Just to briefly mention what I've been up to on this Ash Wednesday, we had a meeting this morning with representatives of Providence Hospital and Lexington Medical Center. They had come to jointly announce a major breakthrough — they've stopped fighting over whether LexMed should be allowed to do open-heart surgery.

As you know, Lexington has tried everything it could think of in recent years — regulatory, legal and political — to get around the fact that DHEC has said (in a shocking, rare instance of DHEC saying "no" to anyone) that they can't do bypasses. Providence and Palmetto Health have been on the opposite side of the table, arguing that a third such program would be duplicative and damage the quality of overall care in the Midlands by reducing the number of procedures they do below the level considered necessary for maintaining proficiency.

We have agreed with Providence and Palmetto Health on this. In fact, we also opposed Palmetto Health expanding its heart program several years back, on the same grounds, but DHEC approved it. We have maintained that yet a third such program would be insupportable.

But now two of these three parties have decided to stop spending millions fighting each other, and after months of negotiations have agreed on the following:

• Providence and Lexington Medical will ask DHEC to "de-certify" one of Providence's four open-heart surgical suites.
• The two will then ask DHEC to certify ONE such unit at Lexington Medical.
• Lexington will drop its challenge to certificates for expansion for Providence Northeast.
• Lexington will pay Providence, in three installments, a total of $15 million to compensate it for the lost revenues from de-certifying a unit.

So what's missing? Well, Palmetto Health. What we have here is a classic 1984 sort of situation: Eastasia and Eurasia have always been at war with Oceania. But now Eurasia and Oceania are friends. Does that mean they are now at war with Eastasia — I mean, Palmetto Health? Well, no — at least not at this moment. But Palmetto Health is not a part of the peace agreement, and it's hard to see how the overall battle over this issue is over until it is. We'll see in the coming days.

All of that is not to take away from what a huge breakthrough this is. This has been a very, VERY bitter battle that has distorted local politics as well as spending all that money on lawyers and such. As one who lives right behind Lexington Medical, I can tell you I've caught a lot of heat over this emotional issue, as has the newspaper. It's been tough to get people to look beyond the feelings to the larger issue. (One way I've tried to do that personally has been by pointing out that if I were having a heart attack, I'd have to be transported right past Lexington, only a mile from my house, to Providence — but that I believe that situation is best for the community overall, in terms of better outcomes for more patients in the Midlands.)

Now, suddenly, it's over? Well, this part of it is. And I find myself torn between on the one hand celebrating the end of a really destructive conflict, and wondering why it's suddenly OK for an experienced open-heart team to be replaced by a startup? Mind you, I'm sure Lexington Medical will do as a good a job as anyone could starting such a program. It's an excellent hospital, and takes tremendous pride in doing everything it does well. Still, all things being equal, would we not be better off with the established team at Providence doing that portion of the region's procedures?

The thing is, politically and financially and in other ways, all things were NOT equal, and continued conflict had its cost. So I can see why Providence has agreed to this even as I have reservations. Lexington Medical is giving ground, too, by the way, aside from giving up money — it still has objections to the wisdom and advisability of the Providence Northeast expansion. But it's dropping those concerns in the interests of agreement.

By the way, as a brief primer on the importance of money in all these considerations: When Providence started doing open-heart decades ago, it wasn't a money-maker. The Sisters of Charity did it because somebody in South Carolina needed to. Later, open-heart surgery became very lucrative. And while I fully believe that all parties believed they were also doing what was best for their patients, the money has played a big role at each step in these battles. Palmetto Richland, with the largest share of indigent care and an extremely expensive trauma unit, needed to expand into heart surgery to have something that brought in revenues. Lexington didn't want to be left out of that. And Providence, which has struggled financially in recent years after an ill-advised partnership with a for-profit corporation (which the good sisters mortgaged their convent to get out of), could ill afford to give up the revenues.

That's the simplistic, "it's all about money" explanation. There are other factors at work as well. One of them is that the treatment of heart disease is increasingly moving beyond open-heart, often to less invasive therapies. That's one reason why Providence was unwilling to give up part of a pie that was diminishing in overall size. But it also seems to be a reason why it is willing to give it up now — open-heart isn't the future the way it once was, so Providence sees no point in continuing a wasteful fight over a portion of the diminishing number of such procedures to be done in the future.

Meanwhile, if I heard it right today, Lexington is NOT giving up its objections to a certificate involving the main Providence campus. So all is not sweetness and light, with all conflicts behind us in this community.

But no doubt about it, this is a major step by these two very important local institutions. It's huge. But it's SO huge, and complicated, that much remains to be sorted out.

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