A Fort Mill hospital operated by Carolinas HealthCare System would erode the quality of health care in York County, especially for specialty services, says an S.C. Administrative Law Court judge.
The effects on existing health care were a primary reason Judge Phillip Lenski ruled Monday that Piedmont Medical Center again has the OK to build a 100-bed hospital at the intersection of S.C. 160 and the U.S. 21 Bypass.
“Approval of Piedmont’s application will help stem the outmigration and maintain the quality of care,” Lenski wrote.
Lenski’s opinion is the latest in a 10-year battle over who has state permission to build a Fort Mill hospital. The state’s Department of Health and Environmental Control originally selected Piedmont and then reversed itself and picked Carolinas HealthCare. Lenski has twice said Piedmont is the best choice to build the hospital.
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Carolinas HealthCare System (CHS) can appeal Lenski’s decision to the state Court of Appeals. It also could pursue a case in federal court. CHS officials are considering their options.
Lenski’s latest opinion is full of detailed testimony and analysis, which gave even more reasons for Piedmont to build in Fort Mill, said Bill Masterton, Piedmont’s chief executive officer.
During the trial before the Adminstrative Law Court in the spring of 2013, Piedmont officials and physicians affiliated with the hospital argued that a hospital run by CHS would affect the quality of care they and Piedmont offer. A continued loss of patients would affect surgeons’ skills and Piedmont could close some of its of specialty services, physicians and Masterton testified.
Dr. Arun Adlakha, a pulmonologist in Rock Hill, said at the trial he stopped using navigational bronchoscopy because of a drop in the number of his cases starting in 2009. Adlakha testified that seeing only a few cases a month made it difficult for him to maintain his proficiency on the technique. When he started using the technique he was seeing eight to 10 cases a month.
Bronchoscopy is an interventional pulmonology technology that uses a flexible tube with a camera that allows physicians to examine inside the lungs and airways.
Lenski wrote that a drop in referrals to Piedmont happened because physicians associated with Carolinas HealthCare are required to make referrals to CHS specialists. The drop in Piedmont referrals from 2009 to 2011 was 11 percent while Carolinas HealthCare saw a 12-percent gain over the same time period, Lenski wrote. For more severely ill patients, PMC’s numbers fell 14 percent while CHS increased 12 percent, Lenski wrote.
Carolinas HealthCare has frequently said a Fort Mill hospital would allow it to shift York County residents from its Pineville, N.C., medical center and other Carolinas Medical Center facilities to a hospital closer to home and not affect Piedmont’s market share.
Lenski said that Carolinas HealthCare’s transfer of patients assumption was “unreliable.”
Lenski also said a reduction in patients at Rock Hill specialists not affiliated with CHS was not “more than speculative.” The judge cited testimony from Dr. R. Norman Taylor, of Rock Hill GYN&OB Associates, the oldest obstetrics practice in York County.
Rock Hill GYN&OB doctors oversee 95 percent of the births at Piedmont. Taylor said that if CHS built a Fort Mill hospital his practice probably would become affiliated with the new hospital. The result “would likely be the closure of Piedmont’s Women’s Tower, which would cause the hospital to lose neonatal services.”
Dr. Sushil Singhi, an cardiologist and vice chief of staff at Piedmont, said Tuesday the issue “is about expertise and experience. If you don’t have either, mortality rates rise.”
Singhi testified at the trial as did Adlakha and Taylor.
Singhi said a lack of cases could affect his accreditation, but more importantly, it is about having enough cases to keep a cardiac care team sharp.
Lynn Bailey, a health care economist based in Columbia, said the changes in health care services is the biggest factor Lenski should have considered.
While there are some specialists, such as cardiologists, oncologists and OB/GYNs, tied to a hospital, most other medical specialties can operate independently, she said.
Robert Sweet, a retired plastic surgeon, disagreed with Lenski’s ruling. “If you’re the best, you will get the surgeries,” regardless of your affiliation, said Sweet, who retired in 2010 after practicing in Rock Hill for 15 years.
“We need to see changes, it’s sorely needed,” Sweet said. “It’s why so many are leaving and going to Charlotte. We need competition.”