State rejects St. Francis hospital expansion

The Virginia state government has rejected a request from Bon Secours’ St. Francis Medical Center to add 36 medical surgical beds to its Midlothian facility, arguing that there isn’t enough need for them.

However, the health system has refiled its application in full.

Bon Secours had been seeking the state’s approval to build two additional floors on an existing inpatient tower that would house the 36 beds, along with four more intensive care unit (ICU) beds. The estimated cost of the project is about $106 million.

But on Sept. 2, State Health Commissioner Dr. Karen Shelton rejected the Certificate of Public Need (COPN) request for the 36 beds, although she did approve the part of the request allowing for the four ICU beds.

The state’s COPN program requires owners and sponsors of medical care facility projects to secure approval from the state health commission before they can begin the projects. The program aims to contain health care costs.

In an August letter recommending denial of the COPN request, state health department adjudication officer Vanessa MacLeod wrote that there is a shortage of ICU beds in the region, with about 73 more needed. She said even with the authorization of the four St. Francis ICU beds, there will still be a shortage.

However, she wrote that “the proposed project in its entirety is not consistent with public need” and called the 36 beds “premature.”

“With a surplus of nearly 435 beds, there is no public need for new medical surgical beds,” she wrote.

The state also examined whether St. Francis is utilizing its existing beds fully.

MacLeod noted that St. Francis implemented 55 new acute care beds in October 2024 and that the health system asserted it needed 36 more medical surgical beds. She said institutional need requires 80% of the medical surgical beds to be occupied.

She noted that St. Francis’ latest published data from 2023 included 130 beds of all classes at 86.4% occupancy, which was before it added 55 beds. Additionally, she wrote that the medical surgical beds St. Francis had allocated to obstetrical beds were not included in its occupancy calculation.

According to the Division of Certificate of Public Need (DCOPN), the occupancy of St. Francis’ medical surgical beds, including those allocated to obstetrics, is 76.5% — falling below the 80% threshold.

DCOPN received 33 letters of support from providers, community members and patients in favor of the 36 beds, noting the area’s growing population and arguing it would ensure patients can have access to the best care possible.

But HCA Healthcare — another health system in the Richmond region — wrote a letter in opposition, arguing that St. Francis’ proposal is premature and that St. Francis’ application was because other competing providers requested additional beds. HCA Healthcare recently submitted a COPN request for a $260 million hospital in Chesterfield County.

In response to HCA’s letter of opposition, St. Francis argued its application was not premature but “the result of carefully considered facility planning,” and projects like this take a significant amount of time to implement.

Bon Secours spokesperson Jenna Green said in a statement that the hospital intends to keep pursuing the full proposal and that the application has been resubmitted.

“While we are appreciative of the partial approval, Bon Secours remains committed to pursuing the project as originally proposed,” the statement said. “We believe this comprehensive expansion is essential to meeting the growing and evolving health care needs of Chesterfield County and the surrounding region, which we have faithfully served for two decades. The demand for additional medical/surgical beds remains clear, and it is a need echoed by other health systems across greater Richmond.

“We remain hopeful the commissioner will ultimately approve the full 40-bed expansion at St. Francis Medical Center, and we will continue to advocate for this project with steadfast commitment to improving access, advancing health equity and delivering high-quality, compassionate care to the communities we serve.”

In July, Bon Secours broke ground on a three-story, 87,790-square-foot medical office building at the St. Francis Medical Center campus Chesterfield County. The health system expects construction to be completed in late 2026.

The Bon Secours Richmond Health System has a network of seven acute hospitals, primary and specialty care practices, ambulatory care sites and continuing care facilities across a 24-locality region. Bon Secours also operates four hospitals and one outpatient facility in Hampton Roads.