One, Two or Both?

One, Two or Both?

Public hearing attendees make their case for hospital proposals.

Will Dan Descutner of Cascades see competition brought about by a second hospital? Will Supervisor James Burton be able to file away a petition he has with 2,000 votes favoring a fully functioning hospital at the Cornwall Campus in Leesburg, something he has wanted back for the past six years? Will Tim Powers see hospital services change with the rest of his community?

"I watched the population develop. We still have one hospital. I watched [the county build] 25 schools. We still have one hospital," said Powers, a Cascades resident who works in Washington, D.C. and a Loudoun resident for 12 years. "I welcome a second hospital. … Loudoun’s healthcare should not be about yesterday. It should be about today. It should be about tomorrow. It should be about the future."

Powers was one of about 30 residents to speak at the public hearing Monday for two Certificate of Public Need (COPN) requests that are under state review. Hospital Corporation of America (HCA) proposes building 164 beds at Broadlands Regional Medical Center, which if approved would be constructed on a 58-acre site in Broadlands, a project expected to take four years from groundbreaking.

At the same time, Loudoun Healthcare, Inc. wants to add 33 licensed medical beds to the Western Loudoun Medical Center, commonly referred to as the Cornwall Campus. The beds would serve a growing population in Leesburg and western Loudoun, along with opening up capacity at the Loudoun Hospital Center in Lansdowne to expand existing medical services there, particularly in cardiology and oncology. Loudoun Healthcare reopened Cornwall Campus in January to establish an emergency department with 16 examination bays. Adding medical beds would allow the campus to operate as a full hospital without a surgery component.

LOUDOUN HEALTHCARE had 30 minutes to present its case to a six-member committee, followed by HCA. Health Systems Agency (HSA) of Northern Virginia’s project review committee asked each applicant questions and allowed the public to comment before taking a vote to forward committee recommendations to the full HSA board. The two applicants made similar requests last year, Loudoun Healthcare to open 32 beds at Loudoun Hospital Center, which currently has 145 beds, and HCA to open 180 beds at Broadlands. HSA denied both requests.

"It’s critical we allow these beds to come online," said Rodney Huebbers, president of Loudoun Healthcare. "As the central and western part of the county grows, this gives better access from a medical perspective."

Loudoun Healthcare opened 42 beds in March, 20 to 30 of which are empty on any given day, Huebbers said, adding that the beds are intended to serve population growth over the next five years. He explained why a second hospital is not needed. By the end of next year, 211 beds are expected to come online in medical facilities in Northern Virginia. "We don’t need another 160 beds on top of that. That would pretty much put us out of business," he said, adding that Loudoun Hospital Center and Broadlands Regional Medical Center would have to draw from the same patient pool. The two hospitals are about 4.5 miles apart in eastern Loudoun, which is also served by hospitals in Reston, Fairfax and Fair Oaks.

"There is no need for additional beds," said Bob Lovic, consultant for Loudoun Healthcare, adding that if Broadlands Regional Medical Center opens as planned in 2008, Loudoun Hospital, which is a non-profit organization, can expect a $14 million net deficit that year. Loudoun Hospital’s annual operating budget currently is $113.22 million. "Those deficits will continue," he said.

"You’re calculations shortchange these people out here," said Burton (I-Mercer) to the HSA committee, referring to the Goose Creek area to the west. "Eastern Loudoun has reasonable access to three hospitals."

Twenty-seven communities in western Loudoun do not have the same access as eastern Loudoun, Burton continued and provided the committee with a chart of the number of miles each town and village is from Loudoun Hospital Center and from the Cornwall Campus. "I live 17.5 miles from Lansdowne. How many of you live 17.5 miles from a hospital?"

A committee member asked why Loudoun Healthcare asked to move hospital services from the Cornwall Campus to Lansdowne, a move made in October 1997, and now wants to open up the facility as a fully functional hospital.

"There’s new management in the hospital, and they recognize the void they left," Burton said. "I’m asking you to fill that void." The Cornwall Campus proposal would cost $5 million.

HCA MADE its presentation next before the HSA committee.

Loudoun residents need the additional beds HCA is proposing and "can’t get them from a retrofit," said Marilyn Tavenner, president of the Central Atlantic Division of HCA.

Projected population growth and present demand demonstrates that need, according to Thomas Hancock, attorney representing HCA, of Hancock Daniel Johnson & Nagle, P.C. "We’re not adding beds. If you build beds to serve patients who are leaving Loudoun County, they will return," he said. "Loudoun Hospital has a wonderful reputation and a wonderful following. Loudoun has a very loyal following, and they will support that hospital."

Forty-seven percent of Loudoun residents needing hospital services went to Loudoun Hospital in 2002, according to information provided at the public hearing.

"The reality is the pace of growth in Loudoun County is accelerating beyond the pace they expected. There is no question we need more beds and that we will in the future," said Megan Descutner, director of community relations for Broadlands Regional Medical Center, in a separate interview. "We keep hearing we’re going to put Loudoun Hospital out of business. We don’t see it. We see a business case for top-of-the-line healthcare for all of these people who are currently leaving the county. … We see competition as good. It makes everyone stronger. In the end, the patient benefits."

In addition, Broadlands Regional Medical Center is proposed to replace two hospitals that are antiquated and underused, since the population centers that once supported the facilities are moving away, Descutner said. HCA is filing the COPN, in part, to replace and relocate Northern Virginia Community Hospital, a 164-bed hospital in Arlington, and Dominion Hospital, a 100-bed child and adolescent mental healthcare facility in Falls Church, to Broadlands. "These beds are not needed inside the beltway, and they are poorly utilized. We want to move the 164 beds into Loudoun County where the beds are desperately needed and construct a state-of-the-art hospital with the latest technology," she said.

RESIDENTS had a chance to speak after the two presentations.

"Loudoun Hospital serves only 50 percent of the population in Loudoun County. … Loudoun County has less beds per 1,000 population than many other jurisdictions, and yet we are the second fastest growing county in the U.S. Third, it almost takes six years to open the doors," said Board of Supervisors chairman Scott York (R-At large) in a separate interview. He could not attend the meeting, so legislative aide Bob Lazaro read his statement at the hearing. In six years, the county’s population is expected to be 300,000 residents, so "Yes, we need another hospital," York said.

Dan Descutner favors the idea of healthy competition rather than "perpetuating the monopoly we have," he said. "We don’t need a second hospital in Leesburg where it’s land-locked."

Supervisor Charles Harris (D-Broad Run) said his family uses Reston Hospital when immediate care is needed. He encouraged both applications be approved, believing that Loudoun Hospital should never have been moved from Leesburg and that the population growth supports a second hospital. "I strongly urge you to approve both applications. I think they are both needed and deserved," he said.

At the end of the comment period, the HSA committee voted 3-3 for Loudoun Healthcare, Inc.’s request, not providing any recommendation, and voted 6-0 to recommend denial of HCA’s request.

The full HSA board will consider the two applications, along with other COPN requests, on Sept. 22 before forwarding final recommendations to state health commissioner Robert Stroube, who will make the final decision on all COPN requests. The applicants will have the chance to make a formal presentation to the Informal Fact Finding Committee, who also will provide a recommendation to the commission. The applicants typically are given a final reply in late February or early March of the next year.

The COPN applications were due July 1. The COPN request for Loudoun Healthcare is listed as VA-6859 and for HCA, VA-6860.