Gwinnett deserves better

Almost half a century ago, the nation — starting in New York — embraced a sweeping regulatory strategy as the solution to rising health care costs.

The approach was to keep costs down by controlling hospital beds and equipment. Before expanding or buying expensive new equipment, providers had to prove “need.”

Mostly the rigidly anti-competitive regulatory system didn’t work and, under President Reagan, the federal requirement for a “certificate of need” (CON) was repealed. But just as American taxpayers still, under New Deal regulation, pay wealthy farmers not to grow crops, the remnants of failed health care cost containment persist today.

Just ask Dr. Manfred Sandler, chief of cardiology at Gwinnett Medical Center. Or state Sen. Renee Unterman of Buford. Both are furious at a legacy regulatory system that continues to make Gwinnett — population 814,215, up 350 percent between 1980 and 2000 — the largest county in the nation without a hospital with a license to perform open-heart surgery.

In January 2008, GMC applied to the state for CON permission to provide open heart surgery. Permission was granted in June. Three hospitals appealed: Piedmont, Emory and Emory Crawford Long. A hearing officer for the Certificate of Need Appeal Panel this week denied Gwinnett Medical permission to build. Hence the anger expressed by Sandler and Unterman.

“I am disgusted and disappointed,” said Sandler. Unterman’s anger is more sweeping. “It’s a way for lawyers to make money and, meanwhile, you have people out in Gwinnett County who are having heart attacks and dying,” said Unterman, who fought to repeal or at least reform the law in the General Assembly two years ago.

If you read the hearing officer’s decision — which, importantly, should be overturned by the Department of Community Health commissioner by July 17 — you get a sense of a regulatory process that is virtually insurmountable.

It notes, for example, that Athens Regional Medical Center in Clarke County “has been struggling to provide at least 300 procedures per year,” the number needed to maintain a high-quality heart surgery program.

In 2007, of the 506 Gwinnett residents requiring open heart surgery, four ventured to Athens. The hospital most affected — St. Joseph’s, just inside I-285, where 71 percent of Gwinnett residents go for open-heart surgery — agreed in April 2008 to partner with GMC in Gwinnett Cardiovascular Services.

The three hospitals that object served 119 residents, or 24 percent of Gwinnett’s patients.
The rejection is based on speculation that Emory’s medical training could be negatively affected and on good health outcomes for Gwinnett patients who travel out of county. It does not, however, note that the health outcomes don’t take into account an increasing number of cardiac-related deaths at GMC’s emergency room, which rose from 149 in 2006 to 181 in 2007. And, the hospital appeal notes, “in-hospital acute myocardial infarction mortality rates were significantly greater at GMC than at other metropolitan Atlanta open heart surgery providers .” For the elderly, those over 65, it was 150 percent greater; for those 55-64, it was 200 percent greater.

It is a regulatory outrage that GMC is denied the opportunity to serve the obvious needs of a rapidly growing county. The outrage is not for the hospital, but for sick people and their families.

41 comments Add your comment

Darren

May 22nd, 2009
8:38 pm

Great stuff. At least Gwinette hostpitals. Cherokee is busting at the seams and the Mayor up in Canton is actually trying to keep a hospital from locating there.

Michael H. Smith

May 22nd, 2009
10:20 pm

This is definitely the practice of medical protectionism at its’ finest. But it is only the tip of the protectionist iceberg with the approach of the national healthcare reform debate soon to begin. Neither Democrat or Republican plans so far offer much encouragement for we the patients who deserve better.

Matt Hyatt

May 23rd, 2009
7:11 am

Great article, Jim. I am an avid supporter of brining open heart services to Gwinnett. Even I was not aware that so many cardiac-related deaths had occurred right here in Gwinnett. Surely some of those people could have been saved if we’d had the ability to serve them here.

clyde

May 23rd, 2009
7:13 am

Considering that Georgia ranked 47th on the National Drivers Test,maybe it’s a real good idea to build a lot more hospitals and give up protectionism.

Road Scholar

May 23rd, 2009
8:18 am

Gwinnett is/was a repub stronghold. I didn’t know repubs had a heart! Brain?

Seriously, it is interested that the big 3 hospitals have that much influence on decisions that affect others. Since St Joe’s has formed a partnership with a Gwinnett hospital, why not let them expand their services.

Munch

May 23rd, 2009
9:52 am

Absolute agreement with Jim. Build the damn heart unit already.

Now, on to topics that might generate some heat and light here in the Wooten Klan. Because if your column generates 5 comments in 14 hours, you know it’s deader than Bob Dole’s dick.

So, some amusing observations from the puckish Son of St Ronald the Great, who seems to think that Friar Rush has perhaps overstepped in his criticism of Pelosi’s physical appearance:

“Limbaugh hasn’t had a natural erection since the Nixon Administration; think he’s compensating for something? Now, I wouldn’t pick on him for any of this stuff, not his blubbiness, not his man-boobs, not his inability to have a natural erection—none of that stuff—to me, off limits until! until! Mr. Limbaugh, you turn that sort of gun on somebody else—once you start doing that, you’re fair game, fat boy. Absolutely, you jiggly pile of mess. You’re just fair game, and you’re going to get it, too.”

Personally, I think the manboobs crack is cruel, but fair.

Michael H. Smith

May 23rd, 2009
10:13 am

When in reviewing over 100 years of the Democrat rule of the State of Georgia, add to that our State’s open borders (particularly on the northern and western sides) it is no wonder why Georgia receives low rankings on anything. Can I say this and get away with it? I’ll venture a try: The Republicans inherited “A MESS” from their predecessors. Touche’ Obumer!

Onto the Republicans and rightly framing the argument: It truly does beg the question why the political party that always ballyhoos “less government regulation”, “anti-protectionism anti-isolationism, free trade capitalism” and claims to oppose “socialized government healthcare” is now seen as the poster child of all of these government controls.

And the GOP wonders why their brand-name is damaged merchandise?

Again it is the case of two wings that keep aloft the one dirty government bird.

Don’t mind me Jay Bookman ~ to each his own barbecue.

@@

May 23rd, 2009
10:16 am

Can the victims’ families sue the deniers for neglect…wrongful death, Jim?

Redneck Convert

May 23rd, 2009
10:36 am

Well, it’s just awful the libruls in Atlanta got places they can go to get their heart fixed fast but a godly Republican place like Gwinnett just got to up and die before they even reach a hospitle. It just shows how much the librul Democrats hate Conservatives. We need heart hospitles in Gwinnett and Forsyth and everyplace else there’s loads of Republicans. If we don’t get them pretty soon all the libruls will be living till about 110 and Republicans will be dead by 55. After awhile we’ll be having Socialized Medicine right here in GA and high taxes and welfare programs and this mass transit and everything else librul because the librul Democrats will be outvoting us.

That’s my opinion and it’s very true. Have a good day everybody and be sure to stock up on booze today. I know you wouldn’t want to violate my Sabbath by trying to buy it tomorrow.

Munch

May 23rd, 2009
12:11 pm

South Korean Ex-President Kills Himself

Roh Moo-hyun, who had been under criminal investigation for corruption, died after leaping off a cliff, the police said.

Wow! The Koreans really know how to deal with disgrace! Dubya and Dick should take a clue.

clyde

May 23rd, 2009
1:09 pm

Tomorrow’s the bootlegger’s day,Redneck.Right after church.

Get your facts straight

May 23rd, 2009
2:04 pm

Well Jim,

As far as I know North Ga Medical Center in Gainsville does Open Heart Surgery in Gwinnett. However as to the patients dying at GMC, look at total pt out comes. The reason St Joe’s is pushing this is they are sucking wind right now. With 80% of their Cardiologist jumping ship and going to Piedmont their revenues are WAY down. If they were not in the “partnership” they would be fighting it along with Piedmont and Emory. This is all about Open Heart being a huge money maker for the hospital. It is reimbursed at a high rate. I can tell you one thing, I live in Gwinnett and I would drive my relative down to one of the big 3 before I would darken GMCs door. The one time I took a relative there they died.

Bristol Palin

May 23rd, 2009
2:33 pm

Girls need to imagine and picture their life with a screaming newborn baby and then think before they have sex. Think about the consequences. If girls realized the consequences of sex, nobody would be having sex. Trust me. Nobody.”

Get your facts straight

May 23rd, 2009
3:52 pm

No Bristol,
They would just be smart enough to wear a condom.

get out much?

May 23rd, 2009
4:14 pm

Mr. Wooten, unless it is an emergency, chances are you go to whichever hospital your insurance company directs you to, regardless of where it is located.

Glenn

May 23rd, 2009
4:58 pm

Perhaps this is unhelpful. I hope it’s helpful in some way. Georgia, as I’ve complained before, is divided into so many counties that counties–even such important counties as Gwinett–tend to get lost in the mix of local services. I’m not saying that this determined or defined Gwinett’s plight viz expansion of medical services; I’m merely suggesting that Georgia is constitutionally incapable of keeping up with its own times.

Georgia deserves restructuring to meet its own expectations and those of its taxpayers. Medical services should indeed be the responsibility of county governments, in my view, but Georgia’s counties, as fabled as many of them are, nonetheless are ancient artifacts of quaint artifice.

Were Georgia’s counties fewer and therefore more robust, they’d be taken more seriously as points of service delivery, in healthcare and everything else appropriate to county service.

Dick Cheney Slime

May 24th, 2009
6:18 am

Far from suffering for its shoddy military contracting in Iraq, Congressional investigators have found that KBR Inc. was awarded $83 million in performance bonuses. Even worse, more than half came after Pentagon investigators linked faulty KBR wiring to the electrocution of four soldiers intent on relaxation. One soldier died taking a shower and another in a swimming pool.

How such settings became part of harm’s way for the military was the question put to an electrical engineer hired by the Army who reported finding that 90 percent of KBR’s wiring work in Iraq was not done safely. Some 70,000 buildings where troops lived and worked were not up to code, according to the engineer, who told a Congressional hearing of “some of the most hazardous, worst-quality work I have ever inspected.”

Officials of KBR, the offshoot of the Halliburton conglomerate once run so lucratively by former Vice President Dick Cheney, deny responsibility and say the work met the British code used in the war zone. Flat denial is an all-too-familiar refrain from this most favored and most questionable of military contractors. The electrical engineer found most wirers were not experienced in the British code and many were third-country nationals with no electrical training at all.

Confronted with the airing of these lethal findings, the Pentagon at least had enough sense to tell Congress last week that KBR bonuses were suspended pending a full review. Senator Byron Dorgan’s description of the Pentagon’s performance as “stunning incompetence” is an understatement for such tragic profiteering.

The Army continues to investigate the deaths and reports of hundreds of nonlethal shocks suffered by troops. It has ordered emergency repairs, but the electrical inspector found that the building where the showering soldier was electrocuted still was not safely grounded by KBR until last October, 10 months after his death.

catlady

May 24th, 2009
7:55 am

Criminal incompetence

RanC87

May 24th, 2009
2:53 pm

Note to Munch: We would all be better off if YOU jumped off a cliff.

DawgBite

May 24th, 2009
5:45 pm

Key Point: Your insurance company dictates where you get care and what treatment you get. They don’t WANT to pay, you won’t get the treatment. You might need it, but you won’t get it. Very simple Wooten. Government isn’t the problem with health care. And then you have all the private care providers bilking the insurance companies AND the government with fraudulant claims and you get the witches brew that our health system has become.

RetLTC

May 24th, 2009
6:01 pm

Let me get this straight. A war that our government started. A war where we bear most of the expense. A war where the majority of deaths have been American, and we use the British electrical code with most of the work performed by untrained workers. This is reprehensible. Of course KBR will blame it on sub contractors that they hired while laughing all the way to the bank. Immense profit for poor performance. Seems to be epidemic in this country all of a sudden doesn’t it.

Take this to the bank folks. When war is no longer profitable you can bet there will be no more war. And did you ever wonder why Dick Cheney’s
Energy Commission requested maps detailing Iraqi oil leases from the National Archives prior to 9/11?

Glenn

May 24th, 2009
6:20 pm

That’s ominous, about the Iraqi oil leases. On the one hand, one might ask why the commission should not have been equipped with such information during the period, prior to 9/11, in which it was deliberating. On the other hand, Cheney and others may have been concerned that Saddam Hussein, who at that time was flouting treaties right and left, was about to pull an Allende; that is, that he was contemplating nationalizing the interests or holdings of American oil companies operating in Iraq. Iraq was then and is now largely dependent on U.S. companies to explore, extract and deliver (and ultimately to refine) Iraqi oil. Saddam may have been considering an illegal taking. Such a taking in the offing would have constituted another–though not a very proud–causus belli.

Very interesting.

Glenn

May 24th, 2009
7:26 pm

To my Allende reference I might add the case of Hugo Chavez, who did indeed steal U.S. oil operations in Venezuela. There was a time when a dictator couldn’t pull a stunt like that and expect to live. Perhaps 2002 was another such time, viz Saddam. Still, at is happened, Saddam did not actually pull an Allende, a Chavez. (Bear in mind that CIA did lay a trap to lure Chavez to Colombia and have him killed there, but Chavez evidently got wind of the ambush and nixed his travel plans.

poofdaddy

May 25th, 2009
3:13 pm

Hey PrezBo, how’s that “unclinched fist” working out for you and dealing with North Korea? Can’t WAIT to see the results of their next nuke test. Golly, we should go the peacenik route for sure!

poofdaddy

May 25th, 2009
3:17 pm

Why are libs on this blog CONTINUING to talk about Bush/Cheney? What mind-numbed morons. Take up the issue of wars with the current administration that is not stopping them, ya left wing retards. Oh wait, your God In Chief can’t do anything wrong, can he?

Cal

May 25th, 2009
4:17 pm

China & Russia were were moving in on Iraq’s oil piling up the contracts. Saddam was manipulating oil prices. Cheney’s “secret” meetings were nothing more than to assess the impact such actions would have on the American economy.

Conspiracy theorists are always creating one where one does not exist.

Jackie

May 25th, 2009
5:44 pm

My greatest disappointment with President Obama is his reluctance to appoint a Special Prosecutor to handle the criminality of the Bush Administration.

What the Bush criminals did was very clever. Create such a mess, knowing that it would take a goodly amount of time to sort out; decimate the economy and dare the Obama Administration to take action. All this, knowing the Repubs in the House and Senate would raise issue with anything found because of their complicity.

I say, investigate and let the chips fall where they may! They are citizens just like you and I!

Jackie

May 25th, 2009
5:50 pm

@poofdaddy

Do you believe that North Korea will ever use their nuclear weapon on another country? With thousands of nuclear arms in our possession, they know the odds are not in their favor. Add China’s nuclear arsenal to that of North Korea and the odds are still prohibitive.

They have a tool THEY CAN NOT USE! What are they going to do with it?

@ Cal

Since you may have insight as to what Cheney was perpetrating at his “secret” meetings, care to share this information with everyone else?

poofdaddy

May 25th, 2009
7:36 pm

Jackie: We may one day find out what the DPRK has in store. By the way sweet cheeks, any 9th grader who went to a decent school in this nation knows that North Korea would not nuke the United States. Clue: their war with South Korea is not officially over. But I do find it amusing that you same liberals that were hell bent on saying the Bush administration did nothing while North Korea worked on their nuclear program now suddenly find their nuke testing (and ballistic missile testing mind you) benign. Amazing how you people change your minds on issues depending on who’s in office.

And for your other moonbatic diatribe on Bush/Cheney crimes, get over it, you liberal wretch. Democrats voted for it, and Nancy Pelosi herself can’t even keep her own story straight about what the CIA told her on “enhanced” interrogation methods. All of this with Democrats BEING MEMBERS OF THE SENATE INTELLIGENCE COMMITTEE.

You moonbats lost all credibility, sister. Deal with it.

poofdaddy

May 25th, 2009
7:41 pm

And when I say “it” I’m referring to Iraq, Jackie. And NONE of you liberals have any say whatsoever in criminal activities with the current misfits in congress, up to taking control over Chrysler and handing it on a silver platter to the UAW knowing FULL WELL the secured debtors of said company had the first rights.

You people are pathetic.

poofdaddy

May 25th, 2009
7:45 pm

And finally, speaking of failures of liberalism and their beloved socialism, I’ll close with some wise words from Sir Winston Churchill which are as true today as they were 70 years ago:

“Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery.”

Cal

May 25th, 2009
8:52 pm

Jackie, WaPo did a piece on the meeting back in 2006-2007? There was nothing sinister about the meeting. Pretty standard by all accounts.

Maybe you can tell us why our newly-elected president voted for the “evil” Bush/Cheney energy bill if the fix was in.

Idle time addles the mind, Jackie.

Glenn

May 25th, 2009
8:53 pm

poofdaddy,

Right on.

Cal,

I’m pretty much in concert with Jackie about the inscrutibility of the Cheney-led meetings on energy. I would hope that they looked in detail at all the challenges that conditioned any further American effort toward energy independence, but I positively resent President Bush’s obvious refusal, in response to 9/11, to declare an all-out national effort toward such independence and to articulate which things each of us might do to cut off the terror-loving petro-tyrants without a cent.

Cal

May 25th, 2009
9:42 pm

Glenn, the reality is the U.S. will continue to rely heavily on oil for the next 30 or 40 years. Cheney’s concern was for waning resources.

If my memory serves, the meeting focused heavily on how to stimulate domestic oil drilling, promote nuclear power and coal, and respond to the Western electricity crisis, which had caused soaring rates and blackouts in California. Cap & Trade was even discussed provided China and India were on board.

Regardless of what they say, neither China or India is going green. Their economies won’t bare the cost. Ours is going to be destroyed if Obama succeeds with the policy. I don’t think he’s got full support from his own party on cap & trade. When oil prices were soaring, Obama toyed with the idea of domestic drilling. Now that they’ve declined, the support for domestic drilling has too.

Domestic drilling, coal, nuclear? All of those would have weaned us off of middle eastern oil. They were included in the bill. Cheney even supported alternative fuels. Ethanol was one of them. I heard him say it on a NewsHour with Lehrer.

This whole “secret meeting” crap is something environmentalists cooked up. They didn’t get equal face time so their feelings are hurt.

Glenn

May 25th, 2009
9:57 pm

Cal,

Let me dispose of a stray thought first. The media notion of excessive secretness, in Cheney’s dealings on energy policy, was, many of us thought at the time, an obvious attempt to excuse the Clinton Administration’s early secrecy over the healthcare deliberations led by Hillary Clinton, Ira Magaziner and Walter Zellman. As the healthcare deliberations had failed, their secrecy was laid to account; as the Clinton healthcare deliberations consequently were thought to have failed in part as a result of their secrecy, so did the media feel somehow justified, or at least symmetrical, in exaggerating the “secrecy” of the Bush Administration’s deliberations on energy. Personally, I believe in Executive Privilege (as long as it’s not in Nixon’s hands), and I don’t care what it costs, in dollars or privacy, to inform the president.

As to the substance of the energy issue, I couldn’t agree more. What I hoped would come out of it would be an even more heterogeneous mix of energy sources than that which you happen to list, together with a very hardassed plan for moving our oil sources elsewhere. (I’d happened to pen a congressional white paper calling for an appreciative shift to the oil deposits lying off the Horn of Africa, in which paper I relished the irony of a prospective infusion of American wealth into the very place America had plundered to build its semi-empire.)

Glenn

May 25th, 2009
9:58 pm

Kindly note the inflected difference between “secretness” and actual secrecy of state.

Jackie

May 25th, 2009
9:59 pm

@poofdaddy

Apparently, you DID NOT!!!!
North Korea uses what it has for bluster, no more.

As for being a wretch, I beg to differ my man!!!!!
You are doing what is usually done by you keyboard warriors, conflate, extrapolate, obfuscate.

Like James Brown’s song says, “Talkin’ Loud and Saying Nuthin’.”

And, how would you know what Nancy Pelosi can’t keep up with? There have been many Reps and Senators indicating that the CIA did not tell the truth; the briefings that were held were either benign if held in the Senate Office Building; they were of the utmost importance if held in the White House; no notes were allowed in the briefings.

Wonder why Boehnier (R-OH), Hoestra(R-MN) amongst those that have spoken out on this matter has publicly stated the CIA lied to them.

Now, how does Nancy Pelosi become culpable for the sins of Dubya. The Pelosi briefing was in September of 2002 and the torture acts were completed in March/April 2002. Was she supposed to give her approval. Secondly, Rep. Harman(D-CA) was the ranking member on the committe – remember, the Repubs controlled the House – wrote a letter of complaint as it was HER responsibility.

Care to find another way to cover YOUR @$$ !!!!!!!

As for the sweet cheeks, it sounds like you and I have the same equipment, bubba!!!!!!!

Jackie

May 25th, 2009
10:02 pm

@ Cal

How do you know that information as it is still classified as TOP SECRET!!!

Dubya is fighting tooth-and-nail to maintain that secrecy. Do you know something that no one else does? Oh, forgot, you are extrapolation like you so-called conservatives usually do.

Cal

May 25th, 2009
10:21 pm

Jackie, the information comes from people in attendance, some of whom weren’t in agreement with Cheney. They thought he missed an opportunity to tweak it.

I repeat, Jackie! There was nothing sinister about the meeting. SOP.

LC723

May 25th, 2009
10:28 pm

Halliburton: The Bush/Iraq Scandal that Wasn’t

Clinton and Gore preferred Halliburton/KBR

In 1997, when LOGCAP was again put up for bid, Halliburton/Brown & Root lost the competition to another contractor, Dyncorp. But the Clinton Defense Department, rather than switch from Halliburton to Dyncorp, elected to award a separate, sole-source contract to Halliburton/Brown & Root to continue its work in the Balkans. According to a later GAO study, the Army made the choice because 1) Brown & Root had already acquired extensive knowledge of how to work in the area; 2) the company “had demonstrated the ability to support the operation”; and 3) changing contractors would have been costly. The Army’s sole-source Bosnia contract with Brown & Root lasted until 1999. At that time, the Clinton Defense Department conducted full-scale competitive bidding for a new contract. The winner was . . . Halliburton/Brown & Root. The company continued its work in Bosnia uninterrupted.

That work received favorable notices throughout the Clinton administration. For example, Vice President Al Gore’s National Performance Review mentioned Halliburton’s performance in its Report on Reinventing the Department of Defense, issued in September 1996. In a section titled “Outsourcing of Logistics Allows Combat Troops to Stick to Basics,” Gore’s reinventing-government team favorably mentioned LOGCAP, the cost-plus-award system, and Brown & Root, which the report said provided “basic life support services — food, water, sanitation, shelter, and laundry; and the full realm of logistics services — transportation, electrical, hazardous materials collection and disposal, fuel delivery, airfield and seaport operations, and road maintenance.

Jackie

May 25th, 2009
10:30 pm

@ Cal

Who are these people and how did YOU find the information?
Care to divulge the information and let everyone decide if the meetings were sinister?

If the meetings were so benign, why were they classified TOP SECRET?