Group tries to revive Mansfield health service facility

To dream the impossible dream is the motivation behind La Mancha Medical Management Group's push to get Mansfield's former Tri-Country Hospital reopened as a critical access care facility. The nonprofit group was issued a Certificate of Need from the Missouri Health Facilities Review Committee on March 31 for the $6,925,214 project.

The board for La Mancha "was formed by the city council of Mansfield" in November 2002, said Jeff Merritt, president of the nine-member, nonprofit group since June. He is also executive director of the nonprofit Mansfield Housing Authority.

Previously, Bob Perry, retired school superintendent, was president of La Mancha, Merritt added.

What La Mancha wants to buy is the 39,600-square-foot hospital building, a 4,000-square-foot clinic and 15 acres of accompanying land. Friends In Action International, a nondenominational missionary supply group, has owned the property and structures since 1994. FIAI has its administrative offices in the building and has remodeled several rooms for visiting missionaries.

The plan

The Certificate of Need project description calls for a 43,600-square-foot, 25-bed critical access hospital, which would renovate the 52-bed hospital last operated by St. John's Health System in 1991. Additional plans call for a 24-hour emergency room, hyperbaric and wound care, oncology, physical therapy, radiology, nuclear medicine, hospice care and home health.

According to Tom Piper, director of the Department of Health and Senior Service's Certificate of Need program, the proposed 25-bed hospital would have an emergency room and is the maximum-sized hospital possible to still qualify for federal cost reimbursement, he added.

Based on population estimates by the Bureau of Health Data Analysis, 22,966 people live within a 15-mile radius of the hospital site. The nearest 24-hour facilities are in Houston at 40 miles away, Springfield and Lebanon are each 48 miles away, and West Plains at 61 miles away.

According to the proposed project budget's calculations, $3,848,646 of the $6,925,214 total is slated for renovation work. Of the remaining $3,076,568 nonconstruction costs, $200,000 is for architectural/engineering fees, $565,975 is for equipment, $207,550 is for major medical equipment, and $150,000 is for interest charges during construction. Consulting and/or legal fees are $163,043 and the cost of the land and buildings total $1,790,000.

According to the Certificate of Need's budget projection, $4,425,214 in unrestricted funds and $2.5 million in loans are set to finance the work.

As a medically under-served area and a health professional shortage area, the project qualifies to receive federal grant money, said Bruce A. McRobert, whose firm, Southwest Missouri Medical Management Inc., performed the feasibility study to secure the Certificate of Need. McRobert is listed on the CON application as president and CEO of La Mancha, however, there is some debate on the issue of leadership.

While McRobert is listed as president and CEO of La Mancha on the CON application, Merritt said, "he was not the president and CEO; he was never on the board of directors, actually." He added, "He was never appointed or elected into that position."

However, McRobert is the contact person on the project, said Donna Schuessler, health planning specialist for Missouri's Certificate of Need program. She added that any change in this capacity would have to come through him per written request.

Changing hands

Kris Rickert, FIAI's manager for Internet technology and communications, said FIAI was approached by La Mancha to buy the property. He said FIAI favors the building sale because of the need to get hospital services into the area. Building a new office complex on FIAI's 42 acres of adjacent property would be the group's next organizational move once the property is sold, Rickert added.

Forward momentum has been halted, however, due to FIAI's decision to retain some of the property for its own use, said Merritt. This, and the fact that the Certificate of Need as issued doesn't account for true project costs. "The total project cost is going to be somewhere in the neighborhood of $8.5 million," he added.

FIAI missionary Dick Thomas said his group is interested in selling somewhere between eight and 10 acres, including the buildings.

A second study

Merritt said he's waiting for the second phase of a feasibility study to come in "before we go on to finalizing the financing." The third and final phase of the study will be to pinpoint areas of need, he added.

Mike Scavotto, president of St. Louis-based Management Performance Associates, said his firm is conducting a feasibility study to re-verify service area and assess demand by updating demographics and looking at discharge data. Merritt wants to find out if there's a market for the service before he continues, he added.

Part of MPA's work will be to see whether turning the existing structure back into a health-care facility or starting from scratch on a new building will be in order, Scavotto said.

MPA is concluding its demographic work to define service area and estimate volume. Next would be to work with area physicians to determine which diagnoses would be treated. "Then we've got the basis to put the financial model together." Fees for MPA's services are about $15,000 for the initial portion of the study, he added.

"(Housing and Urban Development) will do substantially all of the financing" as indicated in the Certificate of Need, Scavotto said. He estimated the project would take somewhere between $8 million and $12 million. HUD is essentially credit support, he added. "HUD's not going to give you the guarantee without there being a real close evaluation of the market."

Hospital history

Tri-County Hospital was built in 1971. It was paid for with individual and corporate pledges, said Hank Flageolle, Mansfield's public works director.

According to McRobert, the original cost for constructing the 52-bed Tri-County Hospital was between $1.3 million and $1.5 million.

In the early 1980s, the city of Mansfield approached St. John's about taking over the hospital, according to Cora Scott, director of media relations. St. John's took over Tri-County's assets and operations in 1982 and during its management pumped a "transfusion of funds" into the hospital in excess of $1 million to assist with operations," due to revenue losses and lack of patient use, she added.

St. John's built the on-site, outpatient care clinic in 1982, but it was "underutilized, as well," Scott added. The hospital closed in 1991; the clinic closed about two years later.

In 1994 St. John's sold the hospital, clinic and 15 acres to FIAI for between $225,000 and $240,000, McRobert said.