Should a hospital be able to handle a medical emergency?

Steve Spivey with wife Tracy.

The answer may seem self-evident. But patients at some hospitals may find the staff resorting to what someone might do at home in a crisis: call 911 for an ambulance.

That happened recently in Texas, where a 44-year-old man named Steve Spivey developed breathing problems after spine surgery. No physician was working there when the staff first recognized he was in trouble. They phoned 911, and he was taken to a nearby full-service hospital, where he was pronounced dead a short time later.

The episode occurred at a small hospital that is owned and run by doctors — one of roughly 140 such hospitals around the country, with nearly two dozen more under development, that are set up to specialize in certain types of procedures like heart surgery, back operations and hip replacements.

These hospitals have been assailed for cherry-picking the most profitable procedures from the nation’s 4,500 or so full-service hospitals.

Critics have argued that the doctors have a financial incentive in sending patients to their own facilities, even when those patients might be better off having their surgery in regular hospitals.

But the Texas case, and others like it, have invited new scrutiny from regulators and members of Congress about these hospitals’ ability to care for patients who suffer complications after their operations.

While some of these hospitals are large sophisticated operations, like those hospitals specializing in cardiac care, others are much more modest. For example, small surgical hospitals may not have separate emergency facilities or, as in the Texas case, a doctor on site at all times during a patient’s recovery.

A similar case involved an 88-year-old woman two years ago at a small doctor-owned hospital in Portland, Ore., where the nurses called 911 after she was given too much pain medicine following spine surgery. She, too, later died.

As the number of doctor-owned surgical hospitals grows, federal and state officials now acknowledge that the government rules may be too vague about the emergency abilities a hospital must have in place. Regulators are particularly concerned about the very small hospitals that focus on only a few kinds of surgery but perform operations that frequently require an overnight stay. While Medicare’s rules currently say a hospital must “meet the emergency needs of patients in accordance with acceptable standards of practice,” the details are left largely to the hospital’s discretion. Federal and state officials say they are now reviewing the guidelines to toughen the rules and make them more specific.

“We’re concerned about good quality of care in any or all settings,” said Thomas E. Hamilton, who oversees hospital certification for the federal Centers for Medicare and Medicaid Services.

Medicare recently terminated its agreement with the facility involved in the Texas case, West Texas Hospital, a 14-bed hospital in Abilene that performed procedures ranging from plastic surgery to complex spine operations.

That is where Mr. Spivey had spine surgery.

Sometime during the night following his surgery, the staff grew alarmed by his breathing difficulties and called the surgeon back to the hospital. Ill-equipped to handle a medical emergency, the West Texas staff phoned 911, said Darrell Keith, the lawyer who is representing Mr. Spivey’s family and is still investigating what happened.

When the paramedics arrived, they inserted a breathing tube before taking him to a nearby full-service hospital where he was pronounced dead a short time later.

“It is horrific that Steve Spivey had to sacrifice his life in order to expose the problems associated with physician-owned hospitals,” Mr. Keith said.

West Texas, citing patient privacy, said it could not comment, although it defended the quality of its care.

After a review of the hospital following Mr. Spivey’s death, federal officials decided last month that the hospital could no longer continue treating patients covered under the government’s Medicare program. Although the chief executive of West Texas Hospital defended its practices, he said it would not appeal the government’s decision. The hospital has since closed.

The doctors who set up the specialized hospitals defend them by saying that by running the centers themselves and concentrating only on certain procedures, they can provide the best results for patients.