GEORGETOWN — A state health board later this month is scheduled to rule on applications from two healthcare systems competing for approval to build a freestanding emergency department in the heart of Sussex County.



Bayhealth and Beebe Healthcare are seeking approval from the Delaware Health Resources Board, which is to meet July 25.



Both applications were dealt a preliminary setback June 25 when a state health review subcommittee voted against recommending approval of either proposal.



Bayhealth is seeking to build an emergency department with eight treatment bays/exam rooms as part of a larger complex on Route 9 at Hudson Road east of Georgetown.



Beebe’s application is for a 14,413-square foot emergency department on Route 404 just west of U.S. 113 about a mile away from Beebe’s primary care and walk-in facility in Georgetown. It would feature 21 exam and treatment rooms, advanced diagnostic imaging, an onsite helipad and a pharmacy on site with total estimated capital costs at just over $20 million.



A public hearing was held May 16 at Delaware Technical Community College in Georgetown.

On June 25, the subcommittee recommended denial of both applications based on the following:



• Comments made at the public hearing stated that emergency services are currently available within the proposed service areas.

• The proposals are not in alignment with Delaware’s initiative to lower the costs of healthcare.

• There are less costly alternatives available rather than additional freestanding emergency services.

• Both proposals will have a negative impact to the existing health care system.



The committee, which stated both applications failed to meet any of the seven criteria, will provide its recommendation to the Delaware Health Resources Board at its meeting set for July 25 at Delaware Tech’s Terry Campus in the Corporate Training Center.



The board may or may not vote on the applications at that public meeting, which is scheduled to begin at 2:30 p.m.

“The full Health Resources Board could say ‘yes’ to both. They could say ‘no’ to both. They could say ‘yes’ to one and ‘no’ to one,” said Jill Friedel, Delaware Department of Health & Social Services communications director.

“They are entirely separate. They make the final decision and may take the recommendation or not take the recommendation.”

Leaders of both healthcare agencies argued that emergency services are needed to fill a void that exists in Sussex County.



“The decision does not change the need for emergency services west of Route 1 in Sussex County,” said John Van Gorp, Bayhealth’s Senior Vice President/Planning & Business Development. “Bayhealth is still committed to the site and will develop it to provide primary care and specialty services for the community. The Delaware Health Resources Board still has the opportunity to overturn the subcommittee’s decision to allow emergency services to be provided to the community.”



An area in need

Alex Sydnor, Vice President External Affairs, Chief Strategy Officer for Beebe Healthcare, said, “Beebe hopes the Health Resources Board will approve our plans for a freestanding emergency department in Georgetown. Our proposal would bring emergency services to central Sussex County — an area in need, much like Beebe’s emergency department near Millville currently under construction. Residents in the Georgetown area will have access to emergency care that will reduce travel times when emergency medical attention is needed.”



Georgetown Mayor Bill West, who has spearheaded the drive for emergency department service in the Georgetown area, is enlisting support in hopes that the upcoming meeting will bring a better decision.

“I’m getting it started already,” said Mayor West, among those who spoke at a May 16 public hearing on the applications. “Maybe we’re not done with it yet.”



He pointed to new homes, senior citizen facilities and sports complexes that drive the need for emergency care in his area.

“You’ve got Sports at the Beach. You’ve got 700 kids playing ball. Over this past two years, I’ve seen nothing but ambulance calls for head injuries. It would have been a lot easier for them to come here and be treated and then sent on.

“As you come back from Sports at the Beach, you come to the new soccer fields that are being built out on Sand Hill Road. Seven hundred kids again any weekend once that gets up and running. A chance for injuries that need to be transported. What better place to come than to come out of there and turn west and come right here? It would be a lot quicker for the families. Then you look at the racetrack — the Georgetown Speedway. It has taken off tremendously,” he said.



Brand new complex

“And CHEER out on Sand Hill Road is building a brand new complex for more senior citizens. As we all know, we get older. The need for emergency services does exist. And I think for them to come out with the Georgetown ambulance and come straight to here would be a lot better. The response time would be quicker and the response to the emergency services would be quicker.”



At the May 16 hearing, Terry Murphy, Bayhealth CEO, said Bayhealth’s plan “is to improve primary care, provide a much needed emergency care in a fast growing and aging part of Sussex County that may have difficulty accessing other emergency departments, and to minimize the impact on other providers.”



Mr. Sydnor, at that hearing, provided a map of the three downstate hospitals — Milford, Beebe and Nanticoke — and the estimated 15-minute drive maps to those emergency departments, as well as Beebe’s freestanding ED under construction at the South Coastal Health Campus in Millville.



“When we did our analysis, we also saw a donut hole. We proceeded differently,” said Mr. Sydnor. “And we perceive that there is in fact a donut hole for emergency care in Delaware. And it is in the center of the county in Georgetown where we are currently located. And it also encompasses the town of Millsboro that’s along Route 113. We think that emergency care is an important service to be offering in the county and this is the appropriate location for it given the location of other emergency services and estimated drive time to reach those services.”



“We don’t want to duplicate care. We don’t want to duplicate services that are already available,” said Mr. Sydnor. “And we believe that a location here in Georgetown does that very well in making care available. The other issue that we want to raise in this depiction is that a Georgetown emergency department is really equidistant to the three existing hospitals in the state.”



Mr. Sydnor added, “We really feel that the Health Resources Board should deny the application from Bayhealth because of the overlap of care and the overlap in services that are currently located in Lewes. We think that the application from Beebe makes a heck of a lot more sense when we consider emergency care in particular and the availability of those services here in the center of the county, as we’ve already depicted. Again, similar 15-minute drive-time estimate maps do not show significant overlap with existing services. We think that this is a much better case for providing care where it is needed in the community. And the Bayhealth application provides a significant amount of overlap.”



Opposition voiced

Opposition to these proposals at the May 16 hearing was voiced by Steven Rose, CEO of Nanticoke Health Services, which in late January announced it was pursuing an affiliate (membership substitution) partnership with Peninsula Regional Health System, which would be the corporate entity.



“We don’t have the sort of the payer mix and the patients that some of the other hospitals have,” Mr. Rose said. “Our focus has really been on quality patient care, safe patient care and patient service, not so much on bricks and mortar. But we are very proud of our mission and what we do in the western side the county. And we are in a little bit of a precarious position because of our bearings. Over 60 percent of our patients are on Medicare.

The rest of them are Medicaid. We have a few commercial payers. And we have a large portion of our population that don’t pay anything. So, it’s really tough for us to sort of balance that budget.”

“So, when Beebe talks about 24,000 visits, we assume that some of those visits from the ED is going to come from us. And yet we are a Level 3 trauma. There’s a lot of expense that goes into Level 3 maintaining the services, having those physicians available. And if we lose our visits, then that jeopardizes us from being a Level 3 trauma. Not only that, but we receive about 66 percent of our emergency room visits — you know, admissions come from the emergency department,” Mr. Rose said. “So, if we start eroding those visits, then that really reaches the bottom line. And I think that whole idea of what our mission of what we’re doing in Western Sussex County really does become jeopardized. So, we got to be really, really careful about where we think we’re going to add emergency room services and where we’re going to put things. Everyone is competing with everybody else. I think it’s pretty interesting that Bayhealth is talking about building on Route 9 and Beebe is opposed to it because it’s a duplication of services, yet they can come to Georgetown and say it’s not a duplication of services to us. So, I think this whole thing is a really slippery slope.”



Looking to the future, Millsboro Town Manager Sheldon Hudson made a case for his town.

“I am hereby once again requesting that Beebe reconsider its plans to build a freestanding emergency department in Georgetown. Otherwise, I would ask the board request that Beebe revise its application in such a way so as to indicate the facility would be built in an alternate location,” said Mr. Hudson. “Needless to say, my concern is that the demand for emergency services would decrease in Millsboro if and when a freestanding emergency department were to be built in Georgetown, thereby obviously making it more difficult for the town of Millsboro to recruit a medical center to build such a facility in Millsboro, which again, ranks number one out of the 25 Sussex County cities for the number of residential building permits issued.”



Impact on other hospitals

“As relates to the impact to other hospitals, I think Bayhealth and Beebe both recognize the need for additional freestanding emergency department emergency services as the population continues to grow,” said Mr. Murphy, Bayhealth’s CEO. “And our site, we believe, minimizes the impact on Nanticoke Health Services.”



Mr. Van Gorp at the May 16 stated “while Beebe’s service area is significantly larger, we don’t believe it adequately services the majority of the population. When taking both service areas into account, the majority of the population is still east of Route 30. So, in summary, a Route 9 medical complex enhances access to primary care, enhances access to emergency services, improves the utilization of those services, improves access to value-added services, and improves the overall service experience for the residents. And our location is at the heart of the applicable service area.”



On July 1, Mr. Van Gorp said “the population of Sussex County continues to grow, particularly in the area west of Route 1. Access to care is an issue in Sussex County given the traffic volume on Route 1 and other major roadways, especially during the summer months. The Route 9 location is optimal because it will provide better access to healthcare for the fastest growing area of Sussex County.”



Key elements in application

Key elements in Bayhealth’s application include: limited services between Georgetown and Lewes; highest growth in the state, particularly among seniors; Route 1 is a barrier to access; Route 9 and Hudson Road location provides most convenient access to majority of people



Irwin “I.G.” Burton III of Lewes, Sussex County Council’s District 3 representative who has held the role of Bayhealth board of directors chairman, favored Bayhealth’s proposal.

“When you knock on 4,000 doors twice, which is what I did, you get a sense of what’s important to the residents in this area. First and foremost, of course, is the traffic. And I would question the 15 minutes. I mean, if you live in this area, I don’t think there’s a 15-minute road left. But that was the No. 1 concern — the traffic. Right? And secondly is the quality of life. And third is the quality of health care,” said Mr. Burton during the hearing.

“This application addresses all three of them. The quality of life is directly attributed to the quality of health care, and the quality of health care is directly impacted by the accessibility of health care. Bayhealth’s location on Route 9 in Cool Springs is the correct place for this facility.”



Mayor West’s testimony focused on growth in the town of Georgetown and surrounding area, and the presence of sports facilities, new business and new residential development including those for senior citizens.



“I’m up here today to talk about 19947. Yeah, 19947 is a small one when it comes to the town limits,” said Mayor West. “But if you look at the overall 19947 and how it affects my emergency services, the ambulance is on the go, constantly running back and forth, to cover this whole area and get to whichever hospital the person wants to go to, unless they’re in desperate need of emergency services and then we get them where we need to as fast as we can.”