While University Hospital will likely also appeal the denial of its application to put an ER there, a University official said it is unlikely the courts will intervene. The state seemed to be opposed to the concept of the centers in general.
The Georgia Department of Community Health denied both applications Friday. The applications were considered together because the proposed sites were within two miles of each other on North Belair Road and both applications were filed within a month of each other.
In a 23-page ruling obtained Monday by The Augusta Chronicle, the state found neither application had “demonstrated a need for a satellite emergency department in Columbia County.”
While noting the argument that it is the largest county without emergency services, that fact “does not in and of itself render these services inaccessible to residents,” the department wrote.
Doctors Hospital still feels it has a compelling case to establish its $9.8 million, 12-bed center across from Marshall Square, Welch said.
“I’d be surprised if we didn’t appeal,” he said. However, he and hospital leaders would like to talk to the state about how its application might be altered to make it more acceptable, and Welch said he needed at least another day to consult with others on whether to appeal.
University will likely only file if Doctors does, but it probably won’t do much good, said Ed Burr, University’s vice president of legal affairs.
Both federal and state high courts have deferred to agency expertise in making these kinds of decisions. He noted that the U.S. Supreme Court recently ruled 9-0 in favor of the U.S. Department of Health and Human Services’ ability to assign compensatory funds for providers who see higher levels of indigent and low-income patients. The Georgia Supreme Court has made similar rulings, Burr said.
“The reality is this is a policy decision, so the courts aren’t going to touch it,” he said.
Both hospitals point to a fast-growing population in Columbia County, which is expected to grow 14.5 percent by 2017 to 141,915, according to the applications. In particular, the number of those older than 65 is projected to skyrocket 35.1 percent by 2017 to 18,074.
Both hospitals can point to already increasing numbers of ER visits and overcrowding, but the state said the need “appears to be met by the existing providers of emergency services in the region.”
The state pointed out that while the rates of most critically ill were increasing, the rates of the less ill were decreasing at University, and those are the ones most likely to use a free-standing ER.
The decision said that while there could be a case made that the centers would provide greater access to care for the uninsured and low-income, the process is designed to prevent unnecessary duplication and the creation of services where the need has not been shown.
“Proliferation of emergency departments with the goal of increasing access for low income and uninsured populations for whom an access issue has not been demonstrated is the very dynamic the department is charged with safeguarding against,” the decision said.
Burr said it was clear from talking with the department that it favored the view that ERs are only for true emergencies.
“And that is a great concept,” he said. “But it is completely detached from the reality of what people do.”
Welch said Doctors hopes to talk to the department to find out what it was thinking and whether it will even consider the concept. No free-standing ER has ever been approved in Georgia.
“If they’re never interested in it, then there is no point in appealing it or reapplying later.” Welch said.
He still thinks the idea has merit.
“Other states have adopted this easily,” he said. “It’s been wildly successful in those areas.”