A Westport plastic surgeon who is on probation and was fined $29,000 last year faces further sanctions following unannounced inspections of his center that found additional violations for lax management of nursing care, sanitation and infection control.
When an inspector from the state Department of Public Health visited Imperial Plastic Surgery for three days in March, the inspector found several violations, including unqualified nurses, slipshod record keeping, improper sterilization procedures and unsanitary conditions, such as an open bag of trash and an open container of soiled linens. These and other violations were delineated in a 58-page, Aug. 29 consent order signed by Dr. Joel B. Singer, the sole owner of the facility, which also operates under the name: Center for Ambulatory Surgery.
Singer says these most recent charges are “all part of an ongoing compliance matter. It’s all part of the same thing. Each time they come, they inspect, they find something else,” he said this week. “I’m sure if they came today, they’d find something.”
But the most recent inspection uncovered new violations. For example, a nurse told the investigator that she was the nursing supervisor, even though she had only started working at the center the day before. This nurse had graduated from nursing school 10 months earlier and lacked the training and experience necessary for that position, the consent order says.
In addition, a review of the clinical records revealed that the facility failed to ensure an accurate and complete clinical record for 13 of the 13 surgical patients whose cases were reviewed, according to the consent order. For example, there was no written record indicating whether most of those patients had received written discharge instructions that typically explain what to expect following surgery and what symptoms constitute complications.
Since then, Singer said, he has taken steps to address the concerns raised by state inspectors. “I have three full-time nurses,” he said. “That’s all in the past. That’s not true anymore. That was taken care of. …Pretty much what it amounts to now are regulatory compliance issues.”
Over the past several years, the state health department has cited Singer for multiple violations against his physician’s license and against his surgery center. Singer has two businesses licensed with the Secretary of State’s office – Imperial Plastic Surgery and the Center for Ambulatory Surgery. The former is the name for his practice and the latter is the name for the surgery facility, he said. For the past year, Singer also has owned and operated Imperial Plastic Surgery in Great Neck, N.Y.
The health department cited the Center for Ambulatory Surgery in May 2011 and imposed a $4,000 fine, a $25,000 civil penalty, a reprimand and two years’ probation. His facility license was suspended and the center remained closed for three months while he implemented state-mandated changes. That consent order was approved by the state Medical Examining Board in December 2011.
Singer, who graduated from Yale University medical school in 1966, has three prior Connecticut health department actions against his physician’s license. In a May 2007 consent order, the state health department fined him $5,000 for a case of “incompetence/negligence.” He admitted to lapses in documenting post-surgical conversations between himself and a patient after complications developed following her breast reduction surgery. That patient required a second operation after failing to heal properly.
In a July 1999 consent order, Singer agreed to be placed on one year’s probation for inserting implants of difference sizes into a patient during breast augmentation surgery. The patient record was altered to read that the implants were the same size, the consent order says.
Following the unannounced inspections in March, conducted to see whether Singer and his facility were complying with terms of his probation, the health department issued an amended consent order. Singer has agreed to hire, at his expense, a health department-approved clinical consulting firm that has expertise in outpatient surgical centers.
The consent order outlines a detailed list of 14 systems that must be monitored and reviewed by the clinical consulting firm, pertaining to: controlling infection; medical documentation; nurse staffing, credentialing and supervision; physician and APRN credentialing; quality assessment; surgical services; medication storage; management; quality assessment and performance improvement; and matters pertaining to sterilization of instruments and the operating room.
The clinical consultant has to spend at least four hours a month at the Imperial Avenue plastic surgery center directly observing the staff’s performance and reviewing the staff’s credentials to be sure that they’re in compliance with federal laws. The consent order requires that the surgery center’s administrator and medical director meet quarterly with the health department during the period of the consent order.
Singer also has a license to practice medicine in New York and California. Because of the disciplinary actions and fines he’s received on his Connecticut license, both California and New York states have issued public reprimands.
New York’s health department issued censures and reprimands in 2000, 2007 and on Sept. 21, levying fines in the amount of $1,000, $5,000 and $1,000, respectively. California’s medical board issued public reprimands in 2000 and 2009. Awaiting a hearing before the California medical board is a petition by the California health department to revoke, suspend or place on probation Singer’s license to practice in California, based on Connecticut’s medical board sanctions on his and his facility’s licenses.