Proposal risky to patient welfare

Practice may not make perfect, but in most activities it increases competence.

Major health care organizations believe, for instance, that it’s important to have a certain amount of experience with tricky procedures before institutions and providers are designated to perform them. Unfortunately, that expectation is neglected by a regulation being proposed by the Washington state Department of Health.

The state agency wants to make certain nonemergency cardiac procedures more convenient for heart patients in rural areas. So far so good, but not if the new rules achieve convenience by lowering existing safeguards.

The procedures at stake include such things as angioplasty or the insertion of stents to open up restricted arteries. These are elective procedures in which doctors take steps to alleviate conditions that are likely to lead to trouble if not addressed. They aren’t emergency-room dramas in which there’s no time to schedule them at a larger facility.

But that’s what they could become.

On rare occasions something goes wrong, and the patient’s well-being depends on whether skilled, experienced backup personnel and appropriate facilities are on hand. Right away.

The Department of Health’s proposed regulation is troublesome on two counts.

• It would allow facilities affected by the new rules to perform as few as 200 coronary interventions a year, even though studies show that complications are more common if fewer than 400 are done annually. It’s practice-improves-competence consideration.

• Despite approving an environment that accepts a lower than recommended level of experience, the proposal would permit such procedures to take place hours away from an open-heart operating room. At a time like that, the convenience of having one’s procedure close to home seems less valuable.

In addition, the large medical centers that are set up to perform those procedures fear that the rules would leave them to handle only the most difficult and costly cases, involving true emergencies. Clearly there are financial motives at work here, but it’s also true that communities like Spokane are at risk when the stability of their major health-care institutions is jeopardized.

More important than the economic issues are the patient-welfare concerns, and for those the critics of the proposed regulation have important allies. Both the American College of Cardiology and the American Heart Association recommend that appropriate backup emergency facilities be available at hospitals where nonemergency cardiac intervention procedures are performed.

Washingtonians – even those living in rural areas – enjoy good access to sophisticated health care. The health risks associated with steps to achieve an extra measure of convenience are not acceptable. For that reason, the Department of Health should withdraw the proposed regulation.