Some doctors putting ‘a touch’ on their Las Vegas patients and insurers

It's called "a touch."

No, it's not related to the sex industry. Or the payday loan industry. Or even the spa industry.

"A touch" is shorthand for a shady procedure that goes on in Southern Nevada operating rooms.

Two reputable surgeons, who each declined to be identified by name, told me about this dreadful practice that I'd never heard of, but which has gone on for years. I'm told it's more prevalent among spine surgeons, neurosurgeons and orthopedic surgeons working in groups.

"It's not an uncommon practice, it's called 'a touch,' where a partner scrubs in, touches the patient for 30 seconds and the insurance pays another 20 percent for the surgical fees for a consultant," one surgeon said. So a $25,000 surgery becomes a $30,000 surgery.

Sometimes it's not another surgeon, sometimes it's a physician's assistant. But it's a disgusting practice driven by greed. The toucher does nothing for the unconscious patient, but the bill goes up anyway.

The operating room nurses know this dirty little secret because they see how long the "consulting" surgeon is in the operating room. But they know better than to blab if they want to keep their jobs.

The patient who bothers to read the bill simply knows that the surgeon has a second set of skilled hands in the room and is probably reassured by that thought. The patient who doesn't read the bill probably is clueless.

It's probably not illegal, unless an insurance company wanted to push it as insurance fraud. To do that, they'd have to haul a bunch of operating room nurses in and put them under oath.

Then there is "ghost surgery."

That's where after you research to get the best surgeon you can find and expect him to do the work, a less-experienced surgeon actually does the work. Again, it's about the money.

If there are no complications, the patient rarely finds out about it. If there are complications and a malpractice suit is filed, then it becomes known that someone else did the actual surgery. Again, the patient and the insurance pay for the fees of the more experienced surgeon.

The patient may have signed an informed consent without reading or understanding that someone else may perform the surgery.

But if you're not going to read the fine print, you might want to just ask your doctor: Are you going to be performing my surgery?

And afterward, you might ask: if a second surgeon was involved, how long was that person in the operating room?

"A touch" and "ghost surgery" both rely on patients not asking because they make assumptions.

The American Medical Association says: "To have another physician operate on one's patient without the patient's knowledge and consent is a deceit. The patient is entitled to choose his own physician and he should be permitted to acquiesce in or refuse to accept the substitution."

This doesn't mean the surgeon you selected can't have residents or other assisting surgeons to help. But they should be doctors who do a little more than scrub up and give you "a touch."

Ghost surgery isn't anything new. Even in the 1950s it was a medical ethics issue. When it comes to ghost surgery, the counterpoint from some surgeons is that as long as the surgeon is present and knows the work is being done right, that doctor is "doing" the surgery. They say this is the way doctors are taught.

That may be true.

"A touch" has been prevalent in Las Vegas for at least five years and seems more common here than in other towns, I'm told. Perhaps it's the greedy nature of Las Vegas. There's not much defense of "a touch."

A touch might as well be called an easy touch or a soft touch, but those aren't the terms you want used to describe you. And it's not just an insurance fraud. You're the one paying the higher co-pay.

Jane Ann Morrison's column appears Monday, Thursday and Saturday. E-mail her at Jane@reviewjournal.com or call 383-0275.