Ruling Allows Certain Elective Procedures in Private, Not Community, Hospitals

By Tom Bacon

In Yakima Washington, one hospital - a private, for-profit facility -may perform elective coronary intervention procedures, but a non-profit community hospital may not.

Yakima's community hospital, Yakima Valley Memorial Hospital, sued the state Department of Health for refusing to issue a certificate of need for elective "percutaneous coronary interventions" commonly called angioplasty.

The hospital claimed it was unfair for a cross-town rival, the Yakima Regional Medical and Cardiac Care Center, to have a monopoly on angioplasty, since the private facility would not take un-insured patients, and charged a 20-30% downpayment before it would conduct a non-emergency intervention.

Yakima Memorial alleged the state was unfairly choking down interstate commerce with its rule, but the case also had undertones of discrimination against the poor and un-insured in access to medical care. The community hospital argued that roughly 25 percent of the region's population has no health insurance, and thus has no access to elective coronary treatment.

But a Spokane federal court granted the state summary judgment in its refusal to issue a certificate of need to Memorial Hospital and the decision was upheld Monday by a panel of federal appeals judges. The state health department decided that a hospital must conduct at least 300 such heart procedures to get a certificate of need; Yakima Memorial conducted only about 130 angioplasties in 2009.

The judges ruled that the minimum requirement set by the state health department is not restraint of trade, but is well-grounded in concerns for patient safety and the quality of medical competence.
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