Smooth Operators Surgical Assistants, With Not A Stitch Of Licensing, Scrub Up And Cash In

Who performed your last hospital operation? Stupid question, right?

Not necessarily. Increasingly, a little-known professional who can suture, retract and clamp as long as he or she is under the watchful eye of a surgeon is entering the picture.

They are known as surgical assistants. Some are doctors, many are not. A lot are former military medics, surgical technicians or doctors from other countries who don’t have a U.S. medical license.

A Texas lawsuit has thrown a spotlight on the largely unregulated profession.

In September, Attorney General Dan Morales sued Assistant Surgeons of Texas Inc., a group of surgical assistants at five Houston-area hospitals, accusing them of fraudulently passing themselves off as surgeons on insurance paperwork to get higher reimbursements. Morales refused to say how much money they obtained this way.

“What we did was expose the fraud in billing process,” said Ron Dusek, a spokesman for Morales. “Some of these persons, some of these groups bill as if they were surgeons.”

Tom Wright, a spokesman for Assistant Surgeons of Texas - now known as International Surgical Assistant Services of Texas Inc. - said his company never got reimbursed at an assistant surgeon’s rate, and he denied any attempt to deceive.

He said the insurance industry recognizes the distinction between assistant surgeons and surgical assistants. And he said that naming his company Assistant Surgeons of Texas was simply a naive mistake.

When Morales sued, he said investigators were looking into whether the use of surgical assistants led to 10 deaths at a hospital. But the hospital denied that, and the lawsuit does not accuse the doctors of practicing medicine without a license or passing themselves off as doctors.

Instead, the crux of the suit is the allegation that AST’s owner Jaime Olmo Jr. passed both himself and 16 of his employees off to insurance companies as surgeons by using the designation code “80” on reimbursement forms.

That “80” is the designation for “assistant surgeons.” The rather vague description of an “assistant surgeon” is someone who provides “surgical assistant services.” Surgical assistants are reimbursed at 20 percent of what a doctor gets, Wright said.

In the medical world, there is a clear distinction between assistant surgeon and surgical assistant. The first has a medical license. The second does not.

Olmo’s group, made up mostly of doctors from other countries who have not undergone the five years of work needed to obtain a U.S. medical license, also was running around several hospitals with the letters “M.D.” and the title “Dr.” on their ID badges.

Wright said that this was not an attempt to deceive. He said it was merely a courtesy extended by the hospital staff in recognition of the foreign medical degrees. At least one hospital dropped the practice after it was called into question.

Unlike doctors, registered nurses or physician’s assistants, a surgical assistant is not licensed by any oversight agency, such as a state board of medicine. The only certification that many receive is from the National Surgical Assistant Association, based in Champaign, Ill., after passing a four-hour, $250 exam and proving that they have had 750 hours of experience each year for three years.