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home : opinions : opinions February 26, 2015


2/19/2014 1:03:00 PM
Insufficient backup for heart procedure
Wayne Arnold, Rice Lake

A Marshfield doctor, not a surgeon, has started implanting heart pacemakers at the Rice Lake hospital.
Implanting a pacemaker involves drilling holes into the heart.  Historically, pacemakers were implanted only in hospitals with a heart surgeon handy so that if something goes wrong, the heart surgeon can quickly fix it.  The Rice Lake doctor used to implant pacemakers in a non-Marshfield owned hospital in Eau Claire, which had heart surgeons.  But Marshfield didn't get the money that comes from doing the procedure in Eau Claire.  So now the doctor is implanting pacemakers at Marshfield owned LMC, which does not have any heart surgeons.  
At LMC, if something goes wrong with drilling the holes in your heart, seconds count, but you have to wait for the trip to someplace with a heart surgeon.

Reader Comments

Posted: Wednesday, February 26, 2014
Article comment by: Wayne Arnold

Implanting a pacemaker involves not only placing the device in a pocket of skin on your chest, leads are driven, punctured, drilled - take your pick - through the wall of the major heart artery and snaked down through the arteries (all while it is beating of course) and then punctured, imbedded, driven, screwed - take your pick - into the heart muscle. This is serious business. Should a tear in the artery occur, or something break loose, a fix by a heart surgeon is needed immediately. If that happens to you, it is of no comfort that you are a minority. I question the morality of a hospital doing such a procedure knowing that the fix is some distance and time away. I wonder if this risk is explained to the patient. I doubt it. Since most pacemaker implants are done on a non-emergency basis, a knowledgeable person would be a fool to have it done where a fix is not at hand.

It is true the cardiologist fees are the same wherever it is done, but Marshfield only gets the substantial hospital fee at a hospital it owns. The only wholly owned Marshfield hospital is LMC.

Posted: Friday, February 21, 2014
Article comment by: Diane Geissler

In response to the article on pacemakers. I have had my pacemaker for 8+ years now and was quite surprised to hear that they "drill holes in your heart" to place them. As far as I know they didn't do that to me, or at least the doctor never told me they did that. Dr Alaoua is an excellent cardiologist here at the Mfld Clinic where I work and has taken very good care of me since I had my pacemaker put in. He just changed it this past fall and I am here to tell you all about what a great physician he is!! People need to be educated before they talk!!

Posted: Wednesday, February 19, 2014
Article comment by: Jeff Anderegg

Mr(not Dr) Arnold:

Your editorial is both misleading and inaccurate. First, some basics. Cardiologists are physicians that are specialists in providing care for people with all kinds of heart problems. Cardiologists, not surgeons, are the physicians that implant pacemakers to help patients with heart rhythm issues. Pacemakers are commonly placed in areas where a heart surgeon is not immediately available. Complications are not likely and can generally be taken care of by the cardiologist themselves. There is rarely a need for surgical intervention. When needed, it is even more infrequently the emergency that you describe.

Implanting a pacemaker never involves "drilling holes into the heart". The leads(the wires that are placed into the heart) are often, but not always, screwed into the inner lining of the heart.

While neither of us are experts on procedural billing, I can say that the physician implanting the pacemaker would do the billing regardless of the placement location.

If you have any self respect you will amend your editorial. It is not based in fact, but merely your opinion. At the same time, it is dangerously misleading for readers seeking heart care. I feel that this community is lucky to have such an excellent cardiologist.

Jeff Anderegg, MD

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