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Community Corner

Nyack Hospital Changes Heart Attack Protocol

Nyack recently opened up a partnership with Columbia Presbyterian Hospital

Doctors and officials from Nyack and Good Samaritan hospitals spoke at the Rockland County Legislature Multi-Service Committee’s meeting Tuesday night about Nyack Hospital's decision to send heart attack victims to Columbia Presbyterian Hospital.

The members from both hospitals were asked to speak about the decision by Rockland County Legislator John Murphy, who said as the president of two non-profits that provide care to 331 people with special needs he has an interest in any sort of policy change at the hospitals. He added that the county has no standing in the matter, and the discussion was just that—and not a hearing for a possible resolution.

Dr. Michael Rader, vice president and medical director of Nyack Hospital, said the decision gives patients at Nyack Hospital primary access to one of the top 10 hospitals in the country. The patients that the decision affects, he added, are primarily those that need angioplasty.

“Based on available resources, based on what we think the transport times are in response to stat times, we feel that in some cases, not every case, that some cases are more appropriately transferred to an academic medical center with 24/7 coverage, with operating rooms in the cardiac catheterization lab,” he said.

Rader said their last ambulance ride times to Columbia are around 22 minutes. One issue opponents of the decision have is Good Samaritan Hospital is located in Suffern and has nationally-recognized cardiac programs.

“When we were part of the grassroots campaign to bring these cardiac services to Rockland County, one of the most important things that we recognized is that the longer it takes for you to get to a point of service where your veins can be opened up so that you can have life-saving blood flowing through your heart is detrimental,” said Deborah Marshall, vice president of Bon Secours Charity Health System.

Rader said the Nyack Hospital doctors and physicians should be trusted to make the right decision regarding whether or not to send their patients out and where to.

“Certainly we would not endanger a patient,” he said. “I think you have to trust that we have very experienced cardiologists, very experienced emergency room physicians -- our emergency room sees 60,000 patients a year -- and they really know who has to be treated locally and who has the ability go into the city.”

Another issue Marshall raised was that Good Samaritan noticed that while there wasn’t a particularly large number of people with cardiac disease in the area, a high percentage of those suffering ended up dying from heart problems. They worked to help improve that issue locally, and this would be taking patients outside of the county.

“We recognized that there were people dying from heart attacks, and we recognized that Rockland County was without an appropriate program,” Marshall said. “We started an emergency angioplasty program and it evolved from that to a full-blown angioplasty program and then open heart surgery. We were able to attract the finest surgeons to this county to open up that cardiac program. My concern is that we are taking a step backwards.”

She added that she feels its important to keep services in the area, and that out-migration has negative effects.

“One of the things as we work in our community with our leadership, we find there is tremendous out-migration from our own county, from our own state at times,” Marshall said. “That out-migration does a lot of things for us. There were eight hospitals in the state of New York that closed last year. Out-migration is an impact to our state, out-migration is an impact to our county, out-migration, more importantly, is an impact to the patients.”

Rader agreed with Marshall about out-migration to an extent.

“We don’t like out-migration either. Out-migration in Rockland County is about 30 percent of the patients. It stings for all of us,” he said. “The truth of the matter is sometimes care is more important than economics, it’s more important than out-migration.”

The most vocally opposed to the decision at Tuesday’s meeting was Dr. Michael Innerfield, who is on staff at both Nyack and Good Samaritan hospitals.

“This policy is immoral,” he said. “I think that it’s a hospital that serves the community and when the hospital does something that is not in the best interest of the community that the community should then hold the hospital accountable.”

Innerfield added that he didn’t think the patient was included in the discussion about the policy change.

“If you’re the person writhing in pain suffering and want your symptoms relieved as soon as possible, I think it’s clear that you want to go to the quickest place possible, and that’s Good Samaritan,” he said.

Nyack Hospital Chief of Cardiology Dr. David Brogno the decision, which he called a pilot project, serves two purposes.

“There are situations where the transport time to the nearest hospital is longer than the transport time to Columbia and so I would be remise as chief of cardiology if we did not look into alternative transport for those particular times,” he said. “The other is that we arrived at this situation at an interesting confluence of events, which culminated in Nyack Hospital not only having this affiliation with Columbia, but now a great number of Columbia cardiologists are on staff at Nyack Hospital. And so part of this was to see if we could leverage that connection to an even high quality cardiac care to some of these these patients.”

Brogno added that it will be up to the patients to decide which hospital they would want to go to if such a situation were to arise. Al Samuels, president of the Rockland Business Association, said he doesn’t think it’s practical to ask patients or families to decide where they want to go.

“I do not believe that the patient in that condition in the emergency room has the ability to make a decision about his or her care, and I don’t know that family members, who are going to be almost as highly stressed at that moment in time, have the ability to make the decision,” he said.

He proposed that all cardiology patients have to fill out a paper saying which hospital they’d prefer to go to if they ended up in that situation.

Brogno said right now the decision is on a trial basis, but there’s no set time or number of patients Nyack is sending out before deciding if the decision will hold. He added that of the 24 patients that fit the description that hospital has sent out this year, only four have gone to Columbia with others going to Good Samaritan, Westchester County Medical Center and other locations.

After the meeting, Marshall said it was good to have an open discussion about the decision. She added that Good Samaritan and Nyack hospitals have had a wonderful working relationship in the past, and that Good Samaritan has treated all heart attack patients that were sent from Nyack Hospital well. Dr. Rawn Salenger, of Good Samaritan, said that in the five-plus years since the hospital has received patients from Nyack Hospital, 100 percent have survived.

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