As reported by The New York Times, March 18, 2007.

Debate Rages Anew on UConn Hospital Expansion

By Cynthia Wolfe Boynton

FARMINGTON - The original plans for John Dempsey Hospital called for a general-care facility with two state-of-the-art towers and close to 400 beds. After budget problems, building delays and protests by local hospitals, the plans were scaled back, and in 1975 Dempsey opened as a teaching hospital that offered limited care in one tower with 224 beds.

Now the debate over the hospital’s size and scale is being played out again.

Executives at the University of Connecticut Health Center, which runs Dempsey, have asked the state to approve a $495 million project to replace it with a 352-bed hospital so it can treat more patients, expand programs and generate revenue for academic programs.

But five nearby hospitals have asked the state to reject the proposal, saying that the competition posed by a larger Dempsey would hurt them financially.

Last week, the Legislature’s higher education committee put off a decision on a new hospital until a study of central Connecticut’s health care needs over the next decade is completed in 2008. The committee also proposed giving Dempsey $10.5 million to help close a projected $21 million deficit. The proposals are subject to approval by the Legislature and the state Office of Health Care Access.

The decision has Dempsey officials “scrambling” but not feeling defeated, said James Walter, a spokesman for the Health Center. “Connecticut’s need for a vibrant and competitive university hospital will only become more evident over time,” he said. “Our plans remain very much alive, and we will press on.”

When Dempsey opened, the treatment and services offered matched medical research being conducted by UConn physicians and faculty but did not compete with local hospitals, said Peter J. Deckers, UConn’s executive vice president for health affairs and dean of the School of Medicine.

Pediatric oncology, musculoskeletal diseases like muscular dystrophy, and inflammatory diseases like rheumatoid arthritis were Dempsey’s focus in its first 20 years, Dr. Deckers said. Slowly, however, as the needs of staff members and patients changed, Dempsey evolved and began offering a full scope of cardiac, orthopedic, neurological, emergency and other acute-care surgical and medical services, he said.

“When Dempsey opened, it was a good teaching hospital with good researchers who did clinical care as a hobby,” Dr. Deckers said. “Today, Dempsey offers first-class intensive care units, a full blood bank and superior services across the board. For that to continue, and for the UConn medical school to attract top faculty, we need a major upgrade, increased space and increased beds.”

Leaders of the Farmington Valley’s five other hospitals — urban facilities, unlike Dempsey’s rural campus — say they fear a larger Dempsey will attract suburban patients with health insurance, leaving the other hospitals with a disproportionate number of poor and uninsured patients, which translates into lost revenue, said Laurence A. Tanner, president and chief executive of the Hospital of Central Connecticut, one of the five hospitals. (The other four are Hartford, Saint Francis in Hartford, Bristol and Middlesex in Essex.)

The growing number of Connecticut residents without health insurance, low reimbursement rates for Medicare, Medicaid and private insurance, and cuts in state and federal aid already have many hospitals in financial trouble, Mr. Tanner said. Lower reimbursement rates alone have Connecticut hospitals facing a combined $280 million shortfall this year, he said. “Most area hospitals are already operating on paper-thin margins,” Mr. Tanner said. “An increase of 128 new beds would upset a delicate balance.”

Yet Dr. Deckers says there’s no reason not to go after more patients. “Health care is a business,” he said, “and we have just as much right to be competitive as anyone else.”

As a state hospital, Dempsey faces several unique challenges, like having to reserve more than half its 224 beds for prison inmates, state psychiatric patients and high-risk maternity and neonatal patients. That leaves about 108 beds for general medical and surgical care — “not enough to stay financially solvent,” Dr. Deckers said.

“Our space is maxed out,” said Jeanne Lattanzio, a retired pediatric registered nurse who volunteers in Dempsey’s neonatal intensive care unit on behalf of the March of Dimes. “I can’t tell you how many hours staff here spend trying to find patients’ beds. It’s a struggle every day.”

Why there is a struggle over the expansion project baffles Dr. Deckers. The new 546,000-square-foot hospital would be paid for with about $25 million in private contributions and, if approved by the General Assembly, $45 million in state bonds earmarked in 2000 — but never used — for UConn Health Center improvements. UConn would repay a mortgage for the additional $425 million with hospital revenue, he said.

But Mr. Tanner and other hospital leaders argue that taxpayers would be forced to pay if Dempsey runs into financial trouble, as they did in 2000, when the Legislature provided $20 million to bail it out. “There’s a real concern that UConn is going to build something, at a huge cost that can’t be supported down the road,” Mr. Tanner said.

UConn officials, however, blame financial shortfalls on size and space restrictions. “We’ve been undersized from the day we opened our doors,” Mr. Walter said.

Despite its many challenges, the UConn Medical Center received a prestigious honor on Monday, when it was named one of the top 100 hospitals in the country by Solucient, a health care consulting firm. (Danbury and Yale-New Haven also made the list.)

Dr. Deckers said Dempsey needed to expand for the state to remain competitive. “We want the best and the brightest, which will only benefit Connecticut residents,” he said. “But for that to happen, I need a new hospital to go with the medical school.”

Mr. Tanner said one new hospital failed to address the health care needs of the entire state.

“There’s absolute truth in the UConn Health Center needing improvements to attract the best students, but not a whole new hospital,” he said. “So many improvements are needed to help Connecticut hospitals and the Connecticut health care system — improvements that can help all of us.”