PBMC Health’s decision to merge with North Shore-LIJ was “mission-driven,” plain and simple, according to hospital leadership. The mission? To provide desperately needed health services to residents of the East End.
“North Shore-LIJ shares PBMC’s vision. It sees the need for a regional medical center to provide services to the East End,” PBMC president and CEO Andrew Mitchell said yesterday during a joint interview with hospital officials at RiverheadLOCAL’s offices.
“North Shore-LIJ committed to a number of major regional programs and it committed to spending the funds necessary to build them,” Mitchell said.
The biggest health care voids on the East End are cardiac care, cancer services and trauma services, hospital leaders say. North Shore-LIJ has committed to address those needs by turning PBMC into a regional medical center that can serve the East End’s growing — and aging — population.
The board’s decision did not sit well with State Sen. Ken LaValle, who has pushed for the three East End hospitals to become part of a Suffolk health system with the state-run Stony Brook University Hospital as a hub. He is a staunch supporter of the university.
“I’m not willing to sit by and watch health care on the East End be ceded to a Nassau County facility,” LaValle said in a phone interview Friday, lamenting what he said would be a loss of local control that’s not in the best interests of his constituents. “We’ll see if there are antitrust violations,” he said. “A Nassau County hospital coming into Suffolk would be a monopolistic system,” LaValle said.
North Shore-LIJ has operated hospitals in Suffolk for many years, including Huntington Hospital, Southside Hospital and South Oaks Hospital.
“We’ll see if the health department will approve this,” LaValle said. “While Peconic Bay has been in their own little world trying to deal with this, they didn’t realize there are other considerations that come into play,” he said.
Southampton Hospital has taken steps toward becoming part of the Stony Brook system, beginning with a letter of intent announced in October 2012 — an affiliation just approved by SUNY trustees in January 2015. LaValle said in 2012 he expected Peconic Bay and Eastern Long Island Hospital in Greenport to follow suit within a year.
Eastern Long Island Hospital is still negotiating with both Stony Brook and North Shore-LIJ and won’t make a decision before the end of May, according to ELIH president and CEO Paul Connor III.
LaValle said he remains committed to seeing the three East End hospitals become part of a Stony Brook health system.
PBMC leaders bristled at LaValle’s characterization of the strategic planning and evaluation process which they said yesterday spanned more than two years. At the end of the process, the choice was clear, PBMC chairwoman Sherry Patterson said. Only North Shore-LIJ committed to establishing programs and services the East End now lacks.
“Health care is not about politics, it’s not about county boundaries. It’s about what’s best for the people of the community,” Patterson said. “If Senator LaValle sat down and looked at the two offerings [North Shore-LIJ and Stony Brook] he would come to the same conclusion,” she said. Instead, when she called him to advise him of the board’s March 26 vote, she said, the senator didn’t even want to discuss it. “He hung up on me twice.”
“PBMC leadership made the right choice for health care for the 220,000 men, women and children on the East End,” Mitchell said.
The hospital’s board of directors stays in place and retains significant oversight and responsibility for a period of five years, he said.
“North Shore values local knowledge and management by a local board,” PBMC vice chairman Gordon Huszagh said, noting that the North Shore-LIJ system has retained local boards at Huntington and Southside.
“Southside Hospital, since becoming part of the North Shore-LIJ system, has been completely transformed,” Mitchell said. Among other things, North Shore-LIJ has brought modern cardiac care to what had been a community hospital that was couldn’t meet the needs of local patients.
That alone was a big factor in PBMC’s decision, Mitchell said.
Despite larger population in need, ‘appropriate’ cardiac care still lacking
The East End has a higher proportion of 55-and-over residents than both Suffolk as a whole, Nassau and the U.S. overall. Given the age demographic, it’s no surprise the rate of interventional cardiac services for East End patients (5.6 per 1,000) is higher than the rest of Suffolk and Nassau, according PBMC’s Mitchell. East End patients required 592 emergency or urgent coronary angioplasty procedures in 2013. The need for cardiac care is growing and will only continue to grow as the population grows and ages, Mitchell said.
A patient suffering the deadliest type of heart attack — an ST-elevated myocardial infarction, known as a STEMI — needs help fast. Without rapid treatment, the patient’s heart can sustain massive damage and the patient may even die.
“Time is muscle. Time is survival,” Dr. Richard Kubiak, PBMC chief medical officer said.
Percutaneous coronary intervention, or PCI, is the preferred treatment for a patient suffering a STEMI heart attack. In this procedure, also known as coronary angioplasty, the doctor inserts a catheter, or long narrow tube, into a patient’s artery to find and eliminate a blockage.
According to the American College of Cardiology, this procedure should be done within 120 minutes of first contact with EMTs. Every 30-minute delay in commencement of PCI increases the risk of mortality.
But the nearest PCI-capable hospitals — Stony Brook, Brookhaven and Mather — are at such a distance that providing treatment within that window of time is difficult at best; more frequently, it’s impossible.
When prompt PCI is unavailable, a second strategy is to make sure patients are receiving clot-busting drugs within 30 minutes of arrival at the hospital, Dr. Gray Ellrodt, chairman of the American Heart Association’s Mission: Lifeline national task force said in a 2012 interview. See “East End emergency cardiac care: Where do you want to be if you have a heart attack?” (Sept. 20, 2012)
The drugs are not for everyone. They can cause dangerous, even deadly, hemorrhaging. And for many STEMI patients, the drugs are a stop-gap measure, Ellrodt said. ER doctors use a “drip and ship” protocol. They start an IV of the drug and do an immediate transfer to a PCI-capable hospital, Ellrodt said.
“We don’t even wait to see if it works, because if it doesn’t, we need to do the PCI right away,” he said.
“Drip and ship” is usually the only strategy available for treating STEMI patients on the East End.
Cardiac mortality rates are higher on the East End than in western Suffolk, according to former Suffolk Regional Emergency Medical Services Council chairman Edward Stapleton in 2011 testimony before the Suffolk County Legislature. And Suffolk as a whole has a higher cardiac mortality rate than Nassau, according to data provided by the American Heart Association.
Long-distance trauma care has many costs
Trauma care is another area of critical need on the East End, Kubiak said. Trauma patients — usually victims of car accidents — must currently be transported to Stony Brook. They are either transported from the scene by helicopter or by a local ambulance crew. Either way, the cost is high and the transport poses patient risks.
When an ambulance takes a patient to Stony Brook, the local ambulance district loses its rig and crew for at least two hours, according to Riverhead Volunteer Ambulance Corps president Kim Pokorny.
“That puts us in a bad position,” she told RiverheadLOCAL in a 2012 interview.
When multiple calls come into the busy EMS company — RVAC answered more than 3,100 calls in 2014 — and one of its rigs is on a long-distance transport, RVAC is more likely to need mutual aid from an outside department. That, in turn, lengthens emergency response time.
Demand for close-to-home cancer services grows
An aging population also need more cancer services, PBMC’s chief medical officer said.
“With North Shore, we have an opportunity to be part of a system that can provide local comprehensive cancer care tied to an academic institution that can do clinical trials,” Kubiak said. “It keeps patients close to home.”
PBMC and North Shore-LIJ ‘a good fit’
“We’ve gone as far as we can alone,” Kubiak said. “We need a partner to take it to the next level.”
Riverhead Supervisor Sean Walter said he supports PBMC’s decision 100 percent. “The community needs the kind of hospital North Shore can transform PBMC into,” Walter said. “Right now, it’s basically a feeder hospital for Stony Brook.”
Mitchell said the PBMC and North Shore-LIJ have a shared vision. “Both are very progressive,” Mitchell said. Both systems have opened ambulatory services centers, primary care medical groups and urgent care centers.
“We share common values. It’s a good fit,” Mitchell said.
Hospital trustees agreed with that assessment.
Patterson said the choice between North Shore-LIJ and Stony Brook became clear as the board examined the proposals on the table and negotiated with each institution. North Shore was willing and able to make commitments to and investments in PBMC that Stony Brook was not, she said.
“North Shore-LIJ has 20 hospitals. It’s a mature system with a long track record,” she said.