"Surgeon cites finances in departure"

Danville Register & Bee
Friday, August 17, 2007

DANVILLE - When Dr. Lee McCann moved to Danville two years ago, he thought his family would stay here until his children graduated from high school. His youngest of five children is 2.
Offers from other hospitals have come and gone throughout the two years McCann has been the medical director of cardiovascular surgery at Danville Regional Medical Center and on the staff at Duke University Medical Center in Durham, N.C.
The doctor didn’t consider any of the offers, however, until about six months ago when his patient load decreased because, he believes, patients no longer wanted to be treated at DanvilleRegional.
“Things have gotten so bad at Danville Regional that when we got another offer, we had to look at it,” McCann said Monday. “You get offers all the time. We have gotten multiple offers over the last two years, and we haven’t even looked at them because we love it here and wanted to stay.”
His situation, however, has changed considerably since he came to Danville, accepting his first full-time job after 17 years of medicaleducation.“My office is now in the red, and I can’t keep losing money,” McCann said. “Duke has probably lost money as well, and they are getting scared.”When he got the offer from Utah Valley Regional Medical Center in Provo, Utah, McCann told Dr. Peter Smith, chief of cardiovascular and thoracic surgery at Duke, he would have to consider it.
The hospital responds
Danville Regional spokesman John Van Mol said the hospital or its parent company, LifePoint Hospitals Inc., shouldn’t shoulder the blame for McCann’s departure.
“When there is an insufficient number of patients in a particular service line, there are almost always a variety of factors that cause it. A variety of reasons, too, no doubt caused the previous open heart surgeon at the hospital to make a decision to leave, well in advance of LifePoint’s purchase of the hospital,” Van Mol said Friday in a written statement. “Therefore, it is inaccurate to say low patient volume is ‘LifePoint’s fault,’ just as it is inaccurate to say it is ‘the surgeon’s fault’ or ‘Danville Regional’s fault,’ or ‘referring physicians’ fault.’”
A news release from the hospital issued Monday announced not only the departure of McCann, but also that Duke would work together with Danville Regional to conduct a “service line assessment” to “determine how (Danville Regional) and Duke will work together to improve cardiovascular care” at the hospital.
“(Duke) can’t keep pouring resources into the hospital,” McCann said. “Duke is afraid, and anything they put their name on has to succeed. Duke agreed to look at it, but by no means agreed to anything.
“They agreed to look at this mess and see if they can help fix it,” he added. “They might agree that it’s too bad, and they won’t go down in flames with the hospital. Or they could fix it, and it would cost Danville Regional a boatload of money.
“There are no guarantees from Duke. But, for all I know, they could turn around in a year and say they could do it. They’re not ruling any possibilities out.”
McCann said he and his wife have agonized over this for six months and have done everything they could to avoid it, but in the end he left because “I couldn’t pay my practice’s bills.”
Van Mol said, “It is true that the revenue from the practice has failed to cover its costs, but all the costs including full pay and benefits for Dr. McCann have been covered by Danville Regional and LifePoint.”
In his own announcement sent to his physician colleagues, McCann wrote, “The situation here has deteriorated to the point that the future of my fairly young career and that of my family are very insecure. Changes in the hospital ownership and administration, and, importantly, public perception of these changes have significantly altered our practice, both in terms of quality and volume.
“Frankly, patients no longer want to come to this hospital for cardiac surgical care despite my best efforts to establish a good program and a respectable reputation ... It will take time for the hospital to gain enough trust back so that patients will return.”During Monday’s interview, he said, “I would like to see the hospital survive and succeed, but in order to do that, there has to be open, honest dialogue. LifePoint needs to do that.”

‘a battle’
“What Dr. McCann says is true,” Dr. Gary Miller, a cardiologist and the hospital’s former chief of staff, said Tuesday. “He did like the community.”Miller called the heart program at Danville Regional a “best-kept secret.”“It was working,” he said. “The infection and mortality rates were extremely low, but people probably didn’t know that.“ But we do catheterizations and recommend surgery, but people say they have heard about the hospital and assume the heart program is not doing well, which it was. One section of the hospital is rubbing off on the other.”
Miller said the heart doctors have been seeing people with a relatively low risk for heart surgery, but the patients are refusing to have it done at Danville Regional and doctors have to send them elsewhere.“
It’s been a battle,” he said. “We’ve always had an agreement with Duke that we would send them the high-risk patients - those that have a 10 to 15 percent chance of dying - but when we have to give up people that will do well, that’s hard.”Miller said that the patient census has been very heavy the last few days, and he did seven angioplasties in seven days because of the effect the hot weather has had on people. “But I have known the surgery numbers have been down for some time because people are opting to go elsewhere because of the things that have gone on in the hospital,” Miller said. “There is always a small minority who have gone out of town (for care), but what has really hurt is that now the average Joe citizen who could stay here is leaving.”
Miller is hopeful, however, that the situation at the hospital will improve soon.“We’ve been working with LifePoint, and I think the interim people here are now much more responsive to the physicians and patients,” he said. “We are being listened to.”Miller said he is confident the hospital will retain its Joint Commission accreditation, but called the effect of McCann’s leaving “demoralizing.”
“The people who work there are proud of the heart program,” he said. “The whole team knew they were doing a good job, and it is very demoralizing to those who worked hard to bring the program here.
“If a program fails because they’re not doing a good job, that’s one thing, but it was not failing. It failed for other reasons.
“It’s a downward spiral, and it feeds on itself.”Miller said he thinks the doctors and nurses are gradually regaining the confidence of the patients.
“We’ve hired enough nurses,” he said. “Even though they are young nurses, we have enough. We have episodic shortages, but it’s not every day.
“But LifePoint has to continue to do what they said they would do. They have to provide enough staff and not worry about the bottom line. If we give good service and people are happy, then business will be good.“We still have a long way to go. We haven’t given up on the heart center. We are going to look at it.”

‘support the hospital’
Cardiologist Dr. Bosh Zakhary said the community deserves part of the blame for the low-patient census at the hospital. “I think the whole community is blaming the hospital, but part of the responsibility lies with the community,” he said Thursday. “The physicians haven’t changed, the programs haven’t changed and LifePoint has realized they have made mistakes and they are rectifying those.”
He took issue with a study that came out recently that reported higher mortality rates among heart patients at Danville Regional. In the study published in June, the Centers for Medicare and Medicaid Services, a division of the Health and Human Services, ranked Danville as one of the seven worst hospitals nationwide for heart attack mortality rates.
Although that study did not concern the cardiovascular surgery program McCann headed, Zakhary said the community was influenced by it. “The outcomes published recently on heart care were erroneous, and we are looking at this,” he said. “Other studies show better outcomes.”
Zakhary said people in the community were not happy with the sale of the hospital, so any time a problem is reported with the hospital, the community’s perception is blown out of proportion. “When people see the problems, they do not come to the hospital,” he said, “and that led to Dr. McCann leaving.”
Changes in the hospital, such as the flow in the emergency department and how heart patients are handled, are occurring, which will result in equal or better care than before the sale, Zakhary said.
“The rest will be up to the community,” he said. “They need to stay in town and support the hospital. We can only do what we can do.”