Ambiguity in the drive-time rule that decides if a patient in Beckley must head for Charleston to undergo emergency heart procedures has prompted Gov. Joe Manchin to ask the state Health Care Authority for an explanation — and a revised rule.

Manchin decided Friday to approve most of the HCA’s revisions, but he demanded the agency revise the “transportation time” portion of the cardiac catheterization service rule and return it to his desk as soon as possible.

In this region, the uncertainty leaves a major question mark: Can Raleigh General Hospital offer angioplasty service, or does the one-hour radius rule force its patients to seek treatment at Charleston Area Medical Center, assuming they live no farther than that away?

Raleigh General’s chief executive officer, Karen Bowling, came away from a Friday meeting in Beckley with Manchin convinced the governor would see to it that her facility eventually can start providing the service, rather than send patients to Charleston when conceivably every minute counts in a life-or-death medical crisis.

“He assured us this was going to be fixed in the new standard, that Beckley and Raleigh County could be served,” Bowling said.

“Unless you’re having a heart attack yourself, you may not realize what the implications are for us not being able to provide that service. If you’re having a heart attack, it will hit home for you.”

Lara Ramsburg, communications director for Manchin, agreed with Bowling that the rule is vague about the term “medical transport drive time.”

“Do they mean the time it takes to truly drive from one place to another?” she asked.

“Or do they mean the time it takes to get a patient ready to get into the ambulance, get them in the ambulance, get all the stuff ready they need to do? Does it include all those things? What exactly is included?”

Manchin hopes to see a more specific proposal within two weeks, Ramsburg said.

“We transfer a significant number of heart patients on a daily basis,” Bowling said. “And we want people to receive care close to home.”

Bowling termed the one-hour rule as “absolutely” unrealistic.

“Just think about it for a moment,” she said.

“No matter where you live, unless you’re in Beckley, and you live five minutes from the hospital, if you’re having chest pains and you’re having ... a heart attack, you’re going to have a significant travel time to the hospital, whether it’s getting in your car coming here or an ambulance, depending on where you live and what the traffic is, and what the weather is.”

Upon arrival, a patient must undergo all the emergency testing and lab work before being sent on to CAMC, she pointed out.

“You’ve already eaten a significant portion of that golden hour and you haven’t even gotten transferred yet,” Bowling said.

“The one-hour rule really doesn’t make any sense. There has to be a reasonable standard. All of the research out there will tell you hospitals in rural communities can provide the service. They can do it safely and effectively. It is the gold standard of care. And in southern West Virginia, there isn’t anyone who provides that service. People in our area deserve quality health care. Raleigh General’s position is to provide that care. We want to be able to do that.”

Ramsburg said she understands the concern voiced by Raleigh General and that the administration is pledged to guaranteeing the service across the state.

“Certainly, hospitals like Raleigh General need that clarification so that they know exactly where they stand,” she said.

“Our goal is to provide this type of service for as many West Virginians as possible. Raleigh General is one of those hospitals that really needs this answer, one way or another, because it’s so close in terms of the difference if you mean drive time, or prep time including the drive time. We want to make sure HCA very clearly states what the rules are so that there can be no confusion, no ambiguity, and everybody can move forward.”

Manchin said his administration took “a very close look” at data compiled in recent years and other facts on the capacity of hospitals to perform heart angioplasty procedures that could mean the difference in life and death for thousands.

The governor said he approved the majority of standards aimed at giving West Virginians improved access to emergency heart procedures.

“This decision, in its entirety, is solely based upon one objective — to provide all of our citizens, regardless of their location, access to the best possible medical care in their time of need,” he added.

— E-mail:

mannix@register-herald.com