Hearts on hold at HMH

Hardin Memorial Hospital is re-evaluating its open heart surgery program after a five-month halt in scheduled surgeries.

The program remains open, according to HMH President and CEO Dennis Johnson, and will remain viable in the future, but the hospital has not scheduled an open heart surgery since last fall.

Johnson said the last surgery was scheduled in late September or early October and the hospital is losing its one cardiothoracic surgeon in the program, Dr. Bill Hymes. Johnson said Hymes wants to move to another hospital where he can perform more open heart surgeries.

The hospital continues to promote the service on its website and Dr. Stephen Toadvine, chief medical officer at HMH, said the hospital is recruiting heart surgeons and interventional cardiologists to keep cardiology services robust.

“The program is open,” Toadvine said. “It’s not closed. We have a CON (certificate of need) to do open hearts and we intend to keep using it.”

Toadvine said the hospital would prefer to have multiple surgeons manage open heart surgery because it is a tall order to place on the shoulders of one person, but the hospital needs to ensure its volumes are high enough to “keep them busy.”

Johnson and Toadvine said the decline in open heart surgeries such as coronary artery bypass grafts and heart valve procedures have followed national decline. The hospital averaged about one open-heart operation a week before it stopped scheduling surgeries, officials said.

Toadvine attributed the decline to advances in medicine that prevent serious heart problems and a focus on less-invasive alternatives to open heart surgery, such as angioplasties, atherectomies and stents, all of which are performed by cardiologists at HMH.

Lisa Motley, executive director of University Cardiothoracic Surgical Associates in Louisville, said smaller programs such as HMH’s are seeing declining volumes in open-heart procedures because of those technological advancements, which have forced hospitals to evaluate the future of their programs.

Heart surgery programs are immensely expensive to maintain for hospitals, she said, and some are finding volumes are too low to justify the cost.

“A lot of the smaller programs are getting out of the business and a lot are partnering with larger programs,” she said.

Some of the more complex and invasive procedures now are being referred to larger programs with more expertise because of their higher volumes, Motley said. Likewise, some patients are opting to have open-heart procedures performed at larger hospitals because they have easier access to high-level expertise if something goes wrong.

HMH recently announced development of its own primary percutaneous coronary intervention program, which treats ST-elevation myocardial infarctions, an especially serious form of heart attack. Toadvine said the recommended maximum amount of time to take a patient with this form of heart attack from the hospital door to the cardiac catheterization lab for a balloon angioplasty is 90 minutes, though the preferred time is 60 minutes. A balloon angioplasty is performed by running a deflated balloon along a catheter through the skin and to the point of blockage, where it is inflated to open vessels and improve blood flow.

Prior to the program’s creation, the hospital treated patients with thrombolytics to dissolve or break down blood clots or would transport them to Louisville for treatment. Johnson said there will be instances where patients still will be transported north, but he described the program as one of the single greatest accomplishments in HMH’s history.

Several patients already have been treated successfully through the program, according to officials. Johnson said the hospital also is upgrading one of its cath labs.

During the last fiscal year, which ended in June, the hospital recorded nearly 10,000 surgeries, 70 of which were open-heart surgeries, Johnson said. In comparison, the hospital recorded nearly 2,300 general surgeries and nearly 1,800 orthopedic surgeries, he said.

Reviewing these numbers, Johnson said the hospital had to “reapportion” its resources based on community need and where demand lies, but it still has faith in the open-heart program.

Johnson did not have an exact number of scheduled surgeries from the start of this fiscal year last summer, but said the number was small and likely did not exceed 10.

Surgeries have not suffered at HMH, though. Johnson said the hospital has seen a 16 percent increase during the past two years in total surgeries, and the hospital spent millions acquiring Surgical Specialists and The Surgical Center practices. Hospital officials have projected an uptick in surgery volume because of the purchases, but Johnson said it also gives the hospital space to move certain outpatient procedures from the main campus to satellite sites. Major procedures still will be performed at the hospital, he added.

As for changes to staff in the open-heart surgery service line, Johnson said some employees have transitioned out of the program but were not forced elsewhere.

“They all made that decision on their own,” Johnson said.

When The News-Enterprise asked for the exact number of employees who had transitioned out of the program, Michelle Murphy, director of marketing and public relations, said HMH would not release those figures.

“I can’t give you that,” she said. “That’s employee information.”

In most cases, Johnson said, staff members who work on open-heart surgeries are surgical assistants or surgery technicians who are actively involved in other surgical procedures.

Marty Finley can be reached at (270) 505-1762 or mfinley@thenewsenterprise.com.