St. Joseph wins catheter skirmish > Concannon will make final decision

In a surprise development, the state’s hospital spending watchdog has recommended that St. Joseph Hospital in Bangor be allowed to add a cardiac catheter laboratory against the wishes of Eastern Maine Medical Center.

The favorable recommendation on the $1.5 million lab, where expensive catheterization and angiogram procedures will be performed, flies in the face of both the state’s initial negative assessment last year and a private consultant’s report released in September.

The proposal has been strenuously opposed by Eastern Maine Healthcare, parent of Eastern Maine Medical Center. EMMC, the only hospital with cardiac catheter services in eastern and northern Maine, fears it will lose business if St. Joseph prevails.

“We are quite dismayed,” said P. Jerry Whalen, vice president for business development for EMH. He said officials were confused by the reversal of opinion by the Department of Human Service’s Certificate of Need Unit, which regulates new hospital services and construction.

The final decision rests with DHS Commissioner Kevin Concannon, who has said he’d decide by the end of the year on pending cardiac catheter applications.

The CON office also recommended approval of catheterization lab applications from MaineGeneral Medical Center with hospitals in Augusta and Waterville, Mercy Hospital in Portland and Southern Maine Medical Center in Biddeford.

It has not issued a recommendation on applications from The Aroostook Medical Center in Presque Isle or Inland Hospital in Waterville. Both are affiliated with EMH.

St. Joseph Officials were pleased with the news.

“It’s at least 100 steps closer than we were,” said Sister Mary Norberta, chief executive officer of St. Joseph.

She said she’s now waiting for Concannon’s final decision. “I’d like it as a Christmas present with or without the bow,” she said.

Each cardiac catheterization procedure costs about $3,000 at EMMC. In the procedure, a doctor inserts a flexible, hollow tube into an artery and slithers it toward the heart with the help of x-ray guidance to detect blockages and narrowing of passageways.

St. Joseph officials have said cardiac catheterization has become a common diagnostic procedure and qualifies as a “bread-and-butter service” that must be offered so the hospital can be competitive with other hospitals.

St. Joseph has also said it is an imposition on patients to transport them across the city to Eastern Maine Medical Center by ambulance for the procedure, which could be done more cheaply in-house. The doctors doing the procedure would be primarily the same as those who already do it at EMMC.

One of the key issues facing DHS officials is whether there is enough patient need to justify building a new facility in Bangor.

In September, Public Health Resource Group of Portland determined there was little need. Ronald D. Deprez, president of the consulting firm, had said in an interview that his St. Joseph recommendation was difficult in that there is a large volume of patients served in Bangor. But, he said, the need is being met by EMMC, which also offers open-heart surgery.

But Bill Perfetto, manager of the state’s CON office, found otherwise.

“The cardiac cath lab volume forecasted by St. Joseph Hospital will exceed the minimum volumes specified in the Healthcare Facility/Agency Space and Needs Guidelines,” Perfetto wrote in his recommendation.

Perfetto’s decision also surprised The Aroostook Medical Center in Presque Isle. TAMC applied for cardiac catheterization services later than St. Joseph. The consultant’s report had given them a strong recommendation. David A. Peterson, chief executive officer of TAMC, wondered where its application now stands.

Peterson said some of TAMC’s volume projections were based on some of the same patients that St. Joseph included in its needs analysis. He called that a “key concern.

For his part, EMH’s Whalen said officials were still trying to understand why the state would throw the consultant’s recommendations out the window.

“It just amazes us the state would spend the time and money on the consulting firm as they did,” Whalen said. “What was the purpose of the study?”

He said there had been no substantial changes to the St. Joseph plan since it was first submitted, although, he said, EMMC did lower the cost of transferring some cardiac catheterization patients to EMMC recently.

In its application, St. Joseph said in 1997 it transferred to EMMC 86 people for catheterizations and 28 for angiography, which is used to look at arteries in the brain, kidneys, intestines and limbs.