- Medical University of South Carolina leaders want state legislators to appropriate an additional $2 million to help pay off the university's dental school building.

Otherwise, they say the dental school's tuition - already among the highest in the country - may have to rise, school leaders told a House subcommittee Wednesday.

MUSC interim President Mark Sothmann said the school faces a difficult financial future. "We're going on hard times," Sothmann told the House panel. "We are on the edge in a lot of different ways."

The state contributed roughly $19 million toward the James B. Edwards College of Dental Medicine building on Bee Street, which was completed in 2008. The school still owes $28 million toward the $60 million cost, which included the cost of the building and new equipment, MUSC lobbyist Mark Sweatman said after the committee meeting.

An additional $2 million is a relatively small amount compared with MUSC's total annual budget - approximately $2 billion a year. The state contributes roughly $58 million toward those costs each year. State funding for MUSC has declined from more than $100 million since 2008.

Without more money, school officials said, they will have to consider a tuition increase for dental students to cover the costs of needed debt payments for the building. Tuition would have to rise from $60,000 per year to at least $66,000, Sothmann said.

The school's students already graduate with an average debt of more than $230,000, a significant issue for the state's future medical care providers, MUSC officials said.

Sweatman said MUSC administrators are not considering a tuition increase for other students outside of the dental school.

Accreditors have raised concerns about the dental school's tuition rate, Sothmann said, and school leaders don't want to consider another hike unless no other financing options are available.

"We will finance it somehow, but we are asking for some assistance," Sothmann told legislators.

These issues are also front and center for the school's bid to find a new president, and Sothmann said leaders have been searching in earnest for one.

Former MUSC President Ray Greenberg in the summer for a position within the University of Texas health care system. A new president isn't expected to be named by the Board of Trustees until later this year, Board Chairman Tom Stephenson said.

Meanwhile, MUSC officials also are pursuing plans for a $325 million children's hospital to replace the school's current facility, which was built in 1987. It is the largest and most expensive proposed capital project in MUSC history.

Officials want the state to put up $50 million, and they believe they can raise $50 million in private donations. The rest would have to be borrowed, Sweatman said.

"We want the state to ... put up something to show this is important," hospital CEO Patrick Cawley said in an interview.

Officials do not regret embarking on an ambitious facelift for the dental school, even if all the funds were not in place, he said.

"Our facilities are extremely aged," Cawley said. "We had to modernize it, and we had to make it safer." The school's facilities provide a significant amount of care for people who wouldn't be able to get or afford care otherwise, officials said.

Rep. Murrell Smith, R-Sumter, who heads the health subcommittee, said he worries about the rising cost of tuition at MUSC. Payments to doctors and dentists are dropping, and the state has a lack of adequate dental and medical services, particularly in rural areas, he said.

"The shortage of dental care in rural areas - I hear that time and time again," Smith said. "(We) need to produce more dentists. With the tuition going up, it's not going to be very attractive."

Still, Smith said he wasn't ready to commit to MUSC's requests so early in the budget cycle. He said he would like to see increased investments in telemedicine, which he believes can provide South Carolinians access to better health care in the future.

Telemedicine connects rural hospitals and providers around South Carolina to experts at MUSC via technology like videoconferencing. The state invested $12.5 million in MUSC's telemedicine network during the last budget cycle. The school is requesting an additional $18 million this year.