March 8, 2006

JAMESON TAKES ACTION TO KEEP ANGIOPLASTY SERVICES LOCAL

            New Castle, PA - A recent decision of the Pennsylvania Department of Health threatens to eliminate the ability of patients to receive life-saving cardiac angioplasty services locally, at Jameson Memorial Hospital.  As a result, Jameson Hospital, along with three other community hospitals in western Pennsylvania, brought legal action against the Department of Health to ensure that patient choice and quality of care is not compromised.  The Commonwealth Court is hearing argument on the hospitals' case this month.  Last July, the General Assembly enacted legislation in connection with the state budget requiring the Department of Health to negotiate and obtain the hospitals’ agreement on any changes to the criteria for continued participation in the angioplasty program.  The Department of Health has ignored that legislative mandate.  The Department's failure to negotiate these changes in criteria is the basis for the hospitals’ lawsuit. 

            Three years ago, the Department of Health granted a groundbreaking waiver that allowed four western Pennsylvania Hospitals – Jameson Memorial Hospital, Monongahela Valley Hospital, Somerset Hospital and Uniontown Hospital – to provide percutaneous coronary intervention (PCI), also known as angioplasty, without on-site open heart surgery.  "Because of medical advances in the angioplasty procedure, the rate of emergency transfer to open heart surgery during or immediately after a PCI has decreased from 4 in 100 patients to about 4 in 1,000 patients receiving PCI.  We have not had any such transfers in the three years we have been operating the program," Thomas White, President and CEO, at Jameson said.  "Through informed consent, we tell our patients that we do not have open heart surgery and the patient has the choice to go to a hospital with open heart surgery.  Some patients are sent automatically to such a hospital because of complicating factors that are more appropriately addressed in that setting."   Selecting a hospital having these capabilities would require Lawrence County patients to delay treatment and leave the county to seek care.

            Currently, the hospitals are allowed to perform both emergency and elective PCI.  An emergency PCI occurs when an individual is experiencing a heart attack.  Studies show that the majority of Americans with heart attack symptoms go to their local community hospital, not to a major hospital center that is often further away.  In recent years, PCI has become the treatment of choice for heart attack patients.  The American College of Cardiology (ACC) recommends that such patients receive emergency PCI within 90 minutes from presentation at the emergency room.  "In order to provide this life-saving emergency treatment to our heart attack patients, it is essential that the hospital also be allowed to provide PCI in situations that are not emergent," explained Dr. Paul Wawrzynski, Director of Cardiology at Jameson Hospital.  Elective PCI may be scheduled the same day that a person receives a diagnostic cardiac catheterization, or it may be scheduled for some later date.  "Elective procedures tend to be less complex than emergency PCI.  Our hospital team needs to perform more than just emergency PCI to retain proficiency with the procedure.  Remarkably, the Department is threatening to take away our ability to do elective PCI, but would allow us to continue to treat the emergency cases.  That approach reverses a trend nationally to allow elective procedures in hospitals without open heart surgery."  Dr. Wawrzynski added.

            The Department of Health notified the hospitals in February that they must stop providing elective PCI unless the hospitals joined a study to be conducted by the Johns Hopkins Medical Institutions, out of Maryland, known as the C-PORT study.  The Department of Health claims it is acting consistent with the ACC guidelines, which do not recommend provision of elective PCI in hospitals without open heart surgery.  Those same guidelines recognize, however, that access issues may be a basis for allowing such procedures in areas not served by major hospital centers. 

            In February of this year, a bipartisan delegation introduced new legislation which would require the Department to discuss the matter with the hospitals.  "It may take a lawsuit and two acts of the General Assembly to get the Department of Health to listen, but we will not allow the Department to substantially change the way cardiac care is delivered to the detriment of our community.  We cannot understand why the Department will not meet with us to gain an understanding of the impact of the C-PORT study on our patients," said Douglas Danko, Vice President of Professional Services at Jameson.  The Hospitals have proposed an alternative study to be conducted by the University of Pittsburgh, but the Department of Health will not meet with the Hospitals or the University researchers.

            To be eligible to participate in the C-PORT study, a hospital must perform at least 200 procedures per year.  This would preclude some of the hospitals from participating in the study, and as a result, those hospitals will be forced to terminate their angioplasty programs by March 30, 2006.  The C-PORT study also requires every fourth patient to be sent out of the area for service.  Patients could elect not to participate in the study, but then they also must leave the area to receive the service.

            The University of Pittsburgh Study, which was originally proposed by the Pennsylvania Chapter of the ACC, would not require 25% of patients to receive the service elsewhere.  It also would not set a minimum of 200 procedures per hospital participating in the study.  Rather, the study would observe actual practice at hospitals to determine if there are particular policies and procedures that should be recommended or not recommended in hospitals that provide PCI without open heart surgery.   Danko clarified, "The University of Pittsburgh study is tailor-made for Pennsylvania's situation because hospitals already are operating successful primary and elective angioplasty programs.  On behalf of our patients and our community, we hope that the Governor and the Department of Health decide to listen to us.  We believe that we all want the same thing – to provide the best care for our patients.”

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