BACTS: A Troubled Youth

From November 2000 until November 2001, I served as president of the BACTS, The Belgian Association of Cardio-Thoracic Surgery. Our sixth General Assembly was held on November 10, 2001 and for my Presidential Address I chose this quotation from Winston Churchill: "This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning". As many things happened during the last year endangering the future of our Society, these words can easily be applied to the BACTS. I would like to summarize the most important events.

Our Belgian Association of Cardio-Thoracic Surgery was founded in November 1995, after careful preparation and long discussions in an excellent restaurant in the neighborhood of Brussels. I represented the Thoracic Surgical Department of the University of Antwerp, in the northern part of Belgium. I was the youngest of the founding members and was chosen as first secretary of the Association. As typical in any Belgian organization, all reports had to be published in both Dutch and French, for which my wife was a great help.

We had a very dynamic start. An important mission for the Society was the data collection from cardiac surgical centers in Belgium. For this purpose a Quality Control Committee was set up which for 5 years did an excellent job. The Belgian database was nearly 100% complete, and several scientific studies were generated from these data.

However, in August 2000, the president of the QC Committee resigned, as he could no longer guarantee the confidentiality of the data. One year prior to this, the Ministry of Health had created a College of Cardiac Pathology, for the purpose of gathering data from cardiology and cardiac surgery departments, with which to perform detailed analyses and to correct any deviations. For this reason, the data of the BACTS had to be transferred to the Ministry. In the College of Cardiac Pathology, the cardiac surgeons were only a minority group and had no definite control over the utilization of the data. As this problem could not be easily solved, the activities of our Quality Control Committee were stopped at the end of August 2000.

In November 2000, our General Assembly decided to continue the data collection but found membership on the Quality Control Committee not to be compatible with that of the College of Cardiac Pathology. To solve the problem of confidentiality, our Board decided in December 2000 to divide the old Quality Control Committee into a Database Committee for collection of the data, and a Peer Review Committee for interpretation and transfer of aggregated data to the Ministry. To assure full control, it was decided that the Peer Review Committee would consist of the BACTS Board members themselves. The new Database Committee was set up with members totally independent of the Ministry and the College of Cardiac Pathology. The members of this committee agreed that no identifiable data on the patient, the surgeon, or the center could be transferred to anybody else.

A long discussion with the Ministry followed. Another difficult point was the contract which the Ministry proposed to the BACTS, offering financial reimbursement for collection of data on cardiac surgery, but asking the Association to provide specific data per center, which would then become the property of the Ministry, and to consult the Ministry before publication of papers using the data or the aggregate reports. This was not acceptable to our Society. To make matters worse, a Ministerial Decree in December 2000 reduced reimbursement for all cardiac surgical procedures by 10%. A specific letter from our Association and multiple negotiations had no effect. Moreover, it became clear that the technical matters on reimbursement for cardiac surgery were discussed in a technical committee of internal medicine in which the cardiac surgeons were not represented.

For these reasons, our Board decided in March 2001 to stop all collaboration with the Ministry and the College of Cardiac Pathology. After an emotional discussion within our Board it was found that another strong signal to the Ministry was necessary. All four cardiac surgical members of the College of Cardiac Pathology were asked to resign. As a consequence, this College could not function properly anymore. In July 2001 a meeting was set up between representatives of the Ministry of Health and our Board, including the old members of the College of Cardiac Pathology. A constructive discussion followed. It was agreed that data collection and quality control are important issues in today's climate, but that confidentiality of the data should be guaranteed. During this meeting it was decided that cardiac surgeons and cardiologists should be equally represented on the College of Cardiac Pathology, and that surgical members of this College would be proposed by the BACTS. Decisions of the College would be based on a consensus model. Further, reimbursement for cardiac surgical procedures will fall under the purvue of a technical committee. The cardiac surgical database remains property of the BACTS and only aggregate data will be sent to the Ministry. Adjustments of the contract with the Ministry will be made to solve the specific problems raised within our Board. These decisions were approved by our General Assembly on November 10, 2001.

Due to the described difficulties the future of our Association was several times in jeopardy. As a new Database Committee was created and strong signals regarding the confidentiality of the data were sent to the Ministry, we experienced a new start. After my one year presidency I could conclude: "But it is, perhaps, the end of the beginning". After 6 years our association is at the end of its beginning, solid foundations have been created and the Society is becoming mature, step by step.

Thanks to the creative ideas of our prior Board members, our Society has been able to solve some difficult problems, and now can look to the future with more confidence. According to the statutes, half of our Board members had to be replaced. With the election of a new Board, new blood has come into our Society, which I hope will enjoy every success in the future.