Doctors Criticize Plan for Merger of Hospitals as a Monopoly : Medicine: Some physicians say that if the chain that owns Los Robles takes over Westlake facility, it would eliminate competition and lower the standard of care.

Several Conejo Valley doctors are sharply criticizing a giant hospital chain’s efforts to buy Westlake Medical Center, charging that the deal will create a medical monopoly.

They also say the hospital chain, which already owns Los Robles Regional Medical Center in Thousand Oaks, has submitted a misleading application to federal regulators who still must decide whether to allow the transaction.

Critics of the deal have written and called the Federal Trade Commission, trying to get the regulatory agency to block the purchase, or at least give it close scrutiny.

For years, Westlake Medical Center in Westlake Village has competed fiercely with its larger rival, Los Robles. Now, Columbia/HCA Health Corp., the 317-hospital chain that owns Los Robles, wants to buy Westlake.

Doctors said they feared federal approval of the deal would put an end to healthy competition that had fostered innovation and improved the quality of care at both hospitals.

“It’s very much a monopoly,” said Dr. Karie McMurray, chief of obstetrics at Westlake. “There’s no other place you can go to now.”

Columbia/HCA officials denied that they were creating a monopoly.

“It’s not exactly like taking out the competition. There’s plenty of other hospitals in our service area that we compete with,” said Ken Underwood, chief operating officer of Los Robles, citing hospitals in Simi Valley and Camarillo.

But doctors said patients in Thousand Oaks or Westlake Village who are giving birth or who need emergency room medical care are unlikely to travel to Simi Valley or Camarillo.

“The reality is, most of the people in this valley don’t go to either of those places,” said Dr. Robert A. Grossman, an obstetrician who was chief of staff at Westlake from 1992 to 1994.

In its application to the FTC, Columbia/HCA Healthcare Corp. says the acquisition “is unlikely to pose any adverse competitive effects.”

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The application asks the FTC to consider Westlake Medical Center as part--a small part--of the highly competitive Los Angeles County market. Never does the 16-page document mention Los Robles or the Conejo Valley market.

“I think it’s ridiculous. I think it’s terrible,” Grossman said.

Critics of the transaction said the FTC should examine the transaction’s effects on the market defined by the geographic boundaries of the Conejo Valley, not the political boundaries of Los Angeles County. Westlake Medical Center lies just inside Los Angeles County.

Columbia/HCA’s proposed acquisition of Westlake shows even more chutzpah, critics say, because it comes as part of a larger, multi-hospital deal that developed after the FTC cited a monopoly in another community.

Federal regulators mandated that the hospital chain sell the Aiken Regional Medical Center in Aiken, S.C. As part of that deal, Columbia/HCA will acquire Westlake from a rival chain.

In essence, critics charge, Columbia/HCA is obeying the government’s orders to get rid of one monopoly, but in the process is creating another in the Conejo Valley.

An FTC official said the agency is still reviewing the case but said regulators would work to avoid eliminating competition from the Conejo Valley market.

“It would be perverse,” said Elizabeth Piotrowski, deputy assistant director of the FTC’s compliance division.

Piotrowski said the FTC will carefully examine all sides of the proposed deal between Columbia/HCA and Universal Health Services Inc.

And she said while Columbia/HCA was “free to put forth whatever markets they think are appropriate” in their application, the commission will also do its own analysis of the deal’s effects on the Conejo Valley.

Those effects have already been the object of intense speculation among local physicians.

“The competition has led to the betterment of both hospitals. I would hope to think that the lack of competition wouldn’t allow for complacency to set in,” said Dr. John Hess, a cardiologist who practices at Westlake and Los Robles.

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Some said the merger would allow for the reduction of costs, ending costly duplication of services. But doctors said the savings would probably be passed on to Columbia/HCA shareholders in the form of profits rather than to patients in the form of lower health insurance premiums.

Steve Valentine, a health care consultant familiar with the Conejo Valley market, said some of the doctors at Westlake might be upset because they were losing bargaining leverage they had used to play the two hospitals against each other. But he added that the purchase, if approved, would give Columbia/HCA a “a very long stretch of geographic area that really does not have any competing hospitals.”

McMurray said the reduced leverage for physicians could not only affect their pay, but would also mean doctors could no longer threaten to take patients elsewhere when standing up against giant hospital corporations for high quality patient care.

“You really are powerless as a physician, and that’s kind of scary,” McMurray said.

The FTC’s public comment period on the merger ends this Friday. Comments may be addressed to the FTC, Office of the Secretary, 6th Street and Pennsylvania Avenue N.W., Washington, D.C. 20580. The commission will consider the comments and vote on the deal in the following weeks.