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Ambulatory Surgical Center Passes First Hurdle

Oct. 26, 2004 – A proposal by a group of local doctors for an ambulatory surgical center on St. Thomas has apparently passed its first hurdle: An ad hoc committee has submitted a report to Health Department Commissioner Darlene Carty recommending issuing a Certificate of Need to the proposed facility.
Carty said back in July that the committee would compile information about the proposal and then make a recommendation to her. She would then approve or disapprove the application.
A call issued by Carty in January for the public to participate in the process was heeded by only three residents, the report states – one for, one against and one undecided. See ("Public To Help Decide Fate Of Surgical Center").
Carty was not available for comment Tuesday morning, but her office said she would be making an announcement Tuesday or Wednesday. However, the employee couldn't say whether that announcement applied to the committee's decision.
Announcement of the committee's decision came as a surprise to Rodney E. Miller, Roy Lester Schneider Hospital chief operating officer. The committee's seven-page document, dated Oct. 15, was obtained by the Source Tuesday morning. As of 10:30 a.m. Tuesday, Miller had not officially received the document.
Michael Burton hospital spokesman, said Tuesday, "Until we know what is in the report, we cannot respond." Burton said, "We have heard from the media, but until we hear from the Health commissioner, we won't make an official statement."
Dr. Byron Biscoe, ambulatory surgical center group manager-member, said Tuesday that while he had heard mention of the report on the radio, he would withhold comment. "I don't think we should comment until the commissioner has made a determination. That is the fairest way to proceed."
Since being announced in December 2003, the proposed facility has been the source of heated debate, especially earlier this year when both sides took out full-page ads in the print newspapers, vigorously defending their views. Both groups also have appeared on numerous radio shows.
Miller is vehemently opposed to the project. He fears the center would drain revenue away and "undermine the mission of the hospital."
The doctors' group – Byron Biscoe, Jeffrey Chase, Horace Griffith, Sonia Taylor Griffith, Derrick Jones, Catherine Kean and Michael Savage – instead argue that the facility will benefit the community and complement the hospital's operations.
Miller said in a July interview that "there is no need" for the center. When asked why the proposal was being made, he answered: "Several individuals see the opportunity to enter into a business enterprise where they stand to gain considerably, financially."
Miller estimates, if the proposal goes through, that the hospital, which he said is already under financial stress, stands to lose $2.3 million in annual revenues.
The revenue loss would come about, according to Miller, because the surgical center would be providing outpatient, elective surgeries that the hospital already provides. He said these are the surgeries for which patients generally pay. He added that the hospital is mandated to provide emergency services, and, often, the people who receive those services do not have the ability to pay.
David Bornn, the doctors' group attorney, said in a March Senate Health Committee meeting that all that's at stake is 2.04 percent of Roy L. Schneider Hospital's outpatient revenue.
"That's what this fight is all about," Bornn said at the time. He estimated the hospital's outpatient revenue at $1.28 million.
Miller said at that same meeting, "The effect of an approval [of the certificate] will be devastating."
Miller said that 53 percent of the hospital's procedures are done on an outpatient basis and added that outpatient procedures are a profit center that offsets losses in other areas. He listed loss of revenue, surgeons and nurses as reasons why the Health Department should deny the Certificate of Need to the group.
The seven-page document leaves many questions unanswered. And it lacks any information from the hospital. It says that "despite repeated requests … RLS Hospital has not submitted information that substantiates its claim that the proposed facility will have a substantial adverse financial impact on the hospital."
Burton, hospital spokesman, reiterated Tuesday that Miller could not comment until the document was officially in his possession.
Many of its recommendations are contingent on the CON being approved before the applicant supplies the necessary requirements.
It states in some cases, what the applicant "intends" to do. For example:

– "The applicant intends to license the ambulatory surgical center with the V.I. Department of Health and obtain certification from [the Centers for Medicare and Medicaid Services] CMS for Medicare. The applicant should provide assurance that the proposed facility and its professional staff will accept Medicare and Medicaid."
Three other major areas of concern are not finalized.
– A system for transferring a patient to the hospital should complications develop after surgery which require immediate emergency room or in patient care. The CMS requires such an agreement to be executed, the report states. "The applicant testified that a transfer protocol will be developed after the CON is granted," the report states.
– "Federal regulations state that an ambulatory surgical center 'must have a written transfer agreement with a hospital, or all physicians performing surgery in the ASC must have admitting privileges at such a hospital.' The committee recommends the CON, if granted, should be that the applicant ASC execute a written transfer agreement with RLS hospital, or provide assurances that their physicians will have admitting privileges at RLS hospital," the report states.
– Hiring of nurses. The report notes that, "as there is a known shortage of nurses in the V. I., there is a need for explanation … of the applicant's recruiting plan. A condition of the CON, if granted, should be that the applicant should submit a nurse availability and recruitment plan."
The report is clear in addressing operating room issues. It says, "The applicant, during its presentation on Oct. 5, testified the operating rooms at RLS operate at about 50 percent capacity; however operations run beyond the 3 p.m. schedule time. So then, it is not true that because the operating rooms run at only 50 percent capacity, that it can double the number of cases. Given the available staff, the number of current cases, and the fact that procedures run beyond the scheduled period, this is proof that the operating rooms cannot handle additional cases."
The report was signed by five of the committee's eight members: Moleto A. Smith Jr., Lewis Stern, Stephanie Scott-Williams, Brian Dooley and Ray J. Barry.
Members Albert F. Richardson and Joseph R. Papa did not sign the document. Carole E. Thompson opposed it. She said she was not in favor of the center "at this time, due to my belief that the proposed facility would create a negative impact on the community.
Thompson told the Source Tuesday morning that she would refrain from commenting for the time being. "I don't think it would be appropriate to comment before the commissioner makes a statement, I cannot respond. I think we owe her that courtesy."

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