State approves determination of need for new hospital plan

By Nelson Sigelman - December 29, 2005

Following a lengthy and complex review process, the state Public Health Council last week voted unanimously to approve plans for a new Martha's Vineyard Hospital that include the renovation of existing facilities and the construction of a new three-story building on the current hospital site.

DPH approval is a significant milestone for the estimated $42 million hospital building project. The council, which operates within the Department of Public Health (DPH), has the authority to evaluate and approve or disapprove the construction of new health care facilities and or the addition of new medical services under an evaluation process known as a determination of need (DoN).

"This is a big step and clears the way on the state level," said Tim Walsh, hospital chief executive officer. "It is gratifying when the state looks at your numbers and agrees it is a feasible project."

Hospital leaders last year unveiled a revised design for a new three-story 90,000 square foot hospital building and renovated administrative and physician office building with a price tag of $42 million.

Plans call for the existing 1974 wooden hospital building to be renovated and used for doctors' offices, hospital administration offices and outside health-care providers such as Hospice and the Vineyard Nursing Association. The new hospital building would include private patient beds, state-of-the-art medical facilities, electronic links to Boston medical facilities and specialists, and a new modern emergency department.

State approval came with a series of conditions. They include a requirement that the hospital provide enhanced medical interpretive services for non-English speakers and that the hospital provide $2 million over a five-year period to fund community health service initiatives in several areas.

With conditions

According to the 12-page DoN staff summary, the need for interpreter services is based in part on a review of hospital policies and procedures conducted by the DPH office of multicultural health of access for non-English or limited-Ennglish proficient patients seeking care at the hospital. That report identified the impact on health services posed by Brazilian patients, "currently a growing population on Martha's Vineyard."

The report noted, "The hospital has indicated that 30 percent of annual births were to Brazilian women and that 95 percent of requests for interpreters in the emergency department were for Portuguese interpreters."

The state is asking the hospital to provide interpreter services beyond telephone interpreter services, provide formal training for all bilingual employees who may be in a position to function as interpreters and post signage at all critical entry points.

Mr. Walsh said that the hospital is working on a plan to address the need for interpretive services as well as to meet a commitment to support several community health initiatives with a total expenditure of $2 million over five years.

The hospital contribution is based on a state requirement that 5 percent of a project cost be directed at health care initiatives.

"We are working with different organizations on the island to come up with plan for that," said Mr. Walsh. "We tried to model it after what was missing on the Island."

According to a summary breakdown, hospital funding would target four general areas: behavioral health $400,000), preventive care ($575,000), primary care ($925,00) and "innovative approaches for existing or new health priorities ($100,000)."

The behavioral health preventive care components would rely heavily on the Dukes County Health Council. The effort to bolster primary care would include spending money to attract new primary care doctors and keep them happy living here.

Strong case

The DoN approval process is meant to avoid spending money and diverting state resources on an expansion of healthcare facilities and services when they are not needed or would result in duplication or oversupply. A review of a project's finances is meant to avoid having a project sink into debt.

Mr. Walsh said the DoN application process is lengthy and complex and began more than one year ago. It required the hospital to document why a new facility and an additional six beds are needed.

The hospital's case was built on the need to serve the Island's growing and aging population and seasonal needs that cannot be measured by standard analysis.

The DoN staff summary noted that the projected population growth rate for Dukes County, which includes the six island towns and Gosnold, exceeds "both the Massachusetts and the United States growth rates by a considerable margin for both total population and 65 and over population."

According to the summary, the total population for Dukes County is expected to increase by 26 percent during this decade compared with 6 percent for Massachusetts and 9 percent in the US as a whole. The number of people 65 and older is expected to increase by 21 percent in Dukes County compared with 5 percent for the state and 11 percent nationally.

The staff summary also pointed out that wide seasonal fluctuations mean demand for services more than doubles during the summer. "When all of its beds are full Martha's Vineyard must hold patients in its emergency department, a practice that limits the hospital's capacity to treat emergency patients," read the summary. "During the summer, when the service area population is at its peak and when hospital emergency departments generally are busier than normal, a shortage of beds can create a crisis situation for the hospital."

The summary conclusion stated that the Martha's Vineyard Hospital, "a sole community provider hospital, has presented a strong case for additional beds to serve a primary service area that is growing faster than the state and national averages."

All in all, Mr. Walsh said there were no surprises in the DoN process. "It went pretty smooth I thought," said Mr. Walsh.

Not so at the local level where the regulatory process is off to a rocky start. Last month Mr. Walsh and Tim Sweet, hospital board member, appeared before the Martha's Vineyard Commission to describe the hospital project and review the reasons hospital leaders decided to build a new facility at the hospital's present Beach Road site.

Instead, many of the commissioners pressed the hospital leaders to take another look at moving to a new site, assuming one can be found, and building a completely new facility, something that would drive the costs up to an estimated $71 million, without including the price of land, a price tag that is not supportable according to Mr. Walsh.

Despite the hospital's analysis, the MVC last month appointed a subcommittee to investigate possible alternative hospital sites. Exactly what is to be accomplished remains unclear.

A change in the hospital building project, particularly a change of site, would require starting the lengthy DoN process over said Mr. Walsh.