Twelve years ago. In the next to last year of President George Bush’s second term, a little more than 1,500 county voters, in an off-year special election, voted in favor of charging in perpetuity a one-cent sales tax that would go towards county health care, predominantly to Weems Memorial Hospital.
With turnout at 30 percent, the 1,553-to-706 result back in 2007 meant two voters were in favor for every one against, a sizeable majority, that backed the creation of a new hospital, as the referendum read.
Since 2007, much has changed in the county’s economy. Real estate, tourism, seafood all have been affected, and so too the lives of the people who work here, visit here, live here, get sick here, get healthy here, and die here.
The question now before the five county commissioners is how much health care has changed in those years, and how much rethinking needs to be done on these original plans.
Two viewpoints emerged at Monday’s workshop as to what Weems should do next.
Should the county move full-steam ahead on what it has long promised the citizens of the county, as Chairman Noah Lockley argued?
Should the county step back, and rethink what now works within a changed world of health care, as stressed by Commissioner Bert Boldt?
At different points between these two poles were the views of Commissioner Ricky Jones, Smokey Parrish and William Massey on this most serious of health care decision-making, the spending of more than a half-million dollars in sales tax monies every year for the next 40 years, towards paying off a $12 million to $14 million project cost.
This Tuesday, they’re going to focus in earnest on this very big ticket item, as part of County Coordinator Michael Moron’s report, and the county will see what direction the commissioners take, given the architect’s and hospital CEOs' picture painted them Monday afternoon before a modest-sized, serious-minded audience.
A vote can’t come too soon in Lockley’s view. “It’s time to build a hospital and get this over with,” he said. “If you’re not going to do it, give the people their penny back and stop taking their money.”
As Boldt sees it, there needs to be more thought put in how this new hospital will fit into the larger scheme of things.
“I’m uncomfortable with the chaos we have here,” he said. “We have 12 years of history and spotty ideas. I don’t feel we have the direction to get there. I need a road map to know where we're going. We’re just grabbing smoke in the air and trying to make a decision.”
Commissioners had hoped to hear from SheNeena Forbes, who would administer the awarding of a proposed $10.2 million USDA rural development loan; Dr. Patrick Conrad, who runs the hospital emergency room; Nick Hill, with the Adams Consulting Group; and a representative of the Agency for Health Care Administration.
But Morón informed commissioners at the meeting’s outset that none of them would be taking part in the workshop.
The bulk of the overview was left to Joe Bynum, with TRO Jung | Brannen, the project’s architect; Weems CEO HD Cannington; and Doug Creamer, chair of the Weems board of directors. In addition, Erin Griffith, the county’s assistant finance officer, offered details on revenues and expenditures dating back to 2007, when the health care sales tax was instituted.
Public voices concerns about expansion
Prior to the architect’s remarks, the commissioners heard from five members of the public, all of whom urged them not to move forward with the project as it currently is envisioned.
Allan Feifer, president of Concerned Citizens of Franklin County, opened with prepared remarks detailing the group’s objections (See letter to the editor, page 4.)
He was followed by Apalachicola resident Diane Brewer, who outlined the history of the project. “Weems has been on downward spiral for a number of years financially,” she said, noting that the hospital had recently secured a variance for lot coverage from the city, pertaining to parking, a drainage ditch around Washington Square, and landscaping.
“How does that help county residents get better health care?” asked Brewer, adding that the county had “rejected out of hand” a recent proposal from Sacred Heart on assuming management of Weems.
St. George Island resident Donna Butterfield then spoke out in favor of scaling back Weems’ expansion plans. “If you want to start a fight in Franklin County, have a couple of beers at the nearest bar any day and bring up Weems hospital,” she said. “I recommend you think outside the box. What is Weems doing right now that is working?”
She said she supported Weems’ continuing to assess and treat emergencies and then transport patients to a larger facility, but said millions more should not be spent on patient rooms that could remain unoccupied.
“Take some of this money and fix up our ER,” Butterfield said. “You’re never going to make any money on Weems hospital in Franklin County. Let’s grab something that’s working, and let’s run with it and make it better.”
Next to speak was Apalachicola resident Mark Milliken, who said he has followed the talk regarding Weems for several years, since he and his wife retired here from the Navy, where he rose to the rank of rear admiral.
“If you think building a new facility is a solution to problems in Franklin County, I think you’re going down the wrong road,” he said. “Let’s throw good money to good ideas.”
Milliken said a series of columns in the Apalachicola Times by retired hospital exec Michael Rindler, who now lives here, offered helpful suggestions on how to transform county health care.
“The problem is management, it’s not about rotating CEOs through here,” he said, citing a three part solution.
He said the first step is a tactical plan, for the next one to three years, followed by an operational plan for the following three to five years, and lastly a strategic plan for five years and beyond.
Last to speak was Brenda Karlin, from St. George Island, who encouraged commissioners to take a closer look at what Gulf Coast Regional Medical Center did in Panama City, with its standalone ER.
“The model you currently want to throw money at I know the community feels would be a waste,” she said. “Your concern (should not be) fulfilling a promise made years and years ago. Times have changed, the county’s not big enough to support a full-service hospital. Let’s do something that will work today, not 15 years ago.”
Architect says new GMP has to be secured
In his report Bynum recounted the history of the decade-long project, reviewing how in 2010, plans were to have 14 private patient rooms, and more extensive services, at a price tag of about $14.3 million, not including financing costs. He said that work was scaled back in 2014 to about $10.2 million, including financing costs.
In 2016, the county secured Tallahassee’s Culpepper Construction as construction manager, and they offered a guaranteed minimum price (GMP) of $7.4 million for construction, and excluded surgical, obstetrical and endoscopic services to meet the hospital target of $10.2 million.
Bynum told Lockley he could not be sure what the GMP would be for the current plans for a 22,000-square-foot addition and renovation to the existing building.
“The way you determine that is go back out to the marketplace,” said Bynum. “Are subcontractors very busy with (Hurricane) Michael work or are they hungry for new work? The market would determine the GMP.”
Bynum said a key concern, if the county went ahead with the project, would be to get started by the end of the year.
“I’m not trying to convince anybody to do anything,” he said. “There is serious discussion now by AHCA that they will adopt new guidelines and codes by the end of the year so if you don’t have approved plans by the end of year, you’ll have to update them. Based on my 41 years, I can say the cost doesn’t go down, it goes up."
Plans for the hospital received a vote of approval from Cannington, who said he had looked closely at the project since December, when the county provided $50,000 to Weems to advance the project.
“I absolutely think we need an upgraded hospital,” he said. “I love the idea of a new lobby, all new patient areas. It needs to look like a 21st century building, not a 1960s building.
“We need a new ER, we need 10 rooms, all private with baths and showers,” Cannington said. “That’s a big problem for us right now. I don’t think it is good for families running up and down the road to visit sick relatives.
“I think we can build this hospital, and it will have the look and feel of Apalachicola and Franklin County,” he said. “It will be something everyone can be proud of. When we’re spending $10, $12, $14 million, I think we need to do it the right way.”
“It will increase our volume, all private rooms will be a plus,” he said. “It will also help us improve (attracting) doctors to this area, which we desperately need.”
Both Jones and Parrish expressed concern about the costs, and both asked to have a clearer idea of the hospital’s cash flow situation and operations budget before they moved forward.
“I’m concerned about health care in Franklin County, period,” said Jones. “Just the ER can’t be our only consideration right now.”
Parrish said he wanted to know the numbers will work before embarking on the project. “I don’t want to be doing change orders at the end,” he said. “Is the hospital financially stable? Can it make its own payroll? We cannot do a $14 million project and continue to pour money into Weems to make payroll. We can't more forward if the hospital is not on sound financial footing.
“The county doesn’t need to make money on the hospital, but it needs to stand on its own two feet,” Parrish said.
Griffith advised that with an annual mortgage payment of more than $600,000 annually, and a reasonable forecast of other capital costs, the county would have about $200,000 left in the health care trust fund for other unforeseen expenditures. She said the county has a nest egg right now of about $3.8 million that has been accrued over the years, with about half of that earmarked for construction of the hospital.
Parrish noted that the county has to keep $2 million in escrow at all times. “This health care tax cannot support everything,” he said.
Cannington said that the hospital did not have to recently transfer money from its money market funds to make payroll, and he estimated the hospital has about $350,000 in accounts payable. “We have no long-term debt,” he said.
Jones noted that the financing would saddle the county for the next 40 years. “By the time we pay it off we’ll need another hospital,” he said, also noting that if the trust fund is used to assume other health care costs, he would like to see funding for the ambulance come out of it.
Lockley closed the workshop by noting that he is not troubled by the voices of those from the public who spoke in opposition.
“I see the same faces,” he said. “They aint going to want it 10 months from now, or 20 years from now. They ain’t gonna never want it.
“They should have moved to a place where Sacred Heart has a hospital,” Lockley said. “It's time to build a hospital, that’s what we told the people we was going to do. We can’t keep putting it off.”