The Missouri Health Facilities Review Committee last week approved one of the hardest-fought hospital construction projects in the state in years. By a vote of 5-3, the committee signed off on a new 55-bed women's hospital in the growing suburbs of west St. Louis County.
The conflict pitted two large Roman Catholic systems in St. Louis-SSM Health Care and Unity Health System-against each other.
In collaboration with Women's Health Physicians, a 70-member independent practice association, SSM will build a 95,000-square-foot women's hospital in Chesterfield, Mo., for $33.6 million. It will offer obstetrics, surgery, breast health and various "well-women" services.
SSM's most active opponent was Unity Health, the local arm of Sisters of Mercy Health System-St. Louis.
"We believe this is an unnecessary duplication of services that are available in abundance within just a few miles of the proposed site," Richard Slack, Unity's vice president of planning and marketing, said a few days before the vote.
After the vote, Unity said in a written statement that the decision is inconsistent with rational health planning and will lead to increased costs. "What may appear as an attractive offering for some St. Louis women may in fact result in diminished levels of both care and access for women in other parts of our community, most notably north St. Louis County," Unity said.
Chesterfield is in a belt of affluent new suburbs that is not exactly starved for hospitals. Three hospitals in west St. Louis County already offer the gamut of women's health services. They are BJC Health System's Missouri Baptist Medical Center in Town and Country, Unity's St. John's Mercy Medical Center in Creve Coeur and St. Luke's Hospital in Chesterfield.
SSM plans to move beds and services from other locations where they are underutilized.
But Unity claimed SSM was trying to enter a new market under the guise of building a replacement facility. That's inconsistent with accepted rules for health policy planning in Missouri and would set a bad precedent, Slack said.
Unity even filed a lawsuit in early fall to delay decisionmaking so a public hearing could be held. But the suit became irrelevant after bureaucratic delays pushed back the process by two months.
SSM plans to shift beds to Chesterfield from 272-bed DePaul Health Center in Bridgeton and 213-bed St. Joseph Hospital of Kirkwood (Mo.). The system will cease providing obstetric services at both facilities, under the certificate of need it filed.
"The bottom line is, an average of two or three babies are delivered per day at DePaul," said Dixie Platt, SSM spokeswoman. That is 10% of the local market, "not enough to make a viable program," she said. "Same thing with St. Joseph Hospital of Kirkwood, where two babies a day are being delivered."
SSM wants to continue providing care in the area, though. "We are committed to serving that community," Platt said. "It's about where to put the resources."
Even after the shift to Chesterfield, residents of north St. Louis County will still have plenty of access to obstetric care at BJC's nearby Christian Hospital Northwest in Florissant, Platt said.
BJC didn't take an official stand, but in a letter to the CON committee, system officials noted, "This replacement at a distance seems to violate the spirit and meaning of the word `replacement.' BJC would suggest that if there is a need, a project of this nature would be more appropriate if it were to remain on a current SSM campus . . . most likely DePaul."
At a public hearing Oct. 26 to discuss SSM's proposal, 12 people testified against it, including the Rev. Stephen Joyce, representing the St. Louis Clergy Coalition. He said north St. Louis County is primarily poor and African-American, and moving the services would contribute to a "pattern of isolating people because of economics, race and female-headed households."
A representative of the United Health Care Workers of St. Louis said the project should be rejected "if it results in the closing of healthcare services to a poorer section of the population at an excessive cost."
Several doctors and nurses also argued that the proposed facility wouldn't provide all the services needed to treat complicated births.
The report by the CON staff found the project financially feasible but did not find community need. The applicant "did not document where the patients for the new hospital would come from or how . . . the `replacement' OB services would impact" St. John's Mercy, St. Luke's or Missouri Baptist, none of which is operating near capacity, a CON staff analyst noted.
This Catholic catfight has proved an unusual spectacle in heavily Catholic St. Louis, which is the headquarters of the Catholic Health Association. After Tenet Healthcare Corp. entered the St. Louis market last year by purchasing St. Louis University Hospital, observers wagered that four competing systems couldn't survive in the heavily overbedded market.
SSM and the IPA Women's Health Physicians said no profits from the new hospital will be distributed to investors until the facility achieves national quality benchmarks. James Stutz, director of the St. Louis Area Business Health Coalition, said the commitment to improving quality and reducing bed capacity in St. Louis "sets a major precedent. It breaks new ground in accountability and sets a new standard for the region."