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Duplication isn't better 

Two NICUs in such a small community will reduce quality of care and increase cost

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 is one of the nation's safest and most elite hospitals (from nationally recognized independent sources, such as The Joint Commission, Health Grades, The Leapfrog Group, to name a few), an amazing honor that lends even more significance to living in such a breathtaking region.

As physicians who 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 2 miles from Sierra Vista—plans to build a neonatal intensive care unit (NICU) at their 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:

• The NICU in our county has been at only 50 percent of facility capacity 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 that there simply are not enough babies needing intensive care to warrant another program.

• The more a hospital performs a surgical procedure, the safer it is. 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) (JAMA Pediatrics, August 2015).

• 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 SLO County's trauma center and 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, the first accredited Advanced Mechanical Thrombectomy Center in San Luis Obispo County, and has been recognized with the IBCLC Award for maternity care and support, putting Sierra Vista in the top 2 percent of community hospitals in the nation.

Since opening its NICU 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 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 mortality rates.

• We risk losing our physicians. If overall quality of 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; it is not something that happens overnight, and the community 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. Δ

Dr. Knox is a volunteer board member and the medical chief of staff. Dr. Van Scoy is the NICU medical director. Dr. Naccasha is a perinatologist (maternal/fetal medicine) and the medical director for Obstetrix Medical Group of the Central Coast. Send comments for publication to letters@newtimesslo.com.

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