BATON ROUGE, La. (AP) — A proposal to ban the creation of most new freestanding emergency rooms in Louisiana has won support from state senators, amid concerns the ERs threaten the survival of the state's fragile rural hospitals.Senate Health and Welfare Chairman Fred Mills, the Republican who sponsored the proposal, said stand-alone emergency departments cherry-pick services that generate the most money from patients and drain dollars from rural hospitals that already operate on narrow margins.

"What this bill does is it protects the delivery of care in those rural areas," Mills, from Parks, told senators. "Those rural areas just cannot take that type of business matrix — they just can't."

Senators voted 36-1 for the measure, which was received Wednesday by the House, where a committee will next debate the legislation.

Mills' proposal would prohibit the creation of freestanding emergency departments in Louisiana that are not licensed as part of the main campus of a hospital or as a hospital's off-site campus. In addition, no hospitals would be able to create an off-site ER within the primary service area of a rural hospital.

The Louisiana Rural Hospital Coalition sought the legislation, saying it builds on a 1997 state law aimed at preserving the small facilities.

While other Southern states have seen rural hospitals shutter, Louisiana has escaped that trend so far, said Charles Castille, executive director of the hospital coalition. As examples, he noted that 17 rural hospitals have closed in Mississippi while 11 such facilities have shut down in Georgia. But Castille said some of Louisiana's 48 rural hospitals are on uncertain footing.

"Twenty percent of Louisiana's rural hospitals are at high risk of closure," he told the Senate health committee when Mills presented the bill.

Castille warned that rural hospital closures can destabilize communities that not only rely on the facilities for health care services, but also for jobs and economic development.

"Clearly, any barrier to a revenue stream to rural hospitals could have a catastrophic effect," he said.

No one spoke in opposition to the measure as it sailed through the Senate, though several lawmakers worked to tweak the language to ensure that any freestanding emergency rooms already being built or permitted by April 1 aren't affected by the measure.

"I want to be fair to the people who are already in this business or in the process of getting into this business," said Sen. Jay Luneau, an Alexandria Democrat.

Mills said he wasn't intending to affect existing construction — or stand-alone ER facilities in urban areas of Louisiana.

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