Critical hospital situation

As a surgeon at Down East Community Hospital, I would like to explain how the status of DECH as a critical access hospital would affect my ability to care for patients in Washington County.

As a critical access hospital the maximum active patient capacity must not exceed 15 patients a day. Currently, more than 50 percent of the time there are more than 15 patients a day in the hospital, sometimes as many as 28 patients a day. As a critical access hospital it is obvious that some of those patients that we are currently caring for here will be transferred to a different hospital, and to another doctor.

I perform emergency, diagnostic, elective and therapeutic surgical procedures here as a surgeon. Some of the emergency surgeries will be sent to another hospital, at the very least an hour away, to another surgeon, leaving me unable to care for my patients in the best way that I know how.

Scheduled surgeries, including diagnostic and elective procedures, will constantly be at risk for cancellation based on admissions to the hospital that were made the day and night before. I cannot ask my patients to absorb the pre-op costs or make the necessary preparations for a surgical procedure that carries a 50 percent chance of cancellation, especially when they are harboring a cancer and delay of surgical care adversely impacts their chances of survival.

This information should very clearly demonstrate how the change to a critical access hospital will affect the services that are provided at DECH. Services will be reduced. This information can also demonstrate how a chance to a critical access hospital would affect the physicians’ and the specialists’ ability and interest in working at this hospital. It may even force them to look for an alternative to DECH in order to protect their patients’ best interests.

Six months ago the medical staff voted unanimously against changing DECH to a critical access hospital for these very reasons. Today these arguments are just as valid as they were six months ago, yet the board of trustees continues to pursue the direction set down by the administrator, with seeming disregard to the opinion of the physicians.

The doctors are opposed to the critical access designation for DECH based on sound medical judgment. The board of trustees supports the financial judgment of this administration. I have grave reservations about the financial studies and judgment of this administrator.

In the “Critical Access Hospital Information Packet,” distributed by this administration, Section II, Cost & Reimbursements for top three payers, for our 24 most frequent DRGs, the average of DRG [Diagnostic Related Group] #148, Major small/large bowel procedure, is $18,524 at DECH. That same surgery is performed at The Cleveland Clinic Foundation [CCF], in Ohio, for $4,321 as direct cost structure per case, as published in the April 2002 issue of Disease of the Colon and Rectum,” page 487. The direct cost usually represents 43 to 55 percent of the total hospital costs depending upon the institution.

As the surgeon performing most of these surgeries (DRG #148) at DECH, I am unable to explain the drastic difference in cost between DECH and CCF. I was trained at The Cleveland Clinic Foundation and I know that I am using the same technique and medications that they use, and according to a report by the Northeast Health Care Quality Foundation, dated April 19, 2002, the Length of Stay for DRG #148 at DECH is 6.4 days, even shorter than the Length of Stay at CCF of 6.8 days. (same article).

I recommend that the board of trustees listen better to the doctors about the quality of the medical care that will be provided under the critical access hospital designation. I recommend that the board of trustees discover why DECH has drifted from a profitable hospital to a financially unstable hospital under the direction of this administration.

Based on just the one example I have given, I recommend that the board of trustees challenge the financial wisdom of an administrator determined to make such drastic changes to our hospital and the medical care we have available in Washington County.

Aziz A. Massaad, M.D., F.A.C.S. is director of surgery at Down East Community Hospital in Machias.