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Worry meter up at St. Charles

Doctor calls Berger Commission's recommendations 'dangerous'

By Tom Burke

PORT JEFFERSON—Neil Kurtz, chief of St. Charles Hospital's premier orthopedics service, says full implementation of the state Berger Commission's recommendations is "dangerous for the community."

Dr. Kurtz spoke at the Miller Place Civic Association's monthly meeting along with Marilyn Fabricante, director of the hospital's public affairs unit, and St. Charles' executive vice president Jim O'Connor.

In an exclusive follow-up interview with The North Shore Sun, Dr. Kurtz explained how the Berger Commission's recommendations, which became law on Dec. 31, 2006, will affect the hospital, especially doctors and their patients.

He began by explaining New York state is now requiring the hospital to shut its orthopedics service by June of next year. The state also requires the emergency department, the pediatrics unit and the intensive care unit be closed by June 2008.

Dr. Kurtz described how closing the ICU and ED would force the hospital to abandon its obstetrics service, as doctors consider practicing obstetrics without an ER and ICU in the building tantamount to malpractice.

Twenty-five-hundred births a year would have to occur somewhere else, he said.

Then, explaining Stony Brook Medical Center's new women's facilities will only accommodate 800 additional births annually, he said 1,700 women a year will need to look for a place and a doctor to deliver their babies.

He further stated that full implementation of the Berger strictures would cause a $25 million a year financial loss for the hospital — something Mr. O'Connor says St. Charles' owner, Catholic Health Services, could not sustain. "If the Berger Commission is implemented as is, it will destroy the hospital," he stated.

How worried should local residents be about the potential closing of St. Charles? Dr. Kurtz provided a "scale of concern" about closing the various units.

On a scale of 1 to 10, where 1 is "not at all concerned" and 10 is "very, very concerned" about closings, here's how Dr. Kurtz said people should consider the future: shutting down the orthopedics service, 7; eliminating the emergency department, 10; closing pediatrics, 11; closing the ICU, 9; shutting down rehab, 8; and the de facto shuttering of obstetrics, 11!

His "worry meter" for the long term is essentially the same except for the ED and orthopedics. He says, long term, Mather could invest $30 or $40 million for new buildings and the danger level would still be a 6. For orthopedics, the long-term effect rises to a 9.

What makes the doctor so concerned?

For his own service, orthopedics, it's a combination of factors.

For one, published research shows that the more knee and hip replacements over 100 a hospital does per year, the better the outcomes (fewer complications, infections, etc.).

St. Charles does over 700 a year, more than any other hospital on Long Island. Moving these 700 cases to other hospitals would mean the quality of patient care would be lessened.

Dr. Kurtz continued, "We're not only a center of excellence for orthopedic surgery, we're a teaching hospital for computer-navigated joint replacement surgery. Doctors come from all over the world to learn here. That, too, will be closed by the Berger Commission," he said.

Dr. Kurtz further explained how difficult it is to recruit doctors to Long Island with the high taxes, expensive homes and soaring cost of living. "So many of our young orthopedic doctors, 'the best and brightest,' come here to specialize in our premier service."

"These doctors have a right to be angry, to be disappointed if we are closed," he went on.

He then explained they might have a difficult time finding a place to practice. "Stony Brook University Medical Center does not grant orthopedic privileges to private practice physicians," he explained. "We've had no overtures from Stony Brook. That leaves hospitals like St. Catherine's or Peconic Bay." He explained, however, there is no guarantee there would be a place for these doctors at other hospitals.

In terms of patients, the net effect is worse: "You might not have a doctor."

At this point in the interview Dr. Kurtz spoke of the least protected and most vulnerable patients.

"The children with severe developmental disabilities at Maryhaven and Little Flower, that's the group being truly stuck," he said.

He described, for example, how the dental clinic, which racks up more than 6,000 visits a year, is the only place many of these youngsters can get treatment.

"How can a child with severe physical and emotional problems be seen in a regular practice? When they close the dental clinic, they're closing these kids out."

Explaining how the hospital might avoid the consequences of a strict implementation of the commission findings, Dr. Kurtz said if the state health commissioner can be convinced "quality of care" and "patient safety" were being compromised, there might be enough "wiggle room" for the hospital to survive.

To demonstrate the community's support for St. Charles and to express the individual concerns of the hospital's home community, Dr. Kurtz suggests people write to Gov. Spitzer, Health Commissioner Richard Daines, as well as local legislators.

Suggested talking points, e-mail addresses, and updated developments can be found on the St. Charles Web site, www.countonstcharles.org. Mr. O'Connor, in his concluding remarks to the Miller Place civic, summarized the hospital's philosophy, "We will do whatever we need to do to keep St. Charles open."

 

St. Charles Hospital · 200 Belle Terre Road · Port Jefferson · NY 11777