hand, are profit-seeking entities that furnish elective, same-day surgical services to their physician owners’ patients. ASCs did not start out with the goal, intent or expectation of contributing emergency services during a disaster. In fact, some states’ (Pennsylvania, for example) licensure requirements even specify ASCs are not to render emergency surgical services. Yet regulatory agencies have started mandating that these privately owned healthcare providers assume a role in catastrophic situations.
It is important to clarify the importance of ASCs participating appropriately in community disaster. Historically, for the ASC, that meant before an anticipated upheaval occurred; procedures might be cancelled and individuals sent home: during/immediately after an emergency; cases in progress would be finished, no new procedures started, people in the facility would leave (or remain based on safety conditions), physicians would report to the local medical center (rendering their services there, as specified in most hospital’s medical staff bylaws), ASC personnel could voluntarily offer their skills as may be needed anywhere in the community, and the center would be closed with its contents secured, until procedures could be resumed.
Currently, the new disaster compliance standards seem to be very innocuous. ASCs are to coordinate their external calamity activities with the local emergency management organization(s). These public safety planning groups have essentially requested only identification information (name and address of the facility, service/specialties offered, number of operating rooms (ORs), and qualifications of personnel), which seems very nondescript in this post 9/11 world. The concern rests in where and when will the requests for just information stop and significant multiplication of required contributions begin? The long-term consequences are that these regulations could escalate to the point that ASCs would be mandated to provide their physical plant, utilities, supplies, pharmaceuticals, equipment and personnel in an emergency.