After several months of debate the Health Services Council declined approval for Neighbors Emergency Center’s initial licensure in a 5-6 vote Tuesday.

Neighbors Emergency Center, NEC, a Texas-based for profit freestanding emergency room, currently has more than 20 facilities throughout Texas and is looking to open two initial locations in Rhode Island, one on Route 2 in West Warwick and the other in Bristol. Each location has undergone several hearings with two separate project committees and came before the full council on Tuesday.

Both Dr. Setul Patel, founder and CEO of NEC, and Patricia Rocha, NEC’s Providence lawyer, urged the council for approval, claiming their organization not only met but “exceeded” requirements of initial licensure. However, the majority of the council felt that the freestanding emergency rooms didn’t establish a firm enough commitment to the underserved populations in their proposed locations.

One member, John Donahue, said that in the months of ongoing meetings he asked time and time again for data or proof that Neighbors would serve underserved populations, but despite their attempts he still felt “uncomfortable with their ability to work with the underserved.”

For the council, one of the biggest issues was that NEC cannot accept Medicare or Medicaid and these patients would either be transferred to another facility or expected to pay for services out of pocket.

Patel explained that under federal law freestanding emergency rooms are not allowed to accept either Medicare or Medicaid, but the organization is “actively” working to change the law and would happily accept those patients in the future.

“We want to serve the resident of Rhode Island and make healthcare better,” Patel said. “We are a niche service, but we will help anyone who comes through our door. You don’t get 21 centers without providing good care.”

Council member Tarah Provencal said alongside Medicare and Medicaid those with behavioral health concerns can be considered the underserved and didn’t believe neighbors would serve them either. Patel explained that Neighbors would ensure that these patients are transferred appropriately to the right psychiatric facility.

Provencal said, “I’m expecting more bells and whistles from you. I need something that shows me you understand the Rhode Island market.”

During the public commentary, representatives from Kent Hospital and Bristol Medical Center expressed their concerns for NEC’s ability to work with the underserved, as well as how the for-profit company would hamper the positive momentum of the state’s healthcare system and deter people from the appropriate and adequate care.

Dr. Leslie Mohlman, a physician at the Bristol Medical Center, said that because NEC advertise themselves as an emergency room but actually aren’t medically equipped or capable to deal with all emergencies such as heart attacks, patients may be wasting often crucial time to receive appropriate care.

On the other hand, Herbert Brennan, a primary care physician and past president of Kent Hospital’s medical staff, said, “An emergency is patient defined. Acne the night before prom is an emergency to a teenager.”

Patients, such as expecting and new mothers and the elderly, all decide what is an emergency for themselves and Brennan doesn’t believe NEC has the right to dictate that.

“Our patients need to be advocated for, protected,” he said.

He argued that Rhode Island’s healthcare system is moving towards a more “comprehensive and coordinated system of care” and especially with a community hospital just down the road NEC would upset the “delicate process.”

Patel said, “We are not here to mitigate or solve Rhode Island’s healthcare problems. We heard Rhode Island was open for business and that’s what we are here to do. We meet the requirements and want to serve Rhode Island patients.”

Now, with a recommendation to deny the initial licensure from the Health Services Council the Director of the Department of Health, Dr. Nicole Alexander-Scott, will make a decision whether or not to approve the application.

Patel and Rocha both said they looked forward to the decision and were hopeful Alexander Scott would work into their favor.

Michael Dacey, president of Kent Hospital, is hopeful the director will stand with the council. Should Neighbors get approval, Dacey believes it would “destabilize Kent Hospital and further disadvantage the underserved.”

More than a fourth of the state on Medicare or Medicaid and Dacey said these populations “disproportionally” rely on the services provided by hospitals, experiencing trauma and critical illness than wealthier insured individuals and yet Neighbors wouldn’t be able to work with these patients.

“I believe the concern over whether or not they would help the underserved really hit home,” Dacey said. “The evidence was striking.”