public healtDelaware Gov. Jack Markell, health board at odds over proposed hospital

Ableman said Selander is incorrect.

Christiana Care bought 108 acres on Del. 299 in 2008 for a hospital and offices. Christiana Care did not specifically object to the HealthSouth proposal but simply presented the review committee with its level of services.

This board has historically been opposed to — or less than thrilled with — the opportunity for greater competition, and the governor believes there is value in having members that share the belief that we should be expanding opportunities for quality health care and looking for ways to put people to work, Selander said. I would not be surprised if new members that filled open seats feel that competition can be a positive thing.

It appears Markell is trying to stack the deck in his vor, some board members said. OConnor said the administration interfered with the process.

The two slots held by Mulhern and Francke were among the six seats filled by members that Markell appointed in early May. Some of the vacant seats had been open for more than a year, Ableman said. Among the new members are Bettina Riveros, who is Markells policy adviser on health care and head of the Delaware Health Care Commissipublic healtDelaware Gov. Jack Markell, health board at odds over proposed hospitalon.

Mulhern, administrator with Limestone Medical Center, served as chairman of the review committee. He had served on the board for more than six years.

To OConnor, thats not a ir criticism.

I understand my term had expired. But I was surprised and disappointed after spending over three months on thispublic health jobs application. I was disappointed with the timing, Mulhern said.

public healtDelaware Gov. Jack Markell, health board at odds over proposed hospital,Traditionally, the comprehensibility of credit card terms has been roughly on par with, say, those…

HealthSouth said its still hopeful the full board will approve its hospital development for the 6.5-acre parcel it will lease.

Im disappointed, with the recommendation, said Kelleher of HealthSouth. But I believe at some point well be able to develop in Middletown. Weve had the support of the governor, the mayor of Middletown and legislators.

Jason Sinclair, who is a financial analyst with Bayhealth, told the review committee that the HealthSouth development wouldnt provide a level of service not already available in Delaware.

Richard Beck, who spoke on behalf of Broadmeadow, echoed those sentiments, saying the Broadmeadow cility has not had to turn patients away because its unable to accommodate people.

Theyre trying to make it out that were incompetents, he said.

For his part, Byrd said Delawares health care community is parochial and close-knit.

Theres clearly a strong difference of opinion between the governors office and the three members of this review committee, Selander said. The governor believes wholeheartedly that putting people back to work and improving our quality of life needs to be the governments top priority. This review board voted to say they dont share that priority. The full committee still has a chance to show they disagree with the decision.

Byrd said the process has been difficult because the application is very sophisticated and one that had not been seen by the board before.

When asked about the changes, Ableman said while hes a devoted n of Jack Markell, he is troubled by the dismissal of Mulhern and Francke, who gave countless volunteer hours to the board.

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State Health and Social Services Secretary Rita Landgraf said she felt HealthSouth would fill a need for care for traumatic head injuries and home health care.

The full board of 17 members is expected to vote on the HealthSouth application no later than July. Ableman said the full panel has never overridden a review committees recommendation in the nearly 20 years hes served on the board.

Used by states since the early 1960s, so-called certificate-of-need programs are designed to rein in health care cility costs while allowing for coordination of new construction and services, according to the National Conference of State Legislatures. The Delaware Health Resources Board was created in 1978. Proponents of these programs say health care doesnt respond to regular market forces because consumers do not shop for services, according to the state legislatures conference. Excess capacity usually leads to over-utili- zation, said S. Bernard Ableman, a public board member and chairman of the Delaware Health Resources Board.

Weve been hearing for years about how the free-market system is going to lower costs, and it hasnt, has it? said William OConnor, a public member of the health resources board and a member of the review committee.

The letter came as a surprise. It was very unexpected, especially in the midst of a review committee. You dont expect that to happen, said Francke, who was a public member of the board and served six years.

Lawmakers spoke at a public hearing and review committee meeting in vor of the application for economic development reasons, committee members said. Sen. Bethany Hall-Long, D-Middletown, said all the lawmakers sent a letter of support for the proposal.

But the political interference into the boards independence reached a new level in early May, according to review committee and board members.

The 48,155-square-foot hospital would serve patients who are no longer in crisis but need additional care after a hospital stay. That would include patients with traumatic brain injuries, she said.

Two members of the review committee — Thomas Mulhern and Christiaan Francke — received letters from Markell saying their terms had expired and would not be renewed.

Alan Levin, the state economic development director, said he wrote a letter to board chairman Ableman supporting the project because it will put people back to work and fill a health care need in the growing Middletown area. The way Levin sees it, competition drives down health care costs.

HealthSouth also hired powerful lobbyist Robert Byrd to develop community support.

The hospital would provide care for medically complex patients who need 24-hour nursing care and daily contact with their physicians, said Cindy Kelleher, vice president of corporate development with HealthSouth.

On the other side, opponents of these programs say there is little evidence that overcapacity leads to higher costs, according to the conference of state legislatures. In ct, such programs may keep prices high by restricting competition. This appears to be the stance of the Markell administration. Opponents say the programs are not consistently administered and certificate approval can be based on ctors other than the interest of the community, such as politics or the prestige of the institution, according to the state legislatures council.

Gov. Jack Markell has come out in vor of the hospital project, believing it would create jobs and provide the state with additional health care services, said Brian Selander, spokesman for Markell.

I think the review committee voted against putting people to work, voted against expanding access to quality care and voted against recommending an opportunity that would be good for Delaware, Selander said.

This is the first time a real outsider has come to Delaware, and that makes it a challenge, he said.

Francke finished his term this spring.

Its not part of the charge to the board to create jobs, Joann Hasse, a public member who chairs the review committee, said after the vote.

Bayhealth Medical Center in Dover and Broadmeadow Healthcare and Rehabilitation Center in Middletown publicly objected to the HealthSouth proposal.

Sinclair and Sharon Kurfuerst, vice president of rehabilitation and orthopaedic services at Christiana Care Health System, called the review committees recommendation ir.

And we very early told them: Were not in that business, OConnor said.

The board and staff have been challenged, Byrd said.

HealthSouth, of Birmingham, Ala., submitted the application for a certificate of public review in November for a rehabilitation hospital of 34 beds on Del. 299 at Del 1.

The national and sometimes intense debate over state regulation and planning of major health care projects appears to have reached the First State. Some suggest this battle ultimately could lead to the demise of the Delaware Health Resources Board.

HealthSouth said the development would create up to 80 full-time jobs for professionals and generate 200 construction jobs during the building process.

Although Mulherns term had expired in January, he had been working since February on the HealthSouth application.

Most disturbing is the timing of the dismissal of these board members — at the very time they were at work on a five-member committee evaluating one of the most significant applications before the board — the establishment of a new hospital, Ableman said. This is akin to replacing five of the 12 jurors halfway through the trial. The statute creating it declares that The Board is an independent public instrumentality, but the clear message from the timing of these dismissals is that we are not so independent after all, and good citizens will surely be discouraged from volunteering for future board and commission assignments.

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From the beginning, HealthSouth was selling the project as economic development, OConnor said.

In a rare move, a committee under the Delaware Health Resources Board, which has been reviewing an application from HealthSouth Corp. for an $18.5 million hospital in Middletown, decided Friday to recommend that the full board reject the proposal.

But Selander said the governor has the right to appoint members to boards and commissions across the state.

During my service on the board since 1995, not one application has been denied, and a review of the hundreds of applications filed since the board was created in 1978 disclosed that only five were denied — with some of these at the request of the applicant, Ableman said.

A proposal by a health care company to build Delawares first free-standing inpatient rehabilitation hospital has turned into a showdown between the Markell administration and members of an independent board charged with scrutinizing and approving public health care developments.

But review committee members said that despite an unprecedented level of political meddling — including the appointment of six newcomers to the 17-member board in early May by Markell — they were not convinced theres a need for the hospital. The duty of the independent board is to foster cost-effective and efficient use of health care resources, including preventing excess capacity, board members say.

But Ableman said the board has imposed conditions on approvals, mostly to do with the charitable care and quality of service.

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