CHARLESTON -- New rules approved by Gov. Joe Manchin will allow many hospitals in West Virginia to start offering a common heart procedure, a move that some of the state's largest hospitals have argued may put patients at risk.

Cardiac angioplasty is a medical procedure in which a small tube with a balloon at the end is threaded through a person's arteries and then inflated to expand blood flow in a particular part of the body. Until recently, West Virginia hospitals had to have a cardiac surgery unit on site before they could offer the procedure.

Only six hospitals in the state have such units -- Charleston Area Medical Center, St. Joseph's Hospital of Parkersburg, Wheeling Hospital, Monongalia General Hospital of Morgantown, West Virginia University Hospital of Morgantown and St. Mary's Medical Center of Huntington.

However, as part of a test run, the West Virginia Health Care Authority gave permission for three hospitals without surgery units to perform the procedure. The experiment showed no significant increase in health risks to patients who had angioplasty at the hospitals without surgery units. The authority in June approved new standards allowing hospitals without surgery units to offer angioplasty and other cardiac catheterization procedures.

The standards didn't go into effect until Manchin signed off on them July 18.

"Any time we're charged with making a decision that affects the quality of health care for our citizens, it's a decision that must be carefully considered," he said in a prepared statement. "In this case, we've taken a very close look at data gathered over several years, and a number of other facts about the ability of our hospitals to perform heart angioplasty procedures that have the potential to save hundreds of lives, especially given our state's high heart disease rates and rural nature."

Manchin's approval of the rules came over the objections of at least three hospitals. Administrators with CAMC, St. Joseph's Hospital and Wheeling Hospital pointed to a study published in the Journal of the American Medical Association they said showed an increased chance of death from angioplasty complications at hospitals without open-heart surgery units.

The hospitals had expressed their concerns in letters to the Health Care Authority and in newspaper advertisements.

CAMC president and CEO David Ramsey could not be reached for comment for this story, but in a June interview, he said that there is only a small window of time to get patients into surgery if complications arise during the angioplasty.

"The patient has been lulled into a false sense of security," he said.

Many of the state's smaller hospitals disputed that fact and took issue with the characterization of the study by CAMC and the other two hospitals. Shooting back in a newspaper advertisement, they chastised the opponents' "scare tactics" and said the quoted study actually found no significant difference in death rates among hospitals with and without surgery units.

They also noted that a demonstration project at United Hospital Center of Clarksburg saved the lives of 57 people during the past five years, and the hospital doesn't have open-heart surgery backup.

"The fact remains that West Virginia experiences one of the highest rates in the nation in cardiovascular deaths," they said in their ad. "...Nationwide, more and more states are moving in the same direction. There are at least 40 states that now permit cardiac angioplasty without on-site cardiac surgery."

Among the hospitals that supported expanding angioplasty were St. Francis Hospital of Charleston, Cabell Huntington Hospital, Camden-Clark Memorial Hospital of Parkersburg and Thomas Memorial Hospital of South Charleston.

While most of the standards are now in place, Manchin did send one back for further review. The proposed rule would allow a hospital more than one hour of "medical transport drive time" from the nearest hospital to perform angioplasty provided that it already has performed at least 300 diagnostic catheterizations a year for the past two years.

Manchin said the term "medical transport drive time" was ambiguous and needed further clarification so there could be no confusion about which hospitals can offer angioplasty.

The language is critical for Raleigh General Hospital of Beckley if it wants to offer the procedure. Hospital president and CEO Karen Bowling said that because of the rural nature of the region, her facility is the closest option for many residents living in the area.

"We believe the citizens of Beckley and Raleigh County certainly deserve the gold standard of care," she said.