On the front page of today’s Roanoke Times is an article about how one local hospital (Lewis-Gale owned by HCA) wants to develop a state of the art NICU to serve those in the area.

Well, that seems fine enough. Let them hire the staff and buy the equipment. Maybe, with two NICUs in the area, care will improve as well as prices – capitalism at its best, right?

No. The business of hospitals is not that easy.

When one hospital wants to add a program, a bed, a CT or MRI machine, anything, they can’t just go buy it and use it. They have to petition the State of Virginia (Attorney General’s office) and prove there is a “public need” for the service.

Seriously.  I recall the first time I learned about this process. I was in lawschool and working as an intern for the AG’s office that handled these petitions.

I asked my then boss Mr. Roberts, “How is it not in the public interest to have more healthcare options in an area? Won’t that reduce prices and perhaps increase the level of services?”

He didn’t respond. He couldn’t. That is the irony of this whole process.

While I don’t understand the purpose of the structure, I do understand the consequences.

Lewis-Gale wants to have a Neonatal Intensive Care Unit, but Carilion Roanoke Memorial, a different hospital owned by a different hospital system, already has one 10 miles away. So when Lewis Gale files their paperwork arguing there is a “public need” – Carilion will likely show up and argue, there is no need for additional NICU services. They might produce numbers that show they can take care of the need for the entire region.

Does it not sound a little funny to you, that competing hospital systems are lobbying for and against what services will be available in your area? Do you get a say? Sort of. There will likely be a public meeting but ultimately public input has very little influence on the decision.

I for one think its odd that healthcare providers cannot just offer services, that they have to get approval from the state first, and their competitors are allowed to argue against it.

Can you imagine a hair salon getting to petition the state that the salon across town shouldn’t be allowed to offer perms or highlights because they already provide that service to the fake blondes of Roanoke? What if Food Lion called the State and said “Hey, its Food Lion here, don’t let Kroger sell strawberries this week because we have enough for everyone.” That would be ridiculous, right?

So why is it allowed in healthcare when access is so important, and competition so vital to keeping costs in a reasonable range.

We will watch and see what happens. In the meanwhile, I think I will call the Gov. and tell him no one else is allowed to blog about medical malpractice and healthcare issues in SW Virginia – there isn’t a need for two voices on the issue and I pretty much have satisfied the public need for dialogue.

Think he’ll take my call?

Dan Frith
Dan Frith

Dan Frith has over 25 years of experience representing individuals and families in cases of medical malpractice throughout Virginia. He has been named "Best Medical Malpractice Attorney" by Roanoker Magazine and is a member of the Million Dollar Advocates Forum. To speak with Dan, contact him by email at