St. John officials voice opposition to new cardiac rules
Tuesday, July 8, 2008 11:34 PM PDT
By Barbara LaBoe
Printable version
E-mail this articleTUMWATER — Speakers opposed to new state cardiac rules outnumbered supporters during a public hearing Tuesday, but St. John Medical Center officials remain concerned about the outcome.
“It seems politics are involved and we’ve been pushing that it be decided based on the evidence,” said hospital spokesman Randy Querin after the three-hour hearing. “If it’s (solely) evidence based, we’d feel a lot of confidence.”
St. John and other smaller hospitals want the state to allow hospitals without open heart surgery programs to perform elective angioplasties. Currently, smaller hospitals can only perform them in emergency cases, and St. John doesn’t even do that because officials say it’s too hard to keep a doctor for just emergencies.
Angioplasties involve inserting a balloon into a blocked artery using a catheter. Often, a mesh stent also is inserted to hold the blocked artery open.
A 2007 state law calls for expanding the procedures to rural areas. St. John officials and others say the Department of Health’s proposed new rules — including a requirement to do 300 procedures a year — make that nearly impossible. They want the state to rework the rules before they take effect.
“The rules are going to cut out rural and some urban areas, and that’s not what we intended,” testified state Rep. Dawn Morrell, a nurse who authored the legislation. The health department “didn’t do what we asked in the legislation. ... Rural hospitals weren’t even taken into consideration in these rules,” said Morrell, D-Puyallup.
State Rep. Jeff Morris, D-Mount Vernon, also testified that the rules “don’t meet the intent of the Legislature.”
Supporters of the rules, mostly larger hospitals who already can perform elective angioplasties, said expanding the practice will risk patient safety. Practice makes perfect, and larger programs, with more procedures a year, have better outcomes, they said.
Increasing the number of elective providers also could hurt existing open heart surgery programs at some hospitals, warned Kristine Sinner of the Heart and Vascular Institute at Vancouver’s Southwest Washington Medical Center. She said SWMC’s costly 24-hour service could be “destroyed” if other nearby hospitals siphon away some of the elective procedures.
“A lower volume standard will compromise, not improve quality,” Sinner said. “Not every hospital can be everything to all people.”
State officials said they developed the rules after doing an independent study and consulting healthcare providers. The proposed 300 angioplasty standard was selected because officials felt the 200 favored by smaller hospitals was too low to guarantee competency and safety.
Smaller hospitals, though, claim the larger facilities are protecting their “monopolies” on the elective procedures. They say the latest data says facilities with between 150 to 200 procedures preform the elective angioplasties safely. Also, they said, if they can’t offer angioplasties, it’s next to impossible to recruit heart doctors to their hospitals for all their patients’ cardiology needs.
A handful of patients from around the state also testified, complaining about the time and money it took to transfer from their local hospital to another for the procedure. The added travel and stress hurts both the patient and family at an already difficult time, said Retha Porter, a St. John spokeswoman who spoke about her father’s transfer to Portland several years ago.
St. John’s Dr. Noel Santo-Domingo also testified that holding hospitals to the 300 number may lead doctors to keep riskier cases local in order meet the state’s threshold instead of transferring them to larger hospitals. He added the proposed rules are difficult to understand given that 45 states allow or are considering allowing elective procedures like this at hospitals like St. John.
In Southwest Washington, St. John, Legacy Salmon Creek Hospital in Vancouver and Grays Harbor Community Hospital in Aberdeen — which serves Pacific County — all favor changing the rules. Southwest Washington Medical Center supports the proposed rules.
Tuesday’s testimony, as well as written comments, will be summarized and forwarded to state Secretary of Health Mary Selecky for a final decision. The earliest a decision will be made is July 15. The rules would be effective 31 days later. She also could ask for revisions or restart the process.
Atrucker wrote on Jul 9, 2008 2:37 AM:
Going to Portland is not a skip in the park I know . I had a quad bypass done last year.
I also spent some time in St Johns, and wanted to leave much sooner than they wanted me to .The care I got there pretty much sucked, when compared to OHSU. Can you afford to kill people because you do not have the right stuff for the job or the right people . I just do not get it "
El Gabilon wrote on Jul 9, 2008 11:34 AM:
Girth VonPhister wrote on Jul 9, 2008 12:44 PM:
local_nurse wrote on Jul 9, 2008 4:25 PM:
Girth VonPhister wrote on Jul 9, 2008 5:11 PM:
Local Mom wrote on Jul 9, 2008 5:46 PM:
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