ALJ Says a Strong “Yes” to Crestwood’s Request
to Continue Elective Angioplasty

In a thirty-nine page order issued yesterday in response to extensive testimony, Judge Algert S. Agricola, Jr. has recommended that the Certificate of Need (CON) Review Board grant Crestwood Medical Center’s request to continue its elective coronary angioplasty program. Crestwood’s request, which was filed on October 5th, 2011, was opposed by Huntsville Hospital for competitive reasons. Judge Agricola heard three days of witnesses at a hearing in January 2012 and reviewed over seventy exhibits.

Crestwood Medical Center has provided emergency angioplasty services for the past eight years, and for the past 5 years it has safely performed elective angioplasty procedures in a national study known as the Atlantic C-PORT Trials sponsored by the Johns Hopkins School of Medicine. Under the current Alabama State Health Plan, Crestwood requires a Certificate of Need (CON) to continue this service after the C-PORT trials end later this year.

Judge Agricola has ruled that Crestwood’s project is in compliance with the CON review standards and is consistent with the cardiac services section of the Alabama State Health Plan. In the summer of 2011, the State Health Care Coordinating Council determined that the State Health Plan be adjusted to allow Crestwood to apply for this CON. Governor Bentley subsequently approved this adjustment on June 14, 2011. Since Huntsville Hospital opposed Crestwood’s CON application, the Administrative Law Judge hearing was the next required step.

The judge denied Huntsville Hospital’s request to send this matter back to the Statewide Health Coordinating Council (SHCC) for further study and additional delay, citing that a number of reassuring developments had occurred since the SHCC decision last summer – namely the American College of Cardiology (ACC) promulgated updated guidelines for elective angioplasty when open heart surgery was not available on site. Crestwood’s performance was consistent with the updated guidelines, and data from the C-PORT trial (in which Crestwood is Alabama’s only participating hospital) was released demonstrating the safety of elective PCI in hospitals without open heart surgery on site when they maintain the level of quality demonstrated by Crestwood.

Judge Agricola heard testimony in support of Crestwood’s request for permanent angioplasty by local, independent Interventional Cardiologists who voiced the need for two providers in the community, each noting that their patients wanted choice when faced with the need for angioplasty. The physicians testified to the high quality of angioplasty care at both Crestwood and Huntsville Hospital. No area physicians spoke in opposition to Crestwood’s proposal.

Dr. Steven Ettinger, a nationally recognized cardiovascular expert and ACC Task Force member for the updated guidelines, testified that after his review of Crestwood’s angioplasty program, he believed that Crestwood’s program satisfied each criterion in the updated ACC Guidelines. Huntsville Hospital provided no experts or cardiologists to refute Dr. Ettinger’s convincing testimony.

Dr. Pam Hudson, CEO of Crestwood, notes that “We appreciate Judge Agricola’s time and careful attention to the testimony of clinicians, experts, and patients during the hearing. Our dedicated team members and cardiologists are due all the credit for the outstanding results of this program. These committed healthcare professionals came to hospital leadership in 2003 and told us ‘We can do this (coronary angioplasty) and save people’s lives, let us do it!’ It has been a long, careful journey with patient safety and quality of care being the first and foremost considerations. This is right for our community. Patients and families deserve a choice.”