Wreck a motorcycle or an ATV in Pinal County's desert and badly break a bone, and the hospital needed for critical care could be a long haul.

In a county with a booming population of more than 300,000 and geographically larger than Connecticut, there's only one hospital.

It's in Casa Grande, and it's not equipped to handle major injuries.

Right now, Air Evac, one of the emergency medical helicopter companies serving Pinal County, is the link between those severely injured in the county and Valleyhospitals equipped to handle major trauma cases.

A "golden hour" to get treatment exists for patients suffering heart attacks and other life-threatening injuries, said Monty Gallegos, manager of business development for the company. As a result, he would welcome more hospitals in the area.

"Oh yeah, the population is on fire. If we want better service to our communities, we need more hospitals."

But the first hospital wanting to build in the hotbed of that growth claims high impact fees imposed by Pinal County are hindering construction.

IMPACT FEE STANDOFF

The 80-acre property at Ironwood Drive and Gantzel Road already has a construction trailer on the property. But not a shovel of dirt has been turned for the Banner Ironwood Medical Center because of a standoff between Banner Health and Pinal County.

The issue: impact fees created by the county in 2006 to pay for roads, open space, parks and other capital improvements in the quickly growing county.

The cost to the 86-bed hospital that could eventually grow to a 600-bed capacity is an estimated $11.5 million, Banner Health spokesman Bill Byron said. Plans are for the facility to open in 2010.

"We appreciate the efforts of the county officials with respect to them creating impact fees," Byron said. "But we're a good bit apart on what they should be."

The issue isn't the hospital building itself, Byron said. It's the medical office buildings near the hospital that would provide office space for pediatricians, obstetricians and orthopedic surgeons staffing the hospital.

Impact fees for the recently opened Banner Gateway in Gilbert amounted to $3.18 per square foot. Pinal County's fee would be $17.47 per square foot, Byron said.

That fee will be passed on to doctors occupying the office buildings, which could make the hospital less attractive to core physicians and the medical specialists the hospital wants to attract.

"You can't operate a hospital without doctors," Byron said.

Pinal County is considered officially "underserved" by medical facilities, as designated by the federal government, county spokeswoman Heather Murphy said.

The hospital would be strategically located between Queen Creek and Johnson Ranch to serve a core population in the county. Some 40,000 residents live in Johnson Ranch and 24,000 in Queen Creek.

Karen Christian, 50, a resident of Solera at Johnson Ranch, said a hospital is important in the area with an aging population - and everyone else for that matter.

Her daughter was dehydrated after dental surgery and they had to make the 25-minute trek to Gilbert to get fluids.

"That's a priority to us - a hospital, specifically in this area."

But there's another priority Pinal County must deal with - improving roads, including those leading to the hospital.

FUNDING ROAD WORK

Pinal County's Hunt Highway and Ironwood Drive areas need more than $359 million in road improvements, according to county officials. Impact fees, especially in the Johnson Ranch and Santan areas, help fuel that funding.

Pinal County Supervisor Sandie Smith, D-District 2, where the hospital would be located, said county staff is looking into the issue in search of a compromise.

"They're still reviewing it with legal to see what the ordinance allows and doesn't allow," she said. "I've told them to go back to the drawing board and take a look."

There's no denying that Pinal County's impact fees are higher than other communities surrounding it. Chandler, for instance, charges $4.26 per square foot for office space to contribute to arterial streets. The fee for an office building of less than 10,000 square feet to pay for streets in the suburban areas around Johnson Ranch is $10.53 per square foot, according to Pinal County's fee schedule.

But Murphy said the impact fees "were not pulled out of thin air," and that Pinal County's footprint is much larger than surrounding communities. The fees were based on a consultant's studies of the 20-year growth and infrastructure needs of the county.

She said the county isn't flexible in what it is charging the hospital. "The impact fee is what it is," she said. "I just don't know if it's appropriate to take an alternate view of those."

She said the argument is suspect that Banner Ironwood Medical Center could drive away doctors and the hospital's eventual growth because of high impact fees.

"It's a little bit of a false argument in the sense that the services come to the demand for where there are a need for services," she said.

Murphy said that Banner could reduce the impact fees of the hospital by building fewer medical offices and housing more of the operations in the hospital.

She said the usage patterns could be different, bringing in fewer people, and therefore having less of an impact. However, she agreed that a hospital makes the community "sustainable."

Asked if the county wants to limit the scope of the hospital, she said, "I don't know how to comment on that."

BALL DROPPED

Approximately 90 percent of the county's impact fees collected between January 2007 and June 30, 2007, were from the area around Johnson Ranch and other unincorporated master-planned suburban neighborhoods.

Ironically, the large majority of those developments were built before the county ever collected impact fees and, therefore, never contributed anything to the county's roads, parks, public safety and other capital projects.

Christian said the county's lack of impact fees during the boom times may be causing them to bump up fees to pay for what are already inadequate roads and services.

"That's where Pinal County dropped the ball - when all the development started," she said. "Now it's too late and they are trying to backtrack."