The question of who will get to build a new hospital in Fort Mill is one of simple economics, attorneys arguing before the South Carolina Administrative Law Court said Monday morning.
Who will be harmed?
Attorneys for Rock Hill’s Piedmont Medical Center said in opening statements that if Charlotte-based Carolinas HealthCare System builds the hospital, PMC would be reduced to serving the uninsured and rural patients of York County. The quality of care would suffer as some services would be cut, PMC officials said.
That transition of patients is already taking place, CHS attorneys said, as the health care system already serves more than 50 percent of the patients in the Fort Mill-Tega Cay area – the area they want to serve with a new 64-bed hospital near the intersection of Sutton Road and Interstate 77. It is an area rich with a high-percentage of insurance-carrying patients.
CHS attorneys argued the shift has been ongoing for a number of years. A rapidly growing northern York County population has sought CHS for health care, not Piedmont, they said.
Attorneys for the state Department of Health and Environmental Control said CHS’ large market share in York County clearly shows a preference for that hospital’s services.
DHEC attorneys said they considered the financial impact and accessibility questions equally and decided to give a state certificate of need to CHS.
Piedmont and Presbyterian Hospital challenged the September 2011 decision to give CHS permission to build.
Their appeals sent the case back to the Administrative Law Court for a second time. CHS and Presbyterian successfully challenged a May 2006 decision that awarded the certificate of need to Piedmont. A judge’s decision sent the case back to DHEC for review. After a second review DHEC awarded the certificate to CHS.
Presbyterian dropped out of the competition in February.
Attorneys for the two hospitals set out what they hoped to prove in their opening arguments Monday, as well as in the first witnesses Piedmont presented.
Columbia attorney Daniel Westbrook, representing Piedmont, said CHS has captured the northern York County health care market by expanding the Carolinas Medical Center-Pineville hospital and the number of physicians it has in York County.
“There’s nothing illegal in what CHS is doing. It’s a good smart strategy. But is it good for York County?” he asked.
Westbrook began demonstrating what he said are the ill effects of that strategy and the effects allowing CHS to proceed would have on Piedmont.
He noted there has been a 23 percent drop in insured patient admissions and a 175 percent increase in uninsured admissions at PMC since 2003.
Piedmont CEO Bill Masterton and Dr. Arun Adalakha, a Rock Hill pulmonologist, testified that this mix will ultimately erode the quality of health care Piedmont offers. For its size, Masterton said, Piedmont now offers care in areas normally seen in larger hospitals such as heart surgery and stroke.
Piedmont has responded to CHS’ strategy with a three-point plan: reverse the certificate of need decision for the Fort Mill hospital, recruit more physicians for PMC and expand the Rock Hill emergency room.
PMC already has secured DHEC approval for a $20 million expansion that will double the size of its emergency department.
PMC wants to hire 14 physicians this year. Physicians usually have the most influence over patients when they need speciality care or hospitalization, Westbrook and Masterton said. Westbrook said this is what CHS has been doing with its York County practices, cutting into the number of patients Piedmont and other specialists in the county see. Adalakha said CHS’ practice has dramatically reduced the number of patients his office sees and his revenue, forcing him to scale back on services offered.
CHS attorney Douglas Muller countered that PMC is part of Tenet Healthcare, “a billion dollar ... monster health care corporation” which “has the ability to compete.”
He started questioning PMC’s assertion it would be forced to end some services if it isn’t allowed to build the Fort Mill hospital, by pointing to the planned expansion of PMC’s emergency department. Emergency rooms historically are where the majority of hospital admissions originate. Increasing the capacity of PMC’s emergency room should increase the number of patients it serves.
Muller also said that PMC’s contract with York County, which requires PMC to offer services at a reasonable cost and to provide EMS service for the county, has evolved into an effort to “fend off other health care providers.”
The contract was first signed in 1980 and expires in 2045. PMC has said the contract would be extended to include a Fort Mill hospital if it is selected.
The adverse impact argument, Muller continued, is a variation of that argument, it’s “no one but us (PMC) can serve York County.”
The trial is expected to last three weeks, with each side planning to call as many as 10 witnesses. Among them are former and current DHEC officials, health care experts and PMC’s former chief executive officer, Charlie Miller.
A series of motions over the scope of what will be initially included in the trial record, as well as the number of witnesses, were argued Monday.
Administrative Law Court Judge Phillip Lenski also denied PMC’s request for a summary judgment that argued CHS didn’t have the authority to build a hospital in South Carolina. That motion was filed last week.