A District of Columbia health planning committee, ignoring new cost-containment guidelines, has voted to allow five hospitals in the city to purchase sophisticated new X-ray scanners at a cost of more than $4 million.
The guidelines assert that the cost of health care will rise unless the expensive new diagnostic tools called CAT (Computerized Axial Tomography) scanners are fully utilized.
Hospital administrators argue that every hospital with an emergency room now neds a CAT scanner in order to practice "state-of-the-art" medicine and avoid harming patients through dangerous delays in diagnosis.
If the recommendation made Thursday night is approved by the city's chief health planner, Sibley, Capitol Hill and D.C. General hospitals will be permitted for the first time to buy CAT scanners, which take cross-sectional X-rays of the head and body.
George Washington University Hospital and Georgetown University Hospital would be allowed to replace scanners they claim are outdated and produce poor quality X-ray films.
The city's health plan advocates that no more hospitals be allowed to purchase CAT scanners until scanner already in use is taking a minimum of 2,500 X-rays a year.
According to the most recent statistics, only four of the nine hospitals in the city that have the scanners meet this criterion.
The health planners' argument is that if the hospitals that own the scanners derive too little revenue from them, they must raise their rates in order to meet the costs of buying and maintaining them.
The proposed purchase of scanners by Sibley and Capitol Hill hospitals cause the most debate. Analysts from the State Health Planning and Development Agency urged that these hospitals continue to send patients who need the specialized X-rays to other hospitals, rather than buy scanners of their own for more than $800,000 each.
Both hospitals have relatively light traffic in their emergency rooms: Sibley treats about 18,000 emergency room patients a year, and Capitol Hill about 28,000.
Neither hospital could give figures on how many patients suffered from lack of the equipment, but Sibley provided testimony by a neurologist, Dr. Harvey H. Ammerman, that quick use of a scanner might have prevented one patient from falling into a coma.
The patient, Dr. Herbert Gates, was a general practitioner on the staff at the hospital. Ammerman said that about two months ago, he fell and was brought to Sibley's emergency room. He became increasingly lethargic, and doctors examining him were unsure whether he had had a stroke or suffered a severe head injury from his fall.
Ammerman said Gates was sent to another hospital for a CAT scan, but by the time he arrived, he was in a coma. The scan showed a hemorrhage from the fall, surgically treatable.
"He was operated on immediately, but the patient has never regained consciousness," Ammerman said. "In these kinds of blood clots, minutes count."
Four of the approximately 15 committee members present opposed scanners for Sibley and Capitol Hill, according to Gottlieb Simon, who serves on the council as a volunteer member.
The vote by the committee, called the Statewide Health Coordinating Council, to permit D.C. General to purchase a CAT scanner was unanimous. cThat hospital's administrators argued that scanners at other hospitals are not truly accessible to D.C. General patients because more than half of those patients have no health insurance and cannot pay for care.
The committee accepted evidence from Georgetown and George Washington hospitals -- each of which has two CAT scanners and does more than the minimum number of X-rays -- that one scanner at each facility is worn out or obsolete and needs replacement.
The recommendations go to Carl Wilson, director of the city's State Health Planning and Development Agency, who must accept or reject them by June 16.