Dr. Gary Poling wants to offer patients in Raleigh County and the surrounding area a deal.

Poling has an ultrasound machine he uses to diagnose everything from kidney stones to gallbladder disease to clogged arteries.

Let's say you need an ultrasound of your abdomen. Poling, a family practice doctor in Beckley, will charge you $360. If you go to the nearest hospital - Raleigh General - you'll pay $830, on average.

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Dr. Gary Poling (right) and his partner, Dr. Scott Lostetter, have battled with the state Health Care Authority for six years, trying to win approval to perform ultrasounds on patients referred to them from other physicians.

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"We could do a lot more ultrasounds in our office," said Poling, who spent $175,000 on the ultrasound machine. "Lots of doctors ask if we could do them. We've had patients ask us if we could do them, but we've had to turn them away."

Doctors such as Poling are becoming increasingly frustrated with state regulations that require them to obtain a special certificate before they can expand services. They want the state to re-examine the way it regulates health care.

A committee of West Virginia legislators studied the review process last year. Although no legislative changes are expected during the current session, lawmakers said they plan to continue to investigate the issue during interim meetings throughout the year.

The certificate-of-need requirement - overseen by the West Virginia Health Care Authority - is designed to limit health-care costs, improve quality and increase access. However, doctors say the hoops and hurdles drive up health costs and limit competition. They say the regulations favor hospitals over physicians, and that the process is unfair.

"Certificate of need was adopted to regulate expansion of unnecessary health services," Poling said, "not to provide a monopoly so hospitals could charge outrageous rates and corner the market so people have no choice."

Poling and his partner, Dr. Scott Lostetter, can do ultrasounds on their own patients, but not on people referred to them by other doctors.

Normally, the Health Care Authority doesn't interfere with private physician practices, but doctors' offices that offer diagnostic imaging services to a substantial number of outside patients are subject to state review. The Health Care Authority considers such practices "diagnostic centers," said Sonia Chambers, chairwoman of the Health Care Authority.

Poling has battled the state unsuccessfully for a certificate of need for six years. He's taken his plea from the Health Care Authority to an administrative law judge to a circuit judge, and all the way to the West Virginia Supreme Court. He hired his brother to serve as his lawyer.

Last week, Poling was back in Charleston at the Health Care Authority's boardroom, making his case yet again after waiting the required year to reapply.

"I want to be fair to the people," Poling said. "I want to give them a fair shake, and [the state] won't let me do it."

Raleigh General Hospital executives repeatedly have objected to Poling's application.

Hospital administrators say there's no need for additional ultrasounds in the region. Therefore, if there's no need, the state won't give Poling permission to perform them.

Dr. Gary Poling wants to offer patients in Raleigh County and the surrounding area a deal.

Poling has an ultrasound machine he uses to diagnose everything from kidney stones to gallbladder disease to clogged arteries.

Let's say you need an ultrasound of your abdomen. Poling, a family practice doctor in Beckley, will charge you $360. If you go to the nearest hospital - Raleigh General - you'll pay $830, on average.

However, Poling can't offer ultrasounds to patients referred to him by other doctors. The state won't allow it. He doesn't have the required "certificate of need."

"We could do a lot more ultrasounds in our office," said Poling, who spent $175,000 on the ultrasound machine. "Lots of doctors ask if we could do them. We've had patients ask us if we could do them, but we've had to turn them away."

Doctors such as Poling are becoming increasingly frustrated with state regulations that require them to obtain a special certificate before they can expand services. They want the state to re-examine the way it regulates health care.

A committee of West Virginia legislators studied the review process last year. Although no legislative changes are expected during the current session, lawmakers said they plan to continue to investigate the issue during interim meetings throughout the year.

The certificate-of-need requirement - overseen by the West Virginia Health Care Authority - is designed to limit health-care costs, improve quality and increase access. However, doctors say the hoops and hurdles drive up health costs and limit competition. They say the regulations favor hospitals over physicians, and that the process is unfair.

"Certificate of need was adopted to regulate expansion of unnecessary health services," Poling said, "not to provide a monopoly so hospitals could charge outrageous rates and corner the market so people have no choice."

Poling and his partner, Dr. Scott Lostetter, can do ultrasounds on their own patients, but not on people referred to them by other doctors.

Normally, the Health Care Authority doesn't interfere with private physician practices, but doctors' offices that offer diagnostic imaging services to a substantial number of outside patients are subject to state review. The Health Care Authority considers such practices "diagnostic centers," said Sonia Chambers, chairwoman of the Health Care Authority.

Poling has battled the state unsuccessfully for a certificate of need for six years. He's taken his plea from the Health Care Authority to an administrative law judge to a circuit judge, and all the way to the West Virginia Supreme Court. He hired his brother to serve as his lawyer.

Last week, Poling was back in Charleston at the Health Care Authority's boardroom, making his case yet again after waiting the required year to reapply.

"I want to be fair to the people," Poling said. "I want to give them a fair shake, and [the state] won't let me do it."

Raleigh General Hospital executives repeatedly have objected to Poling's application.

Hospital administrators say there's no need for additional ultrasounds in the region. Therefore, if there's no need, the state won't give Poling permission to perform them.

"I don't believe their application demonstrates there's an unmet need in the service area," Raymona Kinneberg, a consultant hired by Raleigh General, said during last week's hearing.

Poling and Raleigh General have argued endlessly over whether there's a need for more ultrasounds in Raleigh and the surrounding counties.

They've done studies. The Health Care Authority has done studies. The numbers differ. The conclusions differ.

Raleigh General says there already are enough ultrasound machines in the region. Poling says there aren't enough.

The two sides also continue to bicker over how far people will drive to get an ultrasound. The larger the area, the better Poling's chance of winning approval. A smaller "service area" favors the hospital.

Raleigh General performs the bulk of ultrasounds in the region - 24,000 out of 33,000 a year, according to testimony last week. The hospital has eight machines - up from five when Poling first filed his application to expand ultrasound services in 2002.

Poling says that proves there's a need for more ultrasounds, but hospital executives counter that they're upgrading equipment, replacing older technology, not adding new machines because of an increased demand for ultrasounds.

Why does the hospital charge more than twice what Poling charges for some ultrasounds?

Mike Baker, Raleigh General's administrative director of imaging services, said the hospital must take all patients, including those who can't pay. The higher costs help offset those losses.

"We have more bad debt," Baker said. "We're open 24/7."

Across the state, hospital executives say they're open to taking a second look at West Virginia's certificate-of-need regulations. They point out, though, that the process seems to be working. West Virginia hospital costs rank 44th in the nation, even though the state has one of the oldest, sickest and poorest populations in the country.

"If there's an opportunity to improve [certificate of need], then we're certainly ready to provide input and work collaboratively with all the stakeholders," said Tony Gregory, legislative liaison for the West Virginia Hospital Association. "We strongly support the continuation and improvement of the program to control health costs, increase access and improve quality of care."

Poling said his dispute with Raleigh General boils down to money. Imaging is one of the few profitable services hospitals provide. Those profits are used to subsidize money-losing services, such as emergency care.

Poling understands that, but he doesn't think hospitals should be able to limit competition. He doesn't think patients should have to pay more.

"The bottom line is: Let the person who offers the best quality, the best price, let them compete," Poling said. "They charge $800 because they can. How can you make somebody pay that much more?"

To contact staff writer Eric Eyre, use e-mail or call 348-4869.