York Hospital broke federal rules last year when it allowed two doctors who weren’t licensed in the state to participate in surgeries. Credit: James Crawford | TNS

A southern Maine hospital broke federal rules last year when it allowed two doctors who were not licensed in the state to participate in surgeries.

York Hospital was first sanctioned in March 2019 after state inspectors found that a vascular surgeon who was not licensed to practice in Maine nevertheless operated on a patient there, according to a report by the federal Centers for Medicare and Medicaid Services.

In the wake of that case, the hospital promised the federal agency that it would clarify its rules that providers must be licensed in the state and better educate medical staff about those rules. But on Aug. 13, the hospital ran into similar trouble when a woman who was having a cesarean section birth requested that her father, who was a trained doctor, join her in the operating room.

The woman’s father reportedly assisted with the operation, holding an instrument called a retractor in the woman’s incision and suctioning out the baby’s nose. He also was the first person to pick up the baby once the operation was complete, according to the federal report. Yet he was not licensed to practice medicine in Maine, and hospital administrators “were not positive that he held a valid medical license.”

Additionally, some staff were concerned about his involvement. “I said hell no,” the hospital’s acting chief nursing officer said during a subsequent interview, recalling his reaction to the arrangement. “Ethically and professionally no.”

Two days later, the hospital reported the error to federal authorities, and both the anesthesiologist and surgeon who carried out the operation later accepted fault for allowing the woman’s father to participate.

“In retrospect, I should have been concerned as I am the last gatekeeper,” the anesthesiologist said during an interview with an inspector that’s quoted in the federal report. “The father did touch the patient and then baby.” He added, “I’m sorry. I’m in the wrong.”

In October, the Centers for Medicare and Medicaid Services warned the hospital that it would lose its ability to bill Medicare in three months unless it filed a plan to prevent similar violations, according to documents provided by the Maine Department of Health and Human Services, which inspects hospitals for the federal government.

In early November, the hospital filed a corrective plan that outlined a number of new policies it would implement, such as a procedure for identifying nonlicensed people such as family members and students who are present during an operation. The hospital also indicated it would do a disciplinary review of the two physicians who participated in the Aug. 13 surgery.

“During this instance, our esteemed clinical staff made the safety and wishes of our patients their top priority,” the hospital said in a statement. “There was absolutely no harm to the patients. To maintain our patients’ privacy, we are unable to provide further details about this case. Although this instance was not in CMS compliance, York Hospital gave preference to our patients’ wellbeing and ensured positive outcomes for them and their families.”

Even though the patient apparently asked for her father to be present during the surgery, the case created confusion for the hospital’s staff, according to the federal report.

One worker texted a supervisor “with concerns about an unknown individual scrubbing in to assist” the surgeon, according to the federal report. While a nurse wrote in a medical record that the father was a “Surgeon Assist.,” the surgeon wrote in another record that no assistants were present.

In an interview with an inspector, the surgeon admitted fault for her mistake and recalled a case two years earlier in which she had received permission for a patient’s father to be in the operating room for a birth.

“It is an unusual request and my fault for fighting for my patient,” the surgeon said. “I never even thought there would be an issue [because] two years ago it was okay.” She added, “In my mind, the father had a medical license and he did the same as a student would do. I’m 100% responsible.”

The federal report did not outline what happened in the earlier case in which a vascular surgeon without a Maine medical license operated on a patient at York Hospital.