After a few tumultuous months of debate over the growth plans for Butler Memorial Hospital late last year, it has been quiet - too quiet.

The recent announcement by a group of surgeons to build and operate their own outpatient surgical center has, as hospital officials noted, eased some of the time pressure driving development of BMH plans for the future. With a regular meeting of the hospital board of trustees scheduled for Thursday, there has been a noticeable lack of activity, or communication, that might have been expected after the board decided in late January not to buy property off New Castle Road in Butler Township for the site of a new hospital.

Still, there are issues to be dealt with, even if the time frame in which to develop plans and start building has been relaxed by the announcement of plans for a new outpatient surgical center.

Remaining issues include:

There are continued concerns in the community about the hospital's financial ability to take on the $150 million in debt, which has been suggested as the likely amount of money to be borrowed for a new or even extensively renovated hospital.

Conflicting positions were heard during the public meetings held in January as to the average costs associated with building new hospitals.

A rule of thumb of approximately $1 million per bed was suggested by some concerned with BMH's financial ability to replace the East Brady Street hospital's capacity at a new location. Hospital officials disputed the $1 million per bed guideline, but have not offered concrete evidence to arrive at a different figure.

There have been no progress reports from board and hospital officials on the full evaluation they promised regarding the viability of investing $100 million or more into extensively renovating and building some new facilities at the current East Brady Street location in the city of Butler.

A preliminary study commissioned by the board earlier suggested it would cost less to build from scratch at a new site than it would to refurbish and build new at the East Brady location. Some people in the community have challenged this assertion, questioning how abandoning nearly $100 million worth of still-useable buildings can make economic sense.

The debate over building new or renovating is sure to continue. Related to this, there will also be ongoing discussion about how much it costs to build new hospitals and how much of a new hospital BMH and this community can afford.

While these debates will be contentious at times, the one thing everyone on both sides of the argument can agree on is the importance of having a financially healthy, state-of-the-art hospital to serve the health care needs of the Butler County Community well into the future.

The hospital's record of achievement in both these areas has been good, and the expectation is that it will remain so in the future.

It is important that real public involvement should continue as the administration and the board of trustees face the most significant decisions in the organization's history. The decisions made at BMH in the coming months and years will effect this community for many decades to come. The health care and financial ramifications of these decisions will impact the children and grandchildren of most of today's adults living in the county today.

Public input and open, two-way communication might not always be convenient for the board of trustees or the hospital's management, but is must remain part of the process for a community-owned hospital.