Free hernia surgery for the underserved is possible in the United States
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Inguinal hernia is one of the most common ailments known to mankind. When symptomatic it can severely affect the patient’s quality of life. Nevertheless, the vast majority of inguinal herniorrhaphies are elective and, therefore, not available to uninsured patients who do not have the financial wherewithal to pay for the operation. Using the Surgery on Sunday model developed in Kentucky, hernia repair for the underserved developed a free clinic for hernia surgery, based on institutional commitment to the poor as well as the volunteer efforts of medical students and hospital personnel at all levels.
After consulting with Surgery on Sunday personnel, HRFU determined the number of in need patients by consulting with local free clinic physicians. Second, and most time consuming, was the application for the Federal Tort Claims Act (FTCA) medical legal protection. Under this law, all in hospital credentialed volunteer professionals are medico-legally protected if the surgery is performed in an associated free clinic. After FTCA application re-writes and committee meetings to work out logistics of the pre-op clinic, the follow-up clinic, enlistment of other volunteers such as transporters, translators, housekeeping for the ORs, a pharmacist, registration personnel and creation of HRFU hospital forms we established a surgery date. A memorandum of understanding was drafted and an agreement letter with the hospital system was co-signed. Fourteen patients were seen in the pre-operative clinic and two were placed on waiting list. Patients were operated upon using 3 operating rooms and a volunteer staff of 4 surgeons, 4 anesthesia personnel and 13 nurses.
No surgical complications were encountered intra-operatively or in the recovery room, and all patients were discharged by 2:30 p.m. 1 week post-operatively one patient had severe incisional pain, two had operative site swelling, but there was no evidence of infection or hematoma, and one had a distal sac fluid collection. All patients returned for follow-up and were appreciative of the care provided. The enthusiasm and participation of the patients and staff both pre-operatively, the day of surgery and postoperatively was outstanding.
On the basis of this result HRFU is prepared to assist other US hernia specialists and their respective hospitals to make Surgery on Sunday a possibility in their community.
KeywordsHernia repair Underserved Surgery on Sunday
- 2.Specific hernia repair surgery costs and national cost averages. New Choice health. http://www.newchoicehealth.com/Hernia%20Repair%20Surgery-Cost. Accessed 30 Jan 2013
- 4.U.S. Census Bureau (2012) Poverty thresholds for 2012 by size of family and number of related children under 18 years. http://www.census.gov/hhes/www/poverty/data/threshld/index.html
- 5.Bishaw, Alemayehu, “Areas with concentrated poverty: 2006–2010” American Community Survey Briefs, US Census Bureau. http://www.census.gov/prod/2011pubs/acsbr10-17.pdf. Accessed Sept 2012
- 7.Centers for Medicare and Medicaid services (2013). http://www.medicaid.gov/AffordableCareAct/Provisions/Downloads/MedicaidCHIP-Eligibility-Final-Rule-Fact-Sheet-Final-3-16-12.pdf. Accessed 30 Jan 2013
- 8.Nebraska Department of Health and Human Services (2013). http://www.governor.nebraska.gov/news/2010/08/pdf/Nebraska%20Medicaid%20PPACA%20Fiscal%20Impact.pdf. Accessed 31 Jan 2013
- 9.DeNavas-Walt C, Proctor BD, Smith JC, US Census Bureau Current Population Reports (2011) Income, poverty, and health insurance coverage in the United States. US Government Printing Office, Washington, DC, 2012 pp 60–243Google Scholar
- 10.U.S. Congressional budget office (2012) Estimates for the insurance coverage provisions of the affordable care act updated for the recent supreme court decision. http://www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf. Accessed 31 Jan 2013
- 11.Catholic Health World. Surgery on Sunday volunteers heal the poor and the uninsured. Catholic Health Association of the United States. http://www.chausa.org/Surgery_on_Sunday_volunteers_heal_the_poor_and_the_uninsured.aspx. Accessed Oct 1 2012
- 12.http://quickfacts.census.gov/qfd/states/31/3137000.html. Accessed 31 Jan 2013
- 13.Reutter, H (2009) Eastern Omaha, rural Nebraska have highest uninsured rates in state. The Grand Island Independent. http://www.theindependent.com/news/local/eastern-omaha-rural-nebraska-have-highest-uninsured-rates-in-state/article_1c36f265-7111-5952-b40c-b6b2766ea125.html. Accessed 31 Jan 2013
- 14.Hope Medical Outreach Coalition (2012). http://hopemed.us. Accessed 31 Jan 2012