By Cliff Lewis

At the Lancaster County Hospital Authority’s January 21 meeting, Chairman Dr. Randolph Trostle told NewsLanc that, in the course of issuing tax-exempt debt for health facility projects, the Authority does not assess the public health need for applicant projects. “I think that would be a question that [the commissioners] would have to deal with,” Trostle said. According to the commissioners, however, the assessment of public need would not be under their jurisdiction either.

With no certificate of need process active in the State of Pennsylvania, the approval of tax-exempt financing could be the County’s sole means of leverage against unnecessary hospital expansions.

“It’s very possible,” Commissioner Scott Martin said, “That if the three of us…say ‘No we’re not going to do this, we don’t think it’s needed,’ it could potentially end in some litigation, because that wasn’t in our scope or role as decision-makers.”

County solicitor Don Lefever elaborated that “as an official in the county where a project is proposed, we’re really just approving financing as put together by the Hospital Authority, [which is under] statutory requirement to come before the County for approval. But we don’t get into a question of the need for the project.”

Commissioner Craig Lehman questioned whether the assessment of need would be even be within the Authority’s jurisdiction: “As far as the Hospital Authority is concerned,” Lehman asserted, “My understanding is that it’s simply a financial authority that is the conduit for tax-exempt financing and nothing more.”

The Hospital Authority serves as a conduit for tax-exempt financing for eligible hospital and retirement home projects in Lancaster County. Requests are passed through the Authority for approval by the county commissioners. Before being brought to the commissioners, however, each project is presented in a publicly-advertised hearing.

Comments from Commissioner Dennis Stuckey implicitly questioned the value of any government-level assessment of need: “I fully expect the hospital and the healthcare providers to determine what’s best for Lancaster County—that’s their expertise, that’s the business they’re in,” Stuckey asserted, “We rely on the professionals to determine what’s in the best interest of healthcare in Lancaster County.”

The assessment of public health need is of particular interest in light of Lancaster General’s plan for a West Earl expansion less than three miles from Ephrata Community Hospital—which currently meets the surrounding demand well within its capacity. The Hospital Authority has not yet received any formal requests regarding this plan, although it was reported at the last Authority meeting that LGH has one undisclosed project which may come to the table this year.