St. Mary’s is not alone in offering angioplasty without heart surgery capability.
LEWISTON – St. Mary’s Regional Medical Center is not the only hospital in Maine that performs angioplasty – a lifesaving heart procedure – without on-site heart surgery capability or written permission from the state.
York Hospital has been offering heart patients angioplasties for the past five years without a specific Certificate of Need, that hospital’s president said.
“We really considered that an extension of cardiac imaging, diagnostics and treatment and didn’t believe any particular CON requirements or thresholds were encountered,” president Jud Knox said.
With angioplasty, a tiny balloon is inserted into a narrowed artery and inflated in an effort to boost blood flow to or from the heart.
St. Mary’s came under fire from state health officials this month citing “health care concerns” after the local hospital started offering angioplasties at its diagnostic cardiac catheterization lab earlier this year. A spokesman for the Department of Human Services said St. Mary’s was never OK’d to provide that type of service. A mid-March meeting is planned.
Newell Augur, DHS spokesman, said a chief health concern is that the hospital expects to perform about 40 angioplasties a year, roughly half the number recommended by a national accreditation agency.
“In order to be considered an efficient and quality program, a facility needs to perform a minimum number of services,” he said, citing the Joint Commission on Accreditation of Healthcare Organizations’ guidelines.
But a leading professional and educational medical group, The American College of Cardiology, recommends that it is the doctor, rather than the hospital, who should perform at least 75 angioplasties per year. A hospital, it states, should see a minimum of 36 procedures performed on the premises, according to documents found at that group’s Web site.
The guidelines also state that hospitals lacking on-site surgical capabilities, such as St. Mary’s, should be allowed to perform emergency angioplasties if they have the capability of transporting patients to a full-service heart center within an hour, should transfer become necessary. Maine Medical Center is less than an hour away from St. Mary’s; Central Maine Medical Center is about five minutes drive by ambulance.
Sean Findlen, spokesman for St. Mary’s, said hospital workers confirmed the program “absolutely” meets all of the ACC guidelines, including criteria for admission and patient screening.
Augur said state law requires a hospital to apply for a Certificate of Need if it offers a new medical service that is estimated to cost more than $450,000 during its first three years of operation. “We view it as a new service.”
Jim Cassidy, president of St. Mary’s, said he and the hospital’s legal counsel see things differently.
“This very clearly is not a new service,” Cassidy said. “(Advisers) have been consistently telling us we’re totally within the law here.”
Findlen said estimates of the cost of performing angioplasties at St. Mary’s fall well under the $450,000 threshold.
In addition, the doctors who perform angioplasty at St. Mary’s, contracted through Cardiovascular Consultants of Maine in Scarborough, also have privileges at Maine Medical Center in Portland and each has done more than 75 of the procedures a year.
But that does not mean all heart patients needing surgical cardiac treatment be transported from St. Mary’s to MMC, Cassidy said.
“It has always been our policy to transfer a patient wherever they want to go,” he said. “I know that heart patients have left here and gone to CMMC. … We have no exclusive relationship to Maine Medical (Center) for referrals.”
Augur said state licensing officials simply want to review St. Mary’s plan for transporting patients and have not suggested the hospital stop performing angioplasties.
Cassidy said he was surprised St. Mary’s was being “singled out” for the practice when York Hospital has been doing it for years.
He said the decision to offer angioplasty “sort of evolved as we have become more aware of its importance as an interventional resource.”
York Hospital President Jud Knox said his hospital’s doctors perform about 100 angioplasties annually now. That number likely has grown steadily over the past five years, he said.
Patients in need of heart surgery are taken to Portsmouth Regional Hospital, about 10 minutes away, he said.
Comments are no longer available on this story