Jan 8, 2004 – Acting Health Commissioner Darlene Carty said Wednesday that the application for a Certificate of Need filed for an ambulatory surgical care center on Dec. 11 is incomplete and has been returned to the applicant for more information.
Devin Carrington, Health Department legal counsel, said there were several reasons the application was returned, the main one being that the entity in whose name the application was submitted is not incorporated in the Virgin Islands.
"It's logical we wouldn't begin a review without that," Carrington said. "Finding that the center is not legally incorporated in the V.I. is a big concern."
Additionally, he said the department's Application and Review Manual calls for submission of extended construction and architectural plans and documents showing where the facility is being constructed and that it has the proper zoning and construction permits. These, he said, were lacking in the application.
David Bornn, attorney for the St. Thomas Ambulatory Surgical Center, the name in which the application was submitted, said on Thursday that the applicants "intend to comply as soon as possible" with the requirements.
He said that work has been proceeding under two different names: that of an entity already formed, Surgical Development Co., LLC; and that of the company which will be formed to operate the center, St. Thomas Ambulatory Surgical Center.
"We want to proceed as rapidly as possible," Bornn said. "It's not as if we're hiding anything. We specifically stated in the application that the operations application would be formed at a later time."
The plan by nine local doctors to create a private outpatient surgery center on St. Thomas has stirred considerable controversy within the community — and strong opposition from Roy L. Schneider Hospital. The hospital and the surgical group have been running advertisements in the V.I. Daily News, and the subject has dominated several talk shows in the last week.
The doctors say the center will benefit the community and provide a needed service — and that it will operate in harmony with the hospital, and not drain revenues from it.
Rodney Miller, Schneider Hospital chief executive officer, vehemently disagrees. He says the creation of a "boutique" hospital will bring unfair competition. "The select few physicians who go into these things go into it to make money," he said earlier this month. Capitalizing on the most profitable outpatient procedures, they "leave the hospital with the more complex, major surgeries that are the less profitable services, which is a direct conflict of interest and one that would cripple our hospital." (See "Private surgery center: boon or burden?")
Bornn disputed that argument at the time. Some of the doctors in the group have worked at the hospital and some have not, he said, and some intend to continue performing outpatient surgical procedures at the hospital, as well. The types of outpatient procedures expected to be performed at the center represent about 12 percent of the surgeries now done at Schneider Hospital, he said.
Sen. Douglas E. Canton Jr., who chairs the Senate Health and Human Services Committee, plans to bring the issues into a public forum. He said on Thursday that he hopes to hold a committee hearing on the surgery center's application for a Certificate of Need on Jan. 21 or Jan. 28. "And meetings will probably continue into February," he said, "as there are other health issues that must be addressed as well — the nursing shortage and the government's compliance with two community health centers."
The scheduling of the meeting on the Certificate of Need "depends on our ability to pull all the people together," Canton said, "because when you set a hearing, you need all the stakeholders there."
Carrington said, too, that "the input of the public will be solicited in one form or another." He asked that anyone with concerns submit documentation they want to share to the Health Department "to assist the commissioner in coming up with a decision."
Carrington said he wants to expedite the application review process and that if Canton holds a hearing on the matter, "we would not duplicate that." But, the Health Department attorney added, "the process of evaluation and determination does not begin until the application is completed. We hope this is done in short order."
Canton said his committee will take testimony from all parties without prejudice and that the hearing in no way will be to "grill the commissioner." Further, he said, any effort on the part of the Legislature "to micro-manage what a commissioner does or does not do" would be "the wrong road for the body to contemplate."
What the commissioner can speak to "is the process and the layers of consideration in the Health Department that help her in gathering information," Canton said. "We want to give the Health Department the autonomy to do what in fact the law has empowered it to do."
However, he said, "the law is spread with a broad brush, and everything gets painted," and he wants to refine it. As an example of its flaws, he cited a case where a health provider who had received a certificate in good standing was "suddenly called into question for issues which weren't issues when he had originally applied for the certificate."
Carrington said the doctors' group also has been asked to submit more detailed information about the planned surgery center's hours of service, patient fees and types of patients to be served. Such information is needed "to make a decision about the impact of the center on the health system," he said.
Bornn said it is in the group's best interest to comply fully with the application requirements. "There's a difficulty in procuring things," he said. "You cannot get certain things by law until you have a Certificate of Need. It's a question of talking through with the commissioner's office the list of things they want, and the procedures by which we can provide them."
At the same time, Bornn said: "There is a national trend to eliminate the Certificates of Need. They have been found to be a costly mechanism to development and not necessarily conducive to the development of various facilities needed."
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