Attack of the Three-Million-Dollar Tumor Removers

Two local hospitals take a stab at explaining why Miami needs more than one high-tech gamma knife

Since the time of its invention more than a decade ago, the gamma knife has been hailed for its ability to remove brain tumors that are considered impossible to reach through conventional surgery. Developed in Sweden, the instrument uses radioactive cobalt to excise tumors with gamma radiation, without incisions or damage to surrounding brain tissue.

The technology is expensive: each knife costs more than three million dollars. Currently only thirteen knives are in use in the United States, the nearest being in Atlanta. Only Los Angeles has more than one knife A until now. Within the next several months, not one but two local hospitals A HealthSouth Doctors' Hospital in Coral Gables and Jackson Memorial Hospital in Miami A will introduce gamma-knife programs.

Incredibly, officials at both hospitals admit this area probably doesn't need more than one gamma knife. But the race to bring the new technology to Miami has not been based on need. Rather, it has amounted to insults, arrogance, and a clash of egos at the highest levels of hospital administration.

As a result, both programs stand a greater risk of failing.
Art Tedesco, the administrator for Doctors' Hospital, says his staff began discussing the acquisition of a gamma knife nearly a year ago. This past September, Tedesco says, after he put down a $900,000 deposit on the new equipment, he learned that Jackson was interested in pursuing a similar project. "We wanted to do this with Jackson," explains Tedesco, noting that the hospital already runs two joint programs with the University of Miami at Jackson. "We tried very hard to work with them, but they refused. And then they announced that they were going to get one on their own. This is the kind of equipment where you only need one in an entire state."

Initially Tedesco set up a meeting last November with Ira Clark, Jackson's president. When the two men met, Tedesco claims, he told Clark he thought it would be a foolish waste of money for both hospitals to purchase gamma knives and he offered to participate in a joint venture. Clark demurred. Tedesco says he then suggested that Jackson purchase the knife Doctors' had ordered and simply reimburse the hospital for the down payment that had already been made. "I told him that if he didn't want to work with us, then fine, he should just buy ours," Tedesco sighs. "We were willing to let them have it."

Although Tedesco followed up the November conversation with telephone calls and two letters, Clark never responded. (Clark also failed to return messages left for him by New Times seeking comment for this story.)

In his last letter to Clark, dated January 20, Tedesco wrote that Doctors' Hospital had no choice but to go ahead with its plans, since to do otherwise would mean losing the $900,000 deposit. (The hospital has hired two specialists, including one doctor who has performed more than 600 procedures with the gamma knife.) "We think that our community would best be served with only one institution providing gamma knife services," Tedesco wrote. "This is precisely why I advised you, prior to [Jackson's] decision to buy a gamma knife, that [Doctors' Hospital] had already purchased this same equipment. At that time we also informed you that we would be willing to support an exclusive gamma knife site at Jackson Memorial Hospital if you would assist us in securing release and/or satisfaction of our obligation relating to the gamma knife service. In spite of our willingness you never responded to our offer.... Regrettably, any options that we may have had have now expired."

Although Clark hasn't spoken directly to Tedesco about the gamma knife since November, he hasn't been completely silent about the matter. During a meeting with members of Jackson's governing board, the Public Health Trust, Clark made a series of disparaging remarks about the smaller, community-based Doctors' Hospital. At one point Jackson's president compared Doctors' purchase of a gamma knife to that of "a four-year-old getting a car," according to published reports in Health Manager News.

"He certainly expressed those sentiments," affirms Mark Cohen, a Jackson spokesman. "Whether he said a four-year-old or a five-year-old, and whether he described it as a car or a rocket ship, I don't remember." Because Jackson is a public institution whose purpose is to serve all segments of the community, as well as to be a teaching and research center, Cohen argues, it is far more appropriate for the gamma knife to be located there.

As for Tedesco's request to Clark that Jackson purchase the knife that Doctors' Hospital had already ordered, Cohen explains, "It's not Ira's job to be a part of their business. We don't consult with them about our business decisions and we don't see why they would expect to be included in ours." It was well known, Cohen adds, that Jackson wanted to buy a gamma knife. In his opinion, Doctors' presented the project to the larger hospital as a fait accompli in order to force its way into a joint program.

Meanwhile, Jackson has not had to look far to secure its own gamma knife. Art Tedesco says that when he sat down with Clark in November, he was introduced to Cal Kovens, who was described to him at the time as "an interested party." Kovens runs Cal Kovens Construction, a large local construction company. He is also the largest shareholder and chairman of the board of American Health Services, which owns Radiosurgery Center Incorporated (RCI), the company that will provide Jackson with its gamma knife.

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