HEIDELBERG, Germany – Starting May 1, there will be no more same-day surgery at the Heidelberg Health Center.

People who need colonoscopies, hernia repair and the few other low-risk procedures that were still being done at the health center will instead be referred to local German doctors.

Or depending on availability, patients could have their procedures done at Landstuhl Regional Medical Center. Officials said they expected most patients could be seen at Landstuhl if they preferred.

“We give the patients that option,” said Lt. Col. Lance Raney, Heidelberg’s deputy commander for clinical services.

The reasons for closing the same-day surgery unit include both safety and cost, Raney said.

“The population we support is getting smaller,” Raney said. “The demand is decreasing. As the volume goes down – as physicians, the fewer things we do, the less proficient we become. And the less we do, the more it costs in terms of procedures and personnel.”

And this time, Raney said, the closure is for real.

In July 2009, officials announced the end of outpatient surgery, citing declining patients and the downsizing of what had been Heidelberg Hospital into a health center. But the next month, they said same-day surgeries would continue indefinitely.

No explanation for the change was provided.

The end of the unit follows a dramatic reduction in services in 2008, when the obstetrics and gynecology unit and in-patient surgery in what had been a 63-bed hospital were closed. The emergency room was also closed that year, replaced by an acute care clinic for maladies that weren’t life-threatening.

The clinic’s hours have been repeatedly reduced. Starting Sunday, it will be closed on Sundays and federal holidays.

Not having emergency room capabilities affected in-patient surgeries, Raney said, limiting procedures and patients to only the lowest-risk. Colonoscopies, for instance, routinely done in doctors’ offices, have been the most usual procedure done in the unit, Raney said.

“We were averaging 20 a month,” he said.

Surgeons were also doing hernia repairs, knee arthroscopies, breast biopsies and occasional dental surgeries. All told, he said, there were some 10 surgeries or procedures a week.

The medical center has also been plagued by staff shortages caused by deployments, and surgical team members are due to deploy again.

Raney said he expected the most recent services cuts – a precursor to having no services as the Heidelberg and Mannheim garrisons close down – to create anxiety among both health care consumers and center staffers.

“It’s a big transition for our staff and the community,” he said. “Not only that, we have patients who have retired here.”

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Nancy is an Italy-based reporter for Stars and Stripes who writes about military health, legal and social issues. An upstate New York native who served three years in the U.S. Army before graduating from the University of Arizona, she previously worked at The Anchorage Daily News and The Seattle Times. Over her nearly 40-year journalism career she’s won several regional and national awards for her stories and was part of a newsroom-wide team at the Anchorage Daily News that was awarded the 1989 Pulitzer Prize for Public Service.

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