by Colby Coates

This story originally appeared in the February 2008 issue of DOTmed Business News.

Ever take wire cutters to a 440-volt line that was reported to be in power lock down mode by a hospital's maintenance staff?

But it wasn't.

The results of that miscue can be, as you would imagine, shocking, if not potentially fatal.

But such are the occasional compromising situations faced by a crew of de-installers who might be removing an MRI, Linear Accelerator, RF, CT or a bi-plane Cath Lab.

De-installing expensive, fragile and sometimes massively bulky medical equipment and then rigging, crating, transporting, re-installing and calibrating it in another location can be a very tough job, almost a heroically unsung one in the medical equipment business. And yet, it's still one clients take for granted.

Here's a quick assessment of the basics involved in a de-install, from Michael Profeta, president, Magnetic Resonance Technologies, Willoughby, OH, who views all 50 states as the region his company serves.

"It has many logistical issues. The equipment is large, requiring very special rigging and handling. There are always construction requirements to and coordination issues with general contractors, mechanical contractors for chillers and HVAC units, electricians, riggers, transportation, site personnel. The list is endless." So the de-install involves all of the above plus many variations specific to individual modalities. Bottom line: nothing's easy in the de-install trade.

Quite simply, the de-install business can be dirty, dusty, and frustrating. Often a crew will find itself navigating troughs of bundled wires and cables in the dank basement of a 100-year-old hospital at 3 am on a Saturday morning.
Other times, the pathways, door clearances and corridor routes that once accommodated the installation of a Gamma Knife or an R&F combo might now pose a huge impediment to the de-installation of the same machine.




And the boon in hospital construction, while positive from what it says about the prospects for a hospital's revenue growth, can be a nightmare for the de-installation crew working, perhaps, with outdated blueprints and floor plans.

At times, the situation gets dicey, says James Young, vp, Acceletronics, Inc., Exton, PA, who recalls a recent de-install of a cardiac cath lab that happened to be in an adjoining room to another cardiac cath lab. Access to the cath lab being removed was, of course, through the first room. Acceletronics and the hospital were on such a tight schedule "that we were taking things out while people were on the table in the first room."

Harried hospital administrators are always anxious to keep noise and dust pollution down and not upset the patients. But sometimes, in order to keep schedules, hold down costs and meet shipping deadlines, extraordinary steps are called for and it's up to the savvy de-installer mastermind the effort.

Who's Calling the Shots?

Sometimes one company, especially those that operate in a multi-state region and usually also sell and service the same medical equipment they're de-installing, will handle most, if not all, facets of the job from physically extracting the equipment from one location and delivering it safely to another. Whether it's to a facility across town, a ship loading exports or a warehouse where it will be refurbished or sold for parts, the complexity of the job rises exponentially.

Other times, however, several different specialist firms play key roles as subcontractors in the operation. In such cases, a mix of different crews, bosses and clients, demand intense and direct communication between all parties. And even if several specialists are required, the onus should be on the client to establish one chain of command, giving overall management supervision to one person. Otherwise, as happened to the de-installer who shall remain nameless, a facility maintenance worker might forget to cut off the juice.




A perfect example of how specialized de-installs have become: only a small number of firms are licensed to remove the cobalt from a linear accelerator
(often called putting it in the "pig"). Only then can the de-installer begin the job.

"We prefer to be in charge of everything from the very beginning," says Michael Webster of Legacy Medical Imaging, Fort Worth, TX. "Things go smoother that way."

That's a point heartily endorsed by Steven Ford, president, Professional Imaging Services, San Diego, CA, who says, "it's a mistake to have multiple people responsible for one job. Instead a single company should be hired." That one point company," he says, "then hires any other subcontractors that are needed. That way, the lines of communication and responsibility are clear."

One time when Webster was only handling the de-install of an MRI, the rigger moving its magnet bumped it, ending up with a bill approaching $50,000. That's not the kind of penalty anyone wants to pay for poor planning and, according to most de-installers interviewed, is usually avoidable provided the lines of communication are clear and coordinated from one source.

As Glenn Hammerquist of Berrien X-Ray, Berrien Springs, MI, says about what's necessary to ensure that a de-installation go smoothly, "communication, communication, communication."

Many de-installers interviewed for this piece suggest that clients, be they hospitals, imaging centers or small doctor's offices, will, in what they think is an effort to control costs, try to bring two or three different companies together for one de-install. They think that by parceling out the job, they'll pay less. Unfortunately, while that perhaps makes intellectual sense, the reality is usually different.

Insurance Always an Issue

From an insurance perspective, the cost of being a de-installer can be substantial too.

Many de-installers carry insurance well in excess of $5 million, with the odds of never having to make any panicky calls to the insurance company increasing in direct proportion to the amount of scrupulously detailed planning that goes into each operation. Insurance coverage also varies sometimes according to region, size of the job and scope of the de-installer's responsibilities. But it's not uncommon for some policies to reach as high as $10 million.

Darrel Kile, Classic Diagnostic Imaging, Macedonia, OH says whatever the policy's face value, it should cover, "the workers, tools and truck and any hospital property."

Frank Boseman, president, Boseman Medical Imaging, Greenwood, SC, recommends a variety of policies including, "commercial general liability, products and completed operations, and general cargo insurance."

Carrying suitable insurance is also a necessity given the fact that theft of parts occasionally occurs. A de-installer may get the equipment out but it might sit on a loading dock for a day or two awaiting the arrival of a trucking company, who, industry scuttlebutt suggests, "are never on time," according to one long time veteran of the business. Nowadays, most of a system's loose components will be shrink-wrapped, the packages signed by the de-installer who then takes photographs. Not a panacea for the sticky fingered but particularly helpful in dealing with clients and insurance companies.


It's All About Small Details

It's somewhat ironic how large a role small details play in de-installation. In a business where the simplest, one day de-install of a CT can cost about $1,000 up to the thousands and thousands required to pay for a cross country odyssey, the availability of OEM dollies, for example, are often the difference between keeping a de-install on track or shutting down several crews for hours. All the while the clock is ticking and though it sounds basic, almost too simplistic, it's nonetheless true that a shortage of custom fitting dollies is just one of those small details that can be a real source of angst.

"As soon as an OEM stops production on a certain piece of equipment it stops making the dollies that fit it," says Ed Gibbs, North Coast Medical Equipment, Berea, OH. "So in the aftermarket, we make our own or do whatever it takes."

And that's just one of the hundreds of items that must be factored into any de-installation, remembering, of course, that each and every move is different from the one that preceded it. Nonetheless, tricks of the trade accumulate over time, prompting Gibbs, who serves a 13 state area, to suggest that de-installers with a 25 year track record like his are probably a customer's best bet, especially outfits that ramrod the entire process.

The de-install arena is, in fact, rife with horror stories of operations gone badly. One company, JDI Solutions, Brevard, NC, even hosts what it calls a "Wall of Shame" on its website, displaying pictures of a number of de-installs gone awry.

Dust is another small albeit villainous detail. Of the 50 plus respondents to the DOTmed Business News questionnaire about de-installation, dust was a virtual unanimous choice, as always being an important issue that the de-installer has to contend with.

But as big a problem as dust and dirt poses to the inner workings of sensitive medical equipment; steps can be taken to lessen the risk.

"The surrounding environment can sometimes be a disadvantage during installs/de-installs," says Al Brown, Precision Medical, Kankakee, IL.
"But we find that shrink-wrapping, bubble-wrapping, padding, boxing equipment and components on pallets is always a safe bet."

"Rooms should be isolated from the rest of the facility by placing plastic drapes at doorways and adding blanket drapes to buffer noise," says Larry Knight, Sunrise Medical Technology, Waxahachie, TX. Wearing protective garb, bunny slippers and cleaning up with industrial strength vacuums are also all part of the regular routine for most de-installers. Also popular, dust and grime gathering rubber mats are placed outside the entryway of the room where the de-install is happening so as workers go in and out, much of the excess detritus is captured.

As the new, more sophisticated technology replaces the old and hospitals and clinics continue to upgrade, it seems as if specialization in either particular categories of equipment or brands from one OEM or another is assuming an increasingly important role.

KNJ Tech Service, Monticello, IN, for example, is in line to handle Nationwide Imaging's business in a 15 state area, says company principal James Gant. And Siemens, according to industry scuttlebutt, was so unhappy with the work of a couple of less than professional de-installers that it's authorized five de-installers across the US to handle its work.

The Outlook

Looking forward, most de-installers DMBN are relatively optimistic about their respective futures, though some problems loom.

One company executive said that increased competition from Korean, Chinese and Indian manufacturers has cut into the major OEM's market share to the point that aggressive selling is becoming more prevalent.

Says one exec, "the major OEM's are making new equipment more affordable by lowering prices and offering a variety of attractive financing deals. " In some cases, interest is being waived for up to a year and payments can be deferred." Presumably such activity allows hospitals to continue to upgrade or replace older machines with new ones. As long as that occurs, those unsung heroes of the medical equipment business, the de-installer will continue to toil in anonymity but earning praise for the difficult, thankless job they perform.

Boomers Help Drive Install, De-Install Business

Russ Knowles of Remetronix, Port St. Lucie, FL, is averaging well over 2500 installs, de-installs annually, significant growth from the 100 or so projects Remetronix oversaw when it opened its doors in 1993.

It's obvious Knowles, who concentrates solely on this niche, eschewing sales and service, knows whereof he speaks.

So what's driving such growth? "Baby boomers need diagnostic imagining," he says, noting those boomers' cardio vascular problems spur such demand. In addition, "obesity in this country is at an all time high," another phenomenon that's heightened the need for technology driven healthcare solutions.

As much as the vaunted baby boomer demographic is a huge catalyst for growth, another important one is DRA's effect, which, Knowles says, prompted hospitals and clinics to reconsider buying refurbished or used equipment. New or used, Knowles points out, "We specifically went after de-installs because for every new MRI that's put in, it's likely an old one has to move out."

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DOTmed Registered Deinstallation Companies
Names in boldface are Premium Listings.

Domestic
Steven Ford, Professional Imaging Services, CA
Nationwide - MRI, Other
Stephanie Espinola, JCF Engineering, Inc., CO
Midwest - Denver - Rad Room, R/F Room, Cath, Simulators
Russ Knowles, Remetronix, FL
DOTmed Certified
Region Not Indicated - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo, Bone Densitometers, Nuclear, Simulators
Bryan Coombs, X-ray Repair & Sales, FL
West and North West - Other
Todd Muhlestein, National Deinstall & Refurb, ID
Southwest, Northeast, Northwest - RF Room, Cath
James Gant, KNJ Tech Service, IN
Southwest, Northeast, Northwest - MRI, CT & PET, Rad Room, R/F Room, Cath, Mammo, Nuclear, Other
Ronald Moore, R & D Imaging, Inc., IN
Nationwide - MRI, CT & PET
James Roller, R-TECH Solutions Inc., IN
Nationwide, Europe, Austrailia - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo, Nuclear, Other
Glenn Hammerquist, Berrien Xray, MI
Midwest - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo, Nuclear, Linear Accelerators, Other
Leonardo Parra, Mundi X-Ray, Inc., MI
Midwest for removal, Worldwide for Install - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo, Bone Densitometers, Nuclear, Simulators, Linear Accelerators
Dan Kujawa, Unitech Imaging, Inc., MI
Midwest for removal, Worldwide for Install - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo, Bone Densitometers, Nuclear, Simulators, Linear Accelerators
Tom Gohn, International Health Network, MO
Nationwide - MRI, CT & PET, Rad Room, Simulators, Linear Accelerators
Leon Gugel, Metropolis International, NY
DOTmed Certified/100
Nationwide - All 50 States - CT & PET, Rad Room, R/F Room, C-Arm, Ultrasound, Mammo, Other
Pete Schliebner, Benchmark Imaging Group, OH
DOTmed 100
Nationwide - Rad Room, R/F Room, Cath, Angio, Mammo
Darrel Kile, Classic Diagnostic Imaging, OH
DOTmed Certified/100
Nationwide - CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Mammo, Nuclear
Michael Profeta, Magnetic Resonance Technologies, OH
DOTmed Certified/100
Nationwide - MRI
Edward Gibbs, North Coast Medical Equipment, Inc., OH
DOTmed Certified
North Central & Mid Atlantic - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo, Bone Densitometers, Nuclear, Simulators, Linear Accelerators, Other (Cysto & Dental)
Jim Monro, RSTI Training Center, OH
DOTmed Certified
Northeast - Rad Room, R/F Room, C-Arm, Ultrasound, Mammo
Timothy Paradise, Company Not Available, OH
Nationwide - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo, Bone Densitometers, Nuclear, Simulators, Linear Accelerators
James Bowman, Jr., US Medical Resources Corp, OH
Focus is East of Miss., also Nat'l and Int'l. - CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo, Nuclear, Linear Accelerators
James Young, Acceletronics,Inc., PA
Region Not Indicated - Other
Richard Babyak, Transit Solutions, PA
Northeast, Southeast, and Midwest - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Bone Densitometers, Linear Accelerators
Frank Boseman, BMI, SC
Worldwide - CT & PET, Rad Room, R/F Room, Cath, Angio, Nuclear
Chris Reilly, CER Medical, SC
National - Nuclear
Michael Baumgartner, Remesta Medical Corp., TN
DOTmed Certified
Southeast - CT & PET, Rad Room, R/F Room, C-Arm, Ultrasound, Mammo, Bone Densitometers, Nuclear
Marshall Shannon, Image Technology Consulting, LLC, TX
DOTmed Certified/100
South Central USA and Nationwide - MRI, CT & PET, R/F Room, C-Arm
Michael Webster, Legacy Medical Imaging, TX
DOTmed 100
Nationwide - MRI, CT & PET
Wayde Keeling, Lone Star X-Ray Services, TX
South Central - Licensed in TX Only - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Mammo
Larry Knight, Sunrise Medical Technology, Inc., TX
DOTmed Certified/100
Nationwide - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Mammo, Nuclear, Simulators, Linear Accelerators, Other
Rex Lindsey, BC Technical, Inc., UT
Nationwide - CT & PET, Nuclear
Carl Hoffman, Blue Ridge Medical Imaging, VA
Nationwide and International - CT & PET, Rad Room, R/F Room, Cath, Angio
Paul Zahn, Shared Medical Equipment Group, LLC, WI
DOTmed Certified
Nationwide - MRI, CT & PET
Steve Beno, Sterilizer Services, Inc., WI
DOTmed Certified/100
Midwest - Other
Sam Ames, Systemic Junctures Corp., WI
Nationwide and Crate for International shipment - MRI, CT & PET, Rad Room, Mammo

International
Sergio Leonardo Barral, Wickham S.A., Argentina
Worldwide - MRI, CT & PET, Rad Room, Cath, Nuclear, Linear Accelerators
Norbert Schulz, Schulz Consulting, Austria
Worldwide (Excluding USA) - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo, Nuclear, Linear Accelerators
Saeed Hashemi, NASS MedImage, Canada
National and International - Ultrasound, Linear Accelerators
Steve Clark, Pacific Imaging Sales and Services, Canada
Not Indicated - Other
Abdelrahim Khalil, Besisc, Egypt
USA and World - CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Nuclear, Other
Georges Kardous, Kardous Med Equipment, France
USA and World - MRI, CT & PET, Rad Room, R/F Room, Mammo
Guenter Braun, MediSys Medizintechnik GmbH & Co.KG, Germany
DOTmed Certified/100
Central Europe - MRI, CT & PET, Rad Room, R/F Room, C-Arm
Vinod Dua, C-Max Healthcare, India
All North, South, East, West - International - CT & PET
Dean Kenney, Socios en Tecnologia Mexico, Mexico
Anywhere - MRI, CT & PET
Faisal Mirza, Sunshine, Pakistan
National - MRI, CT & PET, Rad Room, R/F Room, C-Arm, Cath, Angio, Ultrasound, Mammo
Jose Morillo, J Morillo Sistemas Biomedicos, Venezuela
National - CT & PET, Rad Room, Cath, Angio, Other

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