NEW YORK, NY July 16, 2009 —Doctors are performing an increasingly broad array of surgical procedures in offices, rather than hospitals. They’re not doing open-heart surgery, but they are doing a lot more than removing moles. This week, a new state law takes effect, subjecting these practices to greater oversight by state health authorities . . . . in an effort to better protect patients. WNYC’s Fred Mogul has more.

REPORTER: With Bach playing on the stereo system, Dr. Albert Knapp is about to begin a routine colonoscopy in his Manhattan office.

KNAPP-1: We clean our hands. We then speak to the patient, and we ask the patient three questions: Jennifer what is your full name? What is your date of birth? And what procedure are we doing today? And that’s basically called a time-out . . .

REPORTER: Another doctor puts the patient under general anesthesia and monitors her vital signs. Dr. Knapp feeds a 6-foot-long tube through her colon, examines it with a camera, takes a few tissue samples for testing, and knocks out a small benign growth.

KNAPP: Carolyn, can you hold the scope like that for me? Open. Close. Very nice. Turning light. Cauterized. Great. Excellent.

REPORTER: Dr. Knapp says he’s been taking extra precautions to insure patient safety since state law was passed requiring new accreditation for office-based surgery.

KNAPP: I thought and was quite content for many years that I ran a very tight ship. Now that I’m accredited, I realize I was running a relatively loose ship.

REPORTER: Dr. Knapp estimates he spent more than $20,000 dollars preparing for accreditation. Most of that money went for a consultant he chose to hire for advice on complying with the new regulations. That money doesn’t include moving the practice to another office with more space or taking many hours of staff work time over the course of several months to get everyone up to speed.

KNAPP: The main concerns are that your records are classified in a particular order, that you have also have established protocols for infection control, and that your staff is fully trained, not only in their usual procedures, but also in cardiac resuscitation.

REPORTER: Many of the practice are gastro-intestinal practices, like Dr. Knapp’s. Others perform operations on the eyes, urinary tract, reproductive system and other parts of the body. State Health Commissioner Dr. Richard Daines says about 50 percent of operations currently take place in offices, and he expects that number to reach 70 percent in the coming years.

DAINES: And it just wasn’t right to have an area where these were done but we didn’t have the reporting or surveillance or standards of safety that we have in the accredited sites.

REPORTER: Inspectors from a private accreditation agency are responsible for certifying practices. Those inspectors are the ones who met with Dr. Knapp and his staff. They also give a surprise inspection once every three years or so. Michael Kulczycki is with the Joint Commission on Accreditation, one of those private certifying agencies.

KULCZYCKI: New York State is the first to regulate office-based surgery in a way that puts some teeth behind a mandate that says: You must be accredited. In New York State, it’s backed up with potential impact on a physician’s medical license, if they’re practicing without being accredited.

REPORTER: Only offices that conduct surgery requiring “moderate to advanced sedation” are required to get accredited. No one really knows how many medical practices that represents. The Joint Commission estimates there are up to 3-thousand of them in New York. Only 700 have been accredited so far, or have approval pending. Health Commissioner Daines says, ultimately, there’s only so many inspectors. And that often means oversight occurs after things go wrong.

DAINES: It’s an honor system. We don’t have eyes in those practices. We rely on reports -- those that end up in hospitals or potentially lawsuits.

REPORTER: Daines believes accreditation will improve care and protect patient safety. But it will take several years of data to know – and even then, the state will only know what accreditors and self-regulating doctors’ offices tell them. It’ll be up to patients themselves to examine the record of the doctor who’s examining their colon.