Plainfield's Muhlenberg RMC got a breather on Thursday when the Health Care Administration Board voted 6-1 to accept the Department of Health's rewritten regulations concerning participation in a Johns Hopkins study of angioplasty in hospitals where cardiac surgery is not performed. Nine states are participating in the study.
New Jersey's Supreme Court ruled in May that New Jersey hospitals participating in the study would have to shut down their programs after November if the state's selection criteria weren't amended.
Thursday's decision is to allow a maximum of twelve hospitals to participate -- up from the current nine. All of the current participants, including Muhlenberg, must reapply. A mandatory public comment period will be open until October 19, after which the Board will reassess the proposed regulations, make a final adoption and designate twelve participants.
Friday's Ledger reported that Health Commissioner Fred Jacobs said the Supreme Court may be asked to extend the deadline if the new list of twelve participants is not finalized by the November 30 deadline.
The elephant in the room is that cardiac care -- bypass surgery and angioplasty -- is big business to New Jersey's struggling hospitals. The Bergen Record cited a figure of $300-$400 million annually.
Having been personally involved in the community input side of Muhlenberg's original application for a cardiac surgery license, I know about how political the process has been -- despite all the high-minded talk by both hospitals and state regulators -- and how sharp the elbows of the likes of Deborah, Cooper, and RWJ hospitals are.
Back in those days, surgery dominated the strategic thinking of nearly everyone involved. But times have changed and medicine has moved along. As the Bergen Record puts it --
Proponents of allowing more hospitals to offer elective angioplasty say it will increase availability for a much-needed procedure. Advances in angioplasty -- improvements in catheter design, the advent of stents, metal meshes to prop open arteries, and better monitoring -- have made it safer. Emergency bypass surgery is performed in 2 percent to less than 0.4 percent of cases, state health officials said.Bypass surgery -- the bread and butter of the cardiac dinosaurs like Deborah and Cooper -- has plummeted in the last decade, to a high of 2%.
Meanwhile, Muhlenberg has argued all along that it can safely handle the procedure and that its market area includes a large underserved population of minority and low-income candidates for the angioplasty procedure.
Deborah and Cooper have been adept at generating concern -- I won't say hysteria -- over the safety of angioplasty without a cardiac surgery backup, but I hope that their machinations will have more light cast on them.
For instance, much of the discussion of safety in the recent hubbub is centered on a figure of seven deaths cited by NJBIZ ("New rules in a medical market fight"), a statewide business publication, as pointed out by the Record. The magazine cited no source for the figure.
Am I too cynical in thinking that the hand of the publicists representing the entrenched cardiac surgery hospitals is at work here? As well as in last Thursday's Ledger editorial, which seems to have drunk the Deborah/Cooper Kool-Aid and which I found highly suspect as well as annoying?
Muhlenberg and the others have won a reprieve, which is heartening.
Now they must reapply and submit to the winnowing process once again.
Let's hope they sharpen their elbows a bit, too, and not just rely on the kindness of strangers.
Media coverage --
- Ledger - 7/20/2007: "New rules keep N.J. in heart study"
- Ledger, Editorial - 7/18/2007: "Angioplasty Research: Don't experiment with lives"
- Bergen Record - 7/19/2007: "Deaths stir debate on angioplasty"
- Bergen Record - 7/19/2007: " Study's director defends angioplasty programs"
- NJBIZ: "New rules in a medical market fight"
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