Published: July 19, 2008 12:22 am      

New standards for angioplasties approved

Elective guidelines unclear; FGH expects to seek approval for emergency heart procedure

FAIRMONT — Albert Pilkington, CEO of Fairmont General Hospital, did not express any concern that Gov. Joe Manchin asked the West Virginia Health Care Authority on Friday to review standards for elective angioplasties.

At the same time, Manchin approved new standards for emergency angioplasties that will allow hospitals — such as Fairmont General — without open-heart surgery capabilities to apply to the WVHCA for Certificates of Need in order to perform the procedures.

“It didn’t surprise me,” Pilkington said Friday. “He made a good decision, not only from an access viewpoint, but I think he made a good business decision.”

As of now, Fairmont General only offers angioplasties as a diagnostic tool to detect blockages. However, if the hospital applies for and is granted a Certificate of Need from the WVHCA, the hospital would be able to perform emergency angioplasties that also would allow a cardiologist to insert a stent into a blocked artery in an effort to open it up.

Pilkington hopes to begin the process of requesting the Certificate of Need for Fairmont General in about a year.

“If I read the regs (regulations) correctly, we shouldn’t have any problem getting the regs at all,” he said, noting that he wanted his staff to finish up an existing project before beginning the application process. “We’ll want to do a sufficient amount of planning and it will take time up to finish what we’re already working on. We want to do it right.”

Whether or not a cardiologist at certain hospitals will be able to do this in a so-called elective situation, when the patient is not experiencing an immediate medical emergency, may depend upon how the WVHCA re-writes those standards.

On Friday, Manchin approved the new standards for the emergency angioplasties, which three state hospitals — including United Hospital Center in Clarksburg — have been performing for at least five years now under a pilot program in spite of the lack of open-heart surgery services at those hospitals.

At the same time, Manchin asked for the WVHCA to re-write standards on which hospitals can provide elective angioplasties.

Bruce Carter, CEO of UHC, said he wanted to get more clarification on Manchin’s request to have the standards rewritten for elective angioplasties.

“About 70 percent of the angioplasties we do are primary, meaning emergency, which he approved,” Carter said. “I never thought in a million years he would touch that with a 10-foot pole.

“But the other percentage we do is elective. The problem is, when you only do primary and you don’t do any elective angioplasties, it reduces your numbers to the point where it’s hard to maintain a minimum annual target” set by the WVHCA.

Marianne Kapinos, general counsel for the WVHCA, said the governor requested clarification on transport time for patients who would be transferred from one hospital to another in order to have an angioplasty performed. She did not expect the new standards — which she said could be ready to seek Manchin’s approval in a few weeks — to affect hospitals such as UHC.

Since 2003, doctors at UHC have been able to perform the therapeutic angioplasties, or Percutaneous Coronary Interventions (PCI) under a pilot program, along with Saint Francis Hospital in Charleston and Weirton Medical Center.

In that time, Carter estimates, UHC has saved 12 patients a year who would not have survived if the time had been taken to transfer them to Ruby Memorial Hospital in Morgantown, UHC’s sister hospital through the West Virginia United Health System.

In fact, just recently, a 42-year-old Kentucky woman in cardiac distress who was visiting the area was brought in to the hospital and received an emergency angioplasty. She was able to drive herself back home to the Bluegrass State a few days later.

“That lady would have died otherwise,” Carter said.

During the public comment time leading up to Manchin’s approval of the emergency angioplasty, some hospitals that already offer therapeutic angioplasties wrote to the WVHCA to protest the changing of the standards that would allow hospitals without open-heart surgery capabilities to apply for the Certificates of Need.

In some instances, those hospitals would be competing with a nearby medical center that might be allowed to take on the procedure. That is not the case with UHC, Carter noted.

“We are in an area where there is no surgical program available,” he said. “I don’t think it’s as controversial for our patients in our area. There is no other alternative. If you are having a heart attack, you only have 60 minutes to get on the cath table or you either die or have significant heart damage.”

In the five or six years that UHC has been performing the PCIs, no patient has needed to be transferred to Ruby Memorial because of an angioplasty that did not go as planned.

However, if something did happen, the patient could be at Ruby in the time that it takes the operating room to be prepped, Carter said. That time will improve once UHC moves to a new facility off the Jerry Dove Drive exit of Interstate 79 in 2010.

Kapinos noted that pros and cons existed but the WVHCA believes that more hospitals should be allowed to apply to do the procedure.

“We decided to come down on the side of patient care,” she said. “You can be admitted to a hospital that has this service and not be seen for an hour, and often, you don’t get taken to the correct hospital. This will make this service more accessible.”

E-mail Mary Wade Burnside at mwburnside@timeswv.com.