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Concerns aired over competing hospital procedures

Leader-News of Greenville, Kentucky

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GREENVILLE — Several healthcare professionals in the county believe that three is the-perfect number of general surgeons needed to best serve the community and support Muhlenberg Community Hospital.

After the New Trover Health System added a general surgeon to its lineup at Muhlenberg Medical Center, who performs his surgeries in Madisonville, questions have been raised about sustaining the status quo for MCH.

Local surgeon Dr. William Browning said he is not only concerned about how that affects the hospital but also believes he's getting fewer new patient referrals to his office from physicians at Muhlenberg Medical Center. Browning leases an office suite at the center but is not under the Trover umbrella.

"I have a long list of patients and the biggest portion are repeat patients," he said. "When I sit at the computer and look at things, the numbers are about as good in terms of numbers, but I'm seeing a shift in not getting the new patient referrals I've seen in the past."

Browning contacted Berton Whitaker, CEO and president of Trover Health System, about his concerns in a letter dated Sept. 30. In that letter, which he shared with Leader-News, he referred to a direct mailer that Trover sent out to Muhlenberg County residents regarding the addition of Dr. Darren Chapman at the medical center.

"Your actual actions have been to send specialists such as general surgeons and obstetricians here, not to help our community or hospital by living here, paying taxes here, taking call(s) or doing cases here to help the hospital, but to entice patients to travel unnecessarily to Madisonville for the same services we have been delivering for decades," Browning's letter stated.

Dr. Barry Hardison of Muhlenberg Medical Center said Trover's acquisition of the medical center practice around five months ago has been a win-win situation for area residents and will eventually help grow MCH.

"With the addition of Trover cardiologists, we now have cardiology five days a week with Vanderbilt cardiologist still coming here three days a week," said Hardison. "If someone comes into my office that I believe needs a cardiologist, I can direct them down the hall. That is important. This partnership is meant to bring expert top-notch care to our community while still being sensitive to our local hospital."

Hardison said most of his patients are having general surgery at Muhlenberg Community Hospital and that the number of referrals made to Chapman reflect a ratio of his time spent at the medical center, which is one half day per week. Chapman performs his surgeries at the Trover Health System hospital.

"A perfect example of a referral to Dr. Chapman would be a patient who needs general surgery but has cardiac issues," he said. "Since we don't have a cardiology unit at our local hospital, that patient might best be treated at Madisonville, which does."

MCH CEO Tracy Byers said three general surgeons are what the community and the hospital needs. Browning, Dr. Edward Shuttleworth and Dr. Dennis Knoefler complete the trio, he said. Knoefler was recruited to the county earlier this year and is offering new procedures like varicose vein treatment at MCH.

"Trover said they would be bringing specialists like cardiology. We don't have cardiology here. That's a reality," said Byers. "But it seems they're focusing on general surgery and marketing Dr. Chapman. The (Trover) mailer was very aggressive especially: when you think that (Chapman) interviewed here and turned us down."

Byers said ensuring MCH's doors remain open is not only important to the health of the county's residents but also much of the Muhlenberg economy depends on it.

"We are the second largest employer in the county with 500 employees," he said. "We house the ambulance service here and we provide sports trainers free of charge to the schools. Out of 500 employees, 85 percent are Muhlenberg residents, who shop here arid buy groceries and gas here."

Byers said several surrounding counties like McLean, Todd, Butler and Webster do not have hospitals. He said the viability of a community hospital is dependent on general surgeries, which means the hospital can keep its doors open to treat patients 365 days a year.

"We are here all the time," he said. "That is the biggest difference between us and the doctors' office. We don't take off for holidays. If someone gets hurt or sick at 2 a.m., we are here."

Shuttleworth, who partners with MCH at the surgical center behind the Muhlenberg Medical Center, said he is discouraged by Trover's approach to general surgery.

"A rural community hospital depends on the number of general surgery cases done in its (operating rooms)," said Shuttleworth. "You take away six to eight scopes, a few gall bladder and hernia surgeries each month, and in a year, it's the difference between the survival or the closing of a hospital."

Byers said the number crunching is not complete for the period since Trover purchased the Muhlenberg Medical Center to offer comparisons yet.

Shuttleworth said with Knoefler's recruitment, the need for general surgeons in the county is filled and that those three surgeons help support the hospital.

"I know that if I was having a heart attack at 2 a.m., I'd want my wife to drive me to the local hospital and have a clot-busting injection if that's what I needed and then be transferred to Madi-sonville or Nashville," he said. "That's how important a rural hospital is. It's a life saver."

Hardison said that when the decision to move Chapman to the medical center a half day a week was made, there were only two surgeons — Browning and Shuttleworth — in the county.

"From our point of view, we only had two surgeons," said Hardison. "Dr. Knoefler came after that I believe."

Hardison also said some patients make a choice not to have surgery locally and that a patient ' sometimes makes the request to go to Madisonville.

Joe Miller, a Trover Health Sys-tem vice president, said the group is very pleased with Chapman.

"We're very proud of Dr. Chapman," said Miller. "He's an excellent surgeon, who had worked for a large hospital and rotated to an outlying clinic and so he's very familiar doing this."

Miller said Trover's long-term goals are to attract more patients from medically under-served areas from Ohio, Logan, Todd and McLean, which would also add up to more patients being admitted to Muhlenberg Community Hospital.

"By drawing those patients to this clinic, we will see more admissions here at the local hospital instead of seeing them go to Bowling Green, Nashville or Louisville for primary care," he said.

Miller said Trover plans to add oncology and hemotology to its list of specialties at the medical center with doctors from the Mahr Cancer Center coming to the county by the first of the year.

Byers said MCH will also be expanding and offering more procedures in the near future. Knoefler has experience and interest in wound care and advances in that area might be forthcoming at the hospital, he said.

"We have the only MRI in the county and a new CT scan," said Byers. "We have good technology in our radiology department and we do nuclear medicine. Another important thing is this, we are people who live in this community and people you know are going to be caring for you here. You don't get that at a bigger facility."

Martha Roberts, RN, community education coordinator for MCH, said patients are overwhelmingly pleased with the nursing staff at the hospital.

"We never close and when you need us, there are people who you know mat are going to take care of you," said Roberts. "And patients do have a right to choose where they want to go for primary care or general surgery. People need to realize they have the right to choose to come to Muhlenberg Community Hospital."



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Original Publication Date: November 24, 2009



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