The Kentucky Cabinet for Health and Family Services has granted Pikeville Medical Center (PMC) a Certificate of Need (CON) for additional acute beds, which will expand PMC to a 300-bed facility.
A CON is a legal document required in many states, including Kentucky, before proposed acquisitions, expansion or creations of facilities are permitted. Its purpose is aimed at keeping health care costs low while allowing new services and construction.
The State Health Plan sets standards for services and takes public policy concerns into account, which licensure alone does not accomplish.
PMC’s additional beds were approved by the Cabinet for Health and Family Services following a three-day public hearing in Frankfort. The final order approving PMC’s CON application was issued by Brian C. Baugh, administrative law judge. Judge Baugh’s opinion contained his findings as well as the ruling.
Twenty-nine beds will be utilized for a new Intensive Care Unit (ICU) which will be built on the ninth floor of the May Tower. PMC has been forced to turn away critically ill patients because it did not have enough available beds. This means patients must travel for at least an hour and a half to receive critical care services that should be available closer to home.
“It’s not a good plan to put trauma victims or people having heart attacks in an ambulance or in a helicopter and ship them off when they ought to be treated within the first hour, which we call the ‘golden hour,’” said PMC President/CEO Walter E. May.
The remaining beds will be designated for medical patients on the eight floor of the Elliott Building after renovation. Those beds will be able to be converted to ICU beds if necessary in the future. Renovation of the eighth floor is scheduled to begin in July and should be completed by May 2017.
Drawings for the new ICU floor have already been submitted to the state for approval. Construction should begin shortly.
“When this work is completed, we’ll be a 300-bed hospital,” said May.
The CON approval came despite strong opposition from a number of area hospitals, including Tug Valley Appalachian Regional Hospital (ARH), Whitesburg ARH and Highlands Regional Medical Center.
The University of Kentucky, UK Healthcare also opposed PMC’s plans for growth.
Tug Valley ARH and Whitesburg ARH presented testimony from ARH’s Director of Capital Projects Trena Hall, CEO Tim A. Hatfield and CEO Dena Sparkman. Jim Zembrodt, associate vice president for strategy for UK Healthcare testified to deny PMC’s request. Highlands presented testimony from CEO Harold C. Warman Jr. The opposing hospitals jointly presented Richard A. Baehr, an expert in healthcare planning, healthcare policy and healthcare finance, as a witness.
ARH was represented by Michael D. Baker of Wyatt, Tarrant & Combs and Mathew R. Klein Jr. of Dressman, Benzinger & LaVelle represented Highlands.
“They said we didn’t have the need for these additional beds and we’re not as busy as we think we are, but the numbers speak for themselves,” May said.
In addition to May, those who appeared and testified on behalf of PMC included Chief Financial Officer Michelle Hagy, Chief Nursing Officer and Assistant COO Debra Parsons, Chief of Cardiology Dr. Bill Harris, Chief Medical Officer and OB/GYN Dr. Aaron W. Crum, Medical Director of Infection Control Dr. Fadi Al Akhrass and Daniel J. Sullivan, president of Sullivan Consulting Group.
PMC was represented by Pamela T. May and Toney Robinette of East Kentucky Law Group and Janet A. Craig and K. Kelly White Bryant of Stites & Harbison, PLLC.
The 56-page decision states that PMC’s growth has increased since being designated as Kentucky’s only Level II Trauma Center last year. The hospital has seen a 24 percent increase in trauma patients and a 21 percent increase in ICU admissions.
The report notes that the number of patients being transferred to PMC from other facilities has also increased significantly since receiving Level II Trauma status. The findings show that PMC receives a high number of transfers from many hospitals throughout its service region, including the hospitals that opposed PMC’s request for more beds.
From Jan. 1, 2015 to Aug. 31, 2015, Whitesburg ARH transferred 296 patients to PMC, Highlands Regional Medical Center transferred 278 patients to PMC and Tug Valley ARH transferred 223 patients to PMC.
According to the hearing officer, the number of patients transferred to PMC from Highlands Regional Medical Center grew from 47 in 2007 to 391 in 2014.
“The numbers clearly show our need for additional beds,” said Walter E. May. “This finding will now allow us to move forward with building our new 29-bed Intensive Care Unit as well as another patient floor. The judge held that while there are various hospitals in PMC’s proposed service area, including the opposing hospitals [ARH and Highlands], PMC is different in the sense that it serves as a regional referral center that provides a broader scope of services. Eastern Kentucky is relatively isolated geographically and it is important for people to have access to both community hospitals and the more specialized services provided at PMC.”
The judge’s ruling showed PMC proved that its application met the State Health Plan criteria.
PMC established that the conversion of special care acute care beds, including Neonatal Intensive Care Unit beds, ICU beds and Obstetrics beds, is not feasible because each of these bed categories are already highly utilized.
PMC performed an analysis projection of patient-day trends over a five-year timeframe using the past five years as a predictor of future trends. The projection demonstrated a need for 84 more beds by 2020, substantially more beds than the 39 which were requested.
The quality of services PMC provides as well as its numerous accreditations and awards were also considered in the Cabinet for Health and Family Services’ decision to grant the CON. The judge found that PMC is continually recognized as a healthcare leader in its region.
An overwhelming number of letters of support were submitted for PMC’s request, many of which were written by physicians on medical staffs of the hospitals that opposed PMC’s growth.
“As the judge found, where community hospitals do not have coverage for whatever reason, PMC is there as a resource to meet the needs of those patients,” said Walter E. May.
PMC established that the addition of 39 beds was the most effective and economical way to meet the healthcare needs of the residents and that it is prepared to and capable of carrying out the responsibilities involved with operating the 39 beds.
PMC physicians and staff stressed how everyone will benefit from the additional beds.
“The approval of additional beds at PMC is important for the region,” said Dr. Crum. “We currently operate close to full capacity every day due to our ability to provide highly specialized care close to home. The addition of these beds means we can keep more patients at our hospital instead of transferring them to facilities over 100 miles away, which adds undue expense and hardship on patients and families. I am very proud of our ability to serve the needs of our community and grow as the demand grows.”
Dr. Bill Harris said, “There is a tremendous need for additional ICU beds as well as regular beds at PMC due to our growth in several areas, two of those being our heart and stroke center and our trauma center. We’re the only hospital in the region that offers these services. With regard to both of these services, the first hour is the golden hour if you want to reduce death. We need the capability to not turn patients away and have the appropriate beds and services available. These beds will go a long way in addressing those needs.”
The judge noted in his opinion that even Zembrodt from UK Healthcare who opposed PMC’s request acknowledged that if a Tug Valley ARH patient has a heart attack and needs to be transferred to another facility, the patient is going to be better served if he or she is transferred to PMC as opposed to Hazard ARH, which is two hours away, or UK, which is even further away.
“PMC serves as the referral center for our entire region,” said Dr. Al Akhrass. “We’re fully staffed with a wide variety of specialists who provide a high level of care and are available 24/7. Other hospitals in the area do not offer the level of specialty services or the advanced equipment we offer. With the high number of patients transferred to our hospital, we actually need more than 39 additional beds.”
Parsons said, “The addition of licensed beds at our facility will permit patients in the community to receive advanced care while remaining close to their loved ones. This increased bed capacity enables PMC to accept and treat a greater number of patients from hospitals that cannot provide the level of medical and nursing care we offer.”
Over the past 91 years, PMC has grown from a rural 50-bed hospital into a 300-bed regional referral center encompassing more than one million square feet on its main campus.
“We’re pleased to receive approval for these additional beds so that we can continue to grow and keep up with the patient demand,” said Walter E. May. “The future is bright for PMC and for our patients.”
A full copy of the opinion is available for viewing at pikevillehospital.org/opinion.