This story was updated June 27, 2018, at 7:26 p.m. with more information.

NASHVILLE — Erlanger Health System's bid to build a free-standing emergency department in Bradley County was denied Wednesday by the Tennessee Health Services and Development Agency.

The agency also denied a request from Tennova Healthcare — Cleveland, a 351-bed hospital in the heart of Bradley County, to do the same.

Representatives from each hospital presented arguments for why their project and not the other's deserved a certificate of need, or CON, which grants health care providers permission to expand services based on an area's medical needs. Both claimed that the emergency rooms at their main campuses are overwhelmed with patients who could be served by the new facilities.

After more than three hours of testimony, Dr. Kenneth Patric, the physician member of the agency's board of directors, said he was "inclined to not approve either" project, because claiming a need for one facility and denying a need for the other didn't make sense.

Board member Thom Mills, who voted for Tennova's project and against Erlanger's, said he was "struggling" with the idea that Erlanger's presence in Bradley County could funnel patients away from local practices and into Hamilton County.

"With Erlanger, I think that's a good possibility," he said.

This is the second major blow to Erlanger this week after the hospital system was denied a certificate of need for a new cancer center in Ringgold, Georgia, on Monday.

During Wednesday's hearing, Erlanger CEO Kevin Spiegel said Erlanger treats more than 25,000 patients annually from Bradley County and neighboring Polk County, Tennessee, where the local hospital recently closed. Erlanger's CON application was a response to the "unsustainable outmigration" of patients and meant to reduce high volumes as well as help vulnerable patients who travel long distances for care, he said.

"There is no question these proposals would have significantly improved the health of those communities as well as economic development in Bradley County if both had been approved," Spiegel said in a statement after the decision.

Tennova CEO Coleman Foss said he was disappointed in the outcome but respects the decision.

"We have a long-standing history of providing quality care to our community and will always work to be the provider of choice for local residents," Foss said in a statement, adding that Tennova will strive to improve access and better accommodate Bradley County's rapidly growing population.

Foss and Dr. William Johnson, chief medical officer for Tennova Cleveland, both told the Times Free Press that they weren't surprised by the result, and their CON pursuit was primarily about keeping Erlanger out of Bradley County.

"ERs are getting taxed across the country, and people are trying to find solutions," Foss said. "But the right way to address it, in our opinion, is not to come into another county and say, 'Let us take care of your patients.' That just doesn't even make sense."

In their arguments, Erlanger officials attacked Tennova's quality and efficiency, claiming the hospital's current monopoly in Bradley County gives no motive to improve and drives patients away from their homes and into Chattanooga.

Tennova advocates called Erlanger's move a "brazen market grab" and criticized Erlanger for ignoring local providers and creating a "better than" culture.

Other arguments against the projects came from representatives of Starr Regional Medical Center in McMinn County. They said the close proximity of the proposed emergency departments would siphon patients away from their Athens and Etowah facilities.

CHI Memorial Hospital officials also came to argue that Erlanger overstepped by calling the proposed facility a trauma center and touting cardiac catheterization services.

Blows aside, ultimately the agency rejected both projects in a 6-2 vote, citing failure to prove need and emphasizing that health care system problems aren't fixed by more emergency departments.

Contact staff writer Elizabeth Fite at or 423-757-6673.