To the citizens of Orangeburg, Calhoun, Bamberg and Barnwell counties:
Quality health care should not take a back seat to politics.
Those words have constantly resonated in my mind for the last several years as I have matured as not only a surgeon in this community but a citizen as well. I have seen first-hand how health care takes a back seat to political agendas and I find it disturbing.
I write this letter out of an abundance of concern for the future of both our local health care and our community. As many are aware, Ambulatory Partners — which partner Dr. Amit Sanghi, DO ABR, and I founded — has received approval from the S.C. Department of Health and Environmental Control to construct a state-of-the-art ambulatory surgical center for the benefit of area patients.
This center will provide the most technologically advanced treatment in the area, while eliminating the need to travel great distances for care. To fully illustrate my reasons for bringing my issues before the public, it is necessary to look at the actions (or inactions) of our very own Regional Medical Center and Orangeburg County Council.
Since the 1990s, RMC has experienced a dramatic “out migration” of area citizens who choose to seek health care services in other areas of our state because they believe they will not be able to receive adequate care at RMC. These figures are readily available for all to see, and are supported by DHEC’s own data. Although RMC was granted a certificate of need (CON) by the state in the 2004 to build its own ASC, they chose to buy out as many local practices as possible, rather than build necessary facilities to capture the loss of patients.
Their plans to eliminate the competition only served to eliminate quality care for the people of our community. Instead of investing in facilities, they purchased these practices apparently hoping that they could keep the physicians from referring patients to other facilities. This has, as well as numerous other reasons, led to a doubling of this “out migration.”
Fast forward to today and their attitude has abruptly changed when confronted with the prospect of Ambulatory Partners’ desire to give a level of care that the community has been lacking. Whether this is due to their perceived loss of revenue, or the fact that it will highlight the deficiencies of RMC is a question to be posed to each member of the RMC board and Orangeburg County Council.
It is illuminating somewhat as they continue a campaign of inappropriate influence, specifically in an effort to deprive us all of desperately needed health care services. This seems to demonstrate a total disregard for the wishes of their constituents. I find that to be a very disturbing fact as it relates to the future of our community.
More disturbing is the quote from one local political figure stating, “We don’t want to lose patients to your shiny new facility across the street.” However, with their lack of action in the last 20 years, they seem perfectly accepting to lose it to areas outside of our community.
The focus of our project has been lost by those that oppose it. Ambulatory Partners and the proposed Edisto Ambulatory Surgery Center and Edisto Imaging Center aim to offer services through a physician-owned, physician-led project that are not currently offered in the Orangeburg area. The center’s aim is to attract those folks who are migrating to another area of our state for their health care by providing high-quality, highly efficient and reliable health care to our people here at home.
The center’s aim is not to “take” from the Regional Medical Center but augment it. Contrary to board Chairman the Rev. Dr. Caesar Richburg’s false statement, this project is not about the “Have and Have-nots,” a comment found highly offensive to all the physicians involved in the project.
The fact is our project will provide services at a significantly cheaper cost than those offered by RMC. One should ask RMC why they have for decades charged patients significantly higher costs for ambulatory surgery and radiology imaging services as opposed to other providers while at the same time mismanaging the abundance of revenue received for these high-cost services.
RMC recently received approval for renovation of the existing Dialysis Access Institute into an ambulatory surgical facility. Although physicians of Ambulatory Partners opposed its construction to DHEC, particularly since it appeared and is most certainly designed to compete with the proposed Edisto Ambulatory Surgical Center, we did not appeal DHEC’s decision to grant their CON because, as stated by DHEC multiple times, there is a need for both projects and we will not take any steps to deprive citizens of desperately needed services.
We do not, however, believe it will happen. RMC has a history of opposition to health care growth and private investment by opposing physician-led projects or relinquishing their own. It is the hospitals prerogative as to how they intend to spend their money, but their decisions are not and should never go unquestioned by the community and its leaders.
RMC chose to appeal our project and with that, RMC chose to dedicate significant hospital and taxpayer dollars to their effort. When RMC attorney Laura Evans comments the exact cost of the opposition led by RMC and County Council is dependent upon Ambulatory Partners’ actions in response, the implication is Ambulatory Partners is in control of the expense.
To the contrary, RMC is the only entity pursuing legal action against Ambulatory Partners. We did not choose to spend hundreds of thousands of dollars in court, RMC did. And RMC can stop this by simply abandoning its opposition of our project. Therefore, the cost is at the hands of RMC and RMC only!
In addition, what physician investment is being made in RMC’s ASC project? If it is such a glorious plan, why isn’t there a significant interest on the part of physicians to invest. The strength of any ambulatory surgical facility rests with physician commitment. Many hospitals across the country are selling or converting ASCs, but every successful one has a considerable physician interest.
In addition, the project serves to improve recruitment of additional physicians and practices to the area. These facts represent the greatest threat to the Regional Medical Center and thus the community’s health care needs. When patients leave this area for health care, they rarely come back!
Ambulatory Partners believes like most Americans that competition only makes both parties stronger. CON is not complex as RMC would like for you to believe. Simply put, as it has been applied here, CON is a unique avenue where a health care provider can use the courts to oppose and stop health care investment and new projects if they feel the competition may hurt its bottom line.
As we see in many industries today, once large conglomerates force local entities out, the level of service rapidly declines because they no longer have to compete for your business. Rural patients benefit from similar facilities preventing patients from having to travel a great distance to metro areas.
Ambulatory Partners agrees with this concept and it serves as only one of the ba
sic principles for our plan. If RMC indeed plans to move forward with their ASC, it seems reasonable to believe they would welcome Ambulatory Partners. The goal of all is to provide the highest possible health care for our community.
It seems as if Orangeburg County Council and the current RMC board fail to recognize this fact. It is not lost on DHEC, however, which has approved Ambulatory Partners’ bid to construct this facility. Isn’t it curious why a state agency that is tasked with maintaining health care for all citizens of our state sees this need, but our County Council and local hospital do not?
Finally, it is additionally curious that a facility that consistently finds themselves in news articles regarding their dire financial position would spend the significant resources needed to appeal DHEC’s decision.
We see slogans such as “One Orangeburg,” “It’s a Great Day in Orangeburg,”, etc. being promoted, but based on what has transpired recently, it seems difficult to accept those slogans as more than just window dressing.
I would humbly appeal to the good citizens of this community to seek out your council representative and express your concern over how they are failing you. The people of our community deserve quality, cost-effective local health care and its time we “Restore the Confidence” in our community health care.
Dion L. Franga, M.D., F.A.C.S., R.P.V.I., is an Orangeburg board-certified general surgeon, interventional nephrologist and endovascular surgeon. Franga completed his residency in general surgery at the Medical College of Georgia in Augusta. He received his doctor of medicine from the Medical University of South Carolina and bachelor of science in biology, summa cum laude, from South Carolina State University.