In the end, the Columbia County Commission picked all of the above.
In a meeting Tuesday night, the commission voted to approve all three Augusta hospitals to pursue the needed state permission to build the county’s first hospital. The county will then partner with whoever is able to get a Certificate of Need to build at least a 100-bed hospital in the county, the state’s largest without one.
At least two of the three, Doctors Hospital and University Hospital, said they would continue while a Georgia Regents Health System official said it would need to weigh the options and have more discussions.
“During this entire process, it weighed heavily on me, and I’m sure many of the others here, that this particular process would deprive two fine health organizations (of) the opportunity to plead their case before the ultimate deciding authority,” the Georgia Department of Community Health, Commission Chairman Ron Cross said. “If all three of our applicants were agreeable to the commission, why
not let the final decision-maker decide?”
A previous attempt to place a free-standing emergency department in the county last year was turned down by the state because it ruled the county is adequately served by Augusta hospitals.
The county’s hopes for a facility rest in one of three exceptions to the state’s need criteria: if the hospital is a “sole community provider” and the county pays more than 20 percent of the cost; if the facility is an existing teaching hospital; or if the facility is an existing trauma center.
University Hospital would try to get a CON using the first exception but has committed to forego tax-exempt status for that facility and provide enough tax payments to cover the county’s share up-front for a $144 million, 100-bed hospital. Georgia Regents would apply using either the teaching or trauma exception and without county funds to build a $280 million “health campus” that includes a 144-bed hospital.
Doctors would apply using the trauma exception once it is designated a trauma center later this year, also without county funds, to build a $150 million, 108-bed hospital.
After the vote, Georgia Regents was noncommittal about whether it would continue its application.
“I think we’ll evaluate what our next steps are,” said Shawn P. Vincent, vice president of partnerships, international healthcare and strategic partnerships. “I think it’s too early to say.” Georgia Regents has a board meeting Friday, but he wasn’t sure if it would be discussed then.
University will stick with its plan because it believes that still offers the best hope of securing a CON, said Ed Burr, senior vice president for legal affairs. Doctors also will stick with its plan, CEO Doug Welch said, but acknowledged it might be delayed some months as it waits for that trauma designation. In its proposal, Doctors also discussed pursuing the sole county provider with 20 percent from the county exemption, Welch said.
“We’d have to have more discussions with the county about that if we were to pursue that option,” he said.
That could set up an interesting dilemma for the state of choosing between at least two applicants who would claim to be the “sole community provider” for Columbia County.
“It will test the rule as it is written,” Welch said.
But the state could go ahead and make that determination if it grants a CON to one applicant, Burr said. University and conceivably Doctors would also need a 20 percent commitment from the county to qualify for the exemption, but Burr said he felt that was implied in the vote to partner with whoever gets the CON.
“That’s essentially what the chairman was saying is we’re willing to partner with anyone that can go forward and get the exception,” County Administrator Scott Johnson said.
That was another reason not to just pick one, Commissioner Ron Thigpen said.
“If we were to choose the wrong one, if it were not approved by the Department of Community Health on their specific exemption, then we would lose the opportunity for a hospital,” he said.
The magnitude of the decision, which Cross has said could be the largest capital project ever for the county, also weighed on them, Commissioner William Morris said.
“This is the biggest decision I’ve been asked to make since I have been on the commission,” he said. “It’s not only for today but for the foreseeable future.”
Even if CON applications are filed soon and a CON is ultimately awarded, the hospitals not chosen are likely to appeal that decision, officials have said, and a legal battle could add months if not a year to moving forward.
In 2008, the physicians group at Georgia Regents got a CON to pursue a $34 million multispecialty clinic with an ambulatory surgery center in Columbia County – despite admitting the need was not there – by arguing in part that it helped further its teaching mission. University and Doctors Hospital Surgery Center appealed the decision. It was reversed by a hearing officer but then affirmed by the commissioner and finally upheld a year after the approval in Richmond County Superior Court, according to records at the Georgia Department of Community Health. Georgia Regents later abandoned the project for economic reasons.
Staff Writer Steve Crawford contributed to this story.