Cole County judge upholds $15 million state appropriation for new cancer center in Kirksville

An appropriation to help Hannibal Regional Healthcare System provide cancer treatments in Kirksville complies with all laws governing new health facilities, a Cole County judge ruled Monday.

In a 32-page decision, Circuit Judge Cotton Walker found no reason to block the $15 million in this year’s state budget for Hannibal Regional to build a radiation oncology center. The legislature is not a state agency and not bound by the law limiting when state agencies can appropriate or grant funds for health care facilities, Walker wrote.

“State agencies are created by the legislature and are within the executive branch,” Walker wrote. “The legislature itself is not a state agency. It is its own branch of government.”

The lawsuit was filed by Tina Binder of Macon County after she spoke to the lobbyist for Community Health Systems, owner of Northeast Missouri Regional Medical Center in Kirksville. It tests the limits of the legislature’s ability to earmark appropriations using definitions for counties and agencies that are so specific that there is only one possible recipient. The funding was one of about 400 earmarks lawmakers included in the current budget.

The lawsuit challenged whether Hannibal Regional, for example, is “located in more than one county.” 

Walker noted that Hannibal is a community that straddles the Ralls and Marion county line and “the evidence confirms unequivocally that (Hannibal Regional) has business operations and assets in more than one county.”

The main question in the case was whether the legislature could set aside money for a new service that has not been given a “certificate of need” by the Missouri Health Facilities Review Committee. 

Attorneys for Binder argued that the legislature had no power to appropriate the money if the committee had not issued a certificate of need.

In Missouri, anyone proposing to construct or expand a hospital, or purchase new equipment, with a cost exceeding $1 million must obtain a certificate of need. The certificate of need program is intended to prevent expensive duplication of services.

When the appropriation was made, Hannibal Regional did not have a certificate of need. It obtained the certificate on Oct. 1. 

The legislature is not bound by certificate of need law, Walker wrote.

“Even if it were bound by this statute, its appropriation was to the Missouri Department of Social Services, which did not require a certificate of need,” he wrote.

The lawsuit stalled work on a contract to deliver the money to Hannibal Regional. During the December trial, Hannibal Regional attorney Matt Turner said the case needed to be finished by June 30 or the appropriation would lapse with the end of the fiscal year.

The budget for the coming year, approved last week in the Missouri House, included a reappropriation to make the money available for another year.

Hannibal Regional intends to purchase a linear accelerator and build a facility to house it on a 240-acre property it purchased in 2022 in Kirksville. Attorneys for Binder tried to convince Walker that a memorandum of understanding with the city, where Hannibal Regional said it would open a hospital or buy the existing one if it became available, meant the certificate of need should be for a hospital instead of only the accelerator.

Walker wrote that the memorandum does not make the building that will house the accelerator a “health care facility” requiring its own certificate of need. Only the equipment requires the certificate of need, he wrote.

Walker also questioned whether Binder was truthful in the affidavit she filed stating she objected to the spending item based on “knowledge of the facts” regarding appropriations, veto considerations and certificate of need applications.

Under questioning at the December trial, Binder admitted she had limited knowledge of how state appropriations work, the regulatory oversight for building new health care facilities or other key issues in the case.

“I don’t understand the legal jargon without having it in front of me,” Binder said. “I am just a regular old taxpayer concerned about taxpayer dollars.”

That, Walker wrote, shows Binder’s affidavit contains information she did not personally know.

“At trial,” Walker wrote, “she confirmed she had no firsthand knowledge of the information contained in her affidavit and that all the information in her affidavit came from her attorneys or from someone else.”