A “no” vote means that once the current construction — a new imaging department and women’s center, new emergency room, new main entrance and registration area and expanded specialty clinic — is complete, the tools would be put away, the construction scraps cleaned up and that would be that.

Those are the issues SPH service area voters — not just Homer residents and not just those actually using the hospital — will decide.

South Peninsula Hospital service area was established by borough ordinance on March 18, 1969. Its boundaries stretch from the south side of Kachemak Bay, north to Mile 136, which is almost as far as Clam Gulch. It encompasses both the west and east sides of Cook Inlet. In addition to Homer, the communities of Anchor Point, Fritz Creek, Halibut Cove, Ninilchik, Nikolaevsk, Voznesenka, Kachemak Selo and Razdolna reside within the service area. Seldovia, Nanwalek and Port Graham do not. The last count of registered voters within the area totaled 9,600, according to borough clerk Sherry Biggs.

Reaching those voters with information about the expansion project is a tall order.

“We had lunch with the Anchor Point Chamber of Commerce Wednesday with (KPB) Mayor John Williams and the topic was the hospital and whatever else the mayor wanted to discuss,” said Derotha Ferraro, the hospital’s marketing coordinator.

At 1:30 p.m. Monday, Ferraro will speak about the expansion project at the Ninilchik Senior Center. On April 19 and 26, question and answer sessions on the expansion project are scheduled at the Alaska Islands and Ocean Visitor Center in Homer. Ferraro met with the Anchor Point Senior Center a couple of weeks ago, spoke to the McNeil Canyon Elementary School site council and the Seldovia Village Tribe health clinic staff in Homer, and was the guest on local radio station KGTL’s “Straight Talk.”

“We intentionally chose that because it reaches more of the peninsula,” she said of the radio show.

The hospital also is taking advantage of local chamber newsletters, newspapers and radio ads to spread the word about the project to every corner of the service area.

According to Bob Craig, administrator for the Anchor Point Fire and Emergency Service Area, the expansion is finding support among members of his community.

“Everyone I’ve talked to is pretty much in favor of it simply because of (Anchor Point’s) aging population,” Craig said. During the 2006 calendar year, Anchor Point emergency responders transported 139 patients to SPH.

The scenario is a bit different in Ninilchik, even though it is within the SPH service area.

“Out of 130 calls, probably two or three go to Homer,” Sue Simonds, an EMT3 as well as EMT Chief for Ninilchik Emergency Services, said of transporting patients to Central Peninsula Hospital in Soldotna rather than SPH.

Mike Chihuly, also an EMT3 and the NES fire chief, said several factors influence that decision.

“Our standing orders are consistent (with Central Emergency Services), several doctors in the Soldotna emergency room have been our sponsoring physicians in the past, we have a mutual aid agreement with Soldotna and most people are closer to Soldotna.”

If a medivac to Anchorage is required, Chihuly said it makes sense to go north.

“It doesn’t do us any good to go south. We need to go towards the chopper,” he said. “But I won’t argue with a patient if they say they want to go to Homer. They have the right to do that.”

NES response doesn’t necessarily reflect what Ninilchik voters will do when they receive their ballots. So far this year, 124 SPH patients have been from Ninilchik.

“I want people, wherever they live, to have the access they want,” said Ninilchik resident Tom McCutchan. “I think I’m probably going to vote for it.”

Not having a voice in the SPH expansion is almost one-fourth of the hospital’s patients. The reason: They reside outside the service area. In 2005, SPH had a total of 7,155 patients, or 29 percent coming from outside the service area boundaries. Those patients received 11.5 percent of 17,755 services provided by the hospital that year. In 2006, 26 percent of the hospital’s 7,164 patients came from outside the service area; they received 10.7 percent of 17,958 services provided by the hospital. For the first half of the current fiscal year, 23.5 percent of the hospital’s 3,712 patients have been from outside the service area and received 10.3 percent of the services provided.

All nine members of the SPH service area board are from Homer. Board member Marie Walli offered an historical perspective for expanding SPH.

“This is what the original people who settled here, the pioneers wanted — a hospital,” she said.

As a representative of the southern peninsula on the Kenai Peninsula Borough Assembly, Milli Martin refrains from taking an official stand in support of or opposition to the expansion project. She does, however, have a personal opinion.

“As a private citizen, I support it,” she said. “If we don’t do it now, it’s going to cost us more in the future. The cost is only going to continue to escalate. We’re a growing service area.”

The element of time also figured into Craig’s support of the hospital expansion.