CHICAGO—In a move that would benefit hundreds of general surgeons practicing in the state of Georgia and their patients, the Georgia General Assembly may consider legislation during its 2006 legislative session that would amend the state's certificate-of- need (CON) law. Such consideration would have long-reaching effects on surgical care in that state, where general surgery is defined as a multispecialty under the current Georgia statute, and is therefore not eligible for a CON exemption that is granted to single specialties when building ambulatory surgery centers.

The American College of Surgeons (ACS) and its Georgia Chapter have repeatedly disputed this aspect of the law through legal and legislative actions. Recently, Thomas Gadacz, MD, FACS, a member of the ACS Board of Governors who represents the state of Georgia, testified before the state's Study Commission on the Efficacy of the CON Program, after which, the College contacted every commissioner emphasizing the single-specialty definition of general surgery.

As a result of the continuing difficulty in impressing upon the state's legislature the definition of general surgery as a single specialty, the ACS recently decided that Georgia will not be considered as a site for any of its meetings until the state fixes the inaccuracy in its health care laws. In a strongly worded letter to Gov. Sonny Perdue and George Israel, President and CEO of the Georgia Chamber of Commerce, Thomas Russell, MD, FACS, Executive Director of the American College of Surgeons, noted ". . . it would be inappropriate for the American College of Surgeons to consider Georgia as a location for any future meetings until this egregious policy is changed. If the State of Georgia cannot support surgery in this regard, then surgery cannot support bringing business into the state."

The CON laws came into existence following attempts to control the growth of health care spending and ensure that medical facilities were built in the right places to meet the health care needs of patients. As such, Georgia and other states passed CON laws. Under these laws, health care facilities could not be built or expanded unless the need for them could be proven. If the state agreed with the request, a CON was granted, and the facility could be built.

In Georgia, an exemption was included so that single specialists such as plastic surgeons or orthopaedic surgeons could build their own ambulatory surgery centers apart from hospitals without going through the process of getting a CON. However, the specialty of general surgery was left out of the part of the law providing this exemption. Since then general surgeons have been forced to go through the certificate of need process in order to open their own ambulatory surgery centers.

The College and its Georgia Chapter emphasize that general surgeons are, in fact, single specialists. They believe that the CON law discriminates against them and their patients by forcing patients to undergo surgical procedures in hospitals instead of in ambulatory surgery centers, where surgical care can be less costly and often more convenient. Furthermore, the ACS and its Georgia Chapter say, the CON process is a useful tool for hospitals that are attempting to stop competition and force patients to receive care only in their facilities.

They believe that if the problem is to be solved, the specialty of general surgery must be properly recognized in the CON law. Efforts are under way to encourage such action in the Georgia General Assembly. The College and its Georgia Chapter support these efforts and call on Georgia surgeons to urge their state's legislators to help make the CON process one that is fair for general surgeons and their patients.

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 70,000 members, and it is the largest organization of surgeons in the world.

Online January 26 , 2006

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