Legal action against Kuipers’ decision on children’s heart centers

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Minister Kuipers of VWS sees no ‘decisive reasons’ to deviate from his earlier decision to concentrate the number of pediatric heart centers at Erasmus MC and UMC Groningen.

The two centers that have not been designated, UMC Utrecht and CAHAL (a partnership of LUMC and Amsterdam UMC) announced on Thursday that they will contest the decision.

Minister Kuipers announced in a letter to Parliament on Thursday that his decision to reduce the number of children’s heart centers to two locations is final. Two months ago he had announced his intention and explained it to the House of Representatives. Since then, the institutions involved have lodged both written and oral objections. All this, however, could not change the mind of the minister.

Three locations

Kuipers maintains that it is better to concentrate interventions in children with congenital heart defects and highly complex interventions in adults with congenital heart defects in two places. Sticking to four would jeopardize ‘the continuity of care’.

Earlier objections suggested choosing three locations, but Kuipers has pushed that alternative aside. He points to the ‘three pillars’ on which the decision is based: ‘greater chance of survival, relieving the great pressure on professionals and the vulnerability in the continuity of care, and offering a structural and robust solution’.

Field standard

In his letter, the minister discusses the ‘field standard’ of at least sixty interventions per year in neonates, a figure that has been discussed quite a bit, both during the debate on 22 February and elsewhere. For example, the IGJ calls the number of sixty a ‘current field standard’. One of the professional groups, NVT (Dutch Association for Thoracic Surgery), has said that it does not see sixty as the field standard. The minister notes that the NVT ‘has not replaced this with any other standard either’. The IGJ has repeated its earlier position that the number of sixty ‘can be used as a volume standard’.

The minister also discusses the choice for Groningen. He expects that the UMCG’s designation will lead to a ‘more balanced increase in travel time for patients from all parts of the country than if concentration is concentrated in two parts of the Randstad’.

Legal action

LUMC is ‘extremely disappointed’ with the final decision to concentrate pediatric heart surgery in only two centers, of which CAHAL is not a part, a spokesperson said. “We are concerned about the effects of this decision on the quality and availability of care for current and future patients, for our healthcare providers and for pediatric cardiac care in the Netherlands in general.”

UMCU Utrecht believes that the government ‘should have been clear in advance’ about the criteria to be applied and the distribution. It is taking legal action together with the Princess Máxima Center for Pediatric Oncology. In a response, both point out that ‘if the children’s heart center disappears from Utrecht, seriously ill children will have to deal with highly specialized and far-reaching parts of their treatment. [moeten] travel to another location where there is no oncological expertise. This entails major risks.’

The minister’s decision marks the start of a ‘transition period’ of two and a half years.

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