Hospital takes heart

The state gave Citrus Memorial the go-ahead for an open-heart program, and administrators are hopeful other hospitals' challenges will fall short.

By JIM ROSS

© St. Petersburg Times, published July 2, 2000

[Times photo: Steve Hasel] Dr. Ralph Abadier performs a catheterization on a patient Friday morning.

INVERNESS -- Charles Blasband was cautious last week when addressing Citrus Memorial Hospital's governing board.

Blasband, the hospital's chief executive officer, reminded board members of the big news: The state had granted Citrus Memorial permission to begin building an adult open-heart surgery program.

At least one hospital has promised to challenge the state's decision, Blasband said. His tone of voice helped remind everyone in the meeting room that Citrus Memorial must take any such move seriously.

"That challenge could take up to about a year," Blasband said. "That's what our attorneys are telling us now."

But if that challenge, or any similar challenge, fails to derail the plan, look for Blasband to ditch the caution and replace it with glee.

Establishment of an adult open-heart surgery program would provide hundreds of local patients a chance to stay closer to home for angioplasty and heart surgery. That would be the immediate, and obvious, cause for celebration.

The story doesn't stop there, however. Experts say heart surgery programs have a ripple effect on hospitals, inspiring growth throughout the operation and instilling a heightened pride in workers, patients and community members.

It's exciting stuff for any hospital. For Citrus Memorial, a 171-bed facility, the move would be another step in its evolution.

For evidence of a heart program's significance, look to the east. Leesburg Regional Medical Center, a larger hospital than Citrus Memorial, started its open-heart surgery program almost two years ago. It would be difficult to overstate the program's importance.

"It moved us to another level," said Rosanne Brandeburg, the center's spokeswoman.

Citrus Memorial expects to spend more than $11-million to get its program going. About $6.3-million would go toward building a new floor atop the emergency room to house the surgical suites and to equip and staff the program. The rest would go toward expanding the cardiac catheterization program, as well as related expenses.

Julia Doucette, director of human resources at Citrus Memorial, looks forward to doing her part of the job. It's familiar territory, in a way: Doucette's previous job was at a hospital in Mississippi that recently started a heart surgery program.

"They did there what we're going to do here," she said.

Citrus officials still aren't certain how many new employees they would need. Leesburg, which has 294 beds, needed about 50 more people.

In Florida, hospitals can't just start adult open-heart surgery programs. They must obtain permission -- technically called a "certificate of need" -- from the Agency for Health Care Administration.

During the most recent application cycle, Citrus Memorial submitted its paperwork to the state. But it wasn't alone: Also seeking permission to begin adult open-heart surgery programs were Seven Rivers Community Hospital and two Hernando County hospitals.

At first glance, it would seem all four had no shot. The agency staff, recognizing the existence of strong heart surgery programs in Ocala and north Pasco County, ruled that there was no immediate need for Citrus or Hernando county health providers to establish their own.

The hospitals all argued that their patient bases include a large number of people age 65 and older. They also said that getting to nearby heart centers might not be as simple as a map might indicate.

Citrus Memorial, in its application, impressed state regulators in a way that the others didn't: The state report said that by conducting a limited sampling of patient records, the hospital partially demonstrated that patients in Citrus might be suffering from "restricted access" to a heart surgery program.

"I have to tell you, I was pleasantly surprised when they approved it," Edith Orsini said.

Orsini is executive director of the North Central Florida Health Planning Council, which closely tracks health data in the 16-county area that includes Citrus and Hernando.

"I think it's an excellent opportunity for services to be provided within a geographic region that has been shortchanged for a long time," Orsini said.

She was not surprised to learn that a top executive for Health Management Associates Inc., which operates Brooksville Regional Hospital, promised a challenge. Brooksville and Oak Hill were the two Hernando County hospitals that submitted applications.

"When you put in four applications and one gets it, the other guys are going to feel, "What about us?' " Orsini said.

What about Citrus Memorial's cross-county competitor? Will it file a challenge?

"We are still evaluating our options and will complete our internal analysis in the coming weeks," Seven Rivers spokesman Joe Foster said.

Despite the threat of a challenge, many Citrus Memorial workers already are excited about the prospects of the heart program. They know that specially trained heart surgeons and surgical support staff would be coming to town. They know that the newest, state-of-the-art equipment would be headed for the new operating rooms.

But the growth might well inspire more growth at the hospital. At Leesburg, for example, officials are expanding their intensive-care unit because it needs many beds to support its heart surgery program.

"They (hospital employees) are excited, elated. People were just so proud," Brandeburg said.

Many members of the medical staff, especially those with cardiology backgrounds, also are excited about the prospects.

Dr. Ralph Abadier is chief among the supporters. He pushed administrators to submit the state application.

"We can take care of our patients here in Citrus County," he wrote in a letter to state regulators.

Most excited, however, are the patients and their relatives. Driving to Ocala and visiting Outback Steakhouse or the Paddock Mall is one thing. But going there by car or ambulance for surgery and follow-up care is quite another.

"There's a lot of pressure on people when they are recovering to protect themselves, to keep themselves safe," Orsini said.

In that context, the drive between Citrus County and Ocala is "an uncomfortable distance."

- Jim Ross writes about medical issues in Citrus County. Reach him at 860-7302 or by e-mail at jross@sptimes.com

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