By Shelley Davis
Enquirer Columbus Bureau

COLUMBUS - Cincinnati physicians often refer breast cancer patients to the Proscan Women's Imaging Center, a for-profit service that doctors say allows women to receive a biopsy much faster than if they went to the local hospital.

Lynn Mahoney, vice president of operations for Proscan, said the physicians who own the center care enough about the quality of its services to invest in it.

"Who better to judge the quality of service, who better to decide what is good for their patients, than physicians?" she said.

State and hospital officials, however, question such practices. On Tuesday they announced new legislation that would prohibit doctors from referring patients to a hospital in which they invest money.

They said such referrals pose conflicts between doctors' responsibility to help patients get good care and their interest in helping a hospital they own a stake in succeed. In addition, backers of the bill argue that for-profit hospitals siphon money from community hospitals, taking away their ability to offer burn units and other critical services.

The bill "removes the conflict of interest between good medicine and good investment," said Rep. Jon Peterson, R-Delaware, who plans to introduce it in the Ohio House this week.

Legislation already prohibits doctors from referring patients to clinical laboratory services, home health care services and outpatient prescription drug programs in which they have a financial interest. Mahoney and others involved in specialty centers say they see no reason for the legislation.

"Reputable physicians who take the Hippocratic oath say there's no need for any legislation on this topic," she said.

Proponents of the measure argue that physicians shouldn't be placed in the position of having to choose between earning money for a hospital in which they may own a stake and providing the best care for a patient.

The legislation also lies at the center of a statewide debate about the merits and dangers of physician-owned "boutique" hospitals.

Facilities like a proposed for-profit orthopedic specialty hospital in New Albany, Ohio, a Columbus suburb, are harmful both to patients and to community hospitals, said J. Nick Baird, director of the Ohio Department of Health.

Specialty centers often don't provide adequate emergency services for patients, and the money patients spend there is drained away from community hospitals, he said.

"They undermine communities' access to high-quality health care," Baird said. "They leave hospitals without the dollars they now invest in burn units, neonatal intensive care units and poison control centers."

Proponents admit there is no evidence to prove specialized, for-profit hospitals are taking business and money away from community hospitals, but they say the legislation would prevent that from happening.

Dr. Carl Berasi, a Columbus orthopedic surgeon, questions how legislators can crack down on "boutique hospitals" without evidence to back them up.

"It's pretty easy to walk around and say all doctors are going to act unethical and cheat, but you have to ask, where is the evidence that this is a problem?" he asked.

Ken Howell, president of the Dayton Heart Hospital, a for-profit hospital, also opposes the bill. He said physicians who own the hospital did not develop the facility with money in mind - only better care.

"They have not taken a penny of financial gain out of the hospital," he said. "No physician is compensated differently if they refer or don't refer patients."

Howell added his facility provides emergency care, as required by federal guidelines, and said the hospital provides its fair share of care for the indigent, just as community hospitals do.

Competition can only benefit patients, by forcing hospitals to provide lower costs and better care, Berasi said.

"It would be like saying there shouldn't be any Gold Star Chilis because Skyline exists," Mahoney said. "Not all hospitals try to do all things anymore. We provide the very best equipment and the very best care to a community that benefits from it."

Those who oppose the bill say it was proposed as a way to help hospitals keep a monopoly on services.

"It is really infuriating that politicians can get away with mudslinging without data to back up their claims," Berasi said.

Cincinnati isn't home to a for-profit, specialized hospital, largely because the area is not typically viewed as a place where health care providers can make a lot of money, said Lynn Olman, president of the Greater Cincinnati Health Council.