Lancaster General Health, the county's largest employer, operates by far the largest of Lancaster County's hospitals, serving a population area of nearly 1 million.

Its profits in 2008 topped $100 million. It made more money than all but two other hospitals in Pennsylvania.

Is it really necessary for the dominant health-care provider in this region to build a major medical facility in West Earl Township when a full-service hospital — Ephrata Community — already exists 2.5 miles away?

Not surprisingly, LGH and those with concerns about its plan to build a new hospital on 68 acres at the intersection of routes 222 and 322 near Ephrata have different answers to these questions.

LGH officials believe there has been considerable confusion about their plans; in part, they admit, because those plans have not been fully formulated.

Published reports have said the project could include as much as 600,000 square feet of building space — slightly more than currently exist at LGH's Health Campus.

LGH officials say they don't know where that figure came from and that it's "arbitrary and premature." But they don't deny that the final figure might reach 600,000.

The hospital has not put a pricetag on its building plans. But in June, RS Means, a construction cost analysis firm, estimated the national average for hospital construction at $258 per square foot for an unfurnished building.

That's $25.8 million for each 100,000 square feet of hospital space, or about $155 million for a 600,000-square-foot facility.

Much of the concern about the scope of the project has centered on the height of the inpatient hospital.

Providing for a hospital as much as 120 feet tall is an essential part of a proposal to rezone the land to accommodate the project. West Earl Township's supervisors will determine whether to approve that rezoning at the end of this month.

"To us, this project isn't about a hospital," counters Jan Bergen, the LGH vice president in charge of the project. "To everybody else it seems to be, but to us it's not. It's about creating a health destination."

Bergen says tentative plans are to build an inpatient hospital up to six stories and 120 feet tall and several outpatient buildings. But she says there's much more to the plan than that.

"We're looking at trying to use the beauty of this land to actually make it a place where people want to come to stay well," she says. "So we're looking at running trails and walking trails and gardens and a place where farmers will be interested in selling healthy food and to hold healthy-cooking demonstrations."

Another possibility, she says, is continuing to farm some of that land.

So don't think about LGH's hospital in Lancaster city, Bergen urges. Don't think about LGH's health campus on the Harrisburg Pike. The "north campus" project, she says, will be something entirely new.

"The project will be built around environmental stewardship," she says. "It will be a health destination in a serene environment."

But critics say any major medical complex will not only impinge on the existing "serene" agricultural environment but may harm existing medical services in northeastern Lancaster County.

They say the area is becoming overloaded with health-care facilities.

Ephrata Community Hospital, a compact but thriving 134-bed facility just a couple of miles northwest of the LGH site, provides full-service hospital care to a patient base of 200,000 residents of Lancaster County and three nearby counties. The hospital took in nearly $13 million in profits in 2008.

The Welsh Mountain Medical & Dental Center, to the southeast, near New Holland, provides health services to residents, including the most vulnerable, in Lancaster and nearby counties. The federally supported center served more than 6,600 individuals last year.

Reading Hospital, the primary hospital in Berks County, owns 33 acres at the juncture of the Pennsylvania Turnpike and Route 222 in East Cocalico Township, less than four miles north of the LGH site. It plans to build medical facilities there in five to seven years.

Some area residents worry that the LGH initiative might bring duplicative medical services to the area.

Marilee Schwartz, a retired nurse who lives in West Earl Township, recently visited with Old Order Mennonites and Amish who live on farms adjacent to the LGH tract.

"The hospital couldn't have picked a better place to do this because the people are uninformed and ambivalent," she says. "They don't have any concept of the enormity of this project."

But Schwartz said the farmers have patronized nearby Ephrata Community Hospital and believe existing services make a new medical complex unnecessary.

Henry Fortna, an Ephrata Township veterinarian, is more blunt. "It will destroy Ephrata Hospital, he says. "Two hospitals can't exist that close together and survive. We see that with veterinary hospitals."

Ephrata Community, along with the Welsh Mountain Center, originally opposed LGH at a public hearing on the project four years ago in West Earl Township.

Ephrata Community's attorney, Dwight Yoder, questioned the need for the facility. He said it would "largely duplicate what is already provided."

Terri Trimble, executive director of the Welsh Mountain Center, told the West Earl Township supervisors that "there is not a problem obtaining medical care in your community" and that LGH's plan "disrupts what is working."

But two years ago LGH invited Ephrata Community to join with it in developing a new facility and the smaller hospital dropped its opposition. No formal deal has been developed, and no details have been announced.

The state Attorney General's Office has expressed concerns about how a hospital partnership could affect the delivery of health care.

Even so, Ephrata Community remains supportive of LGH's plan, according to Ephrata Community spokeswoman Amy Walsh.

"If we can't join LGH, we hope we can work with them in the future," she says. "Meanwhile, we're pursuing our own strategic goals."

Welsh Mountain's Trimble is more ambivalent. Welsh Mountain is an affiliate of Ephrata Community, so she has sat in on LGH-Ephrata meetings. She expresses "cautious optimism" about LGH's plans.

But not if LGH duplicates Ephrata's services.

"Duplicating services and creating a competitive market place would be a waste of resources," she says.

And then there's Reading Hospital, which is establishing satellite medical facilities throughout Berks County. It bought the 33 acres in East Cocalico Township, Lancaster County, in 2004.

Originally, Reading and LGH considered building a joint facility there. They would have cooperated in operating laundry, food and business services for their hospitals.

That idea is now off the table, according to Richard Mable, Reading's vice president for planning and business development. He says his hospital is considering building a small primary care facility that would grow with the population.

"The scale of what LGH does on its site would affect what we do," he adds. "If they have a sizable operation, we wouldn't have to do what we originally intended."

Some health-care professionals say there is reason to be wary about overextending health services in the region.

The beds of Ephrata Community Hospital are not often filled to capacity, according to spokeswoman Walsh.

The hospital's "divert numbers" for 2008 and 2009 show potential patients had to be sent elsewhere on only a few days during months in winter and early spring — times when people tend to get sick.

The federal government does not consider the Ephrata area deficient in health services, according to maps drawn by the U.S. Health Resources and Services Administration.

Neither Ephrata nor West Earl Township are designated as medically underserved areas (that is, with insufficient health care services) or health professional shortage areas (that is, with a shortage of health care providers).

Some Lancaster County municipalities east and south of Ephrata, however, are considered to have insufficient services or providers.

But Ephrata Community has outpatient health centers in Leola, Rothsville, Stevens and other locations throughout the region. So project critic Martha Wenger, of Hinkletown, wonders if sufficient medical facilities don't already exist.

"What's enough medical services?" she asks. "Now when they schedule a test they call and ask, 'Do you want to go here? Do you want to go there?' Why do we need all these choices?"

But if LGH builds in West Earl Township, suggests Dan Sweigart, of Ephrata Township, there soon may be fewer choices. LGH bought and closed Columbia Hospital. He believes it could do the same with Ephrata Community.

"You can walk to Ephrata Community," he says. "Ephrata is everything that the smart growth people talk about. The LGH project is everything that the smart growth people are against."

LGH's Bergen counters that Columbia Hospital was too small to function effectively.

"People in the community itself didn't use that hospital," she says.

The reason LGH wants to build in West Earl is not to put Ephrata out of business or preempt anything Reading Hospital might do, she says. It's because that area will need more health-care services as it grows.

A projected increase of 10,000 residents in northeastern Lancaster County over the next five years is one driving force, Bergen says.

Another is the conversion of semi-private rooms to private rooms. At the end of that process, there will be fewer beds in the city hospital. LGH currently has 521 beds.

LGH's countywide study shows that the county will need an additional 100 hospital beds in the next 25 years.

LGH should create those beds and the services to go with them, Bergen says, because it is the most highly developed hospital in the region and must continue to grow to remain strong.

"People worry in our community about our getting too large or too profitable," she says. "A lot of communities are worried about losing their hospitals."

Lancastrians have a choice of four hospitals, she notes, but they have only one "tertiary facility," a hospital that delivers highly specialized health care.

"If we want to keep open-heart programs and bariatric (weight reduction) surgery and trauma programs for the county, we have to be able to draw from a larger population," she explains.

"If we focused on the city, we could be the size of Heart of Lancaster," she says, "but a county this size should have specialized services and a hospital that is stable and secure for the future."

For that reason, she notes, LGH is committed to building something new under the county's health-care sun: a "wellness-centered" medical complex to serve a growing northeastern Lancaster County.

Dan Sweigart is not impressed.

"What kind of message does this project send about healthy lifestyles?" he asks. "It's destroying productive farmland and you have to drive to get to it.

"We talk about building livable communities, promoting healthy lifestyles, but when the chips are down we continue to build what we've been building for 40 years."

E-mail: jbrubaker@lnpnews.com