FLORENCE — The methods and standing of RegionalCare Hospital Partners' final direct witness were scrutinized for more than six hours on the sixth day of testimony in the contested case hearing for two proposed health-care facilities planned for Florence.

Noel Falls, a health care consultant and head of Falls Marketing Group, was the sole witness answering questions Monday concerning information contained in the certificate of need applications for a 300-bed replacement hospital and a comprehensive cancer center.

Falls compiled both applications for RegionalCare.

Falls' testimony that the numbers and projections in both certificates were sound was challenged by attorneys representing Helen Keller Hospital and Alliance Oncology, both of which oppose the proposed projects.

Falls testified the calculations and formulas used to determine the projected service area expansion and admission projections for the new facilities were no longer in his possession. He said in Alabama such calculations are not required to be kept or presented.

"(I have) never been asked for a calculation in 30 years," Falls said.

In the certificate of need application for the proposed replacement hospital, the primary service area for the new hospital is projected to be Lauderdale and Colbert counties.

The secondary service area would be Franklin and Lawrence counties in Alabama, Wayne and Lawrence counties in Tennessee and Tishomingo County in Mississippi.

The third service area is projected to include Limestone, Marion and Winston counties in Alabama, Hardin County, Tenn. and Itawamba County, Miss.

Will Somerville, attorney for Helen Keller Hospital, said because the formulas and calculations used to determine the patient draw from those areas were not made available, the opposing parties were being asked to "take the numbers at face value."

That was something he said shouldn't be done.

Somerville said expert witnesses for Helen Keller Hospital will testify that the application of patient migration formulas to determine patient admissions is faulty and inflated.

Falls testified he used data from two hospitals in Dothan he said most closely resemble the local situation.

He said those hospitals — Flowers Hospital and Southeast Alabama Medical Center — draw patients from two bordering states, Georgia and Florida.

Not so similar

Richard Brockman, attorney for Alliance Oncology, said the situations are not as similar as Falls characterized. Brockman said the patient referral patterns in Dothan have been established "for years" and the creation of a similar pattern in northwest Alabama would be a lengthy process. The certificate of need applications show a significant increase in patient admissions within the first two years of operation for the new facilities.

Also questioned was the size of the proposed replacement hospital. Helen Keller representatives have said they aren't attempting to stop a replacement facility from being built. Instead they are trying to "right-size" the project, Helen Keller attorney Dennis Nabors said.

Projections for 2008-2011 show only 215 beds are needed for Lauderdale County. Those are the latest projections available from the state Health Planning and Development Agency.

Falls was questioned about the 2012 annual hospital report filed by Eliza Coffee Memorial Hospital on Feb. 1. Falls said he did not compile the report but had seen it.

In that report, ECM reported just less than 14,000 in-patient admissions. That number included observation patients, but Somerville challenged the legitimacy of including those patients in the notation.

Somerville said, and Falls agreed, that observation patients have not typically been included in the admission data.

Earlier in the hearing, ECM CEO Russell Pigg testified that observation patients are a growing classification that is used primarily for reimbursement purposes.

That means patients receive hospital care and testing but don't meet admission standards set by Medicare, Medicaid or BlueCross BlueShield.

Somerville said including observation patients in the annual reporting data is part of a "smoke and mirrors" case to prove the need for a 300-bed hospital.

Falls will continue to be cross examined Tuesday morning.

At the completion of his testimony, Helen Keller Hospital representatives will begin presenting their case.

Jennifer Edwards can be reached at 256-740-5754 or jennifer.edwards@TimesDaily.com

Monday’s witness

• Noel Falls, health-care consultant for RegionalCare, testified about the content of the certificate of need applications filed by RegionalCare for a 300-bed replacement hospital and a comprehensive cancer center. His expert status was questioned by attorneys for Helen Keller Hospital and Alliance Oncology.

Tuesday’s witnesses

• Noel Falls, health care consultant for RegionalCare, will continue his testimony. Falls compiled the certificate of need applications for the proposed 300-bed hospital and cancer center planned for Florence. Falls began his testimony Monday.

For Helen Keller Hospital

• Larry Collum, president of the Helen Keller Hospital board

• Sheffield Mayor Ian Sanford

• Sheffield Councilman Steve Stanley

• Dr. Laurence Carmichael, pulmonologist and sleep disorders specialist, Helen Keller Hospital

• Sam Strickland, chief financial officer, Helen Keller Hospital

• Colbert County Commissioner Rex Burleson

• Tuscumbia Mayor Bill Shoemaker