Is Another Hospital Hopeless in Loudoun?
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Board's Rejection Raises Questions
Saturday, February 7, 2009
In the aftermath of last week's close vote by Loudoun County supervisors to reject a proposed 164-bed hospital in Broadlands, Loudoun officials have started debating whether the vote effectively killed the county's chances of getting a second hospital in the foreseeable future.
Board Chairman Scott K. York (I), who supported the Broadlands project proposed by HCA Virginia, predicted before a standing-room-only crowd at Tuesday's board meeting that Loudoun would never see another hospital built. He was almost as pessimistic in an interview later.
"If we were to see another hospital opportunity come through, it would be at least 10 years before you'd see doors open up, and probably much longer than that," York said. "And there is speculation at this point, never again."
Supervisor Kelly Burk (D-Leesburg), who voted against HCA's proposal, disagreed with York. She said that HCA and Inova Health System own property along Route 50, an area in which Inova has expressed interest in developing a hospital. Other hospital networks also might want to build in Loudoun, she said.
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"I think there's a lot of possibilities," Burk said. "Those are not the only two organizations that build hospitals. So, conceivably, there could be another group that comes in."
Loudoun has 0.56 acute-care hospital beds per 1,000 residents, well below the 1.34 beds per 1,000 residents in Northern Virginia as a whole, according to figures cited by HCA.
Inova officials said they agree that Loudoun needs more hospital beds, but disagreed with HCA about the Broadlands location. They said the site was too close to Inova Loudoun Hospital, which is five miles away, in Lansdowne, and that Route 50 was a more suitable location.
Inova owns property at Route 50 and Racefield Lane, in the Dulles South area, and it received board approval last year to build a 113,000-square-foot facility on the land. Initially, the building would include an imaging center, a 24-hour emergency room, physician offices and outpatient services, with inpatient services being added in a second phase, Inova officials said. But they put those plans on hold pending the outcome of the Broadlands proposal.
During the months of debate over HCA's Broadlands project, Randall L. Kelley, Inova Loudoun's chief executive, said that Inova would apply for a certificate of public need from the state health commissioner for the Route 50 medical campus if supervisors rejected HCA's proposal. Supervisor Stevens Miller (D-Dulles), who voted in favor of the Broadlands hospital, reminded Kelley of that statement at Tuesday's meeting, saying he looked forward to Inova's filing with the state.
Kelley did not return phone messages last week. An Inova spokeswoman said he was out of town.
HCA's property on Route 50 is at Gum Spring Road, less than a half-mile from the Inova parcel. As part of its plan to build in Broadlands, HCA had agreed to construct a free-standing emergency department or other health-care facility at the Route 50 site. That facility has been shelved because of the board's rejection of the Broadlands project, HCA said.
Mark Foust, HCA's spokesman, reiterated last week that HCA has no plans to seek to build a hospital on Route 50 because it does not believe the area is populous enough.
"We have not changed our position," Foust said. "We are not planning to pursue Route 50 as a hospital site. It simply won't support one."
Burk said that if Inova were to apply now for a certificate of public need for its Route 50 campus, Loudoun could see another hospital "within a couple of years."
York disagreed, citing several factors. The state health commissioner considers population projections, among other criteria, when weighing applications. Even by 2020, about 87 percent of the county's population will live closer to Broadlands than to Dulles South, according to an analysis submitted by HCA as part of its Broadlands application.
York also said that other hospital companies would fight Inova's plans to build on Route 50. Fauquier Hospital and Prince William Hospital have letters on file with the state health department opposing a new hospital in that area, and state officials would take into consideration, he said.
He also cited possible opposition to Inova's plans from the Federal Trade Commission. Last year, the FTC and the Virginia attorney general's office filed a suit to block Inova's acquisition of Prince William Hospital, citing Inova's market share in Northern Virginia and the benefits of competition in the region.
The FTC became part of the debate over the Broadlands hospital at the last minute. During Tuesday's board meeting, Miller announced that the federal agency had recently contacted the county concerning the HCA proposal. He said in an interview later that the agency was acting more as a possible advocate for the Broadlands project than in its role as a regulator.
FTC spokesman Mitch Katz confirmed in an interview that the agency might provide county officials with material explaining its perspective on the hospital issue.
Miller's mention of the FTC during the board meeting prompted some supervisors to object to any involvement by the federal agency. Supervisor Eugene A. Delgaudio (R-Sterling) suggested that the county send a letter to the FTC "telling them we've acted on something and we're not looking for their advice."
Miller and York said in interviews later that they were surprised at the backlash against a federal agency charged with protecting the welfare of consumers.
"I was rather shocked at how much resistance I saw coming from some of my board members to the idea," Miller said. "Suddenly, I was seeing a number of them exerting what looked like efforts to prevent transparency."
After the board's 5 to 4 vote against the Broadlands hospital, Miller switched his vote and joined the majority. It was a procedural move that gave him the option of asking the board to reconsider its decision at its meeting Feb. 17.
Miller said that he is in discussions with the FTC, and that if any new information comes to light from those talks or from elsewhere, he might ask his colleagues to reconsider.
Tagged: hospital, Inova Loudoun Hospital
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Miller said the FTC would act as an advocate for the Broadlands project?
As I heard the discussion during the item, they would offer an opinion if asked.
No "investigation".
No "advocacy".
As for efforts to prevent transparency, Miller truly lives in a glass house, as was implied during Board discussion of his odd insertion.
Chris, I know you haven't been here very long, but truly, now that the FBI chasing the last Board is out of gas, does the Post really want to run the same game plan with the FTC and the new Board?
Posted by BarbaraMunsey (anonymous) on February 6, 2009 at 11:18 p.m. (Suggest removal)
What happened to free enterprise?
If a company wants to build a hospital, they should be able to. It's their business decision.
What business does the board of supervisors have getting involved?
(Campaign contributions, perhaps...?)
Posted by blueridgepro (anonymous) on February 7, 2009 at 8:40 a.m. (Suggest removal)
Barbara, it is his job to report, plain and simple. And for some of "us" (Loudouner since 1967), you haven't lived here very long either. ;)
Posted by t8erman (anonymous) on February 7, 2009 at 9:47 a.m. (Suggest removal)
Barbara, You seem to have some problem with The Post reporting the FACT that the FBI was investigating the last board. I don't ever recall The Post saying the last board was guilty of anything. The Post was doing their job and so was the FBI. The Post's game plan is to report the news. I think we all know your game is to spin it.
Posted by esteenz-post (anonymous) on February 7, 2009 at 11:06 a.m. (Suggest removal)
blueridgepro, the county is in charge of land use.
Two different Board majorities have now denied the land use for the same reasons.
As for campaign contributions, Mr. Miller received the benefit not only of HCA corporate PAC donations through VLF, but apparently also through HCA corporate PAC donations to an attack PAC against his opponent, which selected a filing method that made the documentation unavailable online. Anyone interested in finding those corporate donations would have to go to Richmond during business hours to see who paid for it.
It included only three private citizen donors, one of whom was also Mr. Miller's largest individual donor other than his mother, and who Mr. Miller appointed to a county position.
t8, it IS his job to report. Usually both sides. :)
esteenz, the Post used that story until the 07 election was over, and it appeared multiple times in election literature. VLF was directly funded with HCA PAC money, as was Scott York, and they both put out a lot of literature. That isn't spin, it's fact.
Posted by BarbaraMunsey (anonymous) on February 7, 2009 at 1:07 p.m. (Suggest removal)
There are three possibilities for a new hospital in Loudoun. One, HCA builds it in a different location. Two, Inova builds it. Three, another company comes in to build it. Not one of these looks promising.
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HCA would be fools to continue the fight against the backroom control Inova has over Loudoun County's political system. It's obvious Inova's tentacles reach deep into influences that run Loudoun County. Influences that I believe can't be overcome without outside help. It doesn't take Einstein to tell you doing the same thing over and over again is the definition of stupidity.
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Inova could try and build the next hospital but there is no chance with the FTC watching them. The PW County denial is concrete evidence. Let's not forget the FTC is riding herd on Inova's monopoly with Richmond's active support and assistance. No chance Inova builds the next hospital.
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A third party hospital provider. You have got to be kidding. A simple google search will provide enough evidence that this County is not the place to invest in. We will not see a quality hospital provider cross the County line for a very long time.
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As for the FTC interest, Waters is down playing this as games played by Miller. Well I wouldn't expect anything else, she's a strong advocate for Inova and I am sure Inova is advising Waters on how to position against the FTC. Waters is way to cozy with Inova for our County's good.
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I doubt the FTC is going to be successful in influencing any anti-hospital votes in the next few weeks. In fact, I don't even think that is the FTCs real interest. My guess is they are more interested in the non-profit status of this bully monopoly.
Posted by maravetz (anonymous) on February 7, 2009 at 1:14 p.m. (Suggest removal)
Someone needs to look after the interests of *all* of Louduon County's residents -- and if it means the FTC needs to provide additional insight into the matter, then so be it. People keep repeating the same information over and over, yet no one is integrating it in order to face reality -- if the decision stands as it is, no new hospital for Loudoun County for a long time to come. That's not fair to the children, the seniors, it's not fair to anyone. And to deny our county of the chance for so many new jobs is just downright punitive. Some people say, "it's a land use issue," others say, "it's a competition is bad for business issue," some people say, "not in my backyard," but who, I ask, is saying, "we need a new hospital, we have a nicely situated site on which to build it, let's get it done?" For the life of me, I don't know how some of these supervisors can look at themselves in the mirror and like what they see -- not when so many people are hurting
Posted by Yocomclan (anonymous) on February 7, 2009 at 1:26 p.m. (Suggest removal)
Glenn, the PW denial was of a merger, which would have blended two then-competing entities into one, thus eliminating competition there.
As for the FTC investigating non-profit status, since the same people so violently advocating against any hospital service on Route 50 are also many of the same people who have been supported through a very powerful supposed non-profit in their activities against ANY services on Route 50, maybe the FTC should look at more than one special interest in Loudoun.
Especially since that particular "non-profit" is three million in the hole over a multi-year powerline fight.
I bet they leaped at the chance to have an equally ruthless entity with even deeper pockets to pick up their slack in the last election.
Posted by BarbaraMunsey (anonymous) on February 7, 2009 at 2:48 p.m. (Suggest removal)
Barbara,
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True the FTC action was precipitated by a proposed merger. That doesn't eliminate the FTC's interest in the Inova/BRMC issue. Many of the same tenets of the Complaint are relevant to Loudoun County. The FTC forcefully argued their case based on Inova's dominance in the Northern Virginia healthcare market, and the detrimental effect on consumers when competition is diluted. These arguments became the basis for the FTC and Richmond's victory over powerful Inova. You have probably already read the complaint but others may be interested.
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http://www.ftc.gov/os/adjpro/d9326/08050...
Posted by maravetz (anonymous) on February 7, 2009 at 4:04 p.m. (Suggest removal)
Look at these numbers from the FTC complaint. With these facts, I do not think the argument that Inova already has competition in Loudoun holds any water. (see section 25)
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Northern Virginia Hospital Shares by Beds
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Prince William Hospital (Manassas) 170 beds; 6.0 share
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Inova Hospital System 1,892 beds: 67.0 share
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Potomac Hospital (Woodbridge) 153 beds; 5.4 share
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Fauquier Hospital (Warrenton) 86 beds; 3.0 share
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Reston Hospital Center (HCA) (Reston) 187 beds; 6.6 share
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Virginia Hospital Center (Arlington) 334 beds; 11.8 share
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With the existing dominance by Inova, I see no way that the FTC can't be interested. Especially, after witnessing Inova's seven year fight to keep HCA out of Loudoun. For the real impact on Loudoun citizens read section 9 through 15.
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Here is an excerpt from section 9:
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Like many general acute care hospitals, the Inova hospitals and PWHS sell acute care inpatient hospital services to a variety of commercial health plans. These health insurance plans reduce health care costs by encouraging hospitals to compete vigorously on price and non-price terms. They do so by contracting with hospitals in an area and providing financial incentives to encourage its enrollees to use the hospitals with which it contracts.
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One of the FTC's mission is to protect competition for the benefit of consumers. Do you really think Inova is going to get the next hospital built in Northern Virginia? I think not.
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Loudoun County won't get the next hospital either, unless the BOS reverses their vote.
Posted by maravetz (anonymous) on February 7, 2009 at 4:17 p.m. (Suggest removal)
Dear Board of Supervisors,
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With all due respect. The recent vote against increased healthcare in Loudoun needs to be reconsidered.
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There is no way Inova is going to be building the next hospital in Northern Virginia.
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Like it or not, dismiss it if you like, but this past vote doesn't send out a welcome sign to other hospital providers. I see little chance of any other provider entering Loudoun until Inova's influence is diminished.
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Inova won't be allowed to build the next hospital in Loudoun. Other hospital providers certainly don't feel welcome to build the next hospital in Loudoun. So that only leaves us with HCA.
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As our elected representatives please do not allow this watershed opportunity pass us by. It is now or never (or at least for a very very long time) before we will see another opportunity to get competition and more healthcare into Loudoun County.
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Please do the right thing and reconsider your vote(s) and approve the HCA application.
Posted by maravetz (anonymous) on February 7, 2009 at 4:29 p.m. (Suggest removal)
The question of the day, is, for what reason are certain members of the BOS refusing to recognize/understand that, because they have denied BRMC, there will NOT be a hospital on Route 50 for years and years to come? Next, let's say they do understand this, how do they justify refusing to allow ALL Loudoun County citizens to have needed healthcare services? There is just something so perplexing about this situation -- so troublesome -- do they understand the harm they are doing?
Posted by Yocomclan (anonymous) on February 7, 2009 at 5:19 p.m. (Suggest removal)
As long as this board continues to make decisions based upon their own self serving interests, I have no hope that the needs of this county will be properly and fairly addressed. It seems that the only thing they care about is demonstrating their power, no matter what damage it causes. Does anyone in Loudoun Cnty govt actually care about the needs of the people? The BOS laughs and smirks like it's all a big game --but I guess, to them, it is.
Posted by Yocomclan (anonymous) on February 7, 2009 at 5:28 p.m. (Suggest removal)
One of the NO votes, with whom I spoke on the phone the previous afternoon told me (almost verbatim, though I've slept since then), "Don't worry. After the vote, we'll put something together to get you folks a hospital on Rt. 50." When I reminded her of the letter from HCA to the BoS only a couple of days earlier, in which they unequivocally told the BoS that they would not be back begging for a Rt. 50 Special Exception any time soon, this same Supervisor told me, "That may not be what you think. We'll figure something out." Unfortunately, I believe that she actually and whole-heartedly believes that HCA was bluffing. Which I doubt, at this point. I guess we'll see.
Posted by stephen (anonymous) on February 7, 2009 at 7:14 p.m. (Suggest removal)
"now that the FBI chasing the last Board is out of gas"
Says who? I know you WISH it wouldn't yeild anything, but we're two years into the investigations. When the FBI calls the Justice Dept and the Treasury Dept. reps in, it's almost showtime. When those three meet, they're dividing the case sections to the appropriate prosecutors.
Posted by honchonumberone (anonymous) on February 7, 2009 at 9:47 p.m. (Suggest removal)
Dean, I know you've been getting private updates for several years now.
I thought those indictments were coming DEFINITELY before the 07 election?
Posted by BarbaraMunsey (anonymous) on February 7, 2009 at 11:20 p.m. (Suggest removal)
The trail they had to follow went much deeper than anticipated. People who become arrogant tend to think that they are entitled to do as they wish, no matter how right or wrong their behavior is. They lose their moral compass, and create a paradigmn in which they believe no one can see what they are doing. They can get away with this as long as those around them look the other way/don't care/get something out of the situation too. Sometimes, though, other people make a decision to get involved -- they decide enough is enough, and they take action. The old saying, "you can't fight city hall" didn't come from nowhere -- it takes a tremendous amount of time, energy and personal effort to tackle entrenched systems of power. Everyone thinks "someone else" will handle it -- in certain situations, someone did get involved. The way of life in Loudoun's old school back slapping smirking self important politics is slow to change, but at least it's no longer completely unchecked. Someday, we''ll get leaders on this board who are more concerned about the people than they are just about themselves. Meanwhile, it's important that people who have been sitting on the fence on the hospital and other issues get involved --otherwise, you are at the mercy of some of these self professed (and untrained) land use/planning "authorities" -- and must suffer with whatever self interest is driving them
Posted by Yocomclan (anonymous) on February 8, 2009 at 8:35 a.m. (Suggest removal)
yocom, I see you've been getting updates too?
This has been going on since a FOIA early in the 03 Board's term, and after two years of studying every email, both public and private, of five Board members, the Post ran a huge story and multiple editorials--with no news in them.
The same people involved with the HCA-funded election antics said the indictments were coming before the 07 Republican convention--so vote for their candidates instead.
They said they were coming before the 07 election--so why vote for someone who would be in jail?
There has been one story since, when a few people started wondering wha hoppen to the big impending mass arrest, and still nothing in sight.
But it is enshrined in repetitive "fact"; it's even part of the Loudoun entry on wikipedia!
The same buildup, from the very same people, is now occurring with the FTC.
Yes, people should get involved; otherwise special interests define the debate.
Sometimes with a lot of corporate PAC money.
Chris, re the emergency room? The proffer language did not guarantee one. It offered to make reasonable efforts to build one, or another facility, or be relieved of the obligation if nothing had happened in a year by paying $250K. It's on page A15 of the staff report, online at Loudoun.gov.
Posted by BarbaraMunsey (anonymous) on February 8, 2009 at 9:15 a.m. (Suggest removal)
I don't get any updates. I don't think it was any secret that under the table stuff was going on -- and it was/is/will continue to be investigated, that's all I really know. I'm just grateful that the old school cronyism of Loudoun Cnty is being exposed --people got tired of it, and want something better.
Posted by Yocomclan (anonymous) on February 8, 2009 at 9:19 a.m. (Suggest removal)
Good grief. Could Kelly Burk sound any more clueless? Does she think if she says something over and over that will make it true? The truth is - Loudoun County just lost it's chance to have another hospital for a long, long time.
Supervisor Burk got snookered by Inova and she can't admit it -even to herself. Inova threatened to close Cornwall, even though they are sitting on $2 billion. What a joke. And she's worried that the Inova gang will work against her next election time. Here's a clue for Ms Burk. They were against her last time and will be against her again next time. Her vote didn't negate that. But she has lost a lot of support from people who did vote and work for her last time. So many are saying they are very disappointed in her decision making. Especially on this HCA vote.
The one positive thing she has shown is she is capable of learning more about something and then changing her mind. The FTC information should truly bother her. Knowing that calling HCA's bluff didn't mean they will go to Rt 50 is now reality. I hope she reconsiders her vote.
Posted by PerfectTiming (anonymous) on February 8, 2009 at 12:25 p.m. (Suggest removal)
What bothers me about the "FTC information" is that the people pushing it have already changed their story once, and the vote isn't even a week old.
The first screaming on the net was that the FTC would intervene on behalf of BRMC, as if they could force the supervisors to reverse their land use decision. That seems to be one of Mr. Miller's implications here.
The story has now morphed for some into "the FTC will block Inova from building on Route 50".
That may not be the best game plan with some people still milking the FBI boogeyman.
Given that the most vocal pro-BRMC supporters from the Route 50 area couched their support in terms of being AGAINST a hospital on 50, just as many of the same individuals are equally vocal against any other services on 50, most recently schools, do they really want to make that the theme?
Nothing on 50?
Ever?
So it would seem, for some.
Posted by BarbaraMunsey (anonymous) on February 8, 2009 at 1:09 p.m. (Suggest removal)
Oh, there will be a hospital on route 50, but it'll be down the road, I'm guessing at the earliest, five years from now -- meanwhile we get nothing. Hooray. As for the FBI, the FTC, and whatever entities might be checking into stuff, maybe they'll find things they want to handle, maybe not. But in the meantime, we're stuck with no additional resources for our health needs. Great.
Posted by Yocomclan (anonymous) on February 8, 2009 at 2:34 p.m. (Suggest removal)
I'm just glad I live in Eastern Loudoun and have a choice of Reston HCA or Inova. I have had one opportunity to visit the ER at Inova and was imapressed with the quality of care received, but this is not the argument. The argument is still over Inova's monopoly (regardless of how you dress it) on providing medical care in LoCo. With the generally agreed upon projected growth pattern for LoCo, it makes no sense to locate away from the growth area. Inova is tax payer supported as a "not for profit hospital". HCA is a physician owned system with a patient base of predominately INSURED patients. Do the math. More jobs, less taxpayer investment on write off's for un-insured non payers and a location closer to the popultaion base. Yes, it is time for voters to remember this at the next elections.
Posted by herb.jordan (anonymous) on February 9, 2009 at 4:30 p.m. (Suggest removal)
herb j, I'm glad that you admit the northeastern portion of the county already has a choice.
There is little growth left to occur in that area, unless the board chooses to redevelop the route 28 corridor at higher density.
The rest of the county has and will continue to see growth--it would make better sense to distribute the facilities outside of one small area of the county.
Posted by BarbaraMunsey (anonymous) on February 9, 2009 at 9:54 p.m. (Suggest removal)
Where I moved from (Austin, Texas - home to 800K), there are two huge hospitals (Brackenridge and Seton) in the downtown area, just 13 blocks apart and they are both making money. So to say that 5 miles’ separation makes financial viability untenable is hogwash.
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Brackenridge’s helipad is just 12 blocks from a residential area of condos and apartments, and immediately across the Interstate from the entirely residential East Austin. Seton sits just ONE block from residential zoning, though it doesn’t have a helipad. I know the two things (proximity of the two hospitals to each other and the location of the hospitals and the adjoining residential area) can peacefully coexist -- I've seen it.
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The point is that the two hospitals sited themselves where the population was at the time they built. Seton has since grown to two hospitals and a separate hospital is sited in South Austin, but those two additional hospitals weren’t built until the population around them would support them.
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I am willing to bet dollars to donuts that if there were any chance the Rt. 50 corridor would support the next hospital right now, Inova would already be at the State Health Commissioner’s office with paperwork in hand — with all the boxes checked, just in case …
Posted by stephen (anonymous) on February 10, 2009 at 11:07 p.m. (Suggest removal)
Right, the BOS has done a great disservice to Loudoun Cnty -- not only did they ensure the citizens would not get another hospital for who knows how long, they also said, "who cares whether the community would get 600 new jobs." The irresponsibility of their decision is breathtaking.
Posted by Yocomclan (anonymous) on February 11, 2009 at 6:01 p.m. (Suggest removal)
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