The geography of the East End and its seasonal gyrations in population put public health planners in a quandary today as they considered competing applications by Peconic Bay Medical Center and Southampton Hospital for cardiac catheterization labs.
A committee of the state Public Health and Health Planning Council, meeting today in New York City, ultimately ended up approving both applications. In doing so they bucked the recommendation of state health department staff and a panel of independent cardiologists who comprise the state health department’s cardiac care committee, which recommended approval of Peconic Bay’s application and disapproval of Southampton’s.
The committee members went against the recommendations after hearing testimony from representatives of Southampton Hospital and its proposed health system partner, Stony Brook University Hospital, about the value of a facility on the South Fork and the fiscal impacts of siting the facility in the Northwell Health-owned facility in Riverhead.
The committee’s actions today mean that both applications will now be brought before the full Health Public Health and Health Planning Council. The state commissioner of health has the final decision. Today’s proceedings were webcast live on the DOH website.
It remains unclear whether the state will ultimately be willing to approve cardiac catheterization labs at both sites. According to health department staff, the need for percutaneous coronary intervention — PCI — on the East End does not support two facilities.
But testimony given by representatives of Southampton Hospital, community members and volunteer ambulance companies serving the South Fork regarding the twin forks’ geography and the surge in the region’s summertime population seemed to sway committee members to disregard the staff’s recommendation to disapprove Southampton Hospital’s application.
Southampton made its case after the committee members had already approved Peconic Bay Medical Center’s application.
“East Hampton and Southampton have 60 percent of the East End’s population,” Southampton Hospital’s consultant Frank Cicero told the committee. That’s not taking into account the tripling of the South Fork’s population in summer, he said.
“This unequivocally shows PCI access eight times better if [the cardiac catheterization lab] is in Southampton,” Cicero said.
“The only place Peconic Bay Medical Center is in the middle of is nowhere,” Cicero said.
Cardiac lab at PBMC ‘will do great harm’ to Stony Brook
The consultant also stressed the financial harm he said would result from
establishing a cardiac cath lab at Peconic Bay. Putting the cath lab in Riverhead and not Southampton “will do great harm to Stony Brook University Hospital, Southampton Hospital, Eastern Long Island Hospital and Brookhaven Hospital.”
Cicero said the establishment of a cardiac cath lab at Peconic Bay would result in the loss of $25 million in annual revenue to the other hospitals collectively.
Southampton Hospital and Eastern Long Island Hospital are set to become part of a new health system with Stony Brook University Hospital at its center, while Peconic Bay has already been merged into the Northwell Health System.
Stony Brook would lose $18 million in annual revenue if a cardiac catheterization lab were established by Northwell Health at PBMC in Riverhead, Stony Brook’s chief of cardiology Dr. Javed Butler testified.
Brookhaven Hospital president and CEO Richard Margulis said his hospital would lose $2 million in annual revenue to PBMC if a cath lab is built in Riverhead.
A cardiac cath lab in Southampton would not “cannibalize” services at Stony Brook or Brookhaven in the same way, Southampton Hospital president and CEO Robert Chaloner told the committees.
‘We only have one road in and out of the Hamptons’
Chaloner, who lives in East Hampton, cited summer traffic and travel times to explain the need for a PCI facility on the South Fork. In the summer, he said, “it can take him an hour and a half to get to Riverhead.”
East Hampton Village Ambulance Association chief Diane O’Donnell echoed those concerns.
“We only have one road in and out of the Hamptons,” O’Donnell said. In summer travel time to Riverhead is “at the minimum an hour and a half,” she said.
“Sometimes it has taken me three hours to get back from Stony Brook” when the ambulance transports a patient there, she said. Transportation is a “huge issue for volunteer departments,” she said.
“When your pager goes off, you can’t just say I’m going to be away for three hours,” O’Donnell said. “The ambulance corps are run by volunteers.”
But the traffic issues and the geography of the East End were one of the determining factors in the health department staff’s recommendation to site a facility for the East End in Riverhead rather than Southampton.
All cardiac patients on the North Fork must travel through Riverhead in order to make the drive to Southampton, staff member Charles Abel told the committee members.
Since the number of PCI cases originating on the East End would only support one location, siting it in Riverhead makes sense, Abel said.
“It is clear that [PBMC] has improved access based on its location alone and that soon became the key factor to focus on after we went through our analysis of program, physical plant and financial feasibility,” Abel said.
ELIH supports Southampton over Riverhead
Eastern Long Island Hospital president and CEO Paul Connor testified on behalf of Southampton Hospital. He said Southampton and ELIH, which are both affiliating with Stony Brook, are “following the Berger Commission,” which in 2006 issued a report recommending the creation of a system led by Stony Brook and taking in the three East End hospitals as well as Brookhaven.
Southampton will be able to get its cardiac cath lab built within three or four months, Connor said, while PBMC’s application states the project won’t be completed for two years.
“We need to use some common sense here,” Connor said.
PBMC president and CEO Andrew Mitchell responded that the Riverhead hospital’s cardiac cath labs will be completed in as little as 12 months. The longer time frame stated in the application is for the larger, overall project, which is more expansive.
Chaloner said the people of the East End support the local hospitals’ affiliation with Stony Brook rather than Northwell Health, which he described as “an outside system from Nassau County.” A Northwell facility in Riverhead “hurts Stony Brook,” he said.
Peconic Bay Medical Center is proposing to build a catheterization/electrophysiology suite with two catheterization labs and a nine-bay prep and recovery area within a three-story addition near the existing emergency department, complete with a rooftop helipad, at an estimated cost of more than $42.6 million.
Southampton Hospital is proposing one catheterization operating room with a price tag of between $750,000 and $850,000.
“What’s the worst outcome if both applications are approved and allowed to compete and at the end of the process whoever is left standing is left standing?” asked committee member Harvey Lawrence
“Neither one will reach full operational capacity and neither will be certified,” staff member Abel answered. “The data clearly indicated … there’s only a need for one in the area.”
When Peconic Bay decided in 2015 to become part of the North Shore-LIJ health system — NSLIJ has since changed its name to Northwell — hospital officials cited the need for interventional cardiac care services and North Shore-LIJ’s commitment to provide them as a determining factor in their decision.
Stony Brook University Hospital had not been willing to make a firm commitment to siting a cardiac cath lab on the East End, PBMC officials said. Stony Brook had previously put in an application with the state to establish a cardiac cath lab for the East End at Peconic Bay, but eventually withdrew it. Even then, the three East End hospitals, which were part of the East End Health Alliance were not in agreement about a cardiac cath lab.
Doc: East End residents best to ‘avoid having a cardiac event’
In 2012, Chaloner, speaking for the East End Health Alliance, told RiverheadLOCAL in an interview that the alliance was not convinced a PCI lab was needed on the East End. It’s a very expensive facility to build and also to staff, Chaloner said.
Speaking just for his own hospital, Chaloner said he would need to make sure the PCI lab is worth the investment.
“We get [patients] in the ER and get them transported,” Chaloner said. “Our mortality rates are pretty good. People are not keeling over dead with coronaries in our communities,” Chaloner said.
In 2012, there were 365 cardiac patients from the East End that had PCI procedures, according to data presented at today’s meeting by health department staff.
“Any one of us is too small to support a program financially or clinically,” Chaloner said in the 2012 interview, referring to the three East End hospitals. “You need to be a certain size. On the aggregate, we probably have the numbers, but individually we don’t,” he said. “So how do you pick a location?” he asked.
Chaloner at the time denied that rivalries among the three hospitals of the EEHA have gotten in the way of picking a location and moving forward with establishing a PCI-capable cath lab for the East End.
“There are no turf battles,” he said.
At the time, Stony Brook refused to directly answer questions about whether it planned to seek a CON for a PCI lab on the East End or to provide any data on STEMI patients transferred to Stony Brook from the EEHA hospitals. Instead, it issued a written statement saying it would continue to work to improve the healthcare of all the communities served by the hospital.
“If you live on the North Fork you’ll want one facility. If you live on the South Fork you’ll want another,” observed committee member Dr. Glenn Martin today.
“The thing that’s clear is if you live in Orient or Montauk, you should avoid having a cardiac event,” Martin said.
The applications are expected to be considered by Public Health and Health Planning Council at its next meeting in two weeks.