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Doctors Hospital attacked loopholes for Columbia County facility

Saturday, Jan. 18, 2014 8:34 PM
Last updated Sunday, Jan. 19, 2014 7:13 AM
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Months before it filed a bid to build a hospital in Columbia County, Doctors Hospital of Augusta attacked the very loopholes it now wants to exploit to put a facility there.

An artist's rendering shows the hospital that Doctors Hospital now wants to build in Columbia County.  TODD BENNETT/STAFF
TODD BENNETT/STAFF
An artist's rendering shows the hospital that Doctors Hospital now wants to build in Columbia County.

Doctors, University Hos­pital and Georgia Regents Health System have filed bids in response to Columbia County’s Request for Pro­posals to build at least a 100-bed hospital with a trauma unit in the county, the state’s largest without a hospital. Last year, the Georgia Department of Community Health denied a Certificate of Need to competing proposals from Doctors and University to build a free-standing Emergency Department in Columbia County, saying the county is adequately served by hospitals in Augusta and there is no need for a new facility.

But in conversations with the department, Columbia County officials say they were pointed toward exceptions to the state’s need requirement. The three that would apply are: if the new hospital is part of an existing trauma center; if it is part of an existing teaching hospital; or if the county pays 20 percent of the cost to build it. None of those exceptions have ever been used in Georgia.

University proposed the cheapest option of a 100-bed facility at a cost of $130-$140 million but offered to defer the county’s payment until the end and to give the county the right to appoint some board members. Georgia Regents proposed using the teaching and trauma exceptions so the county pays nothing and it would provide a $280-$310 million health campus with a 144-bed hospital. Doctors proposed using the trauma exception because it hopes to be designated a trauma center this year but, if not, it would work with the county on its share of a $150 million 108-bed hospital.

But even before the county’s RFP went out, Doctors filed a CON Request for Determination on Sept. 20 that asked the department to rule all the exceptions invalid, according to documents obtained by The Augusta Chronicle. In the request, which Doctors filed as “the predominate provider of acute care hospital services to residents of Columbia County,” the hospital argues that there is no support in the legislation to allow for such exemptions and the department “cannot unilaterally create one.”

In further filings, Doctors said the exceptions were proposed by a now-disbanded advisory board and would confer special treatment that is outside its scope of powers.

“The program is not charged with expanding, protecting or incenting trauma hospitals, teaching hospitals, or county-financed facilities,” according to the letter “Whatever the merits of those policy objectives may be, the CON program is not the proper avenue to achieve them, and the General Assembly has not seen fit to authorize exemptions for them.”

The request was filed on behalf of Doctors by Josh Belinfante, a former board member of Georgia Regents Health System. According to his board biography, Belinfante once served as executive counsel to former Gov. Sonny Perdue and “played a key role in the Georgia Certificate of Need legislation” that was revised in 2008.

“The Exemption is simply an anachronistic throwback that erroneously survived the regulatory revisions” in 2008, Belinfante wrote. There are two exemptions to the needs standard written into the CON law, for perinatal services and for destination cancer hospitals, and “the General Assembly could have exempted teaching, trauma, and county-financed hospitals had it chosen, but it did not,” Belinfante wrote.

But in an objection to Doctors’ request, Georgia Regents wrote that it is well within the department’s legal authority to determine how it will judge the need for certain services.

The department “recognized that the need for certain facilities such as teaching hospitals, trauma centers ... and community-funded hospitals cannot be determined using the numeric need methodology due to the unique needs and offerings of these facilities,” according to the Georgia Regents response. Doctors also lacks standing to object, and the request is ill-timed because there is nothing to object to yet because no exemption has been applied, Georgia Regents argued.

But Belinfante counters that “allowing the unauthorized exemption to stand would impair the legal rights of Doctors.”

The department did not agree. It pointed to a rule that says no one can request a determination for an action or proposed action by a third party and therefore “Doctors Hospital’s request is not a proper request,” the department wrote.

Ron Cross, Columbia County Commission chairman, said he did not think Doctors’ request would affect its bid and regardless of which one the county chooses the others are likely to take action. He said an 11-member citizen committee, whose names will be revealed at Tuesday’s commission meeting, will review the three bids and come back with a choice.

“We know it is going to be a fight,” he said. “Two people are going to be unhappy and we are just going to have to face that as we come to it. And see if we can make the best choice, get with our choice and prepare a proposal to be submitted to Community Health and see where it goes from there.”

Comments (13) Add comment
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justputtin
1384
Points
justputtin 01/19/14 - 01:03 am
3
3
Be careful

If GRUesome gets it we could end up with a name that makes as much sense as what GRU stands for. Maybe something like Colossal Asylum Crossing Augusta. or Chic Affluent Center of Awesome. Either way you end up with the same thing! In all seriousness, I hope we CAN get a hospital in Col Co if it makes sense financially.

lawbookfordummies
27
Points
lawbookfordummies 01/19/14 - 02:08 am
6
3
HOSPITAL LOCATION

PLEASE DON'T PLACE THE NEW HOSPITAL ANYWHERE NEAR EVANS TOWN CENTRE. THE CONDOS BY CHILL'S WILL BE BUSY ENOUGH, BUT HAVING 200-300 MORE CARS AND ANOTHER 1,000 CARS DRIVING IN AND OUT BY THE PARK WILL TURN EVERYTHING INTO CRACK ALLEY. NOISE, POLLUTION AND FOLKS HANGING OUT WHILE LOVE ONES ARE SICK WILL MAKE A MESS OF THE WHOLE AREA.

Little Lamb
45146
Points
Little Lamb 01/19/14 - 06:39 am
6
3
Doctors

Doctors Hospital knows it is number three going into this race. That is because it offers third-rate care compared to the other two.

Bodhisattva
5934
Points
Bodhisattva 01/19/14 - 07:53 am
1
3
If we don't get the candy, no

If we don't get the candy, no one gets the candy.

balloon2008
88
Points
balloon2008 01/19/14 - 08:14 am
1
1
Lady Antebellum Ampitheater

I bet Doctors Hospital wished now they would have held on to that land. That would have helped them also.

Riverman1
81925
Points
Riverman1 01/19/14 - 09:24 am
2
1
Don't Deal With Nebulous Sources

“But in conversations with the department, Columbia County officials say they were pointed toward exceptions to the state’s need requirement. The three that would apply are: if the new hospital is part of an existing trauma center; if it is part of an existing teaching hospital; or if the county pays 20 percent of the cost to build it.”

So we are now being told that Columbia County approached the CON committee about a HOSPITAL and they were told the above exceptions would be the way to get a hospital approved? Exactly who in the department did Columbia County officials speak with and who told them this was the only way to obtain approval for a HOSPITAL? Or is this some nebulous impression someone in Columbia County or the media thinks to be the case?

My contention all along is that a CON for a hospital has never been applied for. This supposed backroom conversation doesn't negate my contention.

It is likely a hospital would be approved because of the population growth of the county. The free standing emergency department is what the CON committee ruled on previously and those have not been approved ANYWHERE in the state. Those conditions being thrown out to build a hospital that someone claims someone with the state gave them and being voiced in print are suspect. It could be the unknown person from the county wrongly interpreted what the unknown person with the state told him.

Having said that, to me, it still appears GRU is presenting the best offer. But if Doctors wants to present an offer, I’d certainly keep them in the mix even if they don’t pursue one of the loopholes. Does it not make sense to let the 3 (or more) hospitals attempt to receive a CON without county help or limitations in any way before the county agrees to loan money or limit who can apply?

The biggest concern for the Columbia County Citizens Advisory Committee should be how the profits will be invested back in the county. Recent rulings conclude in many cases CON’s are not needed to expand hospitals. Don’t lose the mega millions this hospital would turn to those who will not reinvest in the county for a better hospital and to create more jobs.

Don’t let Doctors take all the money to their corporate headquarters, University to Richmond County or GRU to their downtown facility. Also, keep in mind the taxation implications of all three with their private or nonprofit statuses. That’s beyond my pay grade.

soapy_725
43672
Points
soapy_725 01/19/14 - 10:15 am
0
0
Maybe Bass Pro Shop could build a combo store/ER.
Unpublished

Maybe Bass Pro Shop could build a combo store/ER.

soapy_725
43672
Points
soapy_725 01/19/14 - 10:17 am
1
0
A CC hospital runs by the likes of Cross, Allen, Allen & Allen.
Unpublished

Gotcha. A new position for the outgoing Mrs. Allen, Dr of $$$$.

soapy_725
43672
Points
soapy_725 01/19/14 - 10:37 am
1
0
Will it fit on the Rhodes-Murphy $3M parcel owned by CC?
Unpublished

Will it fit on the Rhodes-Murphy $3M parcel owned by CC?

soapy_725
43672
Points
soapy_725 01/19/14 - 10:38 am
1
0
The "green space" proposed behind Kroger can be a parking lot.
Unpublished

The "green space" proposed behind Kroger can be a parking lot.

soapy_725
43672
Points
soapy_725 01/19/14 - 10:39 am
1
0
Do any of the CC commissioners own available land in Evans?
Unpublished

Do any of the CC commissioners own available land in Evans?

Esctab
837
Points
Esctab 01/19/14 - 11:08 am
4
3
Riverman: Generally speaking,

Riverman:
Generally speaking, I understand your points. However it does escape me as to why or how anyone can have confidence in GRUs proposal since GRU has proven that they cannot be trusted. Why would we believe their proposal means what it says? Why would we believe they have the intent or the ability to follow through with it? Columbia County might end up being stuck with something far different than what is described in the proposal; and then we would have to listen to David Brond telling us that the proposal was just a concept. GRU needs to work on its credibility factor before I would have any interest in what they say or write.

Rob Pavey
551
Points
Rob Pavey 01/19/14 - 11:19 am
4
1
why Georgia has a failing grade in access to emergency care....

The fate of a hospital for our community shouldn't be determined by lawyers and lobbyists working behind the scenes to open and close loopholes. There is no question Columbia County needs a hospital with emergency facilities, but this whole discussion is yet another example of how heavily politics and influence interfere with those processes here in Georgia. Just last week, the American College of Emergency Physicians released its 2014 "Report Card" that ranks Georgia 46th among 50 states in access to emergency care, with South Carolina only slightly better in 45th place. Competition is healthy, but I hope, in the long run, the choice comes down to which suitor can follow through on its promises and offer the best care at the fairest price.

And as a postscript, I have to agree with the anonymous reader above, that while GRU stands a good chance of being the best candidate, their credibility will be an issue with the Augusta-area committee members who will make the final recommendations. If GRU would lie about something as basic and simple as putting the word "Augusta" at the bottom of a university sign, can they deliver what they promise in something as important as a hospital?

Riverman1
81925
Points
Riverman1 01/19/14 - 02:20 pm
3
1
Keep County Involvement Minimal

Rob especially hits on the point of not allowing backroom secret dealings to affect this decision. If some kind of secret information has been passed to the county, let's hear about it. Rob and Esctab also express valid concerns about GRU with its current leadership. I'm not taking sides in this thing. I actually don't believe the county should even be involved and certainly not involved in financing since it's the state that awards the CON. If 3 or more hospitals all apply for a CON, let the state rule which one gets it without county money being involved.

itsanotherday1
41663
Points
itsanotherday1 01/19/14 - 11:54 am
1
3
I would campaign against

I would campaign against Doctor's. My experience with them has been unsatisfactory to say the least.

Little Lamb
45146
Points
Little Lamb 01/19/14 - 01:17 pm
1
3
Unsatisfactory

That's my experience, too, IAD.

Sweet son
10028
Points
Sweet son 01/19/14 - 03:27 pm
1
1
Riverman said it!

Why would the county commission be charged with the responsibility of choosing the appropriate entity to build a hospital in Columbia County?

Cross' citizens committee which I believe would consist of only 2 physicians in a group of 11 has no business determining the value of any of these proposals.

The commission should stick to their attempts to run/control the local government and stay out of the health care business. I believe the Department of Community Health would be the proper agency to give the go ahead to one of the three who submitted proposals. And, this go ahead should only be affirmed after a true 'need' has been determined for the facility.

Saying that Columbia County is the largest county without a hospital does not seem to be a justification for need.

Gardencity1
88
Points
Gardencity1 01/21/14 - 10:18 pm
0
0
Esctab-Riverman

While credibility may be an issue with the University and Azziz is technically over the hospital and the university, the hospital has it's own board and it's own CEO. So I don't know how much Azziz will have to do with this hospital. If Doctors wins the bid the money will certainly go to Tennessee. If University wins the profit will no doubt go to their downtown hospital. They are bleeding money and were recently financially downgraded. If GRU wins they will have to reinvest in the Columbia county community because that will be the prize jewel of the system. I can't see them pouring money into the old downtown hospital. MCG has been in this area for decades and I don't see them going anywhere. Azziz will be long gone before the first patient is seen in the county. My entire family lives in Martinez and Evans, so I think the one who creates the most jobs, provides the necessary medical services and puts up the most money for a hospital should win. We need good jobs In the county so people will spend money in the county. As Austin said last week GRU doesn't need county money and is the only hospital that could file tomorrow to build it. They don't need the county to approve anything or pick them. I am curious why they just don't go ahead and file. I also agree with Riverman that ultimately the county should focus on what they do best and let the hospitals battle it out. Riverman says that the whole CON process can be challenged. Citizen's money or county liability shouldn't be a part of getting a hospital if possible. You know the losers will sue everyone involved

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