Recently, there have been articles and letters to the editor regarding the change in cardiology services available at Ascension Via Christi Hospital in Manhattan. One of the primary goals in this recent decision was to provide more consistent local cardiology care to patients at Ascension Via Christi Hospital. We would like to address some of the concerns we’ve heard and hopefully, provide some clarification to the recent changes that were put into effect this month.
Beginning in 1998, cardiology services were made available to Manhattan-area residents at Mercy Regional Health Center, now Ascension Via Christi Hospital. Initially, cardiology services consisted of consultation for the management of many heart conditions, placement of pacemakers and other basic cardiology procedures, including diagnostic heart catheterizations. At that time, interventional cardiology services were not available.
In 2007, the hospital recruited two interventional cardiologists to replace Drs. Jim Hurtig and Nirav Mehta, who had left the community. In addition to providing basic cardiology services, Dr. Priyantha Ranaweera and his partner were able to start an interventional cardiology program where the cardiologists were able to place stents (called a percutaneous coronary intervention, or PCI) to open up blocked arteries for either acute STEMI (ST-elevation myocardial infarction), non STEMI and chronic coronary artery disease.
As one can imagine, being on call every other day has taken its toll on the cardiologists, as well as the hospital’s catheterization lab staff. This model is not sustainable for a community our size. Four interventional cardiologists are needed to provide 24/7 coverage for patients with STEMI and who require PCI. For the last two years, there have been several gaps in call coverage, which has resulted in too many Manhattan area residents being transferred out of town for cardiology services.
Local cardiologists proposed a sustainable plan to optimize care, which recommended no longer providing PCI for STEMI, improving the cath lab staffing, providing 24/7 general cardiology coverage and developing a five-year plan to further enhance and expand cardiology services. We very much appreciate their input, opinions and support. Through discernment with cardiologists, medical executive committee, hospital staff and the board, local leadership decided to embark on this different model of care. It was announced that on Oct. 1, the hospital would no longer provide PCI treatment for STEMI patients. We wish to emphasize that this decision was based upon staffing issues with both cardiology coverage and cath lab staffing, and was not related to quality issues. Since then, cardiology coverage has already improved and the goal for the future is for cardiologists to provide 24/7 coverage, which will help to better meet the needs of the patients we serve.
Heart catheterizations and elective interventional procedures such as stents, pacemakers and loop recorders, as well as inpatient and outpatient consultation and other cardiology services will be available every day. STEMI patients will be treated with thrombolytic (clot-dissolving drugs), if appropriate, and transferred to Topeka for further care. This treatment is recommended by the American College of Cardiology and American Heart Association. The approach of using thrombolytic medication in the treatment of a STEMI is becoming increasingly popular in areas where primary intervention is a challenge to sustain due to lack of staffing and resources. Ascension Via Christi Hospital treats roughly 25-30 STEMI patients a year and treats approximately 470 cardiology admissions each year. Studies show that there is little difference (1 percent or less) in patient outcome when they were first treated with thrombolytic medication versus PCI.
We are fortunate to have four experienced cardiologists, including two interventional, providing care at the hospital – Drs. Jack Daley, Hurtig, Gil Katz and Ranaweera. The hospital added a second cath lab in February 2013, is committed to upgrading the original cath lab and is in the process of developing a five-year plan for the cardiology service line as we continue to grow. The decision to suspend PCI for STEMI was made locally and is in no way related to becoming wholly owned by Ascension Via Christi in Wichita. In order to assist with integration of the Ascension Via Christi, the board chairpersons of the Manhattan and Pittsburg hospitals sit on the Via Christi Board in Wichita and help foster communication between the ministries. Ascension Via Christi provides Manhattan with extensive support in several areas, but still defers many decisions to the local board members who know our community best. We want our community to know that the decisions to change and refocus our cardiology services and staffing have been local decisions driven by our cardiology physicians and were made after careful collaboration with the medical executive committee, hospital staff and the board of directors. We feel with these current changes, we will stabilize our cardiology services and keep more patients in Manhattan.
Segen Chase, MD
President, Medical Staff
Douglas Hinkin, MD
Chair, Ascension Via Christi Hospital in Manhattan Board of Directors
Jack Daley, MD
Jim Hurtig, MD
Gil Katz, MD
Priyantha Ranaweera, MD