Hospital appeal won't be heard until spring 2008

The earliest a judge will hear the first round of appeals over who will build a second York County hospital will be spring 2008, a state health official said.

The state Department of Health and Environmental Control approved Piedmont Medical Center's application to build a second York County hospital in the fast-growing Fort Mill area last May. Carolinas HealthCare System and Presbyterian Healthcare, two hospital companies also vying to build the second hospital, appealed the decision.

First, DHEC's board declined to revisit its decision again. An administrative law judge two weeks ago declined to issue a summary judgment to any of the hospitals, opting instead to schedule a potentially weeks-long hearing, said Joel Grice, DHEC's director of health facilities and services development.

The next step is for a full hearing of the three parties' arguments. The earliest that will happen is April 2008, Grice said, but hearings often get rescheduled.

The lengthy appeals are part of South Carolina's complicated 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.

The second hospital will be tangled for years in appeals, experts have said, and it could be a decade before the hospital opens.

"I think it's unfortunate for the community that it's taking as long as it's going to," said Charlie Miller, Piedmont Medical Center CEO.

Still, Miller is a fan of the certificate of need process, he said.

"At the end of the day, it helps manage and control the cost of health care provided in the community, and makes sure medical services are not overbuilt," he said.

Endoscopy/colonoscopy tables on hold

Piedmont recently appealed the state's decision to let Digestive Disease Associates of York County build a free-standing endoscopy center near its Rock Hill offices. The state had given both Piedmont and Digestive Disease Associates permission to build more space to perform procedures like colonoscopies, which look into the lower bowel, and endoscopies, which check the stomach.

DHEC said York County's population is growing fast, and the population will need both the centers.

Both parties appealed that decision.

"We've effectively blocked each other's expansions," said Dr. Stephen Bott, a partner with Digestive Disease. "This will probably drag on for a year or so ... it seems it's not in anyone's interest to do this."

It also will cost both parties a lot of money to protect their decisions, he said.

The problem lies with the certificate of need process, Bott said.

"It's a law that lets the current provider maintain monopolies," he said.

DHEC's Grice hopes both companies will build the endoscopy rooms.

"We see a need for both," he said.

While the certificate of need process can be aggravating, Grice said, it's one way the state can make sure hospitals keep their emergency rooms open. Some 36 states use certificate of need programs.

"Trauma centers generally lose money," he said. "They've got to have services to offset those losses."

Emergency rooms lose money because many of the people have very serious injuries and no insurance, he said.

"Think about teenagers whose parents don't have insurance, who've been in serious car accidents," Grice said. "They're delivered to the emergency room, no income, no assets, no insurance. To save their lives, it could be hundreds of thousands of dollars."

All this could change if the government reforms the health care system, he said. Right now, people with insurance pay negotiated costs for treatment. People without insurance pay the full charges.

The health care system would be much different if everyone made similar payments for similar services, Grice said.

That would be a huge change and will likely depend on who's elected president, he said.

"There may come a day when health care may not be as profitable a business as it is today," Grice said. "We do need to do something, but it's going to be hard."