Hannibal Regional gets closer to building cancer center in Kirksville with Certificate of Need approval

HANNIBAL, Mo. — Hannibal Regional Healthcare System received a favorable 5-0 vote from the Missouri Health Facilities Review Committee last Tuesday to approve a Certificate of Need application to build a new cancer center in Kirksville that would provide radiation oncology services.

Hannibal Regional received a $15 million state appropriation for the cancer center when the Missouri state budget was announced in June. The Certificate of Need is necessary if a hospital spends more than $1 million on a piece of equipment — in this case, a state-of-the-art linear accelerator and concrete vault that would be part of a new building on property Hannibal Regional owns at the intersection of Illinois Street and the alternate U.S. 63 route east of the HyVee on the north part of Kirksville.

This news comes after leaders at the Northeast Regional Medical Center (NRMC) in Kirksville announced updated plans on Sept. 25 to restore “locally-delivered comprehensive cancer services” in the spring of 2025. 

The hospital, which has not offered radiation oncology for 2½ years, will proceed with construction to modify its concrete vault so a larger, existing linear accelerator can be transferred to Kirksville to resume radiation oncology services on the NRMC campus. Because the project can be completed for less than the $1 million threshold that would require a Certificate of Need, the hospital has withdrawn its previously filed application.

Can two cancer centers co-exist in Kirksville? Todd Ahrens, president and CEO of Hannibal Regional Healthcare System, said it’s possible. However, he’s confident people will choose the most up-to-date services.

“There’s nothing prohibiting us from putting in a linear accelerator if (NRMC goes) through with their plans,” he said. “I don’t know if what happened (last week) changes their perspective. If the care that (NRMC) can deliver isn’t the current and most technologically advanced care, to me, that’s a reason to still go forward with the project.”

Radiation oncology, using a linear accelerator, is an effective treatment used to treat many types of cancer. Linear accelerators use high-energy X-rays or electrons that conform to a tumor’s shape to destroy cancer cells while sparing healthy tissue surrounding the tumor.

Cancer care had been offered at Northeast Regional Medical Center for nearly 25 years before the previous linear accelerator was taken out of service in 2022 during the COVID-19 pandemic. Ahrens said the linear accelerator that NRMC is receiving is “seven or eight years old” and is coming from Poplar Bluff. 

“We have decided this is the best and fastest way to make radiation oncology services available and to accelerate access to comprehensive cancer care close to home for our patients and community,” Patrick Avila, CEO of Northeast Regional Medical Center, said in a press release. “Building upon our many years of delivering quality cancer care, with the collaboration and support of our long-term partners and skilled providers, NRMC is in the best position to advance a robust program in Kirksville.”

Ahrens says the Kirksville hospital is putting in “old technology.”

“When (NRMC was) doing radiation oncology services (before shutting it down) two and a half years ago, even though they had a piece of equipment in there, it wasn’t the latest technology,” Ahrens said. “Folks were still leaving the community to get the care with the best equipment that delivers, in theory, the best results.

“I don’t think, in my opinion, putting in a seven- to eight-year-old machine isn’t what the folks in Kirksville need for the delivery of radiation oncology.”

The NRMC press release says the hospital is funding the work to restore local access to radiation oncology using “its existing resources at no cost to the community’s taxpayers.” The Kirksville program will offer medical oncologists, oncology infusion services, radiation oncology, CT scanning with treatment and site mapping, lab services and access to specialty care physicians.

Ahrens said when the Kirksville hospital was close to shutting down radiation oncology, it was doing a tenth of the cases that Hannibal Regional handles. Hannibal Regional has offered radiation oncology services at the Cary Cancer Center in Hannibal since 2003.

“Doctors were referring them outside the community because they couldn’t get the latest technology and the best technology for cancer care,” he said. “We want to provide not just basic or acceptable cancer care. We want to provide the best that’s available at that time. 

“If they’re going to move forward with the machine that, by the time we get construction completed, will be close to 10 years old, that’s not going to be the technology that is the best available from a radiation oncology perspective.”

Part of the application for the Certificate of Need was testimony from two Kirksville residents who shared their stories of having to leave Kirksville for cancer treatment and other basic healthcare needs. 

The Missouri Health Facilities Review Committee typically has nine members, but two positions are vacant. Six members heard the Hannibal application, and one abstained from the vote.

Ahrens said the Certificate of Need approval now means the first spade of dirt to be turned as part of the construction process could happen in early 2025.

However, one more hurdle must be cleared. Ahrens said the attorneys representing NRMC have found a taxpayer to file a lawsuit against the Missouri Department of Social Services, objecting to the $15 million appropriation.

“We saw this lawsuit for the first time (last week), so we’re still looking at it,” he said. “We’re not named in the lawsuit, but this taxpayer would have standing to object to how the state uses their tax dollars. We’re going to work through that and see how that impacts our ability to carry out these plans, if it does at all.”