A certificate of need submitted by Tennova-Cleveland seeking approval to build a 24-hour freestanding emergency room in Cleveland was denied Wednesday during a Tennessee Health Services and Development Agency hearing in Nashville.
The hearing was conducted in House Hearing Room 1 at the Cordell Hull Building. The 11-member board voted 6 to 2 to deny the certificate of request, or CON.
The denial of the CON ends Tennova’s multiyear plan to construct a new freestanding emergency room that would relieve overcrowding at its current hospital emergency room caused by the area’s increasing population, as well as by patients from nearby Polk County where a hospital closed last year.
THSD Board member Dr. Kenneth Patric told fellow board members he was “inclined not to approve either CON because approving one facility while rejecting another didn’t make sense.”
Patric also said he was concerned that orderly care in the area would be affected by Erlanger’s potential impact on Tennova’s current emergency room.
In addition, officials from Starr Regional Medical Center discouraged the board from approving Tennova and Erlanger’s CON’s, claiming that the presence of both freestanding emergency facilities would decrease patient volume at their Etowah and Athens locations.
Representing Tennova, attorney Warren Gooch told the board that Erlanger’s CON should be denied because it would affect patient care in the area.
“It should be denied,” Gooch said. “It does not contribute to orderly healthcare.”
Gooch said economic growth in the area where Erlanger planned to construct its freestanding emergency room was not an appropriate reason to enter the local medical community.
“Economic development is not a reason to grant a CON,” Gooch said.
Gooch also criticized Erlanger’s reference to its emergency facility as a trauma center.
“Freestanding emergency rooms are not allowed [by state regulation] to be called trauma centers,” Gooch said.
Gooch also told board members that Erlanger wanted to redirect emergency room patients from Tennova to meet its volume projections. In addition, he also said the proposed facility was “aggressively opposed by the public and physicians.”
Tennova chief medical officer Dr. William Johnson said the local medical community was opposed to Erlanger’s plan to enter the market.
“I can tell you every doctor does not think it’s a good idea. It’s bad for the community and bad for patients.”
Johnson also told the board that Erlanger was unprepared to provide care to the local community. He also warned the board that Erlanger would refer patients not to local specialists but to ones in Chattanooga, which would have an adverse effect on a medical community that has taken decades to build as Cleveland has grown in population. Johnson referred to Cleveland’s medical community growth as an “orderly, step-like development.”
“No effort or attempt to build a backup roster has been made,” Johnson said. “Referrals will also likely be made to Erlanger doctors. Specialists would get fewer referrals, and it would be hard to recruit doctors due to a lower volume [of patients]. Doctors see it as a duplication [of care] and harmful to their practices.”
It would be a hardship for patients to travel to Chattanooga for follow-up care, according to Johnson.
Others representing Tennova expressed frustration with Erlanger’s claims regarding its proposed emergency room.
“It was sold to the community as a trauma center,” said one representative.
Tennova president and chief executive officer Coleman Foss said its proposed freestanding emergency room was necessary because its hospital was landlocked and prevented from expanding. He also said remodeling its current emergency room was a challenge.
“Our campus can’t expand, and we can’t close our emergency room for remodeling,” Foss said.
Representatives from Starr Regional Medical Center, which has locations in Athens and Etowah discouraged the board from approving Tennova and Erlanger’s CON’s, claiming that either facility would “hurt the Etowah” location.
“We don’t see how spending $12 million on something that is not economically feasible,” said one representative.
SRMC chief executive officer Mark Nichols told the board that Tennova should concentrate on lessening its shortcomings.
“In our view, Tennova’s need is not for another emergency room but to operate more efficiently,” Nichols said.
After the presentations and summations concluded, board member Joe Grandy said he was not in favor of approving Tennova’s CON.
“I struggle with when another medical center is two to three miles away,” Grandy said. “I don’t think it adds to orderly care.”
In a statement to the Cleveland Daily Banner shortly after the conclusion of the hearing, Foss said, “Though we are disappointed in the outcome, we respect the decision of Health Services Development Agency’s board. We have a long-standing history of providing quality care to our community and will always work to be the provider of choice for local residents. We will continue to focus on the development of access points to ensure the community has convenient access to care through the development of urgent care centers or other provider locations. We are proud to serve our growing community, and we remain committed to providing high quality healthcare close to home.”
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