Supreme Court: UMMC must abide by state’s CON law

JACKSON — The University of Mississippi Medical Center must follow the state’s certificate-of-need law, though health officials can decide when it must do so, the Mississippi Supreme Court ruled yesterday.

The law limits where hospitals can locate and expand and what services they can provide.

The unanimous ruling came in a lawsuit on the issue of whether UMMC, as a competitor in the hospital marketplace, must abide by the same CON laws as the other 100-plus hospitals in Mississippi.

UMMC filed a CON application for authority to buy and install a new linear accelerator on its Jackson campus. The equipment is used for cancer radiation treatment.

St. Dominic-Jackson Memorial Hospital, Health Management Associates and Mississippi Baptist Medical Center took the view that the laws apply to UMMC as to all hospitals.

According to the lawsuit, UMMC withdrew the application and took the position that it was not subject to the CON laws that every other hospital in the state must follow. UMMC bought the equipment and installed it without a CON.

“We hold that the Mississippi State Department of Health acted within its authority in determining that UMMC was not required to obtain a CON before acquiring the linear accelerator,” Justice Ann Lamar wrote for the court.

UMMC contended if the CON laws apply to it, then those laws are unconstitutional because the state College Board, which governs the medical center, is created by the state constitution. The Supreme Court declined Thursday to rule on the constitutional question.

“While UMMC’s creation statutes provide that it shall acquire and install ‘needed equipment,’ the statutes do not define ‘needed equipment’ nor do they provide the procedure with which UMMC must comply to obtain needed equipment. The CON statutes provide the procedure with which UMMC must comply to obtain needed equipment,” Lamar wrote.

UMMC said the equipment is necessary for its ongoing education mission. It also argued its role is unique in that it is the state’s only academic health science center and teaching hospital. UMMC contends its statewide mission would be diminished if it were subject to regulation under the CON law.

The other hospitals contended in their lawsuit that because linear accelerators are among the items of major medical equipment for which the certificates are required in the law, UMMC needed one.

UMMC entered into this fray armed with an attorney general’s opinion that it could be exempt from CON law in certain instances where services or equipment are needed for the institution’s teaching and research mission. Discretion is left to the health department.

An attorney general’s opinion does not carry the weight of law but is designed to provide public entities a level of protection in court.

The other hospitals argued that UMMC’s linear accelerator will not be used exclusively for research purposes. They said UMMC’s CON application states that 50 percent of the linear accelerator’s use will be for clinical — and thus profitable — purposes.

From its inception by the federal government in 1974, the CON program has led to Herculean legal battles, most of them among Mississippi’s largest hospitals.

Congress created the CON program to help rural areas struggling to recruit and retain doctors, clinics and hospitals.

Hospitals, for the most part, fear competition as threats to their financial survival. Aggressive action by one medical center brings opposition from others.

So the medical wars have waged off-and-on nearly 40 years, usually in population centers from the Gulf Coast to Jackson to the Memphis suburbs.

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