You Can’t Have a Hospital Because We Don’t Get to Build It

In the continuing saga that is the building of a hospital in Columbia County, The Augusta Chronicle reports today that the Georgia Court of Appeals has voted to send the case Doctors Hospital filed against the Georgia Department of Community Health back to Fulton County Superior Court. Doctors Hospital had asked for a judicial review of the GDCH’s decision to award Augusta University Medical Center a Certificate of Need (CON) through an exemption in 2014, and somehow, all the documentation for the review did not make its way to the Appeals Court. Specifically, Doctors Hospital had asked that some documents be added to the file, and they weren’t for whatever reason. Fulton County was supposed to send those documents within 10 days of the request back on November 8, 2016.

They missed the deadline by 154 days as of this morning.

Now, they have been ordered via ruling to submit the complete review to the Appeals Court, where it will be re-docketed for the next term. Yes, it’s a paperwork error, probably just an oversight from someone who earnestly made a mistake and had no ulterior motives, but Columbia County residents have been held hostage by this drama for almost four years already.

For background, Richmond County has a ton of hospital beds. It’s a medical hub, including hospitals designated as Level 1 and Level 3 trauma centers. Columbia County neighbors Richmond County, so it’s not eligible for its own hospital under Georgia’s CON law. However, the population has grown exponentially within the last decade, and drives to downtown Augusta have gotten slow enough to where it’s necessary to have emergent care within the county’s limits. Recognizing this, GDHC awarded a CON under an exemption that required that the one hospital awarded would be a sole provider and the county would pay 20 percent of the cost to build the facility. Columbia County commissioners concurred. The three large hospitals in Richmond County — AUMC, Doctors Hospital, and University Hospital — all applied under the exemption in 2013, and GDHC eventually awarded the CON to AUMC. As is true with most things involving business (which hospitals are, let’s be real), Doctors Hospital and University Hospital appealed the decision. No one at that point disagreed with their right to do so. It’s a part of the fair bidding process.

Even before exhausting those appeals, however, Doctors Hospital took an approach that could best be described as “whatever will stick for us or we’ll stick it to you.” So desperate were they to get the CON for themselves and only themselves or else, they not only filed those appeals with GDHC, they also asked for a judicial review of the decision and simultaneously sued GDHC, challenging the agency’s ability to make decisions for CONs. That lawsuit was thrown out in 2016. Attorney General Chris Carr pointed out that it made no sense to claim the CON was harmful for your hospital and at the same time apply for the sole license for Columbia County. According to Carr, Doctors Hospital was merely angling to overturn GDHC’s decision in its favor, apparent from the fact that suit was filed at a time that Doctors Hospital was still trying to overturn the exception in its favor through the GDHC’s appeal process.

Doctors Hospital has wanted us to believe it’s all the state’s fault that there’s not yet a hospital in Columbia County. Last year, spokesman Adam Landau told WBRC, “There would be a new emergency center in Columbia County right now, if it wasn’t for the state. The state has decided to have an archaic CON law that really punishes hospitals that want to invest in their communities.”

Last month, they at least quit pretending they weren’t the reason behind the holdup. Spokeswoman Lynthia Owens was quoted in the Chronicle, “Our goal is that we really want to make sure that we’ve gotten fairness in what we believe to be a flawed process. It’s not the business of bureaucrats to reach into legislative authority and hand-pick a hospital for Columbia County or any other community, for that matter.”

Columbia County Commission Chairman Ron Cross said it best this week when he told the Chronicle, “We just wish it would be over and get on with the construction.”

I’m not advocating for or against CON in this case. That’s another post to take up later. It’s the law of Georgia and 36 other states, and it’s been upheld in several court cases as recently as last year. (If you want a good backgrounder, I’d suggest this white paper.) And Carr is correct: This is a clear game by Doctors Hospital to ensure that if they don’t win that nobody will. Reread those quotes from Landau and Owens. Notice who’s missing?

The patients. And that’s absolutely shameful.