Bill Welch, president and chief executive of the Nevada Hospital Association, said Nevada ranks near the worst among states for its bed-to-population ratio.

"That's based on what our population is today," he said. "You add two new hospitals in the next 18 to 24 months we will probably move up from the bottom to the middle initially, but within one or two years if the population continues to grow we'll be behind the 8-ball again."

He said Nevada will also remain behind the average or break even unless hospital expansions ramp up or the population growth slows.

"Based on everything in the legislature and the criticism of the industry, I don't see that the hospital community is going to get any more aggressive in building hospitals," he said.

Among the state bills being considered, hospitals would be required to provide additional financial information to the state and develop and community benefit plan.

"They (the legislators) criticize because the private sector has too high a percentage of beds," Welch said. "They (private hospital operators) have 85 percent of the beds yet we don't see the public sector stepping up and wanting to build the beds. The legislature also admits there needs to be more beds."

He said he is not being critical of University Medical Center, which is the Las Vegas Valley's only government-owned hospital, but privately owned hospitals are getting mixed messages about what is expected of them and may have a tougher time operating in the state.

In August 2006, Catholic Healthcare West is scheduled to open St. Rose Dominican Hospitals -- San Martin campus with 110 private rooms initially and space to expand to 200 private rooms at 8280 W. Warm Springs Road.

The southwest-area hospital joins HCA Inc.'s Southern Hills Hospital & Medical Center and Universal Health Services Inc.'s Spring Valley Hospital Medical Center, which opened in March 2004 and October 2003 respectively.

King of Prussia, Pa.-based Universal Health plans to build its fifth local hospital, Centennial Hills Hospital Medical Center, near the intersection of Las Vegas Beltway and I-95 in northwest Las Vegas. Universal also owns Desert Springs, Valley and Summerlin hospitals.

The hospital operator owns about 36 acres in the southwest corner of the Montecito Town Center, which is made up of retail, restaurant and office space.

Universal Chief Financial Officer Steve Filton told investors and analysts in a conference call last month that design work continues on the hospital, which will mirror the community-hospital models used by Summerlin and Spring Valley.

He said the hospital would likely open in the next 18 to 24 months with 150 beds and space to double the number of beds.

HCA purchased land for a fourth hospital in Henderson on about 41 acres just north of I-215 at Stephanie Street and Wigwam Parkway. The Nashville, Tenn.-based company also owns MountainView and Sunrise hospitals.

Glenda McCartney, spokeswoman for Sunrise Hospital, said HCA is scheduled to break ground on a medical office building on the site where the hospital will be built.

"There's no hard and fast plan for timing of the hospital building yet," she said.

Franklin, Tenn.-based IASIS Healthcare LLC is considering adding a second hospital to its Las Vegas Valley portfolio. The company purchased North Vista Hospital, formerly Lake Mead Hospital, from Tenet Healthcare Corp. in February 2004.

Jim McKinney, market president of IASIS for Nevada and Arizona, said the company prefers to have more than one hospital in each of the markets it operates.

"We generally like to look for opportunities to enhance our position in communities where we serve, particularly in the larger communities," he said.

He said the company is evaluating other sites in the Las Vega Valley but has not purchased any land.

IASIS has had conversations with Meadows Hospital LLC about partnering to build a hospital in North Las Vegas on 14 acres near Tropical Parkway and Losee Road.

"We haven't come to closure or agreement on anything there," McKinney said, adding that the dialogue continues between the companies.

Meadows Hospital is owned by a group of private investors including Fletcher Majors Jr. who is based in Alabama.

In 2003, the company received city permits for its helipad and submitted its final development plan, which was needed to have government-guaranteed financing.

The company was approved for a Housing and Urban Development loan through Prudential Huntoon Paige in 2003 and said in a press release that it would begin construction in early 2004 with construction completion scheduled for January 2006.

John Moran, owner of Moran Financial Services and a broker who aligned the company with the HUD loan, said the company was approved for the Prudential Huntoon Paige financing to cover its debt but has faltered on lining up equity beyond the land the hospital will be built on.

He said financing is readily available for the project once Meadows raises its equity money.

"The project sponsors so far have failed to come up with the right amount of equity," he said. "That equity is a key part of this."

He estimates Meadows needs about $40 million in equity, which takes a special type of investor and is generally raised through the stock market or bond issues for publicly owned hospital companies such as HCA and Universal.

Meadows' plans call for a hospital five-story hospital with 212 private rooms, senior apartments, a hospice center, a skilled-nursing home, an assisted living center a freestanding pharmacy, retail, a hotel and restaurants.

The North Las Vegas City Council approved a hospital at the site in 1997.

Another hospital that was announced for the valley that has not broken ground is the Southern Nevada Rehabilitation Hospital. The hospital was being developed by LandBaron Investments and Luttrell Associates Inc. and was scheduled to break ground in late 2004 with 110 beds for rehabilitation and long-term acute-care on the north side of the Las Vegas Beltway between the exist of Sunset Road and Durango Drive, which is where the beltway curves.

Chris Vito, former chief executive of HealthSouth Rehabilitation Center in Henderson, was supposed to run the hospital.

Plans for the project changed and Vito left the group to pursue other health care options.

The CURVE, which is what the development is now being called, said in a statement issued by its public relations firm Kirvin Doak Communications that "this particular aspect of the project will no longer be a part of the mixed-use development.'

Vito said "the interest of the project changed, which obviously affected me."

He said he is working on other hospital projects but declined to provide details.

Adding enough beds is not the Las Vegas Valley hospital industry's only challenge. They also must find employees to staff the hospitals once they open and many of the professions such as nurses, pharmacists and technicians are experiencing shortages.

"Other than the doubling of the nursing program two years ago we have done nothing else to address the workforce shortage," Welch said. "Doubling of the nursing program dealt with what our needs were four years ago not what our needs and growth are today."

Michelle Swafford covers health care and small business for In Business Las Vegas and its sister publication, the Las Vegas Sun. She can be reached by e-mail at swafford@lasvegassun.com or at (702) 259-2326.