Fort Mill residents have waited six years to learn when a hospital will rise within the fast-growing community, and it appears they'll have to wait a while longer.
How much longer is anyone's guess.
The three applicants vying to build York County's second hospital -- Piedmont Medical Center, Carolinas HealthCare System and Presbyterian Hospital -- are now updating their applications to the state health agency after the S.C. Supreme Court recently denied appeals from all three. The appeals were related to a lower court's ruling that state health officials had misinterpreted the S.C. State Health Plan in deciding Piedmont could build the hospital.
The updating of applications is necessary to have the most recent demographic information, salary and construction expenses because the original applications were filed five years ago.
But so far the state Department of Health and Environmental Control has not been able to provide answers about what the new review will entail, whether additional public input will be sought or how long the process will take.
"There's not really a timeline on it at this point," said DHEC spokesman Adam Myrick.
Despite the unknowns, the applicants are remaining positive about the review.
Charlie Miller, Piedmont's CEO, says it means the hospital is one step closer to getting built. Miller said he first conceived the idea for a second hospital in 1999.
"We're glad to have an opportunity to move this forward," Miller said. "We've been very passionate about this project."
Piedmont's proposal calls for a full-service, 100-bed hospital on S.C. 160. The two Charlotte hospitals each propose a 64-bed facility.
Presbyterian maintains its position that competition is best for area patients.
"Our hope has always been to bring choice and our quality care to York County," spokeswoman Marcia Meredith said.
Representatives for Carolinas HealthCare System could not be reached.
Both Charlotte hospitals questioned in 2006 whether Piedmont, as the only bidding hospital operating in York County, received favored treatment during the application process from DHEC.
Piedmont is a for-profit hospital, subject to more taxes than Presbyterian and Carolinas HealthCare systems, which are operated as nonprofits and are exempt from some taxes paid to the county and state.
State and local governments would receive more tax revenue from a hospital built by Piedmont than from one built by Carolinas HealthCare or Presbyterian.
The hospital saga has generated much interest and debate in the Fort Mill area since 2004, when Piedmont announced its intentions to build a hospital in the fast-growing area. The idea is that the hospitals would serve Fort Mill and Indian Land, the fastest-growing part of Lancaster County, where residents often travel to hospitals in Rock Hill, Pineville, N.C., or Charlotte for treatment.
When the two Charlotte competitors joined the game, throngs of supporters for all three entities emerged in an effort to sway DHEC's decision on which company should be allowed to build. A fourth competitor, Hospital Partners of America, also submitted a proposal.
Piedmont touted its years of service to the community, while the Charlotte hospitals each argued York County residents needed more health care options. DHEC received thousands of letters from the public about the proposals, and a 2006 public forum at Fort Mill High School attracted several hundred people.
DHEC awarded Piedmont the certificate of need in 2006 and, as is typical in these cases, Carolinas HealthCare System and Presbyterian both appealed the decision. The case has been in litigation since. Hospital Partners of America has not been involved with the appeals.
Last December, the state's Administrative Law Court ruled that DHEC had misinterpreted the state's health plan when it gave Piedmont permission to build the new hospital. Piedmont appealed that ruling, and the two Charlotte hospitals also filed appeals related to the decision. On April 8, the state Supreme Court denied all the appeals, sending the case back to DHEC for another review.
Such delays are common in the certificate of need process, which governs how hospitals and clinics can expand and, many times, what equipment they can add.
Hospital companies submit their plans to the state for review, and the state makes a decision based on who it thinks can serve residents best and how the applications meet South Carolinians' needs according to the State Health Plan.
It was that State Health Plan, approved by DHEC in 2004, that said the area needs another hospital, based on population growth. Census estimates say the northern York County area will have a population of more than 110,000 by 2025.
As for how long the new review will take, PMC's Miller said he expects it to conclude by the end of the year, though no official estimate has been made.
"Our best guess is ... anywhere from seven to nine months," he said.
But because of the nature of the certificate of need process, industry experts predicted when the process began that it could take as long as 10 years before a new hospital opens. Even if a final decision on who gets to build the hospital happened quickly, experts say construction would still take two to three years.