Citrus Memorial Hospital hired a consultant, checked its facts and reviewed its options. Eventually, the decision was simple: Now is not the time to try offering cardiac surgery here.
When will the time be right? When the Citrus patient load increases, and when some other statistical categories change.
Charles Blasband, chief executive officer at CMH, offered that assessment Monday evening to the hospital's governing board. The strategy met no objection.
Local cardiologist Rafik Abadier has pushed CMH to seek state approval for cardiac surgery. The approval is required because the state tries to avoid duplicating services in geographical regions.
Abadier sees offering heart surgery as a natural progression in the area's medical landscape, and most experts agree it would be.
Citrus Memorial began offering cardiac catheterization services in February 1992. Seven Rivers Community Hospital also offers the service.
"Cardiac cath," as the procedure often is called, is a diagnostic test that enables doctors to check a patient's heart muscle, heart valves and coronary arteries.
Physicians insert a catheter into the patient's groin, gently moving it toward the heart. They inject dye into the heart chambers and coronary arteries and take X-rays.
But Citrus patients must travel outside the county, usually to Ocala, for heart valve surgery, heart bypass surgery, even angioplasty, which cannot be performed unless a cardiac surgical team is immediately available.
Abadier, Weiss and other local experts have praised the heart surgeons in Ocala and elsewhere. Still, they have pushed CMH to go the extra step.
Abadier, fellow cardiologist Mohammed Ansari and medical staff chief Dr. Edward Weiss met with hospital officials and the consultants earlier this month.
According to Blasband, the consultants explained that, to win a certificate of need from the state, the hospital must show that all cardiac units in this region are handling 350 cases or more.
That certainly is the case in Ocala. In Gainesville, however, one of the three hospitals is handling only 200 cases.
Also, CMH would have to show that no other cardiac surgery unit is getting started.
Leesburg Regional Medical Center is beginning its program.
Blasband noted that about 400 Citrus residents underwent cardiac surgery last year. If Citrus Memorial ever seeks a certificate of need, the Ocala hospitals likely would challenge it.
Abadier said the presentation was "very fair and very articulate." He now agrees that the local case load is not large enough to meet state requirements.
Blasband said the consultants will monitor the statistics and report when to move forward.
"We are going to stay on top of it," he said.