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Next step for cancer center?

Ordinance introduced, but likely to be pulled in March

Posted: February 16, 2012 - 8:24am

Officials reaffirmed Tuesday that a recent impasse regarding competing plans to build a local cancer center has almost been settled, despite action from the Kenai Peninsula Borough Assembly that may indicate otherwise.

On Tuesday, the Kenai Peninsula Borough Assembly unanimously introduced Ordinance 2011-19-72, which calls for appropriation of $4.7 million for Central Peninsula Hospital to build its proposed cancer center. Introduction is the first step ordinances must undergo before being approved or rejected by the assembly. Public testimony on the issue is scheduled for the assembly’s March 13 meeting.

CPH Chief Executive Officer Rick Davis and Anchorage-based Dr. John Halligan both proposed building centers for radiation oncology treatment, but differed on where to build the center — on the hospital campus or off campus — and several other aspects of the specialized care.

Halligan wants to build his own facility off, but near the CPH campus, own the land it sits on and charge for both professional and technical fees associated with cancer treatment.

CPH wants to build a facility to house radiation oncology services and eventually others as part of a larger cancer treatment operation on its campus and lease out the building to radiation oncologists, who would still collect the professional and technical fees.

However, Davis said Tuesday there were some discussions about removing the ordinance before the assembly introduced it, but ultimately all stakeholders wanted a little more time to consider the options.

“This is a 20-year decision that they are getting ready to make,” Davis said. “So if nothing changes in the next 30 days in regards to Dr. Halligan’s position, it probably will be pulled at the next meeting. But I think the group decided there was really no reason to shut that door tonight and really eliminate any of Dr. Halligan’s options.”

On Friday, Davis said the hospital’s idea was “pretty much dead in the water” and CPH’s plans for the comprehensive center would now fall into “fragmented cancer services kind of scattered around.”

Halligan confirmed Tuesday he would continue with Peninsula Cancer Center as proposed.

“I have told them our plans are to move forward, but they were requesting that I at least consider their points further,” he said during a break in the assembly’s meeting.

Halligan likened the situation to a “difference of philosophy,” agreed he wanted to maintain aspects of “physician independence,” and, moreover, thought his proposal would be sufficient, despite being off campus. 

“The clinical aspects of having our unified cancer program right there where we see it, since the overwhelming majority of the cases are as outpatients, is going to be the best fit for patients and our clinic itself,” he said. “I don’t have any hostility toward (Kenai Peninsula Borough) Mayor (Mike) Navarre asking for it to be kept on the agenda.”

The relationship between CPH and Halligan, he said, has “been much more cooperative,” and he has tried to “cut out the past as far as some of the behavior that happened.”

Central Peninsula General Hospital, Inc. board president Lore Weimer said there aren’t any plans for further formal talks between the two sides, but CPH is “holding out hope for an on-campus solution.”

“And maybe continue the dialogue between the borough, him and us and other stakeholders,” she said. “We would like him to see the advantages of the on-campus solution.”

Navarre said the bottom line is having the service in the area.

“If Dr. Halligan is going forward with his project, at that point it really wouldn’t make any sense (for CPH to continue) because he can get under construction much quicker than we can and if that is the case it makes no sense to have two competing projects at that point in time,” he said.

In other news, the assembly:

• Introduced, unanimously, Ordinance 2011-19-71, which seeks to appropriate $35,000 to pay for outside legal counsel to help defend the borough against a lawsuit filed by Kahtnu Ventures, LLC, regarding its proposal to build an ambulatory surgical center in Kenai and a requested an injunction against the Department of Health and Social Services decision that the hospital did not need a Certificate of Need to finish its fourth operating room. The borough and CPH are listed as parties. Public testimony is scheduled for Feb. 28.

• Introduced, unanimously, Oridnance 2011-19-70, which seeks to appropriate $200,000 to hire a consultant to assist the borough in curbing health care costs in the borough and investigate other options. Public testimony is scheduled for March 13.

• Assembly member Linda Murphy was absent.


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Smith1rk 02/18/12 - 07:04 pm
Fact slinging...

Dr. Hallingan states “Mr. Smith first asked me personally to bring cancer treatments to the Kenai on my first visit to Soldotna shortly after I first arrived in Anchorage 4 years ago. I wish to express my extreme surprise and disappointment at his vitriolic and inappropriate comments.”
Fact: I never asked Dr. Halligan to bring cancer treatments to the Kenai on his first trip to Soldotna four years ago. I asked Dr. Halligan if he would be interested in providing the professional radiation oncologist services if we built a comprehensive cancer treatment center on the CPH campus.
Fact: The inability of CPH Internists and Anchorage Medical and Radiation Oncologists to coordinate care for patients diagnosed with cancer on the Central Kenai Peninsula has resulted in harm to several patients. Although several patients have been harmed in the CPH Infusion Center in the past, the majority of patients have received outstanding care from CPH oncology nurses and PIM physicians, despite the nurses frustrations with coordinating their patients’ care with PIM and the Anchorage groups.
Fact: The CPH nurses, patients, community, and some CPH physicians have consistently asked the CPH administration to recruit or arrange to have a full time board certified medical oncologist on the Peninsula.
Fact: Drs. Bramante, Kelley and I traveled to Anchorage to ask both medical oncology groups if they were interested in providing a full time board certified medical oncologist to the Peninsula.
Fact: Both groups told us to more or less pound sand.
Fact: CPH began an all out effort to recruit a medical oncologist to CPH.
Fact: CPH entered into negotiations with a highly qualified and highly respected board certified medical oncologist from Washington, Ellen Chirichella MD.
Fact: CPH was not going to be successful in recruiting Dr. Chirichella unless we could facilitate her developing a relationship with a medical oncology group in Anchorage and bringing radiation oncology services to the Peninsula.
Fact: CPH arranged for Dr. Chirichella to meet with Alaska Oncology/Hematology and Dr. Chung (medical and radiation oncologists at Alaska Regional) and Katmai Oncology and Dr. Halligan (medical and radiation oncologists at Providence)
Fact: As it became apparent CPH was going to be successful in recruiting a highly qualified and respected board certified medical oncologist, both medical and radiation oncology groups in Anchorage tripped all over themselves trying to impress CPH and Dr. Chirichella as they now knew the majority of the cancer referrals from the Peninsula would come from Dr. Chirichella.
Fact: CPH let both Drs. Chung and Halligan know that it was our intent to build a comprehensive cancer treatment center on the CPH campus with medical and radiation oncology in a Planetree environment. (personalizing, humanizing and demystifying the healthcare experience). However, we were requested by several politicians not to present the comprehensive cancer treatment center to the KPB Assembly until after the mayoral elections. Both Drs. Chung and Halligan were notified of this timeframe.
Fact: After being notified of this timeframe, Dr. Halligan and his business partner presented an exclusive agreement to CPH administration that stated we would only deal with them and not Dr. Chung.
Fact: CPH administration denied this exclusive agreement.
Fact: While waiting for the KPB mayoral election to take place, and recognizing that CPH administration was not going to sign an exclusive agreement, Dr. Halligan began plans in the interim to buy land, and build his own radiation oncology treatment facility to avoid a competitive bidding process with Dr. Chung.
Fact: Dr. Halligan and his business partner announced their plans to build their own radiation oncology treatment facility at the public hearing for the Kahtnu Ventures, LLC Ambulatory Surgery center, before CPH could present a resolution for a comprehensive cancer treatment center to the new KPB administration and Assembly.
Fact: Every radiation cancer treatment center in Alaska resides on the campus of an acute care hospital.
Question: While Dr. Halligan may currently accept all patients regardless of ability to pay in Anchorage (Does Providence require this in his exclusive service agreement?) what will happen when reimbursements decline, and Dr. Halligan’s business is on the hook for both professional and technical fees in an off campus building on the Peninsula? Will he “lose money” for the benefit of Peninsula residents?
Opinion: (or vitriol as defined by Drs Halligan, Krull and Carver) If Dr. Halligan is only treating approximately 8 patients at a time on the Peninsula, and reimbursements decline to the point where his professional and technical services are no longer profitable, he will have two options. First, he can sell the off-campus radiation treatment center to CPH or Providence. Second, he can limit his services to self pay and Medicare patients and send these patients to Anchorage. Thus, the patients who the most vulnerable, and those with the fewest resources will be sent to Anchorage to be treated in the non-profit Providence cancer treatment center where Dr. Halligan will only be out the professional fees, since he does not own the equipment at Providence. If the comprehensive cancer treatment center was on-campus, CPH could require all patients in the center be treated regardless of their payor source.
Opinion: The KPB Administration and Assembly should not be held hostage by a physician who has taken advantage of their cumbersome and non-agile ownership/governance structure to present a proposal that is completely self-interested, and then use scare tactics to threaten politicians who are not used to making good business decisions. (vitriol)
Opinion: (I’m sure this one will be classified as vitriol and an ad hominem attack) – While Dr. Chung has respected the process, Dr. Halligan has violated one of CPH’s core values – Integrity. I am sure he has been a fine clinical physician to several KPB residents in Anchorage, but, in this proposal, he is acting as a self-interested physician to the detriment of KPB residents and taxpayers.
Hopefully, Mayor Navarre and the KPB Assembly members will carefully consider the resolution that will be before them on March 13th. Dr. Krull states Dr. Halligan's proposal should be accepted with one word - THANKS. I believe the community should accept it with two words - NO THANKS.

rustyinsoldotna 02/22/12 - 01:18 am
location of proposed cancer center?

I am a resident of Soldotna and have a concern for the development of a cancer center near and adjacent to residential areas. I believe the site that is being looked at is next to the hospital between Rockwell and Katmai Ave. There are numerous residential structures located adjacent and near the mentioned site. This land is zoned for limited commercial and the intent of the code as defined in 17.1.260-A, " intent. The Limited Commercial District (LC) is intended to provide transition areas between commercial and residential districts by allowing low volume business, mixed residential, and other compatible uses which complement and do not materially detract from the uses allowed within adjacent districts. "

A conditional use permit would have to be approved to build such a facility at this location and I believe this would involve public comment. Under the city zoning code, "Institution Health Care", defined by the code as:

Institution, Health Care" means an institution or facility, whether public or private, principally engaged in providing services for health maintenance, diagnosis or treatment of human disease, pain, injury, deformity or physical condition, including but not limited to a general hospital, special hospital, mental hospital, public health center, extended care facility, nursing home, intermediate care facility, tuberculosis hospital, chronic disease hospital, maternity hospital, outpatient clinic, dispensary, home health care agency and a bioanalytical laboratory or central service facility serving one or more such institutions, but excluding community residences"

Limited comercial zoning does allow for medical offices without a conditional use permit , however, i believe the definition of "institution Health Care" clearly applies. The city code 17.10.120-conflicting regulations states "Should a conflict between the provisions of this zoning code and any other ordinance or law occur, then the more restrictive provision of law shall control." Thus the proposed center would fall under the category of needing a conditional use permit (CUP). There is a criteria that must me met for a CUP to be granted. They are as follows:

General Standards. All of the following standards shall be met before a conditional use approval may be granted:
The use and the development scheme for the use is in harmony with the intent of the zoning district in which it is to be located and with any specific standards associated with that conditional use within the district;
The use is in harmony with the general standards of this zoning code, the Comprehensive Plan, and surrounding land uses;
The use shall be so located and arranged on the site to avoid significant noise, glare, odor or other nuisances and dangers;
The development of the use shall not significantly impair the value of the adjoining property;
The size and scale of the use is such that it shall be adequately served by existing public services and facilities; and
Granting of the conditional use shall not be harmful to the public safety, health, or welfare.

I have a few concerns if the center is to be located in the mentioned tract.

1. What safety precautions will be taken by the center to ensure public safety and who ultimately regulates them?

2. Has noise pollution from the coolers been considered as an impact on a residential area?

3. Has there been a assessment of the proximity of the center and a helicopter pad?

4. Will the direction of the radiation be pointed at resitential homes

5. Is the intent of the city code, pertaining to limited commercial, truly meant to act as a buffer?

6. Would developing the center meet the intion of the city code?

I am a proponent of a cancer center public or private, however I believe we need to look closely at the location and ensure the public that development is done in a responsible and open manner according to the law.

Rusty Hippchen

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