A dispute between West Penn Hospital and Children's Hospital has prompted a complaint to the state attorney general.

West Penn officials say Children's has reneged on a long-standing agreement to provide surgeons for some procedures so newborns won't have to be transported, while UPMC maintains it is only looking out for the tiny patients' best interests.

"These are very small kids, sometimes weighing less than a pound-and-a-half, on a ventilator, sometimes with unstable blood pressure," said Dr. Al Lantzy, head of neonatology at West Penn. "I know that transporting a patient cannot be helpful."

Dr. Lantzy said he had been negotiating to continue the agreement with Dr. George Gittes, chairman of pediatric surgery at Children's, and they had even settled on a $450,000 yearly price to have Children's surgeons come to West Penn for the 20-30 cases they typically see.

After negotiations for extending a 25-year-old agreement broke down this spring, Children's officials told West Penn in mid-June that they would no longer provide surgeons.

"I don't know why," Dr. Lantzy said. "I just know I had an agreement with a surgeon at one point in time and now I have to send them out."

Adding to the tension is language in a letter to the attorney general from Dr. Gary Silverman of UPMC in June in response to West Penn's complaint.

In addressing the possibility that West Penn might hire its own pediatric surgeons, Dr. Silverman wrote that "I suggest we welcome the competition rather than placing the UPMC seal on an inferior product and actively facilitate the development of a substandard service."

Dr. Lantzy vigorously disputes that the West Penn program is inferior, adding that Dr. Gittes never raised any concerns about West Penn's care in their discussions.

Paul C. Wood, spokesman for UPMC, yesterday said Dr. Silverman's letter was not meant to disparage West Penn's program.

Rather, Mr. Wood said Dr. Silverman was pointing out that specialized surgical care is better provided in a centralized center, where surgeons and support staff are well practiced in the procedures and their possible complications.

"This is about what's best for the children who need only the kind of high specialized care that only Children's can offer."

But Tom Chakurda, spokesman for the West Penn Allegheny Health System, believes UPMC's decision to stop providing surgeons has more to do with competition than medicine.

"We think it is a sad state of affairs when UPMC resorts to using babies as chattel in their desire to dominate the region's health care."

Dr. Lantzy said Children's had been providing pediatric surgical services since he arrived at West Penn in 1979. But, beginning in late 2004, Children's surgeons stopped coming to West Penn for surgeries, and instead limited their services to procedures such as placing a central line. Dr. Lantzy had been hoping to re-establish the full service agreement when negotiations broke off this spring.

Dr. Lantzy said he did not know of any children suffering setbacks since West Penn started transporting its surgical cases to Children's more than two years ago, but noted that "there is more likely to be complications any time you move a patient."

Dean Walters, spokesman for Children's, said the hospital safely transports sick infants from distant locations all the time.

"We do this every day. This is not something new."