Construction could begin as early as May 2006 on the almost 18,000-square-foot addition to Fulton County Hospital.
The $6.2 million project is expected to be completed in 14 months, which would be late summer or early fall 2007, according to Administrator Frank Wise.
The hospital will be expanded on the west side with new outpatient and emergency services, and then the existing inpatient areas will be renovated. The architectural plans call for 4,000 square feet of major renovations and 2,600 square feet of minor "cosmetic" renovations.
"The intent is to make the services more efficient and accessible," Wise said.
The hospital achieved critical access status in August 2004, five months after Fulton County voters passed a 1/2-cent sales tax for maintenance and operations.
Wise said the tax was a stopgap that allowed the hospital to meet federal requirements for critical access hospitals. With the critical access status, which was created by Congress to keep more rural hospitals open, the facility can receive higher reimbursements for medical services.
He said the hospital would likely have closed in two years if it had not become critical access, which would not have occurred without the tax increase.
In August of this year, voters in the county approved an amendment to the original tax ordinance that allows the revenue raised to be used for debt service.
Wise said many voters have a misconception that the tax revenue alone will pay for the hospital's expansion. He said the hospital needs more than $100,000 a week to operate. But because of the county's small retail base, the tax generates only $250,000 a year.
He said residents are often surprised to learn how little of their purchases go to support the hospital.
"If you spend $10,000 a year in Fulton County, that only generates $50," he said, adding that most residents spend less than that.
While some of the local tax revenue will still be used for maintenance and operations, it will be primarily used for debt service for an estimated $5.8 million in bonds and/or loans that will be necessary to fund the expansion. The payout will extend 30 years.
"The tax provides the stream for paying off the loan," he said.
Wise said the hospital is essential to Fulton County residents because the nearest hospitals to Salem are in Pocahontas, West Plains, Mountain Home and Batesville, leaving a span of some 90 miles east and west, and the same distance north and south. An ambulance ride of 45 minutes could mean the difference between life and death, he said.
The hospital is also crucial to the economic health of the county, he said.
"For the economy we generate, in salaries alone, $2.9 million a year," he said. Adding in the other medical service, such as clinics and pharmacies, that are tied to the hospital, brings the total economic impact to $9 million a year, he said.
The hospital, including the ambulance service, has a staff of 114 full-time equivalents, according to Wise.
The hospital has enjoyed a windfall with the closing of Eastern Ozarks Regional Health System in Cherokee Village in December 2004, he said. Inpatient care is up about 20 percent, outpatient care up about 40 percent.
The exact increase is hard to determine because the hospital has also added additional services that have contributed to the growth, including a mobile MRI, sleep study lab, cardiology clinic and cardiac rehab department, he said.
If the hospital in Cherokee Village reopens it will not have a major impact on the inpatient census, he said, but it would affect outpatient and emergent care volume.