FLORENCE — A contested hearing arguing the merits of two proposed health care facilities in Florence ended Tuesday when both sides rested their cases after two weeks of testimony.

Alliance Oncology argued Tuesday that equipment used to deliver radiation used to treat cancer patients should not be approved for a cancer center proposed by RegionalCare Hospital Partners. The center would be built adjacent to a proposed 300-bed hospital, which would replace Eliza Coffee Memorial Hospital in Florence.

Testimony on Tuesday indicated the services RegionalCare is proposing are offered by Bethesda Regional Cancer Center in Florence and Valley Regional Cancer Center in Sheffield, both of which are owned by Alliance Oncology.

Alliance representatives have argued that the approval of additional radiation oncology services would be an unnecessary duplication and would be detrimental to their business, which has been offered for decades.

Alabama State Health Plan guidelines state an additional linear accelerator should not be approved unless the current facility is administering more than 6,000 treatments annually and serving a population greater than 150,000.

Questions were voiced about both criteria.

The population of Lauderdale County, where the equipment would be placed, is fewer than 100,000.

If Colbert County is included, the population would reach the 150,000 mark in 2016, according to population projections noted in the certificate-of-need application.

RegionalCare's application for the cancer center has defined the primary service area for the proposed cancer center as Lauderdale and Colbert counties.

As for the 6,000 treatment mark, Bethesda Regional Cancer Center in Florence has consistently exceeded the 6,000 treatment mark since before 2010. Craig Weeks, vice president of finance at Alliance, said that number is expected to fall this year because of upgrades to the linear accelerator in the Sheffield treatment center.

In November, Valley Regional Cancer Center completed installation of a new linear accelerator that has the same capabilities of the Florence unit. Weeks said patients from Colbert County previously had to use the Florence center for intensity-modulated radiation therapy. He said that skewed the Florence numbers and said the volume will likely decline in the coming years.

"With the new technology at (Valley Regional Cancer Center), I expect the numbers to normalize between the two locations," Weeks said. "We've actually already started to see that happen since the installation was completed in November."

Detrimental impact

Daniel Sullivan, a health care consultant for Alliance Oncology, said his analysis of the certificate-of-need application and projections made in the document leads him to conclude the two existing radiation oncology clinics could potentially lose 47 percent of their patient volumes if a third clinic were operating within the service area.

Weeks added if 18 percent of the patients now seeking treatment at the two clinics owned by Alliance sought treatment elsewhere, the Alliance operations would lose more than $859,000 annually in revenue.

Radiation oncology differs from other health care services because the costs are fixed and do not fluctuate with patient volume. Weeks said that would inhibit Alliance from making changes to potentially absorb the patient loss.

Sullivan also testified it is unlikely a new cancer center would reach the radiation oncology volumes projected in the application. He said the estimation of radiation oncology need in the service area is overstated, as is the assumption that a new program would automatically draw a large number of patients.

"Right now (North Alabama Medical Center) does not provide radiation therapy services," Sullivan said. "It provides very little in the way of medical oncology services. So they are really starting a de novo cancer program. They don't have in place existing referral networks."

Existing services

Richard Brockman, attorney for Alliance Oncology, said the services offered by Alliance already act as part of the local hospitals. Bethesda Cancer Center is "a weak-armed shortstop's throw" from Eliza Coffee Memorial and Valley Regional Cancer Center is on the campus of Helen Keller Hospital, Brockman said.

Dr. Stanley Clarke, radiation oncologist at both local centers, is also a medical staff member at ECM and Helen Keller hospitals.

Sullivan said with the cancer resources in place in Lauderdale and Colbert counties, the criteria outlined by the RegionalCare certificate of need are met.

"We've heard testimony already that there are comprehensive cancer service available in both Lauderdale County and Colbert County," Sullivan said. "(This certificate of need) is talking about a physical structure in which all of these services are provided."

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

What’s next

With the conclusion of the hearing, the transcript will be prepared before the administrative law judge will make his recommendation to the certificate of need review board. It is expected to take several weeks for the 3,000-page transcript to be completed.