COLUMBIA — Had Piedmont Medical Center been told by state health officials that outside applicants would be allowed to compete for the right to build a Fort Mill hospital, it immediately would have added 64 beds to its Rock Hill hospital in 2004, Piedmont’s former CEO testified Friday.
Charlie Miller, Piedmont’s chief executive officer from 1999 to 2012, testified in the South Carolina Administrative Law Court that he had understood that the S.C. Health Plan reserved those 64 beds for Piedmont.
The addition of 64 beds would have increased the size of Piedmont’s Herlong Avenue hospital to 352 beds, up from 288.
Piedmont was working with Clear Springs Development Co. of Fort Mill, the developer of Baxter Village, to bring health care to the rapidly expanding area of northern York County, Miller said. That contract called for Piedmont to add physician practices, an urgent care center and an imaging center.
A hospital in the Fort Mill area was included in a 10-year plan, contingent on approval from the state Department of Health and Environmental Control, he said.
Piedmont was well on its way to meeting those plans, Miller testified, and that would have meant a Piedmont-owned Fort Mill hospital would have opened in 2009.
Today, eight years later, Piedmont is still seeking permission to build the hospital, appealing a DHEC decision that awarded the required certificate of need to Charlotte-based Carolinas HealthCare System.
Miller and Joel Grice, former head of the DHEC office that reviewed certificate-of-need applications, testified Friday, ending the first week of what is expected to be a three-week trial. The decision of Judge Phillip Lenski may mark the end of the long fight. His decision can be appealed.
Grice testified that he awarded the 2006 certificate of need to Piedmont because it was “the only applicant that could be approved under the 2004-2005 state health plan.” He said Piedmont’s application was consistent with other “satellite” hospital applications that had been made throughout the state where hospitals shifted existing but underutilized beds to areas where the population was growing.
Grice said a Fort Mill hospital would benefit its parent, Piedmont, by being a source of referrals and continue PMC’s commitment to York County. He said it also would stop the flow of patients from York County to North Carolina providers.
Grice also said his focus was to “take care of South Carolina.”
In 1980, he denied certificate-of-need applications for open heart surgery by Piedmont and Aiken Regional Medical Centers near the South Carolina-Georgia border because the proposed programs would have an adverse effect on existing providers in North Carolina and Georgia.
A state Senate committee “raked me over the coals” over those decisions, he said. Grice said he was told to focus his efforts on South Carolina.
A South Carolina judge ruled in 2009 that DHEC misinterpreted the state health plan about who was eligible to build a Fort Mill hospital. The judge sent the process back to DHEC, and competing hospitals were asked to resubmit their applications with current information.
Miller testified that patients leaving York County for care at Carolinas have been a long-standing problem for Piedmont. He said the agreement with Clear Springs Development Corp. was to stop that trend and give Piedmont a stronger presence in northern York County.
He also testified about the effect of Carolinas primary care physicians referring their patients to specialists within the Carolinas HealthCare System. Not only has this resulted in a loss of patients and revenue but almost every York County doctor affiliated with Carolinas has ended his or her privileges to practice at Piedmont, Miler said.
Because of declining patient volumes and revenues, Miller said Piedmont has gone to a flexible work schedule for some of its staff. If there are surgeries for them, they work. If not, “they don’t get paid for hours they don’t work.” The result is that highly skilled workers most often seek employment elsewhere, he said.
Carolinas attorney Douglas Muller questioned Miller extensively about the contract between Piedmont and York County. He asked whether Piedmont has fulfilled the terms of the contract in areas such as providing ambulance service to the county and offering competitive prices. Miller acknowledged there have been some problems but Piedmont has met the terms of the contract.
Muller also asked about a change in the contract prompted by Carolinas’ interest to buy Piedmont in 1980. Provisions in the contract allowed the county to buy the hospital back from its owners, American Medical International. (AMI at the time was negotiating with Tenet to take over Piedmont Medical Center.)
That provision of the contract was removed in exchange for Piedmont agreeing to expand services such as cardiac care, neurosurgery and emergency and update the hospital’s technology.
Carolinas lawyers have argued that Piedmont has used the contract to keep health care competition from coming to York County.
Miller said that unless the trend of losing patients and revenues can be reversed, Piedmont will see a “slow death, to be blunt.” He said he’s “not sure (Piedmont) would have a competitive model” with a shift to more patients with less ability to pay. The shift may mean Piedmont will become “the hospital that it was in 1980.”
Don Worthington • 803-329-4066