The Monroe County Board of County Commissioners is expected to begin talks over the creation of a special hospital tax in the Middle Keys when it meets on Nov. 18.

If the BOCC were to approve such an idea, it would merely set the wheels in motion. A new tax would first require the approval of the Florida Legislature, after which it would have to pass muster at the polls and be approved by Keys voters.

The tax money would be used to support Fishermen's Hospital in Marathon, a facility that has seen its share of turmoil in the past several years.

The board that governs the hospital has had its differences with the company that manages it, Health Management Associates, and even supported bringing in another management company in a takeover bid that ultimately failed early this year. Baptist Health South Florida begin an investigative process to see if it was feasible to take over management operations at Fishermen's Hospital late last year. At the conclusion of the process, however, officials from the company stated Baptist was no longer interested, pointing to the downturn in the economy as a main reason.

Another one of the reasons that takeover bid failed was the impending cost of switching management companies. Although the hospital's governing board owns the building, HMA owns most of the equipment -- gear that would likely be taken if the contract were to be terminated.

As it stands, HMA's contract with the board is set to expire in 2011, with the future beyond that still in question. Board members have said they do not expect HMA to remain in control once the current deal expires, and it remains to be seen if Baptist Health South Florida would still be interested in taking over operations.

Officials from HMA did not return calls for comment as of press time. HMA has managed operations at the hospital since 1986.

Fishermen's Hospital Board President Marv Schindler said the board realizes they are asking for tax money at the worst possible time, but stressed it was an important measure.

"The first few years are going to be very difficult," Schindler said of a new management company taking over for HMA.

Schindler said a property tax rate of .68 would raise about $2.2 million a year for the hospital. A .68 tax rate would mean property owners would pay about $68 dollars a year for every $100,000 of assessed value.

Schindler said the tax rate, which would be imposed on properties between Long Key and the Seven Mile Bridge, could be used for all or part of a five-year period.

"The big reasons Baptist didn't come was financial," Schindler said.

According to the resolution that will be put before the BOCC next week, the taxing district would be used to support the maintenance and equipping of the hospital. The BOCC will meet at the Murray Nelson Government Center in Key Largo starting at 9 a.m. on Nov. 18.

Fishermen's Hospital, one of three hospitals in the Florida Keys, opened with 36 beds in 1962. Today it has 58 beds, six of which are devoted to the intensive care unit. Plans for the hospital were started in 1957 when a group of citizens formed the Marathon Hospital Association, according to the Fishermen's Hospital Web site. In March 1961, construction began, under the chairmanship of one of Marathon's earliest developers, Phil Sadowski.