Hospitals across Florida have grumbled for years about the state's certificate-of-need process, an administrative quagmire that can cost hundreds of thousands of dollars and add years to a building project.
Despite those hassles, even frustrated foes of the CON recognized that every healthcare facility in the state was required to play by the same set of tough rules-at least until now.
Last month, the state Legislature overwhelmingly approved legislation that provides a special CON exemption to a 10-month-old hospital serving an upscale retirement community. The project was developed by a wealthy businessman who has donated about $800,000 to Florida's Republican Party and its candidates since 1999.
The legislation, now awaiting action by Gov. Jeb Bush, would carve out a CON exemption for the 60-bed Villages Regional Medical Center, allowing the small hospital to immediately add 180 beds, expanding its size by 300%. The bill, one of the few nationwide over the past several years to carve out special exemptions for hospitals, triggered sharp criticism from local competitors of the medical center, which opened in July 2002.
"It was a big surprise, to say the least," said Michael Wesolowski, vice president of operations at 323-bed Munroe Regional Medical Center, Ocala, which underwent a nearly three-year process to win CON approval for its new $74 million, 104-bed tower. "We're very disappointed. We were surprised not only by the speed of the legislation but by the size. Normally, in Florida, you're talking about an addition of 50 beds-not 180."
The carve-out legislation was promoted by developer Gary Morse, who built the Villages, a sprawling retirement community with about 30,000 residents located between Ocala and Orlando in booming central Florida. Morse, who gave the Florida governor a ride on his private jet to the 2002 Rose Bowl in Pasadena, Calif., also was feted as a member of a group that raised at least $100,000 for President Bush's 2000 election campaign.
Morse did not respond to a request for an interview about the legislation, which would allow hospitals to skirt the normal CON process in counties where there is only one acute-care hospital and the population has increased by at least 60% during the last decade. Those criteria apply to just two hospitals in the state-the Villages and 81-bed Florida Hospital in Palm Coast, a 7-month-old facility which is not interested in expansion at this time, said spokesman Lewis Clark.
Toni Wilson, a spokeswoman for the Villages, declined to address the controversy over the legislation, saying, "We've been staying comment-free. We're awaiting Gov. Bush's decision."
State Rep. Susan Bucher, a Democrat from West Palm Beach who has fought other attempts to chip away at the state's CON laws as a member of the Legislature's health subcommittee, denounced the legislation as a "campaign favor."
"Apparently it's a lot cheaper to give campaign contributions to the leadership than it is to go through the whole CON process," said Bucher. "It's inequitable."
The special legislation involving the Villages' expansion, approved in late April, underscores concerns across the nation that the CON process is diluted or distorted when hospitals gain special legislative exemptions from guidelines designed to apply to everyone (April 21, p. 4).
Two years ago, HealthSouth Corp., and its politically connected founder, Richard Scrushy, won a free pass through the CON process after the Alabama Legislature passed special legislation for HealthSouth's so-called digital hospital in Birmingham, triggering unsuccessful lawsuits by two local competitors. Despite its CON exemption, the digital hospital project has since stalled in the wake of an ongoing federal investigation into alleged accounting fraud at HealthSouth.
"Whenever there's a special piece of legislation that carves out an exemption, it makes the playing field uneven-it says that there are multiple standards in healthcare," said Thomas Piper, a spokesman for the American Health Planning Association and director of the Missouri Department of Public Health's CON program. "The process relies on treating everyone the same."
Like Piper, the Florida Hospital Association has adamantly opposed special exemptions to the CON law, said spokesman Rich Rasmussen.
"Does it make sense that you have a hospital that opened just six months ago with 60 beds, and ... they're trying to triple it?" he asked. "It doesn't make sense. If they need more beds, they should go through the CON process."
Munroe Regional and another local competitor, 210-bed Ocala Regional Medical Center, which recently won CON approval for a new 60-bed facility, have more than enough capacity to meet the swelling population of the 18,000-acre retirement community, he said. Ocala is about a 15-minute drive from the Villages. The huge retirement village is bidding to purchase the hospital from its current owner, Leesburg Regional Medical Center.
An aide to the governor said Bush "will review the bill when it gets to him and will then take appropriate action." She said Bush supports changes that loosen the CON law.