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In Miami, It's A Challenge To Build New Hospitals, Even In A 'Healthcare Desert'

Doral is the fastest-growing city in Florida, with about 58,000 residents and an estimated 150,000 people moving through the city each day for work. But the closest hospital is Kendall Regional Medical Center, Jackson Health System Senior Vice President for Program Planning and Business Development Laura Hunter said. That means a 25-minute drive, maybe an hour in Doral's notorious traffic. 

Jackson Health System Senior Vice President, Program Planning and Business Development Laura Hunter spoke at Bisnow's Rise of Doral event Jan. 17.

Even though there are urgent care centers in Doral, the Miami Herald labeled the city a “healthcare desert” — where care is not readily available. That label is typically associated with rural areas, not affluent ones like Doral. 

Jackson Health System intends to change that soon. The taxpayer-funded agency, which already operates six public hospitals and assumes the care for many of Miami-Dade’s indigent and low-income residents, had for years been looking to expand facilities for residents in the western part of the county, Hunter said during a phone interview following Bisnow’s Jan. 17 Rise of Doral event.

Jackson bought a 30-acre parcel of land at 7800 NW 29th St. for $38.5M in 2015 in hopes of creating a medical campus with a free-standing emergency room, a pediatric center, doctor’s offices and outpatient surgery facilities. It also planned to build a hospital, to be named after builder Jose Milton.

The whole complex is dubbed Jackson West, and it broke ground in October 2016. Jackson CEO Carlos Migoya has said that almost 600,000 people — including residents of Sweetware and Miami Lakes — live within five miles of the site.

But in Florida, entities that want to build hospitals must first be awarded a certificate of need by the state’s Agency for Health Care Administration. This regulation was put in place years ago to stem unnecessary building and keep down hospital costs. Most states have similar regulations.

Bisnow's panel on the Rise of Doral was moderated by Bilzin Sumberg​ partner Anthony De Yurre and featured Doral Vice Mayor Ana Maria Rodriguez, Zyscovich Architects CEO and founder Bernard Zyscovich, Cushman & Wakefield Vice Chairman Brian Gale and Jackson Health Systems Senior Vice President for Program Planning and Business Development Laura Hunter.

Jackson won approval for a 100-bed hospital shortly after buying its Doral parcel in 2015, but that decision was challenged in court by five rival hospitals, including HCA, which was denied a certificate for an 80-bed hospital there. HCA argued that Doral does need a hospital, but that HCA should build it. The others argued that Doral was already sufficiently served by them. 

An administrative law judge in March sided with the competitors, and the application has been kicked back to AHCA for a final decision. Hunter said she does not know when AHCA will rule, but the Jackson West campus will proceed with or without a hospital. The campus should be open by early 2020, she said. AHCA did not respond to an inquiry by press time.

According to the South Florida Business Journal, East Florida — DMC, a subsidiary of HCA, wants to build a hospital on on the northwest corner of Northwest 41st Street and Northwest 109th Avenue, on a 17-acre-plus site that it bought for $24M in April 2016, where it has proposed a free-standing ER.

Although the saga illuminates how hospitals jockey for patients, Hunter said, “I think our strategy was a strategic growth opportunity for Jackson to access the rest of Dade County. Because we’re a public safety net and academic facility, we were focused on community need and public healthcare, not competition.”

In the meantime, a bill seeking to do away with certificates of need has been filed in the state legislature this session. Free-market advocates have also explored asking voters to repeal the regulation via ballot. 

Doral Mayor Juan Carlos Bermudez spoke at Bisnow's Rise of Doral event Jan. 17.

Also during Bisnow’s Doral event, Mayor Juan Carlos Bermudez touted the city’s highly rated elementary school and said the city has the second-lowest millage rate, used to count personal property taxes, in the county. Vice Mayor Ana Maria Rodriguez said that traffic is the city’s biggest problem — but the city is chipping away at the problem by connecting back roads and taking pressure off main arteries.

Cushman & Wakefield Vice Chairman Brian Gale said Doral’s office market continues to surge despite the elongated recovery cycle.

“Doral is on fire and I don’t see it slowing down,” he said. “Multinationals want to come here. The spread between Class-A space in Coral Gables and Doral is like $3 per foot. It used to be $12, $13, $14."

Codina Partners founder and Chairman Armando Codina has been dubbed 'The Godfather of Doral.'

Architect Bernard Zyscovich said that Doral's rapid development was "earth-shaking" and marveled at how the focus on building a top-rated school had driven demand.

"I've heard stories of people offering money to renters [in the Downtown Doral development] to move out so they could move in, because residents get preference [in admissions]," he said. "The schools drive the property value."

Armando Codina, christened “The Godfather of Doral,” is in the midst of developing hundreds of acres there, but humbly deflected credit for the city’s transformation.

“I think Hugo Chavez was the very best salesman that Doral had,” he said, referring to the influx of residents from Venezuela. He also said it was key that he had asked for “not one penny” of public money, but instead sought a “Chapter 163 development order which etches my rights in stone. That was in exchange for 'Don’t give me any money.'”

Chapter 163 of Florida Statutes lets local governments make agreements with developers for comprehensive planning. 

Cherry Bekaert LLP principal Mark Giallonardo moderated a talk with developer Armando Codina.

Codina said he believes that Doral will continue to grow, especially with the economy in good shape and high taxes in the north driving people to Florida.

“[New York City Mayor Bill] de Blasio is like the Hugo Chavez of New York,” Codina said.