NATCHEZ &045; Becoming a one-hospital town will happen in Natchez, a Greenville physician said Friday. When it happens and how it happens is up to Natchez.

Dr. Hugh Gamble, a surgeon, said Natchez is not in a unique situation. Quite the contrary. &uot;It’s been addressed in Columbus, in Vicksburg, in Greenville, and it needs to be addressed in other parts of the state.&uot;

Why should there be one hospital in Natchez instead of the two, county-owned Natchez Regional Medical Center and Health Management Associates-owned Natchez Community Hospital?

Gamble said when one hospital buys the latest in equipment, the other hospital has to follow suit. Instead of one machine of the latest medical technology, there are two, neither of which is operating at capacity.

&uot;A good example in Greenville was in mammography. Two hospitals had the same equipment, each using it at 25 percent of capacity. But they are paying 100 percent of the cost of the machine,&uot; Gamble said. &uot;That kind of competition is detrimental to health care.&uot;

Natchez physician Dr. Tom Carey, who practices obstetrics and gynecology, said that is exactly the reason Natchez should be a one-hospital town.

In his own field of obstetrics, for example, both facilities are at the borderline of the fairly strict delivery requirements that a hospital must meet in order to qualify for a labor and delivery unit. That requirement is 500 deliveries a year. Both hospitals are &uot;right under the 500 rule,&uot; he said.

&uot;It doesn’t make sense to have a mile or half mile between facilities,&uot; Carey said. &uot;And I think most people in ob-gyn would say we would do better with one facility.&uot;

That goes for other medical services, as well, he said. &uot;All the outlay for equipment like the MRA, CT scanner and other X-ray equipment, the (catheterization) lab equipment, ultrasounds &045; there is all the outlay and the service on the machines and the people to staff them.&uot;

Further, Carey said, there are &uot;the administrative expenses at both hospitals, the CFO, the director of nurses; it starts adding up. And that is money that could be put into expanding medical care.&uot;

Carey said Natchez doctors gathered last month in a private home to hear from Gamble and from a physician from Vicksburg on the consolidation that took place there recently.

&uot;It was exciting when those guys came and talked to us about how much more they were doing, how they could expand. They’ve seen their whole medical facility take off,&uot; Carey said.

Only about four months into the change in Greenville, good results are materializing, Gamble said.

In Greenville, a private for-profit hospital bought a small community hospital, King’s Daughters, and then tried to buy Delta Regional, the public hospital.

&uot;Delta Regional ended up buying them,&uot; Gamble said. &uot;We’ve been at it four months, and in the very first month the increased revenues exceeded their expectations.&uot;

The one hospital now is consolidating services, putting certain medical services in one building and some in another. The long-range goal, however, is to build a new all-inclusive medical center at another location.

Already, Delta Medical Center has purchased 80 acres of land and architects are working on plans, Gamble said.

&uot;The hospital administration thinks three to five years for the new building. I think longer,&uot; he said.

Still, the change has been a positive one for hospital workers, doctors and patients, he said. &uot;We’re letting the community get the best of everything, not three of everything.&uot;

Delta Medical Center took &uot;an unbelievably progressive approach, and I’m dumbfounded we pulled it off,&uot; Gamble said.

The public hospital began to hire doctors, bringing them under the tort-law umbrella they enjoy as a public facility. &uot;Delta Regional could hire physicians and reduce their malpractice insurance,&uot; he said. &uot;I am now employed by the hospital, and my malpractice insurance went from $120,000 a year to $40,000 a year.&uot;

The medical center did not want to hire physicians, he said. But to do so made sense under the circumstances. Of the approximately 80 to 85 physicians in Washington County, half are employed at Delta Medical Center.

&uot;First, they started with the high-risk doctors,&uot; Gamble said. &uot;I was in an eight-man surgery group who went with the hospital.&uot;

The physicians remain in their same offices and receive pay according to productivity.

Gamble believes the approach Delta Medical Center has taken is part of a greater trend. &uot;I see the trend nationally very much away from private practice.&uot;

Dr. David Timm, a Natchez pediatrician who has practiced in the community for 22 years, said he agrees Natchez is a one-hospital town but believes the community must be careful about making decisions.

He does not like the track record at Natchez Regional in recent years, he said, questioning its debt,

commitment of the management company, Quorum, and the expertise of the board of directors.

Dr. Carey said otherwise. &uot;Natchez Regional has such a strong board of directors now, with James Coleman as such a strong chairman,&uot; Carey said.

Timm does favor a public hospital, he said. &uot;I want a new hospital, and I would rather have a public hospital,&uot; Timm said. &uot;But I don’t see how the community could take on a $70 or $80 million dollar debt in this economy.&uot;

Natchez Regional CEO Jack Houghton said the Regional board of trustees is looking into an affiliation with another medical center within Mississippi to &uot;complement the services we currently offer and allow us to expand in all areas.&uot;

That affiliation would preclude asking the community to put up the funds necessary to consolidate the two local hospitals.

James Coleman, chairman of the Natchez Regional Board of Trustees, said board members &uot;chose to go joint venture as opposed to going directly to the citizens to fund us.&uot;

The board supports the one-hospital concept, &uot;and we want to be the hospital of choice for everyone. We’re not a two-hospital town, and we’re committed to have the best hospital in the Miss-Lou and to be a public hospital where people with Medicare, Medicaid or any type of insurance or no insurance can come and get the best medical care. And the money stays here, unlike the HMA hospital, with the profits going out of town.&uot;

Community Hospital CEO Allen Tyra has said the argument about profits leaving town is not valid, as the for-profit hospital pays nearly $500,000 in taxes and has a payroll of $15 million. He believes Community is in the better position to be the one Natchez hospital, he said. &uot;And we are not for sale,&uot; he said.

Carey said, however, that the taxes paid by Natchez Community

is &uot;money generated by the medical industry.&uot;

With one public hospital, that money could be returned to expand the medical facility further.

&uot;The hospital could use that money better than the board of supervisors. That’s money we could be using to fund more medical services,&uot; Carey said.