KELLY PRICE

It wasn’t pretty or quick, but the Nemours Foundation came up with an “A” for “Approved” on its third request to develop a pediatric healthcare system in Central Florida.

After having been turned down by the Florida Agency for Health Care Administration on two previous applications for a Certificate of Need (CON) and two years of trying, Nemours’ plan to site a children’s hospital at the blossoming “medical city” springing from the shores of Lake Nona turned out to be the key to getting a nod of approval.

The FAHCA felt that proximity to the advanced medical facilities of UCF and Burham would be a plus for Nemours.

On June 15, the FAHCA announced approval of the CON for Nemours to build, at its own expense, a comprehensive children’s hospital that will rank in the “top tier” of children’s hospitals in the country. The approval was for a proposed 95-bed, $277 million children’s hospital with a strong research agenda. The committee stipulated that the expectation would require that the children’s hospital Nemours builds would be of the caliber to earn a national ranking among the children’s hospitals in the country.

Although the members of the FAHCA reported that, in their opinion, Nemours had not demonstrated a need for more pediatric hospital beds in Central Florida, the committee approved the Nemours application because of its emphasis on the quality of care it could provide and what could be gained by proximity to and working with UCF and the medical facilities destined for Lake Nona. Regulators also mentioned that expertise with an electronic medical records system that is well tested within the Nemours extensive system could improve quality of care.
Nemours supporters celebrated at the announcement of the CON, with Dr. David Bailey, president and CEO of the Nemours Foundation, saying leaders would move quickly to open its children’s hospital in Central Florida.

The hospital released a statement that said, “This hospital will do much to establish Central Florida as a leading healthcare region in the country. Nemours looks forward to supporting the good work occurring at our community hospitals and other partner institutions and intends to be the preeminent voice for children in this country and, with the announcement, is well on its way to achieving that goal.”

The Nemours application had been strongly resisted by Central Florida’s two existing children’s hospitals, the Arnold Palmer Hospital for Children operated by Orlando Regional Medical Center, and Florida Children’s Hospital, part of the Florida Hospital system. The two hospitals had 28 days to file an objection to the CON from the announcement on June 15, and Orlando Regional indicated that it planned to file an appeal before the deadline of July 20. It is recognized that an appeals process could take months, or even years, to settle.

Although leaders of both of the existing children’s hospitals had agreed to meet with their counterpart, Bailey, before the announcement of the CON, the possibility of an appeal remained open.

Orlando Mayor Buddy Dyer and Orange County Mayor Rich Crotty, at the end of June, jointly asked Dr. Andrew C. Agwunobi, chairman of the FAHCA, to help mediate a working agreement between the three providers.

The state maintained that API and Florida Children’s Hospital would have to file a formal appeal for the state to become involved again in the argument.

Agwunobi replied to the mayors that the state’s position was that it could not mediate the issue and could only respond to a legal appeal to the ruling it had issued with the CON. Agwunobi explained the FAHCA could not intervene without becoming involved in evaluating its own decision to grant the CON and cannot reconsider its own ruling, unless “a formal challenge to our decision is made.”

Florida Children’s Hospital and API insist that their interest is to be sure that Nemours has a legally binding obligation to fulfill the obligations that were part of its request for the CON. Nemours had promised that nearly 54 percent of its patients would be Medicaid or charity care.

Other commitments that Nemours made in the CON were to hire at least 50 pediatric subspecialists in the next five years, and to spend at least $3 million annually on research.

If API and/or Florida Hospital file a successful appeal to the CON, they could come away with an enforcement mechanism to require Nemours to comply with the plan put forth in its application or the JAHCA could reverse its decision to grant the CON.


August 2007