To meet the growing demand for oncology services in Shelby County, Ala., not-for-profit Baptist Health System filed a certificate-of-need application in 1996 to build a $3 million, 7,600-square-foot facility in the town of Pelham that would offer radiation therapy, medical oncology and various support services.
To meet the same demand, for-profit Tenet Healthcare Corp. filed a CON application that year to build a $4.1 million, 12,000-square-foot cancer facility in Pelham.
Although the state of Alabama approved both CON applications last year, neither system has begun construction. Instead, both have been using the state's CON appeals process and legal system to stymie the other's plans, hoping to win the market's lone franchise for oncology services. Meanwhile, the patients the systems claim need those services can get only limited services at each system's hospital and must travel to get most care.
Chuck Colbert, administrator of Baptist's 228-bed Shelby Baptist Medical Center in the Birmingham, Ala., suburb of Alabaster said the delay in building his hospital's new cancer treatment center has affected the quality of care for cancer patients in Shelby County.
"It's been a problem," he conceded. "And it's caused us a problem in fulfilling our mission."
Shelby Baptist's competitor in this CON battle is Tenet's 468-bed Brookwood Medical Center in Birmingham.
Tenet spokesman Lance Ignon, who pointed out that Brookwood filed its CON application first, said the building delay and legal action stem from the company's belief that duplicated services don't help patients.
"(Duplicated service) ultimately weakens the strength of the entire healthcare system and ultimately threatens the interests of patients," he said.
Colbert said Shelby Baptist primary-care physicians and oncologists treat the cancer patients, so the patients are Shelby Baptist's.
"But there's a gap in care because they have to be transferred to Brookwood for radiation therapy," he said. "Brookwood believes these are their patients who have come there on a referral basis and feel it's an interruption in care when they don't go to Brookwood."
Shelby Baptist says its not-for-profit status and mission to treat the poor give it an advantage over for-profit Brookwood in the right to operate exclusively in the area.
But Ignon said tax status is irrelevant. "The not-for-profit issue is . . . a red herring. The ability to provide charity care ultimately rests on financial stability."
Shelby Baptist counters that Brookwood's project would cost nearly $1 million more than its own, so cancer care would be more expensive at the Brookwood facility.
But Brookwood argued that Shelby Baptist's CON approval is invalid because of a legal technicality. It claims the CON board granted Shelby Baptist's approval to the Shelby County Hospital Authority, which sold its hospital to the Baptist system in 1996.
The appeals of both CON approvals are pending in two separate state courts. No trial dates have been set.
Neither center can be constructed until the Alabama Supreme Court rules on where the court case will be held and the trials are completed. That process could drag on for at least another year.