If public support was so strong for one of the other groups vying to build a 64-bed hospital between the Catawba River and the North Carolina line, why did the state Department of Health and Environmental Control give the nod to Tenet?

While DHEC was inundated with letters from potential patients and lobbied by doctors, hospital employees, marketing firms, etc., the decision was made by a state officials whose duty was to review the proposals and pick one. That decision can be appealed by the losing companies, and it appears likely that at least one of them will do so. Construction on the new hospital would be delayed by a year or more.

Even if an appeal goes forward, Tenet may have the upper hand. The challenger(s) would have to prove that DHEC failed to follow procedure in awarding a certificate of need to Tenet. While some aspects of the judgment likely were subjective, Tenet did offer several advantages.

For one, as a for-profit institution, Tenet would pay property taxes estimated at $2.6 million a year. Hospital Partners of America would pay property taxes as well, but that Charlotte-based company owns only two hospitals and was considered a long shot. As nonprofits, Presbyterian Healthcare and Carolinas HealthCare System would have paid no property taxes.

Tenet also had an edge in being able to offer a 100-bed hospital from the start. The other contenders were limited to 64-beds because of limitations set by the State Health Plan and because they could not transfer beds across the state line. Tenet, however, could transfer beds from PMC in Rock Hill. Tenet therefore started with a 36-bed advantage. From the other groups' viewpoint, that's hardly fair, but Tenet played the cards it was dealt. DHEC's decision -- if it stands -- means more beds will be available sooner in the fastest-growing part of the second-fasting growing county in South Carolina.

PMC also bears the heaviest burden for indigent care in York County. Most of the patients who will be served by the new hospital probably will be covered by health insurance. A strong case could be made for allowing Tenet to balance PMC's patient base with the more affluent market in northeastern York County.

Finally, Tenet offered the best site: 40 acres at S.C. 160 and U.S. 21, midway between Rock Hill and Charlotte and close to the center of population in the Fort Mill/Tega Cay/Indian Land area.

Opponents argued that competition from a second health-care provider would lead to lower prices. Even though PMC, responding to demands from the York County government, had lowered its charges from highest in the region to mid-range, many people would prefer to have an alternative, without having to drive to Charlotte or Pineville, N.C.

Also damaging to Tenet's case was that a majority of doctors voting in a York County Medical Association straw ballot chose Presbyterian as their first choice to own the new hospital. (Tenet came in second.) Clearly, having another hospital in the county, owned by any firm but Tenet, would give doctors and other health-care providers more leverage in negotiating charges, influencing treatment practices, etc.

In the end, it appeared that each of the contenders made a strong case. Although we hesitate to second-guess DHEC's decision, we expect one or more of the unsuccessful contenders will challenge the certificate of need.

IN SUMMARY
Tenet went into competition for Fort Mill hospital with several distinct advantages.