Concord Hospital's 10-year-old cardiac surgery department will be shut down temporarily this summer after both of the hospital's surgeons took positions elsewhere. CEO Mike Green said the hospital has stopped scheduling new surgeries and does not expect to resume them until the fall.

The hospital is exploring several options for replacing the surgeons, who perform about 175 open-heart operations a year. Green said he's considering hiring doctors as hospital employees but has also spoken with a number of large Northeast teaching hospitals about partnerships.

In the meantime, patients who need heart surgery will be referred elsewhere. Dr. Carl Levick, the managing partner of Cardiac Associates of New Hampshire, the Concord-based cardiology practice, said he will send his patients to Dartmouth-Hitchcock Medical Center, Catholic Medical Center and Boston hospitals for surgery, depending on his patients' conditions and preferences.

But most cardiac care at the hospital will continue. Recent developments that allow doctors to open blocked arteries without major surgery have led to significant reductions in the number of necessary heart surgeries since the department opened. Those procedures, collectively called cardiac catheterization, will continue through the summer, though patients with rare complications may need to be transferred to a nearby cardiac center. Green said that arrangements for expedited transfer of such patients are still in negotiations.

Concord Hospital's cardiac surgery department was formed in 1998 through a collaboration between Concord Hospital and Dartmouth-Hitchcock Medical Center. Since then, Dartmouth has employed the surgeons and their support staff and has provided administrative oversight for the program.

About six months ago, the hospitals decided to end that relationship. Green said that he started a search for new surgeons, which included negotiations with one of the Dartmouth surgeons who had been practicing at the hospital. But that doctor opted to take a position elsewhere.

Despite that setback, Green said that recruitment was moving along until he thought he had struck a deal with Cardiothoracic Surgical Associates of Manchester. The practice, which has provided heart and lung surgery at Catholic Medical Center for more than 20 years, had agreed to hire new doctors and expand its practice into Concord, Green said. The groups had developed a contract with target dates and new positions, but when the agreement was being vetted by lawyers, executives from Catholic Medical Center intervened, Green said.

"The leadership at CMC made a determination that if the surgeons from there spent any time up here that it would have a catastrophic, deleterious impact on the quality of the care at CMC," Green said. "They told them that if they did do it, that because of the impact, and their concerns about the quality of care at CMC, that they wouldn't have any choice other than to recruit additional cardiac surgeons who would be competing cardiac surgeons down at CMC."

Rivalry between the cardiac surgery programs is not new. Catholic Medical Center, which has offered cardiac surgery for far longer than Concord Hospital, tried to prevent Concord from adding its heart surgery service when the hospital first applied for state permission in 1997. At the time, CMC executives argued that Concord was not a large enough market to provide quality care and that by taking patients from CMC, it would hurt quality in Manchester as well.

The state board gave Concord the go-ahead, and Optima Health, the company that owned CMC at the time, sued to have the decision reversed, though it was unable to do so.

Gail Winslow-Pine, a spokeswoman for CMC, said that hospital executives did not block the deal between the surgeons and Concord Hospital, but that doctors in the practice decided that an expansion would not be a good idea.

"When the cardiothoracic surgeons met with the leadership at CMC, they decided they would not be serving two hospitals, that their capacity was such that they could not take that on," Winslow-Pine said. "We have had a stable and secure and exclusive relationship with the surgeons for over 21 years."

A message left for Dr. David Charlesworth, who Green described as his primary contact at Cardiothoracic Surgical Associates of Manchester, was not returned.

Possible contenders to take over Concord Hospital's heart surgery include Columbia-Presbyterian Hospital in New York and three Boston hospitals - Massachusetts General, Brigham and Women's, and Beth Israel Deaconess.

According to Levick, such partnerships between large teaching hospitals and smaller community hospitals are common in cardiac surgery. Columbia-Presbyterian runs several such departments, and many Massachusetts community hospitals use cardiac surgeons from the Boston hospitals.

Single page