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Specialized hospitals criticized

Some ill-equipped for emergencies

NEW YORK -- Should a hospital be able to handle a medical emergency?

The answer may seem self-evident. But patients at some hospitals may find the staff resorting to what someone might do at home in a crisis: call 911 for an ambulance.

That happened recently in Texas, where Steve Spivey, 44, developed breathing problems after spine surgery. No physician was working at the hospital when the staff first recognized he was in trouble. They phoned 911, and he was taken to a nearby full-service hospital, where he was pronounced dead a short time later.

The event occurred at a small hospital owned and run by doctors -- one of roughly 140 such hospitals around the country, with nearly two dozen more under development -- that are set up to specialize in certain types of procedures like heart surgery, back operations, or hip replacements.

These hospitals have been assailed in the past for cherry-picking the most profitable procedures from the nation's 4,500 or so full-service hospitals.

Critics have argued that the doctors have a financial incentive in sending patients to their own facilities, even when those patients might be better off having their surgeries in regular hospitals.

But the Texas case, and others like it, have invited new scrutiny from regulators and Congress members about the ability of these hospitals to care for patients who have complications after their surgeries.

While some of these hospitals are large, sophisticated operations, like those hospitals specializing in cardiac care, others are much more modest. For example, small surgical hospitals may not have separate emergency facilities or, as in the Texas case, a doctor on site at all times during a patient's recovery.

As the number of doctor-owned surgical hospitals grows, federal and state officials acknowledge that the government rules may be too vague about the emergency capabilities a hospital must have in place. Regulators are particularly concerned about the very small hospitals that focus on only a few kinds of surgery but perform operations that frequently require an overnight stay.

While Medicare's rules say a hospital must "meet the emergency needs of patients in accordance with acceptable standards of practice," the details are left largely to the hospital's discretion. Federal and state officials say they are reviewing the guidelines to toughen the rules and make them more specific.

"We're concerned about good quality of care in any or all settings," said Thomas E. Hamilton, who oversees hospital certification for the federal Centers for Medicare and Medicaid Services.

Medicare recently terminated its agreement with the facility involved in the Texas case, West Texas Hospital, a 14-bed hospital in Abilene that performed procedures ranging from plastic surgery to complex spine operations.

That is where Spivey had spine surgery and developed breathing difficulties.

When the paramedics arrived, they inserted a breathing tube before taking him to the other hospital .

"It is horrific that Steve Spivey had to sacrifice his life in order to expose the problems associated with physician-owned hospitals," said Darrell Keith, the lawyer representing Spivey's family.

After a review of the hospital following Spivey's death, federal officials decided in March that the hospital could no longer continue treating patients covered under the government's Medicare program. Although the chief executive of West Texas Hospital defended its practices, he said it would not appeal the government's decision. The hospital has closed.