Cleveland Physicians:

Planned ED by Erlanger would hurt medical care

Posted 6/3/18

Cleveland physicians affiliated with Tennova Healthcare said

Thursday  if Erlanger Health System succeeds in its plan to construct a

freestanding 24-hour Level IV emergency room here, it …

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Cleveland Physicians:

Planned ED by Erlanger would hurt medical care


Cleveland physicians affiliated with Tennova Healthcare said Thursday  if Erlanger Health System succeeds in its plan to construct a freestanding 24-hour Level IV emergency room here, it will duplicate medical care already available and have detrimental effects on delivering orderly patient care, as well as on efforts made by medical professionals to establish a roster of medical specialists who provide care for a growing community.

Three doctors affiliated with Tennova, Dr. William Johnson, chief medical officer, Tennova; urologist Dr. Ed McIntire; and pulmonologist Dr. John Jaggers all agreed that duplication of care would erode the medical community by causing some physicians to leave Cleveland if the patient base decreases. In addition, an inability to recruit physicians to replace those who retire or move away would be difficult, because they would prefer to practice in areas where they can treat patients locally.

Tennova, like Erlanger, also has plans to construct a 24-hour Level IV freestanding emergency room. Both healthcare providers have filed certificates of need with the Tennessee Health Services and Development Agency. The agency board hearing is scheduled for June 27.

According to Johnson, there currently exists a medical community that can effectively serve residents of Cleveland and Bradley County. He said if Erlanger were to build an emergency facility in Cleveland, it would duplicate the care which area patients already receive.

“It’s not good for the doctors. It’s not good for the patients,” Johnson said. “I know no doctor here that thinks Erlanger is a good idea.”

According to McIntire, having locally competing facilities of both healthcare providers would erode the quality of medical care for local residents.

“Competition in any industry is good; duplication is not. And this is duplication. It’s duplication that can lead to erosion,” McIntire said.

Jaggers said the certificate of need process should indicate the lack of necessity for two emergency rooms run by two different healthcare providers.

“A certificate of need is just that: need. This is not something we need. This duplicates what we already provide. It provides nothing more than what we do provide and can provide. Absolutely nothing else,” Jaggers said.

While many agree there is a  need for expanded emergency room facilities due to area population growth – as well as the absence of an emergency room in Polk County creating crowded conditions at Tennova’s existing emergency room – there is debate over whether the Erlanger facility will erode the established medical community in Cleveland.

Johnson warned patients treated at the Erlanger facility will be referred to doctors in Chattanooga, requiring them to travel over much greater distances for appointments.

“It’s bad for patients and families,” Johnson said. “Orderly healthcare and a lack of duplication is important. We have a solid medical community. If we have two EDs (emergency departments), it will dilute the medical community and that is not good for patients. Ultimately, it’s all about patient care. This does not advance care.”

Jaggers said patients would be inconvenienced by driving to Chattanooga for appointments.

“They will have to spend the entire day driving back and forth,” Jaggers said.

Johnson explainedTennova’s existing hospital emergency room, as well as its proposed freestanding emergency facility, will offer the same care as the one planned by Erlanger.

“It (Erlanger) will be a standard emergency room. The same X-rays, the same lab capabilities, but no MRI, no operating room. It’s an emergency room.”

In addition, Johnson Erlanger’s facility staffing will be the same as available in Cleveland. Importantly, Johnson stressed if Tennova is approved to open its freestanding facility, it will benefit patients because they will already be in the medical system at Tennova, as well as information systems of its roster of affiliated area physicians.

“It will be seamless — the same computer system, the same labs. It would be an extension of the same hospital system. Their staffing roster will be the same we have here — the same ED doctors, the same nurses, the same technicians,” Johnson said. “I’ve looked at their staffing matrix. It’s the same as all EDs. Not worse but not better.”

For example, if a patient damages a knee and seeks treatment at the Tennova facility, they will be referred to orthopedic specialists in Cleveland. However, if they visit the Erlanger facility, they will be referred to an orthopedic specialist in Chattanooga because Cleveland physicians will not be on Erlanger’s roster of specialists to whom it refers patients.

Jaggers agreed a duplication of services will erode medical care services that have expanded over the last several decades. He said Erlanger’s expansion into Bledsoe and Sequatchie Counties was the right thing to do, because both were without emergency medical facilities. Erlanger operates a 24-bed hospital and emergency room in Bledsoe County. It also runs a 24-hour freestanding emergency room in Sequatchie County.

Jagger stressed there was a need in those counties for Erlanger’s presence in the market, unlike Cleveland.

He said Erlanger’s presence in Cleveland will negatively affect patient care if physicians lose patients who visit the proposed freestanding emergency room and are later referred to specialists in Chattanooga.

 “If we erode the specialist base, we all will lose,” Jaggers said. “There will be attrition of subspecialists and an inability to recruit. We will be 30 years behind, and we can’t afford to let that happen.”

Jaggers said he and many other doctors chose to live and work in Cleveland.

“I was born and raised here,” Jaggers said. “We could live anywhere, but this is the lifestyle we want,” referring to Cleveland’s small-town atmosphere.

McIntire, who was born in Louisiana and also lived in Missouri, agreed.

“I visited here for an interview and thought it was a really good place,” said McIntire, who has practiced and lived in Cleveland for 21 years. “I wanted to live in a small community close to a large airport. It checked all the boxes, and I decided to stay.

The doctors stated an erosion of the medical community caused by an Erlanger emergency room that sends its patients to specialists in Chattanooga for treatment would be noticed by those considering moving to the area.

“If someone is moving to Cleveland, they want to know about the medical community. To change it would be bad,” Johnson said.

The doctors repeatedly stressed the proposed Erlanger facility will not be a trauma center.

“The hospital here already does trauma,” Johnson said. “Broken arms, broken hips, stitching cuts — we’ve been doing that for decades. It’s the big car wrecks, the femur sticking out of your leg, or a ruptured spleen — those are the ones that go to Erlanger (in Chattanooga). And they should; they are a Level I trauma center. But their ED here will not be a trauma (facility).

Johnson said the planned Erlanger emergency room would not be a trauma facility. Instead, it would transfer trauma patients to its Level I emergency room in Chattanooga.

“They would transfer the same patients we would. That’s the way the state set the system up,” Johnson said.

Johnson said it was important to understand what type of care both freestanding facilities will offer.

“If someone needs heart surgery, both will send the patient to Erlanger’s trauma ED,” Johnson said.

However, Johnson said, Tennova, in its effort to build a medical community, is now offering enhanced care services to heart patients.

“We have recruited three interventional cardiologists who can do stents. Late summer, we will roll out an acute heart attack treatment program. It’s a big deal in my mind.

Johnson said a competing facility that refers patients to doctors in Chattanooga will damage the effort to recruit and retain specialists such as cardiologists.

“If we have 20 percent of their volume taken away, the doctors may go somewhere else.”

McIntire also said the perception of Erlanger’s freestanding emergency room as a trauma center is wrong.

 “The biggest falsehood is that it’s a trauma center,” said McIntire, who added that Tennova-affiliated physicians have not been approached by Erlanger to join the staff at the freestanding facility.

“We are not against Erlanger," McIntire said. “We’ve had great experience referring to Erlanger for high-level trauma. We don’t want that to change.”

Regarding indigent care, all three doctors stressed Erlanger’s claim that Tennova is unable to provide care to those who cannot pay is false.

“The law is that anyone has to be seen by a doctor,” Johnson said. “Nobody’s going to turn them away. They will be treated, no matter what.”


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