No shortcuts on care
A Times EditorialPublished February 25, 2008
More than a year ago, 44-year-old truck driver Steve Spivey checked into a 14-bed hospital in Abilene, Texas, for surgery to ease the pain in his neck. His wife was by his side after the procedure and thought things were going well. Then he started to choke.
The nurses, she later told a CNN reporter, thought he was having a panic attack. She remembers repeatedly yelling for a doctor. He kept squeezing her hand until his eyes closed. When he stopped breathing, she performed CPR while a nurse scrambled to reach a doctor.
Tracy Spivey, mother of three, still describes herself as stunned by what happened next. The hospital staff dialed 911. "All I can remember," she told CNN, "is looking at him and saying, "You've got to be kidding.'"
West Texas Hospital, owned primarily by 33 physicians, has since been closed. But its tale has not escaped the attention of Congress and medical regulators. The lesson also cannot be lost on Florida, whose governor wants to open the door to what are known as "boutique" hospitals.
Gov. Charlie Crist, as part of his 2008 legislative agenda, is calling for the elimination of the Certificate of Need for new acute care hospitals. He says that "removing the burdensome Certificate of Need process will foster a competitive business climate." The process is without question a regulatory hurdle for those who want to build new hospitals, but it should not be removed.
That thorough analysis serves at least two clear public purposes: eliminating costly duplication of medical services and ensuring the highest quality of care. As the case in Texas demonstrates, the lack of such regulatory rigor can be costly.
Texas is one of only 14 states that no longer require certificates of need, and it has experienced an explosion of small, physician-owned hospitals. A 2006 report for the Medicare Payment Advisory Commission found, not surprisingly, that these specialty hospitals tend to offer more profitable procedures and serve more profitable patients. Medicaid makes up less than 3 percent of their revenue base.
The report also offers an obvious warning to Florida: "Specialty hospitals continue to locate in areas that lack certificate-of-need laws and have above-average population growth."
The financial fear for full-care, community-based hospitals in Florida is obvious. Small boutique hospitals can easily siphon off the well-insured and private-paying patients whom the full-care hospitals need to balance services such as emergency rooms that are an enormous financial drain. At a time when state and federal support for charity care hospitals is in decline, such competition would be unfair and financially crippling.
The death of Steve Spivey is also evidence that specialty hospitals raise legitimate questions of public safety. Any patient can die of surgical complications in any health-care environment, but the specter of a licensed hospital dialing 911 in a medical emergency is unacceptable. Lest anyone think the Spivey situation was unusual, a new report by the U.S. Health and Human Services inspector general finds that less than a third of these hospitals have a physician on site at all times.
More chilling, the report concludes: "Two-thirds of physician-owned specialty hospitals use 911 as part of their emergency response procedures."
Spivey's widow couldn't believe her ears when she heard the order to dial 911. This is not the kind of regulatory shortcut Floridians can afford.