Memorial Hospital of Lafayette County, (MHLC) the Lafayette County Board of Supervisors, and the Hospital Committee are in the process of exploring the most feasible and fiscally responsible options for modernizing and improving the hospital’s physical plant, which is deemed near the end of its useful life.
Collectively, the hospital and county board want to ensure that residents of the community are presented with the facts about the building assessment process, while answering as many questions as possible about the project under consideration and its status.
Following are questions we’ve received after our invitation for our community to participate in this important process. Questions and answers are presented in general categories, including
If you have a question relating to the replacement hospital proposed project not already addressed in this document, we encourage you to email it to firstname.lastname@example.org. As each phase continues, we are committed to keeping our valued community informed and engaged.
Above all, we want you to know that we believe the future of Lafayette County needs to include quality healthcare provided by those we trust have the community’s interests in their hearts.
A: Our hospital has served the region well for nearly 70 years. The facility was built to accommodate healthcare during a different era. The infrastructure, everything from our HVAC system to our boiler, electrical systems, our roof, for example, are aged and, in some cases, failing. We feel fortunate to have a skilled, professional, and creative team of facility maintenance experts; however, they can’t make miracles happen.
Although our inpatient rooms are private, we can only provide one bathroom per two rooms. For those patients hospitalized requiring therapy in their room, space is limiting on many fronts. Our nursing staff and the care they provide are excellent; their stations, however, are inefficient compared to today’s highest standards for nursing. Every hospital must be prepared to provide life-saving care, and our emergency department is always ready, and they are second to none. At the same time, the MHLC ER is another primary consideration for our decision to bring this plan forward.
Technology has changed dramatically over the decades. From year to year, we must always ensure that we stay in step with healthcare innovation to advance privacy and safety. There was no way for our founders to foresee what is required today where technology is concerned. It’s not a luxury, it’s necessary.
The MHLC staff find many ways to work around the facility’s deficiencies, including lack of storage, break rooms, and workstations. Our current footprint cannot appropriately accommodate these vital and proper advancements for the care of patients and protecting our staff.
A recently completed total facility study noted that large portions of the facility are now in “poor” or “fair” condition. It must be noted the state of the facility is related directly to its age and not a lack of maintenance.
The original section of the current facility was built in 1952. There were renovations and expansions in 1983, 1993, 1997, 2003, and 2014. Six years later, and in the first phase of this process, we thoroughly evaluated the options to try and modernize the current space, leading us to a position that a replacement facility is the best option.
Our conclusion: the risk of spending millions of dollars on a hospital building that has been instrumental in our lives for 70 years is higher than investing in building a replacement facility on a green site that will serve the community for decades.
A: During phase one (Feasibility Phase), we started by focusing on our patients and the community’s healthcare needs in our service area. While analyzing the county’s health care needs data, we examined and assessed the state of the current building, including its infrastructure, while also taking into account the areas of our nearly 70-year-old building that don’t and can’t meet specific health facility state mandated regulations and requirements. The last piece of our work in the feasibility phase included an examination of how much of a project would be affordable for MHLC to undertake, factoring in the community health needs assessment and the current facility, its location, its limitations, and the areas where experts had determined we’ve exhausted options for patching, repurposing, or retrofitting.
The final step in phase one included presenting all our findings to the county’s hospital committee to determine which of the options they felt were best to pursue. The committee concluded that a replacement facility was the sound and feasible option to explore further.
A: In each phase of this process, there are several necessary steps to follow. Currently, we are in step one of phase two (Planning Phase) and this includes conducting a more in-depth feasibility study and gaining an understanding of the USDA loan application process and all that it requires. MHLC is working with a firm that specializes in rural hospitals and they are thoughtfully walking us through the process.
Of critical importance is to understand that the phase two does not include any commitment from Lafayette County to pursue a significant construction project; rather, this necessary step is focused on data gathering to assist Lafayette County in their decision-making process, including costs and financing options.
A: MHLC is working with the both the County Board of Supervisors and Hospital Board to prepare an estimated timeline that outlines anticipated activities, milestones and events involved with this process and we plan to have this available in the next few months. Be assured this timeline will also include educational sessions for the Board and those designed for residents of Lafayette County.
The timeframe may fluctuate due to any number of circumstances, and depending on the next level of findings, we estimate phase two being completed by March 2021.
A: We held our first public information meeting on January 16, 2020 to provide details about phase one. On July 21st, we will provide a recap of our phase one progress and findings, while also sharing details about this second phase. Throughout the process, we will keep the community informed through meetings, information posted on our website, and press releases.
A: Should MHLC close emergent, time sensitive medical services leave our community, it would put anyone at any time at a higher risk of having a negative outcome. Closing this facility (be it by choice or force) would cause many in our community to travel long distances for care.
Healthcare is a pillar of communities, ours too. When people look for a community to join, their top criteria include quality schools, and healthcare, housing, and quality of life. Healthcare for every age is essential.
In the United States, small rural hospitals like ours are closing at an alarming rate, especially during this time of pandemic. When a hospital in a community closes, the local economy suffers irreversible damage.
A: A referendum is not required for Lafayette County to move forward with final approval to construct a replacement hospital and health care facility.
A: First, we think it’s important to reiterate that the Lafayette County Board of Supervisors and MHLC leadership continue to follow its five-phase replacement hospital plan. Currently (February 2021), we are still in the second phase of the plan. It involves completing the feasibility study, which will ultimately determine the hospital’s debt capacity, a key factor for future decisions related to financing the project.
Once the feasibility study is complete and assuming it, along with the work happening related to the environmental study affirms the project is affordable and can move forward, the County Board will decide how to proceed in accordance with Wis. Stat. s. 67.045(1)(a)-(h). This Section provides the County two approval options for this project, reiterating that it is a decision that the County has the authority to make at its discretion.
A: No. County debt limits are set forth in Art. XI, Sec. 3 of the Wisconsin Constitution and restated in Wis. Stat. s. 67.03(1)(a).
For counties, the “aggregate amount of indebtedness, including existing indebtedness, of any municipality shall not exceed five percent of the value of the taxable property located in the municipality as equalized for state purposes.” Wis. Stat. s. 67.03(1)(a) and Wis. Const. Art. XI, Sec. 3. Lafayette County’s current equalized value provided in its Certificate of Equalized Value from the Wisconsin Department of Revenue (effective 8/15/2020-8/14/2021) is $70,916,100.
This puts the County’s constitutional debt limit at $63,376,700. There is no mechanism for exceeding a county’s constitutional debt limit.
A: The total amount of general obligation debt issued by the County would count towards its debt limit. For example, if the County issues $50 million in general obligation bonds to construct the hospital, the entire $50 million would be the County’s general obligation and count towards the debt limit.
However, the County may be able to finance a substantial portion of the hospital project using “revenue bonds” pursuant to Wis. Stat. s. 66.0621 because hospitals qualify as a “public utility” under this Section. Unlike general obligation bonds, revenue bonds are not a general obligation of the County and are not secured by a special tax. Rather, revenue bonds are secured by a pledge of revenues from the public utility (in this case the new hospital). Unlike general obligation bonds, revenue bonds do not count towards the County’s constitutional debt limit. For example, if the County were to structure the financing with $10 million in general obligation bonds and $40 million in revenue bonds, only $10 million would count towards the County’s constitutional debt limit.
A: None. Though many community members are under the impression that a stipend of their tax dollars are currently allocated to MHLC, the reality is that in recent years MHLC has not taken any funds from the county. In fact, MHLC has contributed monies back to the county for community benefit. MHLC services our own debt and, unlike many small rural hospitals today, we have a positive cash flow.
A: The first step in phase two, which is where we are at right now, will help us answer many of the questions with respect to the financial details and implications.
What we do know at this time is that the initial source would be to fund the construction through debt financing (most likely tax-exempt revenue bonds or revenue notes) through the USDA. This method would not affect the county’s debt levy capacity. It would be based solely off what MHLC can pay with its own earnings. Our work in phase two will assist us in answering the question of how much we will need to borrow and how much MHLC can afford.
These important details will be discovered, communicated, and contemplated in the second phase.
A: According to the Wisconsin Hospital Association in 2019 MHLC had the following impact on the economic development in our region.
A: First and foremost, please keep in mind that in a medical emergency, the nearest hospital is your best option for saving a life. With that said, we support each person receiving their care wherever they are most comfortable.
Even if you don’t receive your care at MHLC, it’s important to understand that MHLC provides employment for 160 people, stable jobs, competitive good wages and benefits, and economic stability to the communities we serve throughout the county.
MHLC employees are embedded and invested in the county and their contributions to our region do not end when they complete a shift.
A: Should someone else want to purchase MHLC there is a high probability they would reduce the number of services offered at our facility. Under different ownership, it’s likely that only primary care, emergency services, and urgent care services would be retained. Our patients who rely on us to be their medical home would be forced to seek care elsewhere. This would also cause a large portion of staff to be left unemployed, which would devastate the community’s economic standing. The reality today for Critical Access Hospitals like ours is that those who seek to acquire them do so to limit competition and drive profitable services to their large facilities.
A: MHLC doesn’t consider it to be a new facility, it is a replacement facility. We know the services we provide are excellent and needed and we will do everything possible to ensure they are maintained. In addition to this, hospital leaders, medical providers and staff do have a vision and goals to responsibly grow our services for the benefit of Lafayette County residents of all ages. We believe that by remaining competitive, we will continue to attract and retain quality health providers, talented and committed staff, and provide opportunities for younger generations to pursue careers in healthcare in the place they were raised.
A: MHLC cannot speak for any of the other projects; however, we know that 2020 has been a challenging and uncertain year for us all. This is a valid concern. We do know it is never an ideal time to undertake several large capital projects at the same time, let alone during a pandemic.
The county’s finance department is in the process of developing a capital improvement project to address the full spectrum of infrastructure needs in the county. MHLC has engaged an unbiased, experienced consultant (Wipfli) to guide and aid us through our part of this process. Wipfli has specific expertise in Critical Access Hospitals. The work we’ve done to date is being factored into their planning process and the education they are providing to the board, especially newer members, is essential to the decision-making process.
In addition to the above, MHLC has arranged for a preferred USDA lender and a representative from the USDA to facilitate an education session with the board, finance committee and other stakeholders in the planning process. They will present a depth of information on the USDA Rural Development Community Facilities Program, including broadband and water infrastructure. This meeting is planned to occur sometime in September or October this year.
A: Currently MHLC cannot provide a specific timeline as these answers will come during the latter steps of the planning phase should we be given the green light to proceed. As the second phase progresses, there will be further discussion, information and education meetings, and communication to community stakeholders about a project timeline.
A: The Lafayette County Board of Supervisors, Memorial Hospital of Lafayette County (MHLC), and Lafayette Manor have reached an agreement with New Legacy, LLC, to purchase a 36-acre parcel of land listed with Roelli Realty Group, LLC. The land selected as the site for the proposed replacement hospital and healthcare campus, and future replacement long-term care facility, Lafayette Manor, is located south of the City of Darlington, in Darlington Township, adjacent to the City.
The one-year option agreement between the County and New Legacy, LLC, is an essential next step in the overall replacement facility planning process and is required by lending institutions as a condition for loan eligibility. The agreement signed on Monday, February 2, 2021, provides MHLC with the green light to begin a mandatory environmental study and set the wheels in motion to receive a preliminary architectural site report. Funds required to engage experts to complete these studies and plans were previously approved.
A: Facility design, how each area will be laid out, the size of the footprint, all of these items will be decided if the project is approved to move forward and will include a great deal of input from each of the hospital’s department heads, as well as a careful study of similar replacement hospitals.
A: We currently have 25 beds and we would keep the 25 beds.
A: This is a great question! Every service we provide is informed by community health needs and driven by data. Put simply, when the demand is there, and the service can be provided cost-effectively and safely, it’s a service we work to deliver with the highest level of clinical excellence and safety, such as our primary health clinics, imaging, laboratory, surgical, rehabilitation, and other current services.
We use the same evaluation process to determine if services are no longer feasible to maintain, such as obstetrics and dialysis. As difficult and disappointing as it is to eliminate certain services, we must always do what’s responsible for ensuring patient safety first while examining if a service has become cost-prohibitive due to a decline in market demand, or if that service has become too expensive based on many factors, including liability, provider fees, and declining reimbursements.
At present, MHLC anticipates keeping all its current services. With additional space in a new location, we will look to expand services that meet current and future community health needs with an eye on the services we know are in demand; however, will not fit in the existing structure.
A: Yes! There are many prominent examples and case studies that show a modern health facility, complete with advanced technology, not only aids in recruiting physicians, but also specialists and allied health providers. In addition, a modern facility is ideal to attract younger community members with an interest in pursuing a healthcare career near to where they live.
A: We will hire providers as the needs demand. We will not hire just because of a new building; however, we do anticipate increasing our specialty services and surgeons.
A: Building a replacement facility will not cause us to hire new staff based on the services we currently have; however, as we grow our service lines, it is likely we will increase the number of our employees, keeping us as one of the largest employers in the region.
A: Unrelated to the proposed replacement hospital and healthcare facility, in November of 2020, the Lafayette County Board of Supervisors approved the formation of a county-based EMS division. Lafayette County EMS Service will replace the current service operated by Rural Medical and supported by Green County EMS, led by Chief Daniel Nufer. Rural Medical has been an EMS provider for many municipalities in the County. Green County EMS had what was to be a short-term agreement with Rural Medical to assume operations when it could no longer meet requirements.
Operations of the newly established Lafayette County EMS Service will fall under Memorial Hospital of Lafayette County; however, managed by a department head once identified. Although MHLC had conducted a market analysis to understand if EMS would be a path to pursue and previously determined that a hospital-based EMS would be cost-prohibitive, the county-owned, operated by MHLC model is being embraced by hospital administrators, recognizing that EMS is an essential community need.
A: As a part of the replacement facility plan, we will bring the Darlington clinic to the new campus to provide continuity of care to clinics and ensure that staff from both operations are situated on the same campus.
A: Yes. The way replacement hospital construction works is to utilize the services of a primary contractor that specializes in health facilities; however, we would request the primary contractor subcontract with as many local contractors as possible. We value having community members working in our facilities, as we know it will be the local contractors who will assist us once we are officially in our building. As the project progresses, we will know more about the positive economic impact the construction phase will have on our county.
A: The manor is currently conducting its own facility assessment plan. Ultimately, the goal is to identify a parcel of land that could accommodate a hospital, medical offices, as well as a long-term skilled care facility. Both Lafayette Manor and MHLC administration along with a subcommittee (made up of members of the County Board of Supervisors), have been meeting to discuss the future of both facilities, the agendas and minutes are posted on the county website.
It would be very unfortunate for the future of healthcare in this region. We will have missed a once-in-a-lifetime opportunity to transform healthcare not only for today but for generations to come. Practically speaking, we would continue to provide excellent care to our patients and community members and try to accommodate and adapt to new advances in healthcare delivery and technology; however, it will greatly hinder our ability to keep pace with the ever-changing healthcare landscape and maintain our competitiveness with other healthcare organizations in the region. It will be increasingly difficult to attract new physicians and the staff needed to provide contemporary healthcare.
Though difficult news to share, our reality is that the current facility has been granted ‘grandfathered’ status for areas that don’t meet current state requirements. There is a very real possibility that in a relatively short period of time, MHLC would be required to close its doors as result of the building’s age.
A: Once there is official approval to build off site MHLC will contract with an engineering consulting firm to help us with a comprehensive evaluation of the potential repurposing of the current facilities. It’s important to note that other hospitals that have relocated to new campuses have repurposed their old buildings as schools, government office buildings, and other facilities for community benefit.
A: Any project of this magnitude and visibility will draw opinions from those who are proponents and opponents. Often, those who oppose are more typically having their views amplified in media and social media outlets. It is our policy to not go ‘toe-to-toe’ in these spaces; rather, create an environment that provides for constructive dialog.
The majority of all those we meet with, hear from, the MHLC staff, our providers have shared with us that they are fully supportive of pursuing a replacement hospital and developing a health campus that will serve the community’s current and future needs.
We welcome feedback, questions and ideas that are based in truth and fact. A replacement hospital is a new and positive discussion to responsibly address and solve problems with sound solutions. This is where our focus will remain.
“Failing to plan is planning to fail.” – Benjamin Franklin