FLORENCE — The next step in determining the fate of a proposed hospital in Florence begins Monday as the contested case hearing gets under way for two planned health care facilities.

The hearing is part of the state's certificate of need review process that allows the project developer and its supporters to voice their case for the project before a judge, while the opposition states its objections.

In this case, RegionalCare, the Brentwood, Tenn.-based owner of Eliza Coffee Memorial Hospital, has proposed building a 300-bed, $250 million "regional referral medical center" in Florence to replace the aging ECM facility, and a $19 million cancer center.

Helen Keller Hospital, along with Huntsville Hospital affiliates Athens Limestone Hospital, Lawrence County Medical Center in Moulton, Parkway Medical Center in Decatur and Decatur General and Alliance Oncology have opposed the projects. Alliance operates cancer treatment centers in Florence and Sheffield.

Administrative law judge William Robert Chandler, of Montgomery, will preside over the hearing, which begins at 9 a.m. Monday in the conference room at the Marriott Shoals. Three weeks have been blocked off for the hearing but it could take less time or more time.

After the hearing concludes, the judge has 30 days to render an opinion.

That opinion will then go the Certificate of Need review board which has the option to side with or reject that opinion.

According to an official at the State Health Planning and Development Agency, the contested case hearing is an option chosen by those in opposition to the project. It is a time of fact finding. Parties can intervene or oppose a project without requesting a contested case hearing.

Jeff Atwood, vice president of communication for RegionalCare, said his side will present first and have submitted a witness list of more than 50 people to bolster their assertion that a replacement hospital is needed in Lauderdale County.

When RegionalCare purchased ECM and Shoals Hospital in Muscle Shoals in 2010, a key point in the asset purchase agreement was the construction of a new facility to replace ECM.

"We expect it will take a about a week for us to make our case for the new facility and services," Atwood said. "Those opposed to the people of the Shoals getting a new hospital, both locally and from out of town, will then tell why they think the people of the Shoals do not need or deserve a new hospital."

The anticipated witnesses for RegionalCare include an array of elected officials, community representatives, doctors and hospital officials.

Doug Arnold, CEO of Helen Keller Hospital, reiterated his stance that his hospital is not opposed to the project. He has often said there are questions that need to be discussed about the details of the proposed projects and that the upcoming hearing is the avenue to have that discussion.

A central question, Arnold said, is the size of the proposed hospital in a time with reimbursements to hospitals continue to be decreased.

"It is a very tough time to consider going out and building a new hospital of any size," Arnold said. "We support a new hospital for Lauderdale County but it needs to be the correct size for Lauderdale County and its primary service areas. There is a simple state formula that dictates that"

The state health plan projections do show that both Lauderdale and Colbert counties have more beds than needed, but hospital beds licensed before 1970 are "granfathered in," meaning they are allowed to stay above the state health plan projections.

Arnold equated the balance of hospitals to the overpopulation of retail stores.

"It is like having 15 shoe stores on the same corner," Arnold said. "It just is not going to be feasible to do."

Helen Keller has submitted a witness list of about 20 people including current and former hospital officials, a professor from the school of business at the University of Alabama Birmingham, health-care consultants and doctors.

The objection from Alliance Oncology, which operates Bethesda Regional Cancer Treatment Center in Florence and Valley Regional Cancer Treatment Center in Sheffield, according to filings made to the state, is mainly to the proposed cancer treatment center.

Alliance officials have said they already provide the proposed cancer treatments in their two centers and object to the duplication of services that would occur if the cancer center is built.

Daily proceedings are expected to begin at 9 a.m. and conclude at 5 p.m. The hearing is open to the public.

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