Saturday Surgery Sessions
A waitress who suffers from varicose veins needs surgery to alleviate her pain, but her employer-sponsored health insurance doesn't cover pre-existing conditions. A bicycle messenger has a hernia that makes riding uphill nearly impossible, but he doesn't work enough hours each week to qualify for health care coverage.
Over 120 volunteers had breakfast together before Super Surgery Day at Kaiser Permanente San Francisco last March.
Suddenly finding oneself outside the system without appropriate health care coverage can happen to just about anyone. The Centers for Disease Control & Prevention estimates that 51.3 million Americans—nearly 18 percent of the U.S. population—were uninsured for at least part of 2005. While the numbers are staggering, Kaiser Permanente health care workers aren't letting that stop them.
More than 270 Kaiser Permanente volunteers, from surgeons, anesthesiologists, and registered nurses to operating room technicians, admitting clerks and housekeepers, help alleviate some of the medical problems the uninsured face by volunteering their services one or more times a year for Kaiser Permanente Northern California’s free "Saturday Surgery Sessions."
The Bay-Area phenomenon is a collaboration between Kaiser Permanente and Operation Access, a nonprofit corporation that coordinates with area hospitals to provide low-risk, outpatient surgeries for people who are uninsured. The free surgeries take place at least four Saturdays a year at Kaiser Permanente medical facilities in Oakland, Redwood City, Richmond, San Francisco, San Rafael, Santa Rosa, and South San Francisco.
"We try to focus on the people who fall between the cracks," said Alex Tejada, regional program manager for Operation Access. The organization targets its services primarily to people who make too much money to qualify for county care but not enough money to purchase their own insurance or have it supplied by their employers. The goal is to eliminate the pre-existing conditions that may be precluding them from getting a job or health insurance in the first place.
A Long Road to Operation Access
Operation Access is the brainchild of Douglas Grey, MD, chief of vascular surgery at Kaiser Permanente San Francisco, and Bill Schecter, MD, chief of surgery at San Francisco General Hospital, who together more than 13 years ago proposed to the Hospital Council of Northern California the idea of mobilizing a network of medical volunteers and hospitals to provide the uninsured with donated outpatient surgeries. The premise, according to Dr. Grey, was to provide health care workers who normally volunteer their services all over the world a way to do the same thing in their own backyard.
"The motivations of most health care workers are basically altruistic, but a lot of that altruism gets lost because of the arbitrary constraints of America's health care infrastructure"
Dr Grey, MD
"The motivations of most health care workers are basically altruistic, but a lot of that altruism gets lost because of the arbitrary constraints of America's health care infrastructure," said Dr. Grey. "We thought providing a simple, safe program like this could help a lot of us get back to the mission of why we entered the health care profession in the first place."
The proposal from Drs. Grey and Schecter didn't exactly get a warm reception at the council conference. "Everyone thought we were nuts," Dr. Grey said. "They thought no one would be willing to take on the liability or the extra patient burden."
But both men persevered, and a few years later, after working through a lot of legal issues and red tape, Kaiser Permanente San Francisco hosted the first Saturday Surgery Session on Jan. 14, 1994. Fifteen volunteers were on hand to perform two surgeries, which were completed in less than an hour.
Operation Access has grown in size and scope every year since. A recent Saturday Surgery Day at Kaiser Permanente San Francisco had 120 volunteers who performed 22 surgeries—the largest charitable surgery session to date in the United States. In total, over 350 health care workers have volunteered at 17 hospitals in six counties around the Bay Area to perform more than 2,100 surgeries.
Getting Hooked on Giving
The most common type of surgery is for inguinal hernias, which represent about 27 percent of all surgeries facilitated by Operation Access. Other surgeries include biopsies and cystoscopies, varicose vein surgeries, tonsillectomies, meniscal repairs (knee surgery), hemorrhoidectomies, and cataract surgeries.
According to Dr. Grey, the level of cooperation that exists among the volunteers is intense—more than could ever be observed during a regular work week.
"It's a very interesting dynamic. Everyone helps each other—you see surgeons mopping floors and starting IVs," Grey said. "All of us observe it, including the patients, who can't believe we're giving up our Saturdays to help them."
"The patients can't believe we're giving up our Saturdays to help them"
Dr Grey, MD
Delma Sapalo, RN, a nurse who worked in the operating room at Kaiser Permanente San Francisco in 1995, was asked by a coworker to fill in for her during a free surgery session. Now the charge nurse for the Head & Neck Surgery Department, Sapalo hasn't missed a Saturday Surgery Session since.
"Knowing that patients who couldn't afford to fix a health problem before are OK now because of our efforts is very rewarding," said Sapalo.
One of the biggest challenges for all of the volunteers, according to Dr. Grey, is the almost infinite supply of patients who need this type of service. "People want to feel like they’re biting off a chunk of the problem, but the problem keeps growing," he said.
Tejada agrees. "Until a broader solution exists," he said, "we won't be working ourselves out of business any time soon, no matter how much we might try. In the meantime, we feel good that we can help 400 people a year go back to work or live pain free."
Operation Access is coordinating with Kaiser Permanente to begin Saturday Surgery Sessions at the Hayward and Fremont medical facilities this month. The nonprofit is also looking to expand its program beyond the Bay Area, and currently is in conversations with a coalition of providers in Orange County.
How to Get Referred to a Saturday Surgery Session
Find out more about the referral process, participating hospitals and eligibility criteria.