The Gadsden County Board of Commissioners have a tough decision to make and they must make it soon according to Michael Glazer, attorney for Gadsden Hospital Inc. Board of Directors, who laid the board’s options on the line Tuesday.
An administrator or a management company must be hired immediately if the hospital is to open by the extended date of June 21, 2010, he told them. Glazer said the ideal situation would be if Tallahassee Memorial Hospital or Hospital Corporation of America would take the facility over and operate it. HCA is the parent company of Capital Regional Medical Center in Tallahassee and is the largest owner of hospitals in the nation.
The commission, Glazer said, is making a decision by indecision. At the end of the meeting, commissioners agreed to pursue three options: meet with Tallahassee Memorial Hospital and Capital Regional Medical Center to see if either has any interest in operating the hospital, continue trying to access the trust fund through the court or access all of the money from the half-cent sales tax for the immediate future.
If the county opts to operate the hospital, the process could take months and there is the risk of not opening before June 21, 2010, which would result in the loss of the operating license. Glazer said if the county wanted to run the hospital, a staff should have been hired months ago. As of Tuesday, no specifications for requests for proposals had been written or advertised and no medical staff had been assembled.
Glazer said that either TMH or CRMC could walk in and get the hospital open because they already have the staff and the surveys required to open the hospital, as well as the numerous licenses required to operate a hospital. Glazer said officials from CRMC did a walk-through of the hospital 2 weeks ago and were pleased with the physical plant.
"They didn't make any commitments though," he said.
Neither hospital, he said, is likely to purchase the millions of dollars in equipment and furniture required to open the facility. If either decided to run the hospital, those purchases will fall on the county's shoulders.
The only source of funding for that kind of purchase is the hospital trust fund. The county is seeking to access the trust fund but there is no guarantee that a judge will rule in the county's favor. A new wrinkle in accessing the trust fund is a $6 million lawsuit that could land the trust account in court at any time.
According to Glazer, a lawsuit was filed by the company against the county. The company wanted $6 million it claimed to have spent on indigent health care while it operated the facility. The county, the suit alleges, never reimbursed it for those expenses.
"When Ashford filed for bankruptcy, everything stopped. Through the bankruptcy court the lawsuit was not a part of the settlement the county made with Ashford to regain the license. The bankruptcy is over this month but an outside collections company in New Jersey would be allowed to take the county to court in an attempt to collect. It would be at their own expense but the company could receive two-thirds of the $6 million and the rest would go back to the court to be divided among Ashford's other creditors," he said.
Nicholas Thomas, Gadsden County clerk of court, said a little over $9 million is in the trust fund and there is nothing left in the interest account because that money is now being used as fast as dividend checks arrive to subsidize urgent care.
Using the facility as a free-standing emergency room isn’t an option either. Glazer said by law an emergency room must be connected to a hospital.
"There is no way possible this county can run a hospital. Now, from what we've been told today, it might be difficult to access the trust fund with the lawsuit hanging over our heads," said Eugene Lamb, commission chairman.
The other option the county has is to look at using all of the half-cent sales tax. Deborah Mennis, county attorney, advised commissioners that they could use all of the money for a designated period of time but the law clearly states that the money must be used for the intent stated on the referendum: that one-third of the funds collected must go to indigent care.
"The health care plan can be amended. No matter how you structure it, you have to address all of the issues in the referendum," Mennis said.
Commissioner Doug Croley asked Thomas if he knew where the county might be able to get funds to buy the needed equipment and furnishings.
"When the hospital closed we had $2.5 million in dividends. A lot of those resources have been used. There are no dividends. The only real source is getting funds from the trust or the general fund," Thomas said.
"We are like a bride with no groom," said GHI chairman Craig McMillan.
Commissioner Brenda Holt suggested that while the county is going through the 2009-10 budget process this month, $500,000 be set aside for the hospital.
"This is a time-sensitive matter. We need to work together with other municipalities and we need to market this hospital. We need a plan. I'm in favor of getting a consultant because we've allowed 2 months to pass without action. We have a mandate from the citizens to open the hospital and we have to do that. We've spent over $8 million at that facility to allow it to mildew. We need to put together a plan and stand by it," said Commissioner Sherrie Taylor.
"Ladies and gentlemen, you have a problem. Mr. Thomas has told you that you don't have any money to operate the hospital. I'd love to see us have a hospital but your primary responsibility is to operate this county in a fiscally responsible manner," said Ron Tiller, a Gadsden County resident.