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Range Wars Target Healthcare's Richest Turf

Birmingham hospitals battle for prime locations in Alabama’s biggest healthcare market. Prized territories: the U.S. 280 corridor and western Hoover.

Trinity Medical Center plans to move from the Crestwood neighborhood in Birmingham to the property shown here, the

Trinity Medical Center plans to move from the Crestwood neighborhood in Birmingham to the property shown here, the "digital hospital," located on U.S. Highway 280, which HealthSouth Corp. brought near to completion before former CEO Richard Scrushy's legal troubles spiked the development.

Photos by Steve Gates

Healthcare has become big business in Birmingham. Iron and steel, once the backbone of the area’s economy, have been replaced by healthcare and health services industries. And as local hospitals strive to keep up with urban sprawl, a pair of turf wars has flared up.

Several of the largest hospitals in Birmingham, moving to stake out the wealthier suburbs, find themselves pitted against each other in the fight to serve lucrative areas. The battle for the 280 corridor pits Brookwood Medical Center and St. Vincent’s Health System against the proposed move of Trinity Medical Center to the abandoned HealthSouth digital hospital on U.S. Highway 280. To crosscheck Trinity’s move, Brookwood has moved to set up a freestanding emergency department on Highway 280. And in a separate action, the battle for western Hoover sees Baptist Health Systems and UAB’s Medical West fighting each other’s attempts to set up freestanding emergency departments.

Fighting for 280

For several years, hospital care on U.S. Highway 280 has been elusive. Richard Scrushy began building his “digital hospital” on 280 East during his HealthSouth heyday, but the facility was incomplete when Scrushy was indicted on federal charges and eventually went to prison.

After sitting empty for several years, the facility is now eyed by Trinity Medical Center, which plans to complete construction and relocate to the high-tech facility from its current location, in the Crestwood neighborhood of Birmingham. Crestwood was developed when U.S. 280 was still a blue highway through pastures.

“The greatest and overriding reason for our relocation is the desperate need for hospital care along the 280 corridor,” says Keith Granger, president and CEO of Trinity Medical Center. “Residents in this fast-growing area of the state have lived without adequate access to healthcare for far too long. Though many local hospitals have considered moving there, only Trinity has committed to making the investments necessary to do so.” 

"This is the right time, for the right project, in the right location, and we fully expect that, once our opponents' legal manipulations have been exhausted, we will move to Highway 280."               -Keith Granger

“Trinity’s current hospital site was constructed, for the most part, in the 1960s,” Granger adds. “Continuing to keep an older facility in compliance with current building codes is costly, time consuming and not the best use of healthcare dollars. Trinity would prefer, instead, to devote its resources for use in the delivery of the highest quality healthcare at the Highway 280 location.”

In September 2010, the State Certificate of Need Review Board unanimously approved Trinity Hospital’s proposed move from Montclair Road to U.S. Highway 280. But in December, Brookwood Medical Center and St. Vincent’s Hospital filed appeals of that decision, and the relocation remains stalled, as the battle makes its way through the court system.

“Despite the unanimous approval of the State CON Review Board and the recommendation of an administrative law judge, our competitors are doing nothing more than delaying our relocation and denying the community of thousands of good-paying jobs and hundreds of millions of dollars in economic impact,” Granger says. Representatives from Brookwood and St. Vincent’s did not respond to repeated requests for comment for this story.

The fight took a new twist when the Alabama Legislature waded into the fray this spring. State Rep. Mary Sue McClurkin, R-Indian Springs Village, presented a bill that would allow hospitals and health care providers to appeal the denial of a Certificate of Need to the Alabama Court of Civil Appeals, rather than going through the circuit court first. In April, the Alabama House of Representatives approved the bill on a 75-16 vote, but the measure did not get a vote in the Senate before the end of the legislative session.

Rep. Patricia Todd, D-Birmingham, represents the Crestwood neighborhood, where Trinity Hospital has been located since it opened in 1966 as Baptist Montclair Hospital. Todd says she believes the Certificate of Need process should be revised, but she opposed McClurkin’s bill because it was retroactive and would apply to appeals, like Trinity’s, that are already pending.

“I understand that folks near 280 need a hospital. My primary objection is how Trinity handled this move, and that they appear to not care about the blight that their move will create in a wonderful neighborhood,” Todd says. “The people who decided to move down 280 knew when they moved there where hospital services were, and it did not seem to make a difference to them in their housing decision. Also, the traffic on 280 is a nightmare during rush hours, and I cannot imagine the minutes that will be lost when the emergency services try to make their way to the hospital in time to save a life.”

While others have said that Trinity’s move will create jobs, nobody talks about “the loss of jobs at restaurants and drug stores near Trinity that patients use,” Todd says. “I don’t fault any business for wanting to increase their profits, but hospitals are different. The location of a hospital directly affects a community in a different way. Older folks make a decision about where they will live based on the location of health care services. For dozens of elderly folks in Crestwood, East Lake, Woodlawn, and other neighborhoods, losing Trinity means they have a longer travel period for emergency services.”

Granger notes that the CON streamlining bill applies to projects that have been or will be approved by the CON Review Board but are contested by others. “In the case of Trinity’s relocation, the project was unanimously approved by the Review Board but was contested by St. Vincent’s and Brookwood,” he says. “If the legislation is passed as it was written and is signed into law by the governor, the Trinity relocation project, along with several other projects that have been stalled in the CON appeals process, will move directly to the State Court of Civil Appeals for review. In short, the legislation will hasten the ultimate decision of all CON matters, including Trinity’s replacement hospital.”

Despite opposition, Trinity “will not be deterred,” Granger says. “Our commitment to our patients and our community has never wavered. This is the right time, for the right project, in the right location, and we fully expect that, once our opponents’ legal manipulations have been exhausted, we will move to Highway 280.”

However, Trinity won’t be the only one moving to 280. Earlier this year, Brookwood received approval to build the state’s first free-standing emergency department (FED) at Highways 280 and 119. A Montgomery Circuit Court judge rescinded that approval in June, agreeing with a Trinity complaint that Brookwood failed to provide adequate public notice in the CON process. Brookwood has appealed.

Western Hoover Showdown

While the battle rages for healthcare on Highway 280, just a few miles down Interstate 459, two other hospitals are fighting to stake their claims in western Hoover. Late last year, both UAB’s Medical West and Baptist Health System (BHS) filed applications with the state CON board to build free-standing emergency departments in the area. Within a few months, both hospitals and Medicaid filed notices with the State Health Planning and Development Agency opposing each other’s plans.

Baptist plans a new free-standing emergency unit on property the non-profit health network already owns near Baptist Health Center Hoover, near Interstate 459 and Alabama Highway 150. The emergency unit would offer a full-range of 24-hour emergency services, plus diagnostic imaging, laboratory and therapy services needed to serve emergency patients, as well as other outpatients, says Ross Mitchell, BHS vice president of communications and government relations. It would operate as an extension of Princeton Baptist’s emergency department.

“We made a commitment to the Hoover market in 2006 when we purchased real estate and established several physician practices,” Mitchell says. “Clearly, we think the market is under-served and that a hospital is truly needed. A free-standing emergency department is a logical next step to bringing services to the Hoover market.”

Medical West, an affiliate of UAB Health System, proposes to build a facility in the Interstate 459 corridor that will provide 24-hour emergency services as an extension of the Bessemer hospital. The FED would offer stabilizing treatment, diagnostic testing and imaging services, and be staffed by emergency medicine doctors with the 300-bed acute care hospital in Bessemer. Medical West anticipates spending approximately $8 million to build the facility plus $2.8 million on equipment. 

Because both CON cases are contested, both will be resolved by an administrative law judge. And because each governor appoints new administrative law judges and Governor Bentley just took office this year, those judges have not yet been appointed. Currently, the FED plans of both Baptist and Medical West are in a holding pattern. According to a representative with the state CON board, the opposition will delay the Certificate of Need review process for months at least.

Nancy Mann Jackson is a regular freelance contributor to Business Alabama. She lives in Florence.

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