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Medford hospitals feud over heart attack patients Sunday Apr 30, 2017 at 12:01 AM Vickie Aldous Mail Tribune @VickieAldous Providence has sued Mercy Flights in a bid to get the ground and air ambulance service to bring more severe heart attack patients to its Medford hospital. Mercy Flights currently transports those patients to Asante Rogue Regional Medical Center in Medford unless the patient or family member requests transport to Providence Medford Medical Center. Providence Health & Services is also suing Dr. Paul Rostykus, the supervising physician for Jackson County's EMS system. The lawsuit, filed in Jackson County Circuit Court in 2016, is scheduled to go to trial in July. Providence is arguing Mercy Flights should bring patients to the closest hospital unless the patient specifies a different hospital. Bringing patients to the nearest hospital would upend a practice adopted in 2003 to take severe heart attack patients to RRMC. Area hospitals and ambulance providers agreed to send patients there when they showed signs of the most severe type of heart attack, known as STEMI because of an ST-segment elevation wave pattern produced on electrocardiograms. At the time, RRMC was the only local hospital with a catheterization laboratory, where physicians insert a thin wire into a patient's artery and guide it toward the heart, where it releases a tiny balloon that opens a blockage. Without quick intervention, the heart muscle can suffer damage and the patient can die. After the local medical community began concentrating STEMI heart attack patients at RRMC, mortality rates dropped to 2.1 percent — compared to 11.8 percent mortality in American hospitals with similar staff and capabilities. The American Journal of Cardiology published a report about the dramatic local results. However, Providence Medford Medical Center saw a 30 percent decline in the number of cardiac patients brought through its doors in the years after the change. It responded by increasing its own cardiology services, including the ability to open blockages with a balloon. Many cardiologists voiced worries about having two hospitals treating severe heart attacks, saying cardiology programs have better results when they maintain a high volume of patients. Other medical experts said the Rogue Valley's growing population — especially of senior citizens — would create enough volume for both hospitals. In late 2011, Providence asked Mercy Flights to begin transporting severe heart attack patients to the closest hospital that could treat STEMI cases, rather than automatically taking them to RRMC, according to the lawsuit. Providence's request was sent to Rostykus, the supervising physician for the countywide EMS system, the lawsuit said. In January 2012, Rostykus said he would switch to a protocol in which ambulance crews would transport patients to the hospital of the patients' choice, or to the nearest hospital if they expressed no preference, the lawsuit said. Providence contends Rostykus then changed his mind and reverted to the existing protocol that favors RRMC after he was pressured by the Mercy Flights board of directors and RRMC. Providence said RRMC sent a letter falsely claiming that including the Providence hospital would "endanger the lives of all severe heart attack patients in Southern Oregon and Northern California." The RRMC letter argued there are not enough patients to support a two-hospital STEMI program in the Rogue Valley, Providence said in the lawsuit. Providence accused RRMC of "seeking to continue a monopoly over the STEMI program." The lawsuit alleges the Mercy Flights board of directors sent a letter to Providence, saying the board "does not consider it appropriate to recognize PMMC as a primary receiving STEMI hospital at this time." Providence argued in the lawsuit it is being economically harmed by Mercy Flights. In emails included as exhibits in the lawsuit, Rostykus said the decision about where to send STEMI patients should not be in his hands, since it is "a hospital issue and not an EMS issue." "I think that I, and the Jackson County EMS transporting (ambulance) agencies, have been asked to resolve this dilemma and that this has put us in the challenging and uncomfortable position of the 'referee' for this issue," Rostykus wrote. Rostykus wrote he would leave the existing protocol in place until the hospitals could together give him direction. He said directions could come from the hospitals agreeing on a plan on their own or with the help of a mediator or lawyers. Alternately, an ethics committee or group of experts could craft a decision. Providence contends in the lawsuit that patients would benefit if they are taken to the closest hospital because transport time would be reduced. The Providence hospital and RRMC are approximately 10 minutes apart under standard driving conditions. Outside court, the two hospitals are attempting to win over patients. On its website, Providence urges, "If you or a family member or friend experiences heart attack symptoms, remember to direct EMS personnel to transport the patient to the nearest STEMI capable hospital." RRMC is promoting its longer STEMI track record and quick response rates on its website, saying, "Experience matters when every second counts." At RRMC, the average time is 42 minutes between the time a patient enters the emergency room and has blood restored to the heart through a balloon procedure. Results for that critical performance measure put RRMC in the fastest 5 percent of hospitals in the country, its website says. Rather than an average time, Providence reports a 53-minute median time for the procedure. Both hospital numbers are better than national average of 59 minutes. National guidelines call for blood flow to be restored within 90 minutes. Representatives for the hospitals declined to comment on the lawsuit, citing the pending litigation. Mercy Flights Chief Executive Officer Doug Stewart said the ambulance service is caught in the middle. It must follow the current protocol to take STEMI patients to RRMC unless the patient requests Providence. "The protocol has not changed. It's the patient's prerogative first, and if there is none, then it's Rogue Regional Medical Center," Stewart said. "They're both qualified hospitals with cath labs, and they can put in stents. I've had friends and neighbors who have used both and had great results." Dr. Brian Gross, a cardiologist with Southern Oregon Cardiology, helped spearhead the effort years ago to funnel STEMI patients to RRMC for emergency treatment. "Everyone tries to do the absolute best they can for a patient with a heart attack," he said. "The program at Rogue Valley (RRMC) has been around the longest and is the largest in the area." Gross said unlike Providence, RRMC has open-heart surgery capabilities in case a patient needs that option. "There can be individual cases where that can have a profound effect. It isn't very common," he said. Gross said a patient at Providence who ends up needing open-heart surgery would have to be transported to RRMC. In its lawsuit, Providence pointed to a study that found no greater risk of death or heart problems after a patient was treated at a hospital without heart surgery capabilities. — Reach staff reporter Vickie Aldous at 541-776-4486 or [email protected]. Follow her at www.twitter.com/VickieAldous.