Wheeling Hospital Contends New Heart Cath Regulation Puts Patients in Jeopardy
June 20, 2008
WHEELING, W.Va. – A Wheeling Hospital interventional cardiologist today said it is a bad decision to permit West Virginia hospitals to perform interventional heart catheterizations (balloon angioplasty) without having open heart surgery onsite as an emergency backup.
An affirmative vote Wednesday by the West Virginia Health Care Authority paved the way for hospitals to perform the procedure without the surgical backup. Without backup, an unsuccessful balloon angioplasty case requiring cardiac surgery would have to be transferred to a hospital that provides the critical procedure.
“Hospitals that want to perform balloon angioplasty without surgical backup will argue that balloon angioplasty usually fixes a person’s problem and, therefore, open heart surgery is not often needed. But all it takes is one death due to a delay in transferring the patient to a cardiac hospital for surgery to prove our point,” said Dr. Robert Fanning, interventional cardiologist at Wheeling Hospital.
“If a hospital doesn’t have cardiac surgery as an option, the time it takes to transfer the patient to a hospital with that capability can mean the difference between life and death. Time is of the essence. Why would anyone take that risk?”
The authority’s action was taken despite objections from Wheeling Hospital, Charleston Area Medical Center and Huntington-based St. Mary’s Hospital, all of which have the capability of providing cardiac surgery if a patient develops problems during interventional catheterizations.
Several national cardiac-related organizations, including the American College of Cardiology, also call for hospitals performing balloon angioplasties to have open heart surgical capabilities onsite as standby.
“We perform balloon angioplasty in our cardiac cath lab. It’s only 18 feet from our lab to our surgical unit. But imagine if you’re in a hospital that doesn’t perform open heart surgery and it becomes apparent you need it when something goes wrong in their cath lab. You have to wait for an ambulance, its crew, the ride to the cardiac hospital, get unloaded and then be taken to surgery. That’s time lost. The longer you wait, the greater the chance of death,” explained Fanning.
When a coronary artery is blocked, a small incision is made in the groin and a tiny tube is inserted into the femoral artery. The tube guides a balloon through the artery to the heart and the site of the blocked coronary artery. The balloon is inflated, opening the artery, followed by the insertion of a stent to keep the artery open to restore blood flow. When complications occur, often the only alternative is open heart surgery.
Fanning said allowing small-volume hospitals without cardiac surgical units to perform balloon angioplasties will dilute volumes at large hospitals, thereby causing quality care at the larger hospital to suffer. By national standards, a large-volume hospital is one that annually performs at least 400 balloon angioplasties. Last year, Wheeling Hospital performed 574 of the procedures.
“Some of these small-volume hospitals will be lucky to perform at the most a couple dozen balloon angioplasties per year. How do you build experience and quality care with those numbers?” asked Fanning.
“We specialize in balloon angioplasties. We do them all the time. If small-volume hospitals start performing them, they could drag down our volume of cases and possibly lower our experience level. Some may say we’re only worried about losing money, but I’ve got news for them. Heart attack patients are often not paying customers. I'm not worried about money. I'm worried about patient care.”
Fanning has a personal question for the Health Care Authority members.
“Hopefully, none of the members will ever need balloon angioplasty. But if so, would they rather have it at a hospital that has a cardiac surgeon standing by onsite if needed? Or, would they be fine having the angioplasty at a hospital that can’t perform cardiac surgery with the nearest cardiac surgeon miles away? So why would the authority permit West Virginians to be put in that same risky position?” asked Fanning.
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