When I joined the nursing profession 6 years ago, I made it my goal to provide the best health care possible to all of my patients. And part of that care is to ensure that my patients and their families have access to necessary medical services when they need it. However, there’s a law on the books in the Commonwealth of Virginia that is making that difficult.
For those unfamiliar with Virginia’s Certificate of Public Need Law or COPN, it was established in 1973 and requires any hospital wanting to expand their services – from purchasing a new MRI machine to adding a neonatal intensive care unit (NICU) to adding beds to even expanding a parking garage – get prior approval from the Virginia Health Commissioner. While it sounds straightforward, in reality, the process is unduly burdensome and lengthy, requiring an upfront application fee of up to $20,000 and taking a minimum of nine months to complete. And in the end, the Commissioner could end up denying the request.
The goals of the COPN law were lofty: control health care costs and ensure access to care for all Virginians. Unfortunately, neither has been achieved and in the process, competition is stifled and key medical services are denied to those in need.
Case in point: Virginia ranks in the bottom third of all states for its capacity to treat patients overnight. Yet if any hospital wants to add beds for both medical and mental healthcare, they must first apply for a COPN. When it comes to treatment of mental illness in particular, studies show that over 300,000 Virginians have suffered from a serious mental illness in the past year. These patients, possibly a danger to themselves and others, don’t have nine months to wait for a hospital bed. They may not even have one night.
It’s not just beds either, but operating rooms. Virginia hospitals are forced to turn away critically injured patients needing surgery because they don’t have the capacity to treat them. Contributing to this inability is an overly bureaucratic COPN process that a hospital must navigate in order to add additional operating rooms. Rather than ensuring access, the reality is the COPN law is restricting access to the services most needed for patients and impeding hospitals from meeting the needs of the communities, they serve.
Finally, consider the most vulnerable – newborn infants. In Virginia, only 40 percent of hospitals with a maternity ward have a NICU and are able to provide basic NICU care and emergency services. The result is a critically ill infant, instead of receiving life-saving care immediately, must be transported to another facility during a crucial time period. If a NICU could be added without a difficult and lengthy COPN process, parents-to-be would head to the hospital reassured their newborn would be able to receive any necessary critical care in-house.
It’s clear that despite the best intentions, COPN isn’t working anymore. This leads me to question why we haven’t reformed a law that was passed over forty years when bell bottoms were the cutting edge of fashion.
We need reform that will streamline the COPN approval process and increase, not restrict, access to quality medical care. The Virginia General Assembly has tried COPN reform previously and has failed. Mentally ill patients should not be turned away for shortage of beds, patients should not be denied surgery for want of operating rooms and newborns should not have to be put in peril for lack of a NICU. It’s time for our lawmakers in Richmond to finally buckle down and pass reform of an outdated law that is preventing the Commonwealth from embracing a 21″ century health care system. Virginians deserve nothing less.
