A group of Montgomery County legislators is lobbying state health officials to approve the opening of a satellite hospital emergency center to serve the growing upcounty area.

Shady Grove Adventist Hospital had applied for state approval to operate a 24-hour medical care center in a building on Route 118 near Middlebrook Road in Germantown, but the Maryland Health Care Commission rejected the proposal in September.

In its decision, the commission suggested that the hospital divert less serious patients away from emergency rooms to places such as urgent-care centers. The panel also expressed concern that Shady Grove's proposal, which included five inpatient beds, would make it a small-scale hospital without the full facilities of a hospital.

But hospital administrators and county lawmakers said the commission didn't understand the upcounty area's lack of quick access to emergency care.

"You've got a young population upcounty, with kids," said state Sen. P.J. Hogan (D-Montgomery). "Given the tremendous growth in upper Montgomery County, an emergency room type of facility is urgently needed."

County projections show that the upcounty area, which includes Clarksburg and Germantown, has nearly 140,000 residents, a figure that will jump by nearly 16 percent over the next six years. Shady Grove Adventist Hospital, in Rockville, has the second-busiest emergency department in Maryland, after Johns Hopkins Hospital in Baltimore. Shady Grove's emergency department has three times the volume of the national average for a hospital of its size (281 beds), and last year, there were 85,600 visits.

Fire and rescue officials also have said that the area's worsening traffic problems make it difficult for ambulances to transport patients from the upcounty to Shady Grove's emergency room in Rockville, Frederick Memorial Hospital in Frederick or other Montgomery hospitals.

The Montgomery County Council also has expressed concern about upcounty health care and approved a resolution last week urging the state to allow the development of the satellite emergency care center.

Hogan and seven other state lawmakers who represent the area wrote a letter dated Oct. 14 to S. Anthony McCann, the acting secretary for the Maryland Department of Health and Mental Hygiene, asking for the commission's decision to be reconsidered. Hogan said he and Sen. Robert J. Garagiola (D-Montgomery) also plan to meet with state health officials in December.

In their letter to McCann, the lawmakers asked for a change in the regulations that the commission cited in its rejection of Shady Grove's application. For a health care center to be reimbursed by insurance, Medicare and Medicaid at higher hospital rates, Maryland regulations require that it have inpatient beds. The commission said it rejected Shady Grove's proposal partly because it included five inpatient beds, making it a hospital, rather than a free-standing emergency room.

The lawmakers said the hospital is being caught in a catch-22 and asked that the regulations be changed to allow an emergency center without inpatient beds.

John Hammond, a spokesman for the Department of Health and Mental Hygiene, said a regulatory change may be "too premature" at this time.

Barbara McLean, executive director of the health care commission, said Shady Grove's proposal was rejected because it was "essentially proposing an emergency system without a hospital behind it."

She said that it would be a "bad precedent" for the state to allow Shady Grove to charge higher hospital rates for care in a center that was not an actual hospital. She added that many people are using the Shady Grove emergency room for less critical visits and that sending them to urgent-care facilities made more sense than building an entirely new emergency room department.

McLean also said that Shady Grove has another proposal pending before the commission to expand its emergency room department in Rockville, which would increase the number of treatment bays from 55 to 74.

Robert Jepson, a spokesman for Shady Grove Adventist Hospital, said that even if the hospital's Rockville campus expands, it will not help people in the upcounty area. He also said that Shady Grove would have to charge the higher hospital rate at the proposed emergency facility because it would be providing hospital-level services, with emergency room doctors and diagnostic equipment that wouldn't be available at a typical physician's office.

"The issue is access," Jepson said. "All we're doing is making it easier for people to access the care."

Hospital officials say they could get an emergency care facility ready within six to eight months of its approval. The hospital said it would invest $7.5 million in equipment, permits and engineering fees for the 27,000-square-foot facility, which they would rent from the developers.