PROVIDENCE – The R.I. Department of Health yesterday agreed to allow Kent Hospital to begin performing angioplasties without setting up a cardiac surgery program.

In approving the Warwick hospital’s request, Dr. David R. Gifford, the state health director, was following a recommendation issued March 25 by the R.I. Health Services Council. The council, in turn, had followed the advice of a committee convened by Gifford to review the regulation of cardiac services.

The decision – a departure from the state’s previous requirement that angioplasty programs be backed up by open-heart surgery capabilities – could have implications for another struggling hospital.

Landmark Medical Center started an open-heart surgery program three years ago, to support a diagnostic cardiac catheterization and angioplasty program.

The Woonsocket hospital initially projected it would be doing hundreds of heart operations per year by now. But Landmark actually is doing only about 80 per year, according to spokesman Bill Fischer; it is losing more than $3 million per year on the surgery program, even as its cath lab thrives.

Gifford already had been reviewing the heart surgery program, concerned that it threatens the financial health of the entire hospital.

Now, in a waiver request filed last Friday, Landmark is seeking to drop the surgery program while continuing to offer diagnostic catheterizations and angioplasties. Last year, the hospital performed about 800 and 400 of those procedures, respectively, Fischer said.

“We don’t want to shut the program down, but it’s become an economic reality, and we’re hoping that Dr. Gifford will allow that, because they’re two very important programs for the Northern Rhode Island community,” he said.

Angioplasty – known formally as percutaneous coronary intervention – involves inserting a catheter with a balloon and often a stent to open up a clogged artery and restore blood flow after a heart attack. When performed rapidly (the national standard is within 90 minutes of arriving at the hospital), it is considered the most effective treatment for certain kinds of heart attacks; the alternative is drug treatment alone.

Complications from angioplasty, although relatively rare, can be serious and life-threatening. Regulators, therefore, historically have required that hospitals offering the procedure have open-heart surgery capabilities, as well. That’s why Landmark set up its cardiac surgery program.

Yet, Fischer noted, 40 states already allow hospitals to offer angioplasty without open-heart surgery. And indeed, the Kent decision shows that Gifford sees the appeal of that approach.

“This program will provide residents of Kent and Washington Counties suffering a heart attack more rapid access to a procedure that can help save lives,” Gifford said in a statement yesterday afternoon.

In a letter to Kent Hospital President and CEO Mark E. Crevier, the health director wrote that the hospital had demonstrated the need for only an angioplasty program; that being able to do the procedure promptly is “one of the primary factors in successful outcomes”; and that the need for specialized services must be balanced with the need for primary care and prevention.

But Gifford’s approval came with a long list of conditions, some recommended by the Health Services Council and others added by him.

For starters, the capital costs of setting up Kent’s new angioplasty program must be limited to $76,900, all from equity, and the operating costs of the program’s first full year must be limited to $387,210.

In addition, Kent must set up an agreement with Rhode Island Hospital – which has a full-fledged cardiac program, including open-heart surgery capabilities and multiple cath labs – to receive oversight and support from that hospital’s experts.

To ensure that angioplasties are performed as promptly as possible, Kent must work with local emergency services (following a model recommended by the American Heart Association) to ensure that patients get electrocardiograms (EKGs) while on the way to the hospital – so if they need an angioplasty, preparations can begin right away. As part of that requirement, Kent will have to buy EKG units for all 23 rescue trucks serving Washington and Kent counties.

It also must set up standardized rapid screening and transfer protocols with South County Hospital, The Westerly Hospital and Newport Hospital, all of which may refer heart-attack patients to Kent.

Gifford’s order also requires Kent to provide detailed reports on its new program – including how quickly it performs angioplasties (the “door-to-balloon” time) – and to participate in a national registry for coronary catheterization and angioplasty.

Additional information, including the Kent Hospital angioplasty program approval letter, is available from the R.I. Department of Health at www.health.ri.gov.