Insights into the political struggle over the construction of a rural hospital in Georgia

This story was originally published by KFF Health News.

Ed Whitehouse stood beside a state highway in rural Butts County, Georgia, overlooking acres of rolling fields and woods near Interstate 75. Instead of farmland and trees, he envisioned a hospital.

Whitehouse, a consultant to a local health care company that wants to build a hospital there with at least 150 beds, said the group could begin construction within a year. The idea is to offer medical services beyond those currently provided by Wellstar Sylvan Grove Medical Center, an aging, nonprofit “critical access hospital” that offers limited services, including emergency care, rehabilitation, wound care and imaging.

But it took a new law pushed by the state's powerful Republican lieutenant governor, Burt Jones, to clear the way for construction. The land is owned in part by his father, Bill Jones, a successful businessman whose interest in building a hospital in his home district caught the attention of Democrats and the hospital industry.

The situation was described as follows: “This billionaire entrepreneur Bill Jones is abusing the legal system through his son, imposing his will on people and trying to make money out of it,” Whitehouse said. “Nothing could be further from the truth.”

Also woven into the drama in Butts County are obscure but momentous regulations that require state approval for hospital construction and expansion. These regulations, which applied almost nationwide until the 1980s, require prospective developers to apply for permits for new projects. State authorities assess need based on criteria such as population growth and existing hospital capacity.

This year, Georgia lawmakers joined several other states in seeking drastic changes to certificate of need (CON) regulations. Some states have exempted certain medical providers from the process; others have taken more drastic steps, including South Carolina, which has repealed most of its regulations.

The efforts to pave the way for a new hospital in Butts County show how the debate over certificates of need can intensify as lawmakers try to balance the often conflicting priorities of politicians, the health care industry and local communities.

The laws have been accused of restricting competition, and some health analysts, such as Matthew Mitchell, a senior research fellow at West Virginia University, say citizens may be losing out.

“Such regulations often exist because powerful companies want them,” Mitchell said, “not because they protect consumers.”

Bill Jones, a 79-year-old former state legislator, sponsored a 2022 bill to open a new hospital in Butts County, but the plan faced intense opposition from Wellstar Health System, which operates Sylvan Grove and 10 other hospitals in Georgia.

“As a not-for-profit health system, we are always looking for partnerships that expand our mission to improve wellness in the communities we serve,” said Matthew O'Connor, a Wellstar spokesman. “Our analysis shows there is currently no need for another hospital in this area.”

This year, Democrats in Georgia believed they could use Republicans' interest in loosening regulations to gain support for expanding Medicaid. But Democrats were outnumbered in the House, and lawmakers relaxed several regulations without making that compromise.

For example, certain hospital projects in rural districts are now tax-exempt. Jones' project and his home district are likely to benefit from this.

Burt Jones, the lieutenant governor of Georgia who is being investigated for his role as a sham elector for Donald Trump in the 2020 presidential election, stresses that his push for rule changes is not about helping his father.

“It will give people access to health care within a reasonable travel time and in a convenient manner,” said Burt Jones.

Bill Jones has used Butts County as a home base for building his network of businesses, which includes petroleum distribution, grocery stores and fast-food restaurants, among others. In a recent interview, he complained about media coverage of his son's ties to the hospital project.

He said his interest in opening another local hospital was driven by community need and at least in part by his personal experiences. His wife receives medical care at Emory Healthcare, more than 40 miles away in Atlanta.

“You're not going to get the health care you need,” he said at the 25-bed Sylvan Grove hospital in Jackson. “Health care shouldn't be politics.”

But the lieutenant governor had to be aware that the legislation he was pushing could be viewed as a financial benefit to a close family member, said Josh McLaurin, a Democratic senator whose district stretches from Atlanta to the northern suburbs. His fellow Democrats were encouraged to support the certificate of need bill even though Republicans hold a majority in the Georgia legislature, he said.

“If they want Democrats to support a bill that they could probably pass without our votes, that suggests there are concerns about representation,” McLaurin said.

Hospital industry lobbyists, aware of the connection between Jones and Butts County, watched the debate with fears that the certificate of need laws would be completely repealed, but that ultimately did not happen.

The final bill does not mention Butts County by name, but it exempts “a new general acute care hospital in a rural county” from the need to obtain a certificate of need. With a population of about 27,000, Butts County meets the definition of “rural” set forth in Georgia law.

Now the small local company Whitehouse works for – Interstate Health Systems, which is partly owned by Bill Jones – is moving forward, clearing land to build medical offices, possibly to attract doctors to the area.

Whitehouse said major hospital systems already operating in Georgia are interested in partnering to build and operate a new facility.

Members of the Butts County Hospital Authority, which oversees Sylvan Grove, declined to comment. But last year, county commissioners passed a resolution encouraging the hospital authority to seek a new facility.

Byrd Garland, a retired lawyer and former hospital board member, said he would welcome any project that gives people local access to health care “so they don't have to drive an hour or two to get there.”

Garland said he has been treated both well and poorly at Sylvan Grove and sometimes would rather travel to Atlanta to a better-equipped hospital.

“That’s the attitude you develop when you grow up here in this medical desert that we are in now,” he said.

KFF Health News is a national newsroom that produces in-depth coverage of health issues and is one of the core operating programs of KFF – an independent source of health policy research, polling and journalism. Learn more about KFF.

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