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On April 18, Nemours Foundation filed its third Certificate of Need (CON) application proposing to build an additional children's hospital for the Orlando area. A ruling from Florida's Agency for Health Care Administration (AHCA) is anticipated by the middle of June.

State law requires that a proposed hospital must receive a "certificate of need" in order to avoid duplicating medical services in an area. The Nemours Foundation has submitted two previous CON applications to build a children's hospital in the Orlando area. The applications were denied in 2006, in June and again in December. The previous applications proposed a hospital site in the Mall at Millenia area.

In March, after the rejection of its second application for a CON, Nemours leaders announced they would propose a site for a new hospital in the Lake Nona area. Since their CON application process began, the Lake Nona area has been chosen as the site for the new medical school for the University of Central Florida (UCF), a new Veterans Hospital, and the east coast headquarters of the multi-million dollar Burnham Institute for Medical Research, an internationally recognized nonprofit lifesciences research laboratory.

The current CON application under consideration reflects the Nemours assertion that a new children's hospital in the Lake Nona area will contribute, and benefit, significantly to the developing "Medical City" at Lake Nona, and also includes a letter of support for the Nemours case from UCF.

The Orlando area is already home to two fully accredited children's hospitals: Florida Children's Hospital, one of seven Orlando hospitals that make up Florida Hospital, which is owned and operated by Adventist Health System as part of the worldwide organization of the Seventh-day Adventist Church; and the Arnold Palmer Hospital for Children which, with the opening of the Winnie Palmer Hospital for Women & Babies, last year became a fully accredited children's hospital under the umbrella of the Orlando Regional Healthcare system, which includes the Orlando Regional Medical Center, the only Level I Trauma Center in Central Florida.
According to the National Association of Children's Hospitals and Related Institutes (NACHRI), only three markets that are comparable in size to Orlando (pediatric population of 100,000 to 250,000) have more than one pediatric hospital serving the community.

Supporters of the existing children's hospitals have resisted the additional Nemours facility, feeling that it will overload the system, raise costs, and be difficult to staff with physicians who are pediatric specialists, pediatric nurses and other qualified staff.

Nemours, one of the largest children's health systems in the United States, is part of The Nemours Foundation, the primary beneficiary of the Alfred I. duPont Testamentary Trust, which has assets of more than $4 billion. The foundation plans to spend almost $280 million of its own assets to build the proposed children's hospital and supplement revenues with up to $40 million for operating expenses.

The Nemours group has been proactive in garnering support from groups in the Orlando area. Resolutions in support of a Nemours Children's Hospital, now billed as an "integrated pediatric healthcare system," have been announced by a range of municipalities and organizations, including the City of Orlando and Orange County, the City of Belle Isle, Orange County Public Schools, and the Orange County League of Women Voters.

In April, Nemours announced the formation of the Nemours Council, a group of 14 community leaders who will help "to build bridges to advance Nemours' plan to bring an integrated pediatric healthcare system to Central Florida."

On May 9, Nemours announced the formation of a Florida public relations team created to "build more favorable awareness and advocacy locally and regionally" to bring an integrated pediatric healthcare system to Central Florida.

Noticeably lacking in the Nemours campaign for support of their CON application has been any endorsements or support from officials and staff of the existing children's hospitals or from the local pediatric specialist community.

Resistance to the idea of a Nemours Children's Hospital is largely due to the perception that a third pediatric hospital would be redundant with the existing hospitals' dozens of pediatric subspecialty programs and duplicate some of their combined 300 licensed pediatric beds. There is apprehension that a duplication of existing programs and facilities will result in higher costs for patients and providers, and exacerbate the national shortages of pediatric physician specialists and trained nurses as they are starting to be felt locally.

Nemours initial entrée to the Orlando medical scene came in 1997 with the opening of a pediatric multi-specialty outpatient clinic, which grew to include a staff of 60 full-time pediatric specialists. The number of local physicians connected with the clinic has fallen to about 20 since Nemours announced its intention to build a free-standing hospital not connected to the Orlando Regional Medical Center (ORMC).

The new CON application shows that Nemours intends to commit millions of dollars to pediatric research and plans to fund seven pediatric sub-specialty fellowships. Their application also includes a statement of intention to bring pediatricians in subspecialty fields to the Orlando area to practice in the hospital and community.

ORMC maintains that it has always been eager to sit down with Nemours officials to see how they could work together again. (A previous relationship went awry after ORMC decided to build the Winnie Palmer Womens and Babies Hospital and renovate the Arnold Palmer Hospital into a full-service children's hospital.) Both sides see positive possibilities in the Nemours proposal to move from ORMC's back yard to the Lake Nona area and to emphasize pediatric research.

"We're encouraged by the prospect of Nemours wanting to conduct research, and we're equally encouraged by their interest in helping meet unmet needs as opposed to duplication of services," said Joe Brown, spokesman for Arnold Palmer Hospital for Children. "We look forward to sitting down with Nemours and discussing these challenges."

Results of the AGHC study of the Nemours application will be announced by June 15. In the meantime, proponents of both points of view expect to continue to enlist support from the central Florida community.


June 2007

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