General Opposition to Spring Hill Hospital

By a seven to one vote, the Health Services and Development Agency has determined that there is a need for a new hospital in Spring Hill. Based on population growth, commercial development, and approved subdivisions, the Health Services and Development Agency concludes the best way to meet the needs of the citizens of Spring Hill is with a new general hospital that provides a laboratory and medical technology, including x-ray, CT, MRI and ultrasound. Spring Hill's most significant need is more primary care physicians who make the area their home or the primary focus of their medical care. Primary care physicians will be attracted by a general hospital providing these services. This need is not based solely on hospital beds. The bed need as calculated by the Department of Health is only a guideline and does not consider other immediate needs within Spring Hill; empty beds at MRH and WMC do not mean that there is an excess of medical care. Based on population growth and traffic patterns, the HSDA sees the need for a hospital within the city limits of Spring Hill.

Moreover, no matter whose population projections are accepted, the evidence establishes that there will be a sufficient population in Spring Hill between the years 2010 and 2014 to support a 56 bed hospital.

The Agency recognizes the fact that any new provider will take patients away from an existing provider. The CON process in Tennessee is not intended to protect hospitals from all competition, but rather to provide the public with reasonable access to healthcare while at the same time protecting existing facilities from unnecessary and duplicative competition that would threaten the ability of the existing facilities to continue to provide services in the community. The Agency therefore finds that while some patients and/or their physicians will choose SHH instead of MRH or WMC, there is no evidence that as a result either MRH or WMC will be unable to continue to provide their services to the community

The Health Services and Development Agency concludes that establishing a hospital in Spring Hill will attract primary care physicians, provide comprehensive care to the citizens of Spring Hill, and provide referral sources to tertiary care hospitals in the region, thus contributing to the orderly development of healthcare.

The SHH CON application did not satisfy the Guidelines bed need formula. However, WMC's 40-bed CON application and Stonecrest's CON application each failed the formula but both were granted a CON by the Agency. Pursuant to Tenn. Code Ann. § 68-1 1-1609(b), the Guidelines are not mandatory but should be merely used as a guide. Additional evidence was presented and should be considered as to whether or not additional beds are needed in the Spring Hill area.

The Health Services and Development Agency concludes that establishing a hospital in Spring Hill will attract primary care physicians, provide comprehensive care to the citizens of Spring Hill, and provide referral sources to tertiary care hospitals in the region, thus contributing to the orderly development of healthcare.

The HSDA concludes that, regardless of which expert's dollar amounts are accepted, the "losses" referred to by the experts for MRH and WMC were never netted by them against the increase in discharges that will result from the population growth that everyone agrees is occurring. Without any evidence of the net effect of these "losses," there is no evidence in this record of substantial financial harm that would prevent WMC or MRH from continuing to provide services to their communities.

The HSDA concludes that Dr. Luke's population projections are not outside the range of reason in light of the fact that the undisputed evidence in the record shows that Spring Hill has grown at a rate faster than either Dr. Luke or Dr. Swanson projected in the years 2005-2007. Furthermore, this accelerated growth rate establishes that Dr. Swanson's "high" scenario is actually at the low end of the range of reason.

Moreover, no matter whose population projections are accepted, the evidence establishes that there will be a sufficient population in Spring Hill between the years 2010 and 2014 to support a 56 bed hospital.

The HSDA concludes that there is no evidence in the record that either MRH or WMC would likely be less able to provide for the health care needs of citizens in their service areas.

Maury Regional Hospital and Williamson Medical Center have not established by a preponderance of the evidence that the application for a Certificate of Need for Spring Hill Hospital fails to meet the statutory and regulatory criteria. Further, Spring Hill Hospital has established by a preponderance of the evidence that the application for a Certificate of Need for Spring Hill Hospital does meet the statutory and regulatory criteria. THEREFORE, it is hereby ORDERED that the Certificate of Need filed for the Spring Hill Hospital be GRANTED.

It is further ORDERED, pursuant to Tenn. Code Annotated § 68-1 1-1610(i), that all of the costs in the contested case proceeding, including the Administrative Law Judge's costs, deposition costs, and expert witness fees are assessed to and shall be paid by MRH and WMC.