Published: July 21, 2008 11:21 pm      

HCA attorney says RGH can apply for cardiac care

Raleigh General Hospital is eligible to apply for angioplasty service since the “one-hour rule” of proximity considers prep time for a patient before the trip is made to Charleston, says the legal counsel for the West Virginia Health Care Authority.

Under that rule, if a patient is within one hour of Charleston Area Medical Center, treatment is supposed to be conducted there.

“A lot of people think it just means commute time, but it doesn’t,” Marianne Kapinos told The Register-Herald Monday.

“It means the time it takes from the time a patient is diagnosed and determined that they need the procedure and the time it takes to stabilize them and the time it takes to get them on a gurney and get into an ambulance, or helicopter, or whatever is being used.”

Gov. Joe Manchin approved the majority of HCA’s recommendations last week but called on the agency to provide him a clarification of just what the one-hour standard entails and how it applies.

If the one-hour rule is applied strictly to the actual time on the road, say Raleigh General and other critics, emergencies would have to be delayed that long in a crisis when every minute counts in a life-or-death struggle.

“It’s the entire time, not just the amount of time spent driving,” Kapinos said.

As she interprets the rule, Raleigh General could ask for permission to provide the cardiac catheterization service, since it would be “very difficult” for the hospital to get a patient prepped and moved to Charleston within an hour. Merely driving to CAMC alone from Beckley to Charleston would be hard to accomplish within an hour, given the series of traffic lights in Kanawha City.

“We actually thought that under the current language that they would be eligible,” the attorney said.

“They seem to think otherwise. So we’re going to clarify it.”

Manchin termed the language in that rule as ambiguous and asked HCA to send him a clarification.

The HCA will meet again Aug. 6 to take up the matter, the legal counsel said.

“They’re going to be eligible to apply,” Kapinos said. “I assume that they will. We just assumed that everybody understood what ‘medical transport time’ meant and apparently they didn’t. So, we’re going to clarify that.”

Raleigh General’s chief executive officer, Karen Bowling, met with Manchin last Friday in Beckley and afterward indicated she was encouraged that the governor would make sure her hospital would be eligible to provide the service.

Manchin’s communications director, Lara Ramsburg, said the governor examined very closely all data gathered in recent years on the ability of West Virginia hospitals to perform heart angioplasty procedures.

A Register-Herald reader at the University of Vermont said the American Heart Association and the American College of Cardiology recommend a level of 200 angioplasty procedures annually, along with 36 emergency standards to assure care of a high quality.

In response, Bowling said her hospital can meet those standards, pointing out that with this year only slightly half over, it already has transferred 166 in-patients with cardiac-related problems. In addition, another 52 patients suffering acute myocardial infarction (MI) have been transferred from Raleigh General’s emergency department, she said.

“We regularly transfer a significant number of patients from Raleigh General Hospital to other facilities where they undergo interventional cardiac care, including angioplasty,” Bowling said.

“When you consider that the overall level of cardiac disease in our area is so pervasive, it is clear that we need to be able to provide angioplasty services to the residents of southern West Virginia. Angioplasty is the gold standard of care for many of these patients and they need to be able to receive that care close to home.”

— E-mail:

mannix@register-herald.com