OBITUARIES: Decatur | Shoals | Huntsville
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Keller consultant critical of RegionalCare application
By Jennifer Edwards -
Jim Hannon/TimesDaily
Dennis Nabor, center, attorney for Helen Keller Hospital, presents information during a hospital hearing at Marriott Shoals Hotel on Monday.

FLORENCE — A health care consultant testifying for Helen Keller Hospital described the certificate of need application filed by RegionalCare Hospital Partners for a 300-bed hospital in Florence as being inadequate and incomplete.

Gary Griffin, a health care planner and consultant from Gadsden-based Gary Griffin & Associates, said information in the application for the proposed replacement hospital does not meet the mandatory standards of the Alabama State Health Plan.

He added the application does not justify building a 300-bed hospital or one that includes the space allotted for ancillary services such as the additional operating rooms and increased emergency room space.

Griffin also criticized the application for the perceived lack of study on the potential impact to other health care facilities in the health care service area.

RegionalCare witnesses have said the new hospital will not negatively impact other facilities, predominantly Helen Keller Hospital in Sheffield. Griffin said those filing the application did no analysis to make that conclusion or to determine if the new hospital would have detrimental impact on other health care facilities in the area.

"These projections by (North Alabama Medical Center) soak up the market so much that it at least has a detrimental impact on Helen Keller Hospital," Griffin said. "(That is) detrimental not only to Helen Keller but to other hospitals receiving any patient discharges from Colbert or Lauderdale County."

North Alabama Medical Center is the name for the planned replacement hospital.

Griffin said his projections show that if the new hospital reaches its number of patient discharges outlined in the certificate of need application, Helen Keller's discharges from Colbert and Lauderdale County would drop from 4,092 to 3,289 in the new hospital's first year and to 2,150 in the second year.

Griffin said the primary service area would not see a large increase in hospital discharges as a result of population increase or aging population.

It has been Helen Keller's position through the contested hearing that they do not oppose a new hospital for Lauderdale County but want it to be the "right size." To achieve that, Griffin said, the certificate of need review board has at least two options. The board can apply the 2011 projected bed need chart, which states Lauderdale County needs 215 acute care hospital beds or the board can apply the "60 percent rule," which states a hospital should reduce the number of beds to a point where it maintains 60 percent occupancy.

Under that provision, Griffin said the replacement hospital should be between 229-234 beds.

Services in question

Certain specialty services offered by ECM were also questioned during Griffin's testimony.

He said the projected obstetrical services noted in the application was in contrast to national and local trends. In the application, the replacement hospital is projected to have 1,750 obstetrical discharges in the first year of the new hospital. That is about 400 more than in 2011.

Griffin said Helen Keller Hospital has seen an increase in obstetrical discharges in recent years, while ECM's numbers have declined.

The much-discussed open heart surgery program at ECM was again brought up Monday. Griffin questioned whether the program at ECM is sustainable after the hiring of two open heart surgeons. He said nationally and in Alabama the number of open heart surgery cases has declined. He said that trend is also true at ECM, the only hospital in the Shoals equipped to perform open-heart surgery.

Griffin also said the steps put in place by ECM to advance that program are not best practices, particularly employing Dr. Constantine Athanasuleas. Griffin said his age, which was originally estimated by Griffin to be 67, meant it was likely Athanasuleas wouldn't still be practicing when the new hospital is built.

Athanasuleas' age, 62, was corrected under cross examination, but Griffin still said "that is not something long term to build a program on."

Expert changes predictions

Bob Robicheaux, chairman of the department of marketing, industrial distribution and economics at the University of Alabama at Birmingham, lowered his market share predictions about inpatient volume for ECM and Helen Keller Hospital after he said he found a error during the weekend.

On Friday, Robicheaux said the replacement hospital would attract between 14,200 and 15,900 admissions, and Keller would get about 6,100 admissions from the projected service area of the replacement hospital.

On Monday, he lowered those predictions to about 8,200 for the replacement hospital and 4,100 at Keller.

Those numbers are much below the numbers the two hospitals are currently experiencing. The data used by Robicheaux was from 2010. In that year, ECM reported 11,435 admissions and Keller reported 6,296 admissions.

Robicheaux said the error was the result of him using an incorrect number for Lauderdale County's population. Despite the error, Robicheaux stood by his belief a new hospital would dramatically affect patient volumes at Helen Keller.

"From a competitive stand point, it's hard, maybe nearly impossible, to accept that a new regional medical center with an attractiveness much greater than a decrepit ECM facility would be built in the primary trade area and have no measurable or demonstrable impact on an existing competitor like Helen Keller," Robicheaux said.

RegionalCare leadership changes

Recent leadership changes at the corporate offices at RegionalCare raised questions of commitment during the contested case hearing.

RegionalCare CEO Marty Rash was moved to an executive chairman position and RegionalCare Chief Operating Officer John Rutledge left the company.

Kent Wallace, president and chief operating officer of Vanguard Health Systems, was hired to replace Rash in the CEO role and in Rutledge's operating role.

Company officials said the changes are not a factor in the commitment to the two projects in Florence, but Helen Keller attorneys asked that the record of the trial remain open for 60 days after the hearing is complete to allow for the addition of information that may come from the leadership changes at RegionalCare.

Administrative law judge Bill Chandler tabled the motion and said it will be addressed when the hearing is completed.

Steve Rowe, attorney for RegionalCare and ECM, said RegionalCare is contractually obligated to build a new hospital in Florence and would be penalized $40 million if those plans don't come to fruition.

Jennifer Edwards can be reached at 256-740-5754 or



Bob Robicheaux, professor from the University of Alabama at Birmingham, testified to his estimates of discharges for Eliza Coffee Memorial and Helen Keller hospitals and the possible impact of a replacement hospital on Helen Keller.

Gary Griffin, health care planner and consultant for Helen Keller Hospital, testified about inadequacies he saw in the certificate of need application filed by RegionalCare for a replacement hospital.


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