It took Marietta's WellStar Kennestone Hospital nearly a decade to break the monopoly on open-heart surgery, held for years by a handful of Atlanta hospitals. Gwinnett Medical Center —- the largest hospital in the state's second-largest county —- should not be similarly thwarted in its efforts to offer the lifesaving procedure.

State health-planning regulators last month approved the Gwinnett hospital's request for a Certificate of Need to establish a $33 million cardiovascular center. Predictably, several metro-area hospitals have already lined up to challenge the decision. Piedmont Hospital, Emory University Hospital and Emory Crawford Long Hospital —- all of which have made money by treating Gwinnett County residents —- want the state to reverse the decision.

Their protests are obviously about protecting finances, not patients. Any Gwinnett resident who comes to Gwinnett Medical Center's emergency room with symptoms of a heart attack and in need of surgery must be stabilized with clot-dissolving drugs and then transferred somewhere else. In Atlanta's traffic, such delays can cause the loss of life. State statistics show that, on average, 400 Gwinnett County residents a year have open-heart surgery, but the closest hospital providing it is at least 20 miles away.

The competing hospitals argue that allowing Gwinnett Medical Center to perform open-heart surgeries will be risky because the hospital lacks expertise. They point out that CON regulations require hospitals to show they can perform enough surgeries to stay technically competent and ensure a high quality of care.

That's a valid point. Coronary bypass surgery is risky, as is the aftercare. There is still a 1 percent to 3 percent death rate connected to it. Studies have shown that the more surgeries a hospital performs, the better the outcome for most patients.

But the Gwinnett hospital took a huge step toward ensuring quality in April when it agreed to team up with St. Joseph's Hospital, which performs more of the procedures than any other facility in the state. The north Atlanta hospital and the Lawrenceville hospital will jointly own and manage the Gwinnett center's cardiovascular services.

WellStar Kennestone took a similar route when it teamed up with Emory University to open its cardiac surgery program in 2004. The Marietta hospital applied for approval to do coronary surgery and angioplasty procedures in the mid-1990s; even after the state gave its approval, some of the same opponents tied the process up in court for years.

After finally winning the battle, Kennestone showed the service was needed. From July 1, 2006, through June 30, 2007, the hospital performed 634 open-heart procedures.

In the 2008 General Assembly, legislators contemplated eliminating the Certificate of Need, but in the end they correctly left important parts of it in place. The state has a legitimate role in monitoring the quality and cost of many hospital services.

And the state has performed that role wisely in this case. Gwinnett Medical Center should be allowed to perform open-heart surgery.

—- Mike King, for the editorial board (mking@ajc.com)

WHO DOES OPEN-HEART SURGERY IN ATLANTA?

About 400 Gwinnett County residents each year get open-heart surgery —- all of them in hospitals outside the state's second-largest county. Gwinnett Medical Center wants permission to start doing the procedure.

WellStar Kennestone ....323

Emory University........716

Atlanta Medical Center ..62

Emory Crawford Long ....926

Grady Memorial..........101

Piedmont Hospital ......831

St. Joseph's..........1,317

Source: Georgia Department of Community Health, adult surgeries performed in 2006