BMC was one of nine hospitals included in a Johns Hopkins University study designed to evaluate the benefit of allowing hospitals that do not have a cardiac surgical team to conduct elective angioplasty.
The state Department of Health and Senior Services said it would rewrite its regulations on how hospitals were selected for the study, and ask hospitals previously accepted into the program to reapply.
The state Supreme Court has given the state until Nov. 30 to revise the selection process, although the state will likely seek an extension on that deadline.
BMC began conducting emergency angioplasty in January 2006, and offered the elective process after being accepted into the study in March 2006.
A lifesaving procedure
Angioplasty is a treatment that allows doctors to clear clogged arteries to the heart by threading a tube into the artery.
Dr. Peter Wong, head of BMC's Cardiology Department, said the procedure is significantly better than using drugs to clear the arteries because it reduces the risk of blood clots that could travel to other parts of the body, including the brain. Medications designed to clear clogs can put patients at risk for strokes.
Angioplasty - especially in emergency situations - can halt or even prevent damage to the heart.
Dr. Wong said the sooner the clog is opened, the less damage to the heart occurs during critical situations. This is the reason why hospitals like BMC need to be able to provide the procedure rather than ship patients off to hospitals with surgical teams.
"A patient can suffer significant heart damage over time," Wong said.
In a heart attack, time means heart muscle. The faster a patient gets treatment for the clog, the better the chances of a successful outcome, said Marvin Aspel, chief operating officer of Bayonne Medical Center.
The study also allows hospitals like BMC to conduct the angioplasty procedure as a preventative measure. If tests indicate that a patient has significant blockage that will inevitably lead to a heart attack, doctors can perform the procedure in a non-emergency or elective basis.
Dr. Wong said elective and emergency angioplasty go hand in hand. To provide the service in emergency situations, the hospitals need to be able offer the elective service simply to make it economically worthwhile for the hospital.
Deciding if procedure should be expanded
Under existing health practices, hospitals without backup heart surgical teams must send patients to a regional cardiac center for the angioplasty to be performed. This is to guard against the possibility that something might go wrong with the procedure and the surgical team would intervene. Statistics, however, seemed to indicate that such interventions are extremely rare, and that more lives would be saved if more hospitals could be allowed to perform the angioplasty.
The Johns Hopkins study is designed to allow select hospitals to use the procedure to gauge the effectiveness of expanding the program to hospitals without heart surgical teams.
In an attempt to stop losing some of its patients to one of the nine hospitals participating in the study, three hospitals in southern New Jersey that provide heart surgery sued to halt non-surgical hospitals from doing elective angioplasty.
Although the heart surgery hospitals that filed the suit claimed questions of safety, in truth, the suit was about finances. Those hospitals with surgical teams in place have a literal monopoly of angioplasty and would lose that monopoly if the study shows, as many expect, that patients would be better served - and more lives would be saved - if other hospitals were allowed to supply the service.
'Wave of the future'
When BMC sought to be part of the study in late 2005, the competition was fierce. This was partly because many hospitals saw the procedure as the wave of the future and believed the study would lead to more hospitals being authorized to perform it. Those hospitals in the study would get more experienced in the procedure, and thus would become more attractive to patients who would seek the most qualified hospitals.
For BMC, this would mean a significant boost to its finances.
Daniel Kane, executive director of BMC, said hospitals need to distinguish themselves in some way. By providing such a specialization early, BMC will have a leg up in becoming a premier facility for heart care.
BMC is already rated by the Centers for Medicare and Medicaid Services (CMMS) as one of the leading hospitals for health care in the state. It is among the top 17 hospitals statewide for treating heart attacks, according to the CMMS's report, issued in June.
Part of this success has to be attributed to its participation in the angioplasty study, hospital officials said.
While the hospital can continue to provide angioplasty on an emergency basis even if not part of the study, Dr. Wong said BMC would not have been able to afford to keep up the program.
As a result of the State Supreme Court decision, the New Jersey Department of Health will require BMC and other hospitals in study group to reapply.
"This does not mean that we are being asked to stop," Kane said.
In fact, BMC's center record of successful procedures may add to its qualifications for continuing the study. To date, BMC has done 185 procedures, both elective and emergency.
Kane also pointed out that the ruling had nothing to do with the safety of the program.
"The Supreme Court did say that there was a defect in the administration process. There is no problem within the research program," he said.