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Virginia officials say Chesapeake Regional Medical Center can start performing open heart surgeries, the conclusion to a years-long battle for approval that included legal infighting up to the state Supreme Court.

State Health Commissioner Dr. Colin Greene recently approved the hospital's application for a certificate of public need for the procedures.

It’s a convoluted process Virginia uses to regulate health care operations.

"All the twists and turns, roadblocks, nuances, make today all the more gratifying," President and CEO Reese Jackson said Monday. "Now, with approval on hand, we can move forward, innovate and provide consumers with a healthy choice."

He said the hospital embarked on the process in part because of population growth in Chesapeake, particularly among seniors.

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Photo by Katherine Hafner

Chesapeake Regional's new hybrid operating room, which will be used for open heart surgeries in early 2024. As seen January 2023.

Chesapeake Regional first applied to launch an open heart surgery program in 2017. Staff with the health department recommended approval as long as the hospital agreed to do a certain amount of charity care, according to court documents.

Sentara Healthcare soon petitioned to be involved in the decision. The hospital system disputed some of the medical numbers on which Chesapeake Regional’s application was based and argued that the project didn’t meet the standards for community need. 

In 2018, then-Health Commissioner Dr. Norman Oliver agreed and rejected the heart surgery application, stating in part that it duplicated existing services in the region and did not improve geographic or financial access for residents.

Chesapeake Regional sued Sentara and appealed the state’s decision in court, where it made its way to the Virginia Supreme Court. Last spring, a justice sided with the Chesapeake system, ruling that the state had erred in how it calculated public need.

That allowed the health system to re-apply last summer. Jackson told WHRO at the time that the Supreme Court's decision clarified what state officials should weigh in their deliberations.

Chesapeake Regional had also codified in law its ability to include North Carolina residents – who make up about 15% of its overall patient population –  in the numbers. 

In the meantime, Sentara agreed to drop its opposition to the heart program during a standoff over unrelated legislation at the General Assembly in 2019, the Daily Press reported.

The certificate of public need system was created in 1973 because of a federal mandate that health care providers prove a community needs a facility before opening one. The mandate was repealed in 1986 but the program in the Commonwealth persists, according to the Medical Society of Virginia

Commissioner Greene's approval stipulates that the hospital's open heart program will "inject beneficial competition in a highly concentrated" surgery market, according to Chesapeake Regional.

Asked Monday whether that means offering lower prices than elsewhere, Jackson said "we already have the lowest prices."

"We think there's enough room for us and we intend to make the most of it," he said.

Dr. Tom Carter, medical director of cardiovascular surgeon services, said they intend to use a "universal bed model," meaning patients can stay in one place while seeing a range of providers at different phases of their stay. 

He also said offering surgery on-site will prevent patients from having to travel between providers.

"We believe that for good quality heart surgery care, you need your cardiologist and your heart surgeon involved, and you can't do that in a different institution."

The hospital will immediately begin installing equipment and hiring surgeons and other staff. Construction is almost complete on a new hybrid operating room that doctors will use for the procedure.

Officials plan to start performing the surgeries early next year. Jackson said they expect to handle about 150 surgeries the first year, increasing to about 250 in the years following.

The heart program is one of several massive efforts the hospital’s undertaking for a total of about $150 million, including a new critical care tower, which opened in October, and increasing the size of postpartum rooms.