I have been following the debate concerning a private outpatient surgery center in the V.I. with great interest because it will effect the health care of every citizen one way or another. Because of the critical nature of this decision, I would like all parties including the public to debate the issue. I understand that Acting Health Commissioner Darlene Carty said the application for a certificate of need for an ambulatory surgical care center was filed on Dec. 11 and that it has been forwarded to the Health Department's legal counsel, that it now is being reviewed, and that a decision on the application could come in the next 60 days.
In the District of Columbia, the U.S. Department of Health as the district's designated "Statewide Health Coordinating Council" can call for a public hearing on a proposed certificate of need, as stated on its Web site. I hope to see the same done here by the V.I. Health Department and other government agencies.
By law in D.C., such certificates allow health-care providers to establish new services, make certain capital expenditures and/or take certain other actions. The federal district's designated "State Health Planning and Development Agency" reviews applications.
The review process is relatively straightforward. The planning and development agency staff prepares an analysis of the applicant's proposal with information on the type of service or facility proposed and a description of the applicant's plans. It also assesses those plans in relation to the D.C. Comprehensive Health Plan and applicable regulations.
Once the agency director issues a decision, anyone can appeal based on the allowable grounds for reconsideration specified in D.C. law and regulations. If the director determines reconsideration is warranted, the agency will hold a public hearing, after which a new decision may be issued. The director's decision on reconsideration may be further appealed to a Board of Appeals and Review, and then to the courts.
Certificate of need criteria and standards have been approved by the Health Coordinating Council and adopted by the planning and development agency. "Metropolitan review criteria" may also be used in the case of projects that have impact beyond the boundaries of the District of Columbia. Criteria might include such things as management capability, travel time to a facility and construction cost.
The D.C. Comprehensive Health Plan is a major factor; although all applications are considered, by law those that do not conform to the comprehensive plan cannot be approved.
Public hearings are held prior to the consideration of applications by the Project Review Committee of the Health Coordinating Council.
Public hearings during reviews normally are held only upon request. During the first 30 days of the review period, any interested person (including the applicant) may request that a hearing be held; upon such a request, the planning and development agency will hold a hearing. The agency also may decide to hold a hearing even if there is no request.
Here in the Virgin Islands, Schneider Hospital cannot appeal the Health Department's decision but the applicants have that option, CEO Rodney Miller said on "Behind the Headlines" on WTJX-TV. Amos Carty, the hospital's chief operating officer and legal counsel, confirmed this.
Here are my questions concerning review of the private outpatient surgery center application for a certificate of need:
– How can the public and the community hospital provide input into this decision?
– By what criteria is the certificate of need application being judged? Has an impact study on the ambulatory surgical care center been done? And if so, can it be reviewed by the public? If one has not been done, how can a valid decision be made?
– Has the Joint Commission on Accreditation of Healthcare Organizations, which just provisionally certified the hospital, weighed in on the process?
I have every reason to believe that the commissioner and the Health Department legal counsel are working toward a reasonable decision within the limited resources of their budget. However, it would be wise to include the public in this very important decision.
Therefore, I am imploring non-aligned organizations such as the AARP and the League of Women Voters to hold a formal town hall meeting within the next 60 days. Invite spokespersons for both sides of the debate, and place the information on the record.
Right now, it seems as though the process is flawed and needs reform. After a decision is made, reform might be too late. I simply wish to have more transparency, and the means to have greater participation, in government.
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