The DHEC board was right to grant Lexington Medical’s request for a revote on a previous action by an advisory committee before proceeding with the much, much larger issue of whether LexMed’s umpty-umpth request for reconsideration of its quest for an open-heart center:
Do it over.
Those are the marching orders passed down
Thursday by the DHEC board on a committee vote cast six weeks ago that
seemed to end Lexington Medical Center’s four-year pursuit of a new
open-heart surgery unit.The decision, reached after complaints
lodged by Lexington Medical over how the State Health Planning
Committee conducted its June vote, breathes temporary new life into the
issue.
Of course, in the end, DHEC must stick to its guns and say no yet again on the open-heart center, as we said again editorially on Thursday. DHEC shouldn’t have approved the Palmetto Richland expansion request several years ago; it must not compound the problem by approving a third program. That would quite likely take us in short order from the enviable position of having had one truly exceptional, excellent open-heart center (Providence) to having three mediocre ones. As we’ve explained time and again, you’ve got to do a lot of these to be good at it, and there won’t be enough bypasses done in the Midlands to keep three separate operations at the top level of excellence and competence (and remember, it’s less about the surgeons that it’s about the impossibility of keeping that many full surgical teams at razor sharpness).
But that final decision must be made against a backdrop in which nobody has an excuse to say that it was dealt with unfairly at any step of the way.
So by all means, have the advisory committee redo its vote. And then, deny the CON request, again.
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This is exactly the type of behavior you will see if the government ever ran healthcare. Bureacracy, delays, decisions to ration care not based on what the healthcare providers (the experts) want to do but on what some bureaucrat decides is the “best” solution.
Your claims about the supposed competency of the surgeons needs some supporting data. Where is your research that supports your claims?
How many operations must a heart surgeon perform before YOU will say he is qualified? Who decides? Isn’t that a decision made by very competent people already?
How long are YOU willing to make patients wait for surgery until a time slot opens up in the operating room?
South Carolina has more cardiac surgery facilities, more MRI, more CAT scanners and more PET scanners than all of Canada.
To logical people, that’s a good thing for private enterprise to service the patients.
To statists, it’s a bad thing for government to spend money providing medical care.
That’s why socialized medicine in Europe and Canada not only leaves people undiagnosed, untreated, and allows them to die, but actually kills very sick people, the elderly and infants whom it deems “not worth sustaining”, to The State.
I hope the above writer has done extensive research on how many people waited in the greater Columbia for surgery because of no slots available in an operating room-as opposed to those who chose to wait because they wanted a particular surgeon or heart center.
Why is it necessary for me or DHEC or anyone else “to do extensive research” on waiting times? That only applies to systems under the thumb of dumb government control.
In a truly free market, good service means short waits and lots of choices among good physicians. That is a selling point for them. Government wants to hide its sorry service statistics.
If anyone needs to come up with statistics on wait times in the US, it is those socialists who are trying to degrade our medical care to the sorry level of Canada and Europe.
Doug, I am listening to the health care providers — the guys who actually crack open the chests and do this surgery, the pros from Dover.
Hospitals want to do open-heart surgery because there is lots and lots of money in it. That was not the case when Providence started its program. Back then, it was a huge, thankless burden. But Providence took it on to provide a needed service, and became the best in the business in this part of the country. But if you take the number of open-heart surgeries that are done in this region now, and will be into the future (what with all the competing therapies), and spread it across three sites, neither Providence nor Lexington nor Richland will be as good as Providence is now.
THIS IS WHAT THE PROFESSIONALS TELL ME, and they are very persuasive. Please, please try to look past your prejudice with regard to gummint v. markets and see this.
Anyway, as I said, hospitals want to do this (and just go ahead and DO it in unregulated markets, thereby reducing quality) because there is now a lot of money in it. When hospitals tell you that they NEED to do it because they have so many critical cases coming into their ERs, a logical question to ask is, if your ER is so busy, why don’t you upgrade to a Level One trauma center?
The folks at LexMed will tell you they don’t do that because the region doesn’t need more than one such center (Richland). Suddenly, when we’re talking trauma, community needs become a factor.
But it’s interesting to note that trauma centers are a big expense for hospitals, instead of being money machines a la open heart. One reason Richland fought as hard as it did for an expansion of its open-heart operation is because it had to offset costs from its ER — and from its disproportionate share of indigent care.
We still opposed that expansion as well, because Richland’s cash-flow challenges were not as compelling as the need to avoid duplication that would degrade the quality of open-heart care in the Midlands. Unfortunately, DHEC approved it, the way DHEC approves most things. The great shock is that DHEC did NOT exacerbate the situation by approving the Lexington request. Yet.
SO let me get this straight.. according to your theory, when Providence opened its center, the patients who were operated on at that time were taking a big risk because the surgeons may not have done enough of them?
True or not?
And now you surmise that if another heart center opened, the quality would suffer at both centers because there would’t be enough demand? That the surgeons at Providence would somehow have deteriorating skills because the number of surgeries would go down? Is that how it works?
Could it be that some of the surgeons at Providence might see some better opportunities at Lexington and move their in order to advance their careers, thus opening up more spots?
And wouldn’t an increase in the supply of available heart surgeons result in a lowered cost for the consumer? Isn’t that what you want to see? And then in order to compete, the centers will have to provide either better service or lose business.
Also, have you asked these same experts who crack chests what they think of your national healthcare plan? Tell them the government will be setting their rates and deciding who gets treated and when. Let’s see how they go for that one.
It is not the government’s right nor purpose to decide what hospitals want to provide for services.
The bureaucrats aren’t qualified to make these decisions, either. The same people who complain about insurance clerks second-guessing the prescriptions of doctors now want government clerks to make wholesale decisions affecting thousands of future patients. How stupid is that!
Maybe the government needs to decide if Columbia doesn’t need another newspaper, or whether it should renew the license for The State paper.
I went to Lexington Medical Centers website to get its position on the heart center.
They have an open letter to the public on the website explaining their rationale and it starts with their belief that certain political factions are trying to protect the financial interests of the Columbia hospitals. Based on Brad’s own assertion that the cardiac surgery business is very profitable, that doesn’t really surprise me. It’s nice to have a monopoly on a product that people might be willing to pay anything to get.
How about we ask Providence to stop gouging the consumer? When are we going to declare aorta-independence?
The discussion going on between the bloggers is very interesting. I certainly do not portend to know the answer to the question of whether or not Lexington Medical can open a heart center.
For what it is worth I will give my opinion on the matter and maybe add to the confusion.
A doctor gets a MD degree and then decides to specialize and be a heart surgeon. He gets his degree and goes on to get to be board certified. When he gets his board certification, he has accomplished the highest degree of certification that he can get as a medical professional.
Question: How can Providence Hospital or Richland Heart Center say that their doctors or more qualified to do heart surgery than those that would be doing heart surgery at Lexington if they are board certified?
What I can’t figure out is why is there a Palmetto Baptist Hospital sitting off the Irmo exit at I-26 when there is one a short drive away at I-26 and 378!
That certainly looks like a duplication of services that Columbia doesn’t need.
Another thing you should realize is that the cutters who tell me these things make the point that as far as they’re concerned, they can do the surgery wherever. They expect that if LexMed did open-heart, they’d be the ones doing it. Folks with their kinds of skills don’t grow on trees.
What they are concerned about is the TEAM they work with. A lot of extremely complex and life-critical stuff is going on at once when you’re operating on a heart. You have to have a team of people who not only can do their respective parts of the job in their sleep, but who work together with the other members of the team as naturally as breathing (actually, more naturally than breathing, since that’s another thing that can’t be taken for granted under these circumstances).
And these docs say there is no way that you can reproduce those conditions at a third hospital in Columbia and have it operate at the same level as the teams they work with now; the quality would have to drop.
Now, changing the subject, Doug — on the off-chance that you were NOT being facetious with the question: Yeah, when Providence started doing open-heart, it was WAY the hell more dangerous than it is now. Of course, the choice was between risky surgery and dying for sure.
One of the arguments used by LexMed — and this connects powerfully on an emotional level with folks in Lexington County, who generally have not been exposed to the points I raise above — is that sometimes the surgery is needed NOW, and people could die if they have to wait an hour. Or, if they don’t die right away, those extra moments mean a lot of muscle tissue dying, making the patients’ long-term prognosis deteriorates considerably.
The docs I speak to who OPPOSE the LexMed bid say yes, that can happen — but very, very seldom. Very few of these operations are done on that kind of narrow-time emergency basis. The cost of putting such a facility at LexMed to save or help that tiny percentage of patients is outweighed by the fact that EVERY patient would have a lower survival and recovery chance with a surgery program of lesser quality.
Unlike some of my interlocutors here on the blog, I have spent many hours over the years listening to folks at LexMed, Richland and Providence. I’ve toured facilities at Lex and Prov (I haven’t been through the new Richland facility), and heard all sorts of presentations and had the opportunity to question the medicos at length on multiple occasions.
This isn’t some knee-jerk thing, folks. It’s a highly complex issue that goes far, far beyond some sort of silly argument between “anti-government” and “pro-government.” Given the stakes, it’s obscene even to couch the debate in those terms.
It’s a position that costs a great deal in terms of good will in the community, but we have to be honest about the inescapable conclusion we arrive at every time we dig back into this.
Oh, something I forgot to mention. My family has a history of heart disease. I can’t get to any hospital in the area without passing right by Lexington Med. If I were one of those rare cases that can’t wait another few minutes, I would die if LexMed can’t do the surgery.
But I think a whole lot more people would survive if we keep up the quality of the programs we have, and that’s more important. Mind you, that’s not completely altruistic. Most likely, if I have heart trouble, I will NOT be in that tiny minority that needs the surgery NOW. The odds are against anyone being in that category. So it’s better for me, and you, and the overwhelming majority of patients, if the surgical quality is maintained at the current high standard.
One more thing: LexMed is a fine hospital. I’ve had a lot more personal and family involvement with it than with any other hospital in the area — or anywhere. My youngest child was born there; I had major abdominal surgery there in 1993. I’m very happy with the care I and my family have received there, and wouldn’t have gone anywhere else.
But I don’t think it’s in the best interest of the community for it to do open heart.
Brad,
Do you believe for a minute that Lexington would not recruit the very best surgical heart technicians to assist in surgery? If Richland and Providence can hire the best, then why not Lexington?
> It’s a highly complex issue that goes far,
>far beyond some sort of silly argument
>between “anti-government” and
>”pro-government”
As long as the government decides the fact of the Lexington Heart Center, that’s all it is.
It should be a business decision. If the government wants to run hospitals (like the Veterans hospitals), let them. We’ll see which ones the public decides to use.
Brad, Have you ever personally visited either hospital in recent days?
Providence has a great reputation but also their equipment and infrastructure is very outdated. Additionally they do not seem to have the desire or funds to update.
Lexington has all new state of the art equipment and surgical units and is one of the few hospitals operating “in the black”.
Doctors will come to the best conditions for their patients success.
Methinks your primary concern is to protect downtown Columbia, i.e., your opposition to SCE&G’s relocation, your opposition to the Lexington Farmer’s Market, Mr. Bolton’s vision for Columbia to take over Richland and Lexington counties. Maybe The State needs to relocate to Blythewood or Batesburg to gain better perspective of the Midlands and not just downtown Columbia
I had heart surgery two years ago, my cardiologist gave me options which included out of state…. Perhaps those who comment on not having a heart unit at Lexington ought to be on the table with their chest cavity open. As a woman it is easy for me to see this is all politicaly and monetarily drive. Wake up, the next surgery my be yours.
As Doug, said, this decision belongs to the surgeons, hospital and patients.
It is not the business of DHEC, newspaper editors, or people who will never use the facilities.
Who is DHEC to rule on whether a heart center is added or not. Automobile dealers are not limited, restaurants either, etc. DHEC has trouble enough regulating sewer dumpage into the Saluda River. DHEC needs to stick with its core business.
Exactly, Mr. Judy.
Are these the people we want telling cardiologists what to do?
http://blogs.thestate.com/bradwarthensblog/2008/08/mayor-bobs-call.html
Saw an ad for Palmetto Heart Center on WIS-TV this morning. It was one of those fake drama situations with a voiceover between a guy experiencing chest pain and an EMT. The guy’s thinking he’s going to die and the EMT is asking him where he wants to go to be treated. When he says something like “My heart.. my heart!!” we hear the EMT say “we’re taking you to Palmetto Heart Center” and “we’ll be there in six minutes”.
Couple questions popped into my mind…
If you’ve got the monopoly on heart treatment in the Midlands, why would you need to advertise?
Who is the ad REALLY targeted at? Because I know if someone is having a heart attack, I doubt they are going to be pushing for a particular treatment center?
Could this just be a way to try and influence public opinion on preventing Lexington from making a decision that best suits its own community?
Governor Sanford agrees with DHEC, not because they are right, but because that is the law. He says change the law.
How does Brad Warthen feel with Sanford on his side?