After nearly two years of appeals and challenges, two Orangeburg doctors are one step closer to being able to proceed with their plans to build an ambulatory surgery facility.

The main obstacle — the South Carolina Department of Health and Environmental Control’s Certificate of Need process — is on life support.

Orangeburg general surgeon Dr. Dion Franga and Orangeburg radiologist Dr. Amit Sanghi of Ambulatory Partners LLC want to build a one-story, $12.5 million, 16,640-square-foot facility to provide medical services to the Greater Orangeburg community. The surgery center would be located across from the Regional Medical Center.

The doctors submitted a CON in April 2020 to proceed with its plans.

A week after the doctors submitted their plans, the RMC also submitted a CON to DHEC saying that it too had plans to spend $2.4 million to convert its existing Dialysis Access Institute into an ambulatory surgery center on its St. Matthews Road campus.

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Health care providers have had to go through the CON process before certain types of health care acquisitions, expansions and new facilities were allowed. The process was intended to reduce the duplication of services.

But South Carolina senators have voted 35-6 to end the requirement that health care providers go through the CON process.

“It is time we put quality health care in front of politics and quit with the senseless monopolies,” Franga said in an op/ed submitted to The T&D and published Jan. 30. “It is shameful to know that in an area as underserved and diverse as Orangeburg, there are those who have used the CON process to the detriment of health care expansion in our area.”

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“The time will soon come that health care will  no longer be restricted,” Franga continued. “Raise yourself to a higher standard or allow others to deliver the care deserved by the citizens in our area.”

“It is very clear that the Certificate of Need process is in need of reform in South Carolina,” the RMC said in a statement released Friday. “However, a repeal of the process would be detrimental to all rural hospitals across the state.”

“A complete repeal of CON would allow for-profit healthcare corporations to enter communities and deny services to low-income and indigent patients,” the statement continued. “It will create an unlevel playing field between non-profit hospitals, like RMC, and for-profit corporations.”

“While the Senate decision to repeal the entire process is unfortunate, we hope that the House of Representatives will protect rural healthcare providers across the state,” the statement continued.

RMC declined comment on what would happen with the legal case before the Administrative Law Court, citing the matter as a legal issue.

As for the hospital’s surgery center, the plans will go forward to build it.

“Currently we are implementing our surgery ASC plans,” the RMC said.

Sens. Brad Hutto, D-Orangeburg, and Vernon Stephens, D-Bowman, voted against the bill on both first and second reading. Hutto was absent for the third and final reading and Stephens’ name was not on the roll call list for the third and final vote.

Sen. Nikki Setzler, D-Lexington, who represents the western or upper portion of Calhoun County, voted to get rid of the CON.

Attempts to reach the three senators about the bill were unsuccessful.

COMMENTARY: Goodbye CON, welcome care, competition

Sen. Kevin Johnson, D-Clarendon, who will represent portions of eastern Orangeburg County and portions of Calhoun County due to the redrawing of the maps, voted for keeping the CON because he has heard from hospitals asking for the process to be reformed and not completely done away with.

He says many rural hospitals like the RMC and his own McLeod Health in Manning are concerned the failure to keep the CON is a risk that could hurt them resulting in possible closures.

“I wanted a compromise so the RMCs and the McLeod Healths of the world could find a happy median,” he said.

He said while he is not sure exactly what reform of the CON “would look like,” a concern is that the CON process can often get “tied up in litigation” and prevent hospitals from providing the care they need to provide. He is also against the CON process being used to block legitimate projects.

Johnson said as the bill works through the House, he is hoping perhaps amendments would help to bring about the compromise he would like to see.

One amendment he says is promising is the desire to place a five-year look-back on the law that will allow the bill to be revisited to see what if any impact it has had on rural hospitals in the state.

The bill has moved to the S.C. House, where it has been given first reading and referred to the Ways and Means Committee. The bill still needs to pass the House before going to the governor for his signature.

Rep. Jerry Govan, D-Orangeburg, said he has not made a final decision on how he will vote on the matter. He would like to hear the debate on the House floor and he would like information from both Orangeburg and Calhoun counties, who own the hospital, as to their insights.

“I do have some major concerns,” Govan said. “I don’t think anybody has fully answered the question of how it will impact the Regional Medical Center and the quality of health care in the area. I think those two factors are key if we are going to talk about dealing with the elimination of the CON.”

Govan said when the CON was put in place, it was to provide a “level of transparency” and was to ensure there was “quality control when it comes to the provision of health care services and facilities.”

He said time has perhaps changed some of the original intentions of the CON but, “I am not totally convinced we need to throw the baby out with the bath water in terms of getting rid of it.” $5.99 for the first month

“We don’t want to undercut the hospital but at the same time you want to respond on the principle of allowing for competition if that is going to improve the quality of health care and reduce the costs for citizens,” Govan said.

Rep. Russell Ott, D-St. Matthews, echoed Govan, noting he was on a “fact-finding mission” to learn more about the impacts of keeping and repealing the CON and its impact on RMC.

He said he is convening meetings with interested parties such as RMC and those in support of repealing the CON in an effort to listen to both sides of the debate.

“I know there will be different opinions on the issue,” he said. “I can tell you I want to make sure we do what we have to do to continue to provide care to the folks in Orangeburg, Calhoun, Bamberg and Barnwell counties, to make sure we are doing and putting policies in place for the state of South Carolina to understand the unique dynamics in the rural part of South Carolina.”

“It is not the same for us in the metro or urban area,” Ott said. “I am going to take a strong hard look at this and go into it with an open mind.”

Reps. Gilda Cobb-Hunter, D-Orangeburg, and Justin Bamberg, D-Bamberg, could not be reached for comment.

Ambulatory Partners has consistently said its center would benefit the community by capturing outmigration. RMC claims the center will harm the hospital financially.

Ambulatory Partners has said both surgery centers are needed.

Both AP’s and the RMC’s plans were immediately reviewed by DHEC upon their submittal. RMC’s plan was accepted and the doctors’ plan rejected.

Ambulatory Partners appealed the DHEC decision and DHEC overturned its initial decision by giving AP the go-ahead for its center.

RMC then appealed the decision to the state’s Administrative Law Court. The ALC is a court established to hear contested state agency cases.

A hearing on the case had been scheduled for Dec. 10 but was delayed as both RMC and the doctors continued talks with the hopes of settling the matter out of court. The case was scheduled to be heard in April.

DHEC has approved a Certificate of Need for Ambulatory Partners LLC, essentially giving it permission to build a $12.5 million, 12,640-square-foot ambulatory surgery center across the road from the hospital.

The South Carolina Hospital Association has gone on record supporting the CON process, saying it protects health care in rural areas and can prevent hospitals from overspending because of competition.

Fifteen states have repealed their CON programs, which were mandated by the federal government in the 1970s.

The CON program nearly died in 2013 when then-Gov. Nikki Haley vetoed from the state budget the $2 million officials used to run the program. Hospitals sued, saying lawmakers never voted to end the program, and the state Supreme Court ruled in 2014 that it should continue.

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