Firm Gambles on High-Tech Cancer Unit at Westlake : Thousand Oaks: Patients who commute are thrilled with plan aimed at boosting hospital’s occupancy. But some doctors warn of waste and gimmickry.

In a high-stakes scramble for east county patients, the parent company of the struggling Westlake Medical Center has agreed to put up $10 million to install a high-tech cancer care unit.

By focusing on a disease that strikes one in three Americans, Westlake administrators hope to boost the occupancy rate at the hospital, which is locked in competition with Los Robles Regional Medical Center in Thousand Oaks.

To do so, however, they will have to import millions of dollars worth of state-of-the-art equipment, including linear accelerators that bombard tumors with radioactive particles and sophisticated computers that guide tiny cancer-busting pellets into the brain’s innermost crevices.

“We want a comprehensive cancer care center, not a semi-, quasi-, almost-maybe center, and we will aggressively pursue that,” said Les Bell, chief financial officer of Salick Health Care Inc., a joint-venture partner that will split the costs and profits of the new facility with the hospital’s parent company, Universal Health Services of Pennsylvania.

Ventura County patients who commute two hours a day for treatment at Salick’s cancer care center at Cedars-Sinai in West Los Angeles are thrilled about the idea.

“The people at the center are attuned better to you because cancer is all they deal with, and they see it in such volume,” said Moorpark resident Joe Trovato, who suffers from a rare blood tumor. “If they had one out in Westlake, it would be just perfect.”

But independent physicians fear the new facility will siphon off their patients when it opens in mid-May.

Blasting Westlake’s plans as wasteful and gimmicky, the oncologists say the Conejo Valley simply does not have enough cancer patients to warrant a new facility. Furthermore, they add, their private offices have the same high-tech, high-cost equipment that is planned for the center.

Duplication of services in an already-bloated health care system could drive up costs for patients across the board, they warn, because administrators will have to subsidize underused machines by jacking up the prices of everything from cotton swabs to hospital beds.

And they offer more dire predictions as well.

Without enough patients, the hospital center and the independent oncologists may run at half steam, earning enough to stay in business but not enough to provide truly top-notch care.

“If they’re moderately successful and can reduce our patient load by 30% to 50%, that won’t be enough for them and it won’t be enough for us to upgrade our equipment, pay our support staff and deliver the same quality of care,” said Paul J. Miller, a radiation oncologist.

Yet analysts at Westlake Medical Center and Universal Health Services say they’re convinced their cancer unit will boom, drawing patients from throughout Ventura County with its round-the-clock care.

“Residents shouldn’t have to travel to Los Angeles if they want to see a foreign movie or go to a bookstore, and certainly not if they have cancer,” said Dr. Bernard Salick, whose firm will operate the Westlake facility.

“The purpose of our center is to make the Conejo Valley a major focus for cancer care throughout Ventura.” Salick, a kidney specialist, founded the company that bears his name after his then 6-year-old daughter was found to have bone cancer in 1983. She has since recovered.

Salick Health Care now runs nine cancer care centers across the United States, including the one at Cedars-Sinai, plus eight outpatient kidney dialysis wards. The company reported after-tax profits of $6.9 million in 1992.

Salick Health Care specifically wanted to hitch its latest cancer center onto a less-than-bustling hospital, and Westlake filled the bill, with its occupancy rate of 20% to 25% for the first three quarters of 1992.

“It was attractive to us because we have operating room time readily available and we have beds available,” said Anthony LaMacchia, executive director of the Cedars-Sinai cancer center.

Insisting that Westlake Medical Center is “not on shaky ground at all,” Alan Miller, chairman of the board of the hospital’s parent company, vowed to pump in as much money as necessary to create a “premiere cancer center that’s second to none.”

That attitude inspired Eileen Brown, a registered nurse for 22 years, to join the Cedars-Sinai cancer care center in 1991.

“The atmosphere is progressive and sensitive,” she said. “People are able to keep track of who they are as individuals, even when they lose their hair or are not feeling well.

“I put myself in their place. It frightens me to think that if I had cancer, I might get lost in a system and become a set of symptoms.”

The Westlake center will open in stages, starting with chemotherapy, a laboratory and a pharmacy and eventually expanding to include radiation therapy, bone marrow transplant and a breast care ward that will offer reconstructive surgery.

While Salick Health Care and Universal Health Services plan to fill the center with top-of-the-line machines, they will not hire any physicians. Instead, they hope the expensive equipment will lure oncologists to apply for affiliation with Westlake Medical Center and work in the cancer care facility.

It could be a hard sell, for the center requires oncologists to dramatically shift the way they do business.

When they join the center, physicians must transfer responsibility for the technical aspects of care--taking X-rays, mixing chemotherapy drugs, tallying white blood cells--to the health care professionals employed by Salick.

Yet oncologists say they earn half to three-quarters of their total income by providing these services. Fees for the “technical component” of care can cost a patient--and earn a physician--thousands of dollars a day.

Doctors affiliated with the center retain the right to set their own “professional charges” for actual time spent with a patient. But this income, while substantial, often amounts to less than 50% of a physician’s revenue.

Giving up the technical service fees is a gamble: doctors are betting they’ll cover their losses through additional professional charges gleaned as patients flock to a prestigious new facility. About 300 patients a day come for treatment at the Cedars-Sinai center, and Westlake administrators project a similar volume after a few years.

But an outspoken group of Conejo Valley oncologists, some affiliated with both Westlake Medical Center and Los Robles, insist they will never relinquish their independent practices.

“Outside of bone marrow transplant, there is nothing Dr. Salick can deliver in his center that we can’t provide in our own offices,” Dr. Robert Joseph said. “If Universal Health Services has the money, it would be better to spend it on other services for this community, which is not just a cancer community.”

While boosters of the new facility repeat that their center will be “comprehensive” and offer a package of services unavailable elsewhere, competing oncologists disagree--loudly.

First, they quibble about Salick’s description of the center as comprehensive.

The National Cancer Institute has designated 18 comprehensive care centers nationwide, including ones at USC and UCLA, because they offer experimental treatments and sponsor research. Without these features, Salick’s centers do not qualify as truly comprehensive, said Dr. Richard J. Steckel, director of the Jonsson Comprehensive Cancer Care Center at UCLA.

Some of Salick’s other claims have also come under fire.

For example, Salick boasts that his center offers 24-hour care. But the Cedars-Sinai staff members do not routinely provide chemotherapy or radiation after 6 p.m. and are available mainly for emergencies.

That’s no different from most doctors, who wear beepers at home and can meet acutely ill patients in a hospital emergency room if necessary, said Dr. Harry S. Menco, a medical oncologist.

Then there’s the concept Salick calls “under one roof”--radiation therapy right next to chemotherapy and down the hall from diagnostic X-rays, psychological counseling and a Ph.D.-staffed pharmacy.

That is slick advertising, oncologists say, a mere gimmick. Most patients use only one service at a time, alternating every few months between radiation and chemotherapy. As for the pharmacy and support group, they exist in most hospitals, where many private offices are.

However strenuously the oncologists object, however, patients say they like Salick’s plan for one-stop cancer treatment.

Leigh Ann Heneen, a registered nurse who works at Westlake and Simi Valley hospitals, takes her 3-year-old son to the Salick center at Cedars-Sinai because “you can park your car once and do everything you need to do.”

She also appreciates 24-hour care. When her son, a leukemia patient, runs a high fever in the middle of the night, she feels more comfortable taking him to the Los Angeles center than to a local emergency room, which may be crowded with accident victims or people in the throes of cardiac arrest.

Members of a community advisory committee from Thousand Oaks, Westlake Village and Agoura Hills, who recently toured the Cedars-Sinai cancer center to see what will be coming to their neighborhood, tended to agree.

“There’s some resentment about an outsider coming in,” said Thousand Oaks representative Edwin Trent. “But I think once it becomes a fait accompli, people will start cooperating.”