SNELLVILLE -- Local cardiologists will be able to continue seeing patients at Eastside Medical Center after all, at least to some extent.
Eastside officially began offering advanced interventional cardiac procedures like angioplasty and stenting on Tuesday, through an exclusivity agreement reached with Atlanta's Piedmont Heart Institute. Initially, that was believed to leave local cardiology groups out in the cold, without the right to practice at the Snellville hospital at all.
That policy has been tweaked, an Eastside spokesperson confirmed Friday.
Cardiologists from long-standing Gwinnett groups -- namely CardioVascular Group and Gwinnett Consultants in Cardiology -- will be able to "manage the care of their current cardiac patients" at Eastside, spokeswoman Pattie Page said.
Piedmont doctors will retain exclusive privileges to the interventional procedures, but established doctors in the community will be able to do things like read EKGs, perform stress tests and examine existing patients prior to non-cardiac surgeries, Page said.
"I think it's going to make for a better arrangement," she said.
Dr. Manfred Sandler, a cardiologist from CardioVascular Group, said he and his colleagues would continue to see patients at Eastside "because it's right for the patients," but was less than hopeful for the future of such an arrangement.
Sandler called this week's decision "like life imprisonment rather than the death sentence."
"I think this is an interim thing. I have no doubt about it," he said. "There's no doubt that Piedmont does not want us (after they signed an exclusivity agreement). They're going to put their foot down."
Dr. Lanny Lesser -- who has practiced in Gwinnett since becoming the county's first board-certified cardiologist in 1979 -- was equally as pessimistic about the long-term ramifications, but called the adjustment a "moral victory."
"The idea of abandoning (a patient) is the worst thing a physician can do," he said.
Page was unsure if there is a timetable on the current arrangement.
An April 12 meeting put together by the Gwinnett-Forsyth County Medical Society brought together representatives from Gwinnett's main cardiology groups, Emory, Eastside and Piedmont, as well as several other physicians. Discussions were heated, but shed more light on the developments that led to Eastside's decision to grant Piedmont exclusivity.
At the meeting, Eastside CEO Kim Ryan said bringing PCIs (percutaneous coronary intervention, or angioplasty) to the hospital was one of her first orders of business once landing the job four years ago. She said she "worked for two solid years trying to get the support" of local cardiology groups for a PCI program.
None would sign the affidavit necessary for Eastside to apply for a certificate of need from the state, Ryan said, a point none of those present at the meeting denied.
At the time, Gwinnett Medical Center was already well into the process of developing similar services of its own. Some physicians have expressed their concern about hospitals located just eight miles away from each other offering the advanced cardiac services, which require a high volume of patients to remain viable.
The certificate of need granting Eastside the right to perform PCIs was ultimately approved anyway.
Sandler and Gwinnett Consultants in Cardiology's Dr. Sean Delaney both said their groups had offered to cooperate with Eastside after the certificate of need was established, but asked for more support to deliver a quality program.
"The first thing that the hospital needs to do is improve its protocols and its general supporting care," Delaney said, addressing Ryan. "I've said that to you every time we've spoken."
Ryan said she continued to come up empty when asking for support from CVG and GCC.
"I believed and I still believe that the only viable solution was to go to the board and ask for an exclusive," Ryan said. "And I did that, and I was granted that."
Eastside is owned by Hospital Corporation of America, a for-profit organization based out of Nashville, Tenn. Once the HCA board granted Ryan the ability to create an exclusivity agreement, a request for proposals was put out.
The hospital received bids from GCC, CVG, Emory and Piedmont. Piedmont was chosen.
"Along the way you all had opportunities to be where we are," Piedmont Heart Institute CEO Sid Kirschner said. "We were invited in, won the bid, and we want to do the very best, finest job."
Still, local cardiologists found fault in the outcome. Sandler admitted Piedmont's bid was likely more lucrative for HCA than those of the local groups because "they're gaining a whole hospital (of patients)."
Said Dr. Searle Videlefsky, from GCC: "For continuity of care, for the patients, we definitely feel that if someone has a better proposal, give us a chance to give another proposal."
Ryan said she wasn't given permission to re-open the bidding.
There's still a possibility that local cardiologists will challenge the legal authority of the bylaws that allowed Eastside to establish a program in the first place, Sandler said. Even given the latest concession, the issue isn't likely to die on the table.
"This is the right fight," Lesser said. "It's the good fight."