It's not unusual for the certificate-of-need application process to slow the bricks-and-mortar phase of a new hospital. And it's not unusual for competing hospitals to try to stall or kill a project by objecting to another hospital's CON.
But in Mississippi, a CON dispute may close a hospital that's been admitting patients for more than three years. If that happens, it may be the first time that competing hospitals have used a state CON appeals process to close a functioning hospital.
On Nov. 18, Mississippi State Health Officer Ed Thompson, M.D., is scheduled to announce his decision about a CON application filed by Naples, Fla.-based Health Management Associates for its 64-bed Central Mississippi Medical Center North in an affluent section of Jackson.
If he rejects the application, the facility must close by 5 p.m. on Dec. 31 to comply with a June ruling by Judge Patricia Wise of the Hinds County Chancery Court.
It's the second CON application the facility has filed. If the second round is anything like the first, the hospital has a long bureaucratic road ahead.
"I'm disappointed that the opposition continues to oppose this project," said Jay Finnegan, the HMA-appointed chief executive officer of Central Mississippi Medical Center. "I think this community's resources would be better served in providing for the healthcare of our community instead of conducting a prolonged and protracted legal battle."
Finnegan said the hospital satellite employs 200 people and pays about $800,000 annually in property taxes.
Neither of the hospitals opposing the CON would say how much they've spent trying to shut down the hospital.
The story began when the hospital's previous owners, Memphis, Tenn.-based Methodist Healthcare, filed the first CON application in late 1992 to relocate 64 beds from its existing Methodist Medical Center in south Jackson to build the new hospital about 15 miles to the northeast.
Two competing Jackson hospitals, 571-bed St. Dominic-Jackson Memorial Hospital and 631-bed Mississippi Baptist Health Systems, opposed the application and requested administrative hearings, arguing that the need for another acute-care hospital in Jackson had not been demonstrated.
"We contended that the building and operation of this facility were a willful disregard of the wisdom and requirements of the State Health Plan," recalled Keith Buchanan, a spokesman for St. Dominic-Jackson Memorial.
The Mississippi Department of Health, however, granted the CON a year later. The two hospitals appealed to the Hinds County Chancery Court, which sent the issue back to the Department of Health. The department conducted more hearings and again decided to grant the CON.
Construction began in 1995, and the hospital opened in 1996.
Mississippi Baptist and St. Dominic-Jackson Memorial continued their appeal, eventually bringing the issue to the state Supreme Court, which in 1998 overturned the rulings of the lower court and the health department, directing the chancery court to deal with the details of closing the hospital.
Meanwhile, Methodist sold both Jackson campuses to HMA for $131 million on April 1 of this year. The new owner renamed the hospitals Central Mississippi Medical Center and Central Mississippi Medical Center North. HMA filed its new CON application and started the ball rolling a second time in July.
"We have filed a different certificate-of-need application than was filed in the past," Finnegan said. "In our application, not only do we present the need for the project and the financial viability of the project but we are also proposing to relocate beds and services from the main campus to the north campus."
In 1998 the north campus saw more than 20,000 patients, Finnegan said. He declined to provide financial information but said the satellite facility and the two campuses are profitable.
One bone of contention with the first CON application was whether the beds were truly being relocated.
"We think the new application is just the old application in new wrapping by a different company, but the effect of it is exactly the same," said Andy Taggart, a local lawyer representing Mississippi Baptist.
Outside observers have scratched their heads about how the situation reached this point.
"I'm not aware of any case where this has happened," said George Barker, associate director of the Health Systems Agency of Northern Virginia and a member of the American Health Planning Association. "In most situations, they don't go forward with the project while it is under appeal. Most applicants would not want to go forward when something like this could happen."
If Thompson upholds the CON, the two competing hospitals have vowed to appeal the matter in court.