The proposed affiliation between Harrison Medical Center in Kitsap County and the Franciscan Health Care System of Tacoma will go forward without further study by the state or additional comments from the public.

The Washington State Department of Health issued a decision on Tuesday that the affiliation will not require a certificate of need process.

A certificate of need is a lengthy process that potentially would have cost millions of dollars and would have required more public comment.

“We’re pleased and excited,” said Harrison CEO Scott Bosch. “This is the culmination of nearly 10 months of discussion and hard work and will improve the quality of health care in Kitsap County, and will reduce the cost and give more access to care for residents in the county.”

Officials with Franciscan echoed Bosch’s comments.

“We are extremely pleased,” said Joe Wilczek, Franciscan Health System CEO. “It’s a real opportunity to expand health care for those who live in the area. They’ll be able to get their health care needs met close to home and won’t have to travel anywhere for services.”

The hospitals had requested a “determination of non-reviewability” from the Department of Health which in essence says the certificate of need process was not required because the affiliation is not a merger or a purchase. The proposed affiliation was announced in October 2012.

Bosch said Wednesday that the affiliation will be final this week and will not delay the opening of Harrison’s new Orthopaedic Center set for Sept. 13.

He said Harrison has a separate preliminary certificate of need on the orthopaedic center project which will just have to be transferred to Franciscan following the finalization of the affiliation.

“It’s really just a matter of paperwork and does not affect the affiliation,” Bosch said.

Harrison now becomes part of the Franciscan Health System which officials have said is necessary because of economic needs.

“We can enhance the services we offer and build on the economies of scale that a larger organization can provide,” Bosch said. “In light of upcoming national reforms, this partnership helps ensure we keep our enduring promise of exceptional health care to the residents of the Kitsap and Olympic peninsulas and north Mason County now and for generations to come.”

In the state’s decision, Janis Sigman, manager of the certificate of need program, wrote that “based on the totality of information considered by the department and consistent with previous similar determinations issued by the department, the proposed affiliation between Franciscan Health System and Harrison Medical Center is not subject to prior certificate of need review.”

The decision went on the say that a certificate of need review and approval may be required if changes occur in the facts the department relied on to make the determination. There is an appeals process in which anyone was file an appeal within the next 28 days.

What’s at stake for many is whether Harrison, a secular medical center, will affiliate with Franciscan, which is a religious hospital system and part of the Catholic Health Initiatives throughout the U.S.

During the six weeks that the Department of Health was reviewing the affiliation, New York based MergerWatch and the Seattle American Civil Liberties Union asked the state to require the Certificate of Need and to delay the possible hospital affiliation until the state re-works its Certificate of Need process, as is being required by a directive of Gov. Jay Inslee.

Both groups said they fear the affiliation will limit medical services available on the Kitsap Peninsula for those seeking abortions or assisted suicides.

Area residents also have voiced concerns about whether Harrison would operate with the Ethical and Religious Directives that are a part of the Franciscan system.

Those directives limit abortions, end-of-life counseling, and can affect the sterilization and birth control procedures that are performed.

On Wednesday, Bosch again said Harrison will remain a secular hospital, offering the same range of services that it does now. He said he will continue to answer phone calls and email and speak to public groups about the affiliation.

“We will remain secular with the same services that we have had prior to this,” Bosch said. “Franciscan celebrates diversity.”

Wilczek agreed.

“There will be no difference in the services that Harrison offers today than it did last week,” he said. “And in the future services will be expanded. There is no intent to take away services.”

But others are not so sure.

Doug Honig, spokesman for the ACLU in Seattle issued the following response to the affiliation decision:

“In declining to review the proposed affiliation between Franciscan Health System and Harrison Medical Center, the state is abdicating its role as a watchdog for health care transactions,” the statement read. “The proposed affiliation will have significant impacts on patient access to lawful health care and is precisely the type of transaction which should undergo government review.

“The decision highlights the need for a serious overhaul of the certificate of need process. The Department of Health statement did not explain how its decision was arrived at or how various factors were weighed. Our state needs clear standards for determining which transactions undergo review; creative writing by lawyers should not determine whether the government exercises its important oversight function. The certificate of need process must be transparent, so that the public can easily understand how the DOH makes its decisions about transactions.”

Sheila Reynertson, advocacy coordinator for the MergerWatch Project, reacted to the affiliation with caution.

“Yet another hospital deal in Washington that has the potential to seriously limit access to care in a geographically isolated area,” Reynertson said.

“Without state review for this type of transaction, there is no avenue to seek and secure written reassurances, leaving the Kitsap community vulnerable to religious restrictions to health care at their local hospital.”