July 16, 2024
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Opinion: Two NICUs in San Luis Obispo would be one too many


By Dr. Steve Van Scoy, Dr. Brad Knox and Dr. Nihal Naccasha

Health care is an important concern for all citizens, and we must demand both the highest and safest level of quality care.

Fortunately, Tenet Health Central Coast — consisting of Sierra Vista Regional Medical Center in San Luis Obispo and Twin Cities Community Hospital in Templeton — is one of the nation’s safest and best hospitals (from nationally recognized independent sources, such as The Joint Commission, Health Grades, The Leapfrog Group, HRC’s Health Equality Index, the California Health and Human Services Agency and Cal Hospital Compare), an amazing honor that lends even more significance to living in such a breathtaking region.

As physicians that practice at Sierra Vista Regional Medical Center, we are privileged to offer high-quality care to all residents. But the quality of the county’s outstanding health care is in danger of diminishing.

We understand that French Hospital Medical Center — less than two miles from Sierra Vista — plans to build a Neonatal Intensive Care Unit at its facility.

While we agree that competition is good in most cases, this type of duplicative competition in a county as small as ours will be detrimental to patients and the community.

Sierra Vista Regional Medical Center’s Level III NICU has given advanced newborn intensive care to the tiniest, most vulnerable patients — a level of care rarely found in communities the size of San Luis Obispo County. To have the safest outcomes and not put babies at risk, it must have a high volume of babies.

In addition to the NICU, Sierra Vista specializes in high-risk pregnancy and offers the county’s only obstetric hospitalist program and pediatric unit.

We believe two NICUs in a small community will prevent both facilities from providing the safest outcomes for the babies. This would be devastating for our community. It really is a matter of life or death.

Here are some important facts to consider:

• NICU babies are at only 50% of facility capacity in our county going back 10 years — even as the only NICU and even while caring for babies transferred from neighboring hospitals so they do not have to go outside the county — meaning there simply are not enough babies needing intensive care to warrant another program, according to a recent study conducted by the nationally acclaimed Journal of American Medical Association.

• The more a hospital performs a surgical procedure, the safer it is. According to JAMA Pediatrics, many reports dating as far back as 1979 identify a link between higher mortality rates (more deaths) and low surgical volume (less experience with a particular operation).

• Having a highly honored hospital helps with the recruitment and retention of highly trained and skilled physicians of all disciplines. Studies show that physicians seek areas that strive for quality and provide outstanding opportunities.

As San Luis Obispo County’s trauma center and its only hospital with 24/7/365 pediatric and obstetrics physician hospitalists, Sierra Vista Regional Medical Center is directly accountable to the community it serves.

Volunteers and patient advocates make up Sierra Vista’s board of directors, along with physicians, and promote patient safety to ensure that Sierra Vista provides the highest quality care possible. This is evident in the hospital’s more than 50 awards in patient safety and satisfaction and in recognition of excellent outcomes for quality patient care.

Sierra Vista provides cutting-edge, nationally acclaimed innovations such as the NicView, Tele-ER, and the first accredited Advanced Mechanical Thrombectomy Center, and has been recognized with the International Board of Lactation Consultant Examiners Award for maternity care and support, putting Sierra Vista in the top 2% of community hospitals in the nation.

Since opening its new baby intensive care unit in 1986, Sierra Vista has taken care of about 7,000 high-risk newborn babies. This high volume has created an experienced, well-educated, local team that is prepared for any newborn crisis.

What are we risking with a new by adding a new NICU?

• We risk increasing health care costs locally. Duplication of services means a duplication of costly, highly specialized equipment and staff, resulting in increased health care costs for the patient.

• We risk mediocre care and higher mortality rates. No one can be the expert if volume for any program goes down. With two NICUs, each team gets less experience. National data indicates mediocre care contributes to poorer outcomes in general and ultimately higher death rates.

• We risk losing our physicians. If overall quality care decreases or there is a loss of opportunity, physicians across disciplines might leave the area entirely.

• We risk losing a quality neonatal intensive care program. Sierra Vista Regional Medical Center has worked hard to become an elite center for care that includes the county’s trauma center, a Level III NICU, nationally renowned neurosurgical and stroke care, and state-of-the-art technology and innovations. This is not something that happens overnight, and the community has already has too much of a vested interest in the quality of NICU services to let it fail now.

It’s simple: Two hospitals each with their own specialized NICU programs in such a small community will increase local health care costs, reduce quality of care and hurt retention of our best and brightest physicians. That’s a price too expensive to pay.

• Dr. Brad Knox is a volunteer board member and the medical chief of staff at Sierra Vista Regional Medical Center. Dr. Steve Van Scoy is the hospital’s NICU medical director. Dr. Nihal Naccasha is a perinatologist and the medical director for Obstetrix Medical Group of the Central Coast.