Barely a month into the head-to-head competition in Monroeville, rivals Forbes Regional Hospital and the new UPMC East hospital are at odds over emergency heart catheterization procedures being done at the UPMC facility.
Because UPMC East does not have on-site surgical backup in case of complications, Forbes officials have protested to state Department of Health Deputy Secretary Anne Marie Sossong that doing a catheterization on a heart attack patient "goes contrary to both East's current license with the State as well as the existing [Department of Health] rules and regulations governing this type of program."
So far, UPMC East has treated five emergency patients with stent replacement and has referred four non-emergent patients to one of the system's tertiary care hospitals such as UPMC Shadyside, UPMC spokesman Paul Wood said. He also said the hospital intends to seek approval from the state to perform elective procedures once it has the required six months of data.
"Of course, we have full DOH approval to do diagnostic and emergency interventional catheterizations," he said -- and the health department backs him up.
Health department spokeswoman Christine Cronkright said UPMC East does not need a waiver for the emergency procedures, although the hospital staff must report to the department within 72 hours of each procedure. UPMC East officials and staff, she said, "are within the regulations for the procedures that our staff has reviewed to date."
Tony Farah, a cardiologist and the chief medical officer for Forbes parent West Penn Allegheny Health System, said he's not aware of any hospital in Western Pennsylvania getting approval to do interventional catheterizations without on-site surgical backup, other than facilities located in remote areas, many of which participated in a now-closed trial study headed by Johns Hopkins University.
"If I had a heart attack and have a choice between going to a facility with surgical backup and one that doesn't have surgical backup -- and distance is not an issue -- I would always prefer the place that has surgical backup," he said.
Advances in treatment have reduced complications to less than 1 percent, said Dr. Farah, but the mortality rate is high for those in that 1 percent. "You really don't want to be a patient that goes to a facility that doesn't have full capacity for dealing with a situation, whether they have on-site surgery or not."
Texas-based cardiologist Gregory J. Dehmer, former president of the Society for Cardiovascular Angiography and Interventions, has written extensively on the issue of surgical backup for interventional catheterization.
In a phone interview Tuesday, he said interventional catheterization at facilities without surgical backup has been controversial for a long time but the practice is becoming more common in the U.S. and has been done for a long time in Europe. "They kind of look at us and say, 'What's the problem?' "
Dr. Dehmer was the lead author of a 2007 consensus document that concluded catheterization without onsite surgical backup "is being performed with acceptable outcomes and risks in the United States and many other countries."
The 2007 paper also states that "it is inappropriate to open [interventional catheterizations] centers if they are not based on the health needs of the community" and also that "desires for personal or financial gain, prestige, market share or other similar motives should not be part of the decision process" in determining whether the center is needed.
Dr. Dehmer wasn't willing to make the call on how that might apply in the Monroeville case. "I cannot make a comment as to whether it's the right thing to do in your local area. Sometimes competition makes everybody better."
The dispute reflects ongoing bad feelings between UPMC and Forbes parent West Penn Allegheny Health System since UPMC announced plans to open a hospital less than a mile from Forbes.
In the first month, said Mr. Wood, the average daily census at UPMC has grown to 75 patients, filling more than half the 140 beds. The hospital has averaged 90 to 100 emergency room visits per day, "more than 2.5 times what we anticipated," he said.
Forbes, which is undergoing a $20 million facility upgrade, has seen a 17 percent drop in its emergency room visits since UPMC East opened, as compared with visits in July 2011. That is about what was expected, said spokeswoman Kelly Sorice. Combined discharges and observations for the month are about the same as last year.
In the fiscal year ended June 30, she said Forbes performed 1,358 diagnostic catheterizations and 441 interventional catheterizations, 11 of which then required surgery.
Forbes is banking on its long-term relationship with people in Pittsburgh's eastern suburbs and its plans to become a Level II trauma center, which means it would be able to treat more serious injuries and illnesses.
Caught in between are local EMS agencies that transport the emergency cases to one facility or the other -- and they are trying to stay out of the fray.
In an email sent to several colleagues, a copy of which was obtained by the Post-Gazette, Woodland Hills EMS Supervisor Keith Morse tried to clarify what UPMC East could and could not do, while cautioning, "This is not intended to be part of the propaganda war that has been going on between UPMC and WPAHS." Mr. Morse did not return a phone message Tuesday.
A Monroeville EMS staff member who declined to give his name over the phone said simply, "We are trying to be good neighbors to both of them and we will take the patient to wherever the patient requests or to the best of our knowledge for the services they need."
If no request is made, he added, "We look at what insurance they have. If they have UPMC insurance, we will take them to a UPMC facility because that will benefit the patient."