ASCs provide charitable care to patients in need

by Sahely Mukerji

“You have not lived today until you have done something for someone who can never repay you.”
—John Bunyan, 17th century English author and preacher

Locally, nationally and internationally, ASCs and ASC professionals from across the country sponsor and participate in different kinds of programs to deliver free and reduced cost surgical care and other health services to patients in need.

“It is important to remember that when ASCs and ASC professionals provide charitable care, they are expending their own personal resources to cover the costs of that care because they are not eligible for the many federal subsidies and tax incentives nonprofit hospitals and others receive to provide that care,” says ASCA Chief Executive Officer William Prentice. “The people and the ASCs that are involved in these programs are truly extraordinary. As small businesses that pay taxes, employ local residents and participate in a diverse mix of community-based events and local business development activities, ASCs are exactly the kind of neighbor you want to encourage to move into your community.”

Below are stories from a few ASCs that provide charity care at home, in their community and to people abroad.

Lexington Surgery Center, Lexington, Kentucky

Andrew Moore, MD, president of the medical staff at the ASC, started Surgery on Sunday back in 2005, says Laura Ebert, executive director of Surgery on Sunday, a nonprofit organization that provides free surgery to income-eligible individuals and families who do not have health insurance or state assistance. The volunteer doctors, nurses, medical social workers and office staff offer a free surgical clinic once a month at the Lexington Surgery Center, an affiliate of Surgical Care Affiliates (SCA).

Andrew Moore, MD, (right), president of Lexington Surgery Center in Lexington, Kentucky, and his brother Woody Moore operate on a patient.

“Surgery on Sunday uses our facility the third Sunday of the month,” says Joyce Dicken, administrator of Lexington Surgery Center. “We have been the site for Surgery on Sunday since its inception. Surgeons and nurses from all over Kentucky, probably six each of surgeons and anesthesiologists and at least 40 volunteer nurses and clerical staff, come together to do about 20 surgeries a month. They do gall bladder removals, arthroscopies, cancer reconstruction, colonoscopy screening and cataract surgery. All of the volunteers have to be credentialed. I help with this process and other behind-the-scenes support to ensure everything is in order.”

The patients have to be referred through an outreach program, such as the Salvation Army, Nathaniel United Methodist Mission in Lexington or The Hope Center, also in Lexington, Dicken says. “The requirements are that they have to be uninsured and fall 200 percent or below the poverty level,” Ebert says. “Most of these people are lower middle class, lower income. My office handles the screening procedure.”

The screening itself is a full-time job because the office sees 15–20 new referrals every week and all have to be processed, Ebert says. “We have multiple free clinics across the state and we hook them up with a sliding-scale clinic before the surgery,” she says. “Our volunteer surgeons accept these patients and they accept them for life, uninsured or insured. We have repeat patients more than once every year, and they are all so grateful. We keep so many of them off disability by doing this one surgery.”

SCA has said that it would like to see this program in all of its surgery centers across the country, Ebert says. The company has about 150 ASCs “and they have been very encouraging. I volunteered since the beginning and took the directorship in January 2009. We have served more than 5,100 patients as of today [February 27, 2013]. We have 530 on the waiting list. We have 2.5 employees, the rest are all volunteers. We have more than 400 volunteers. On a surgery day, we have 60–70 volunteers on average.”

Surgery on Sunday is trying to extend its program on to all the local hospitals, Ebert says. “Currently, Saint Joseph Hospital in Lexington is serving the patients once per quarter. The University of Kentucky Hospital—Lexington, Kentucky, is in line, too.”

Surgery on Sunday operates on an annual budget of $200,000 a year, Ebert says. “Lately, we’ve been aver- aging 1,000 patients a year, meaning only $200 applies to each patient. We are a United Way partner, and the Rotary Club of Washington does a huge fundraiser for us. The Good Samaritan Foundation also gives us a grant. We do not accept state or federal funding because it’d take away the autonomy of the program.”

This is a first of its kind program in the country, Ebert says. “On January 20, 2013, Omaha, Nebraska, started its Surgery on Sunday using our template.”

“The Lexington Surgery Center has supported us through our lowest times, making sure we have supplies,” Ebert says. “The OR manager at the surgery center and the environmental specialist have been at every Surgery on Sunday. One of them is the first to enter the building on those Sundays and the last one to leave. They don’t have to be there! They always sponsor us. Joyce has come many times, any time I need her. They are a truly admirable community partner. We are totally indebted and grateful to the surgery center. They make our world possible.”

Garden City SurgiCenter, Garden City, New York

In 2012, the Garden City SurgiCenter sent its medical director, Michael Sable, MD, and surgical technician, Lorena Chinchilla, to Peru to perform eye surgery. The mission, called A Promise to Peru, provides an annual cataract surgical and general medical mission to the remote villages of the Sacred Valley of Peru. Physicians and other health professionals from across the US volunteer their time and services at A Promise to Peru, a mission that includes a mentoring program for the students from the School of Medicine at Stony Brook University in Stony Brook, New York.

“After having the opportunity to directly observe the tremendous amount of advanced cataracts among the people living in remote villages high in the Andes Mountains, I decided to initiate a surgical expedition there for the first time last summer,” says Debra Messina, MD, of Stony Brook University. “Working with the minister of health, local Peruvian physicians and ophthalmologists, we were able to establish an operating room in the midst of an elementary school. Surgical Eye Expeditions (SEE) from California lent us the equipment and instruments to perform the surgeries.”

Nine staff members from the program transported 25 pieces of cargo, essentially an entire operating room (OR) to Peru. “Creating a completely portable operating room, working with foreign government leaders on the national and municipal level, working with fellow ophthalmologists locally, nationally and internationally, all in an effort to give a patient population that will travel 11 hours for their cataract surgery has been an indescribable experience: one that both Dr. Sable and I highly recommend,” Messina says.

Sable says he came away from the mission being the most satisfied he has ever been as a physician. “Several patients stuck in my mind,” he says. “Our very first, a middle-aged man by Peruvian standards, claimed to have poor vision and was evaluated in the preoperative area. His vision was 20/50. Certainly not terrible, and with supplies to operate on just 50 people, we wanted to save for those who needed it most. Turns out this man was only complaining of difficulty reading. After fitting him with reading glasses he cried out with joy ‘Aye, perfecto!’ followed by hugs for everyone in scrubs. Imagine a $2 over-the-counter pair of spectacles and a new man was created.”

Sable is proud of his team for the quality of care they delivered and “mostly for what they helped me achieve as a physician but more as a person,” he says. “Many thanks to my new friends here and in Peru and, of course, mostly to my patients who always teach me how to be a better physician.”

A Promise to Peru is looking for assistance from volunteers for financial support, donations of medical and surgical equipment and medications.

Missoula Bone & Joint (MB&J) Surgery Center, Missoula, Montana

Andrew Puckett, MD, one of the nine surgeons of the ASC, goes to Honduras to provide charity care. “The people we work with in the small village of La Esparanza, which means ‘hope’ in Spanish, would never have an opportunity to receive the care we are able to provide for even such a short period of time,” Puckett says.

Honduran women from the Linca Native Indian Tribe wait at a school to see Andrew Puckett, MD, a surgeon at Missoula Bone & Joint Surgery Center in Missoula, Montana, and other physicians who travel to that country every year to provide charity care.

Last year was Puckett’s fifth trip to Honduras. “During this trip the team did 21 surgeries in four days,” he says. “Most of the patients were children. We fixed multiple upper extremity fractures . . . that were truly life-changing surgeries for most of these children.”

An RN, a scrub technician and an anesthesiologist make up the rest of the team that accompanies Puckett. The surgery center works with Missoula Medical Aid.

“Two days of travel to get there, eight days with little or no sleep on cots, noisy roosters, barking dogs, two more days to get home . . . worth every minute,” Puckett says.

The MB&J Surgery Center physicians also volunteer their services for the Osprey, a local semiprofessional baseball team, and do sports physical and locker room visits at the local high school games. A few of the surgeons work with Partnership Health Center, which works with low-income people and sees patients for free.

Peak One Surgery Center, Frisco, Colorado

The ASC hosts an annual charity day— Summit Community Surgery Day— and last year was its third year. “This past October, we performed 14 cases across a mix of different specialties, orthopedic cases, gynecology procedures and spine pain injections,” says Diane Lampron, RN, director of operations for Pinnacle III and administrator of Peak One. Pinnacle III manages the ASC.

“We ran two ORs and a procedure room,” Lampron says. “Each room had two ASC staff and an anesthetist, and we staffed our recovery room. In total, approximately 20 people volunteered this past year.”

The patients are chosen through the Community Care Clinic, next door to the ASC, Lampron says. “They select the patients for initial consideration. The surgeons then decide what surgery is appropriate for each individual,” she explains. “Final selection is based on the patients’ financial needs as well as the urgency at which the procedure has to be done. The ASC coordinates all the procedures and supplies the OR/procedure room, staff and materials necessary to successfully complete each case.”

Peter Janes, MD, president of the board of the ASC, came up with the idea of the Summit Community Surgery Day approximately four years ago. “He’s very active in the local community and participates in international relief efforts that provide charity care,” Lampron says. “He identified the need for free surgery, which presented an opportunity for Peak One to give back to the community. Dr. Janes has been with the ASC since its inception in 2005 and was one of the key people in getting the ASC open.”

The patients are extremely grateful after their surgery, Lampron says. “They are beaming at the end of the day. The employees are happy to be involved in the process and willingly volunteer their time to give back to the community. It is also rewarding for everyone involved.”

Eye Associates of Boca Raton, Boca Raton, Florida

Eye Associates of Boca Raton conducts its Gift of Sight program every year on the Tuesday before Thanksgiving. “We work with a local charity clinic, Caridad Clinic, which takes care of migrant workers and the working poor who can’t afford health insurance,” says Howard Goldman, MD, chief executive officer of the Eye Associates of Boca Raton. “They send us consults and eye surgeries that they can’t handle on site. They have surgeons, mostly retired ophthalmologists, there. We do 20 to 22 cases that one day and cover all costs.”

A reporter from WPTV News Channel 5 interviews a cataract surgery patient at the Eye Associates of Boca Raton surgery center.

This year marks the fifth year that Eye Associates of Boca Raton, which is co-owned by AmSurg and local physicians, has offered its Gift of Sight program. “Our five surgeons, all of our RNs (4 to 5), and the two scrub technicians at the surgery center join in,” Goldman says. “Our two anesthesiologists, doctors Steven Kiffel and Michelle Dresner, provide service without charge as well. The Caridad Clinic sends the patients to us to examine before surgery, and we see them the day after surgery. Then they go back to Caridad for the balance of their postoperative care.”

Some of the patients speak English, and the surgery center has translators for the ones who don’t. Some of the patients speak only Creole and Spanish.

“It’s a good feeling, obviously, to restore vision,” Goldman says. “These are folks who don’t have regular care, so when they come to us, they are blind. And then, after surgery, they can see! They can see their children, their grandchildren, and they are joyous.”

Goldman also has been doing charity care with Surgical Eye Expeditions, based in California, for many years. “1981 was the first time I went on a mission overseas. I’ve been to Jamaica, Mexico, Guyana, Panama and Ecuador with them. Since September 11, 2001, it’s been hard to send surgeons overseas with something like 60 boxes and trunks of equipment. We developed this program recently, and I’m glad we are doing this in the US. We also realize there are many people who make this possible other than us. It is the equipment, the staff and everyone that comes together that make it successful.”

Advanced Vision Institute, Williamsburg, Virginia

In December 2012, Glenn Campbell, MD, of Advanced Vision Institute dedicated his last two surgery days of the year to providing free eye surgery to residents of his local community who could not afford the surgery they needed. He performed more than 25 free surgeries on those with vision impairments such as cataracts. Thanks to the generous donation of the Doctors Surgery Center in Williamsburg, Virginia, he says, he was able to implant advanced technology lens implants in many of those patients.

“We worked with numerous local organizations including Project C.A.R.E. to screen patients to determine their need for surgery,” says Alex Robinson, director of clinical operations at the ASC. “We are planning a similar event this December. We feel the gift of sight is one of the best gifts to give.”

Tri-Cities Surgery Center LLC, Geneva, Illinois

The charitable care that the Tri-Cities Surgery Center provides, says Administrator Joe Ollayos, comes to the ASC from two primary sources: (1) a local charitable organization called Tri City Health Partnership (TCHP) and (2) a collaborative process the ASC has established with its joint venture partner Delnor Hospital, also in Geneva, Illinois.

According to its web site, TCHP “is staffed by dedicated physicians, nurses and other local area health care professionals, who volunteer their time to provide quality care to the community. Our services are for low-income residents of central Kane County who do not have Medicare, Medicaid/Public Aid or who are underinsured.”

“A number of our physicians participate in TCHP,” says Ollayos. “If one of our doctors participating in the program accepts a patient who needs a procedure that our surgery center provides, we will take the case and perform it at no charge.”

In collaboration with Delnor Hospital, says Ollayos, some of the physicians who treat patients at the ASC will sometimes identify an indigent patient who needs a procedure that the surgery center provides. “If the patient has been through the hardship vetting process at the hospital, and qualifies for charity care, we will take the case and perform it at no charge.”

Parham Surgery Center in Henrico, Virginia

“In Virginia there is a Certificate of Need program,” says Sandra W. Pearson, administrator of Parham Surgery Center in Henrico, Virginia. “ASCs, among other providers, have to apply for permission to the Certificate of Public Need Program (COPN) Board for permission for expansion or replacement based on a threshold of a specific dollar amount. If the request is granted by the COPN Board, it is with a specific percentage of billed charges due in charity care or we have to write a check to the state of Virginia for the shortfall. The dollars can also be sent to Accent Now or other qualified charity care organizations. Access Now is run by the Medical Society of Virginia.”

At ASCA, we know that these few stories about the many ways that ASCs provide charitable care can contribute free health services in their local communities and abroad are just the tip of the iceberg. Please take a moment to send us an email or give us a call to tell us about the voluntary services that your ASC provides. Share your story by contacting Sahely Mukerji at smukerji@ascassociation.org or 703.345.0278.