It's not complicated at all, I've been working with construction companies for 5 years; it is just that
none ever handled the FAA for me (sweet), they paid
me to do that. Yes, I understand a company may require adherence to certain safety guidelines; I deal with that all the time. I was confused when you mentioned what the hospital wanted; understood but it is still the FAA who grants airspace privileges.
Just wanted to ensure others that read this are not confused.
No city, county, state, hospital, or helipad operator "authorizes" operations in the national airspace. However, in my state you fly over a prison in the furtherance of any criminal offense. and you'll face state felony charges (not FAA ,unless the prison is in controlled airspace

)
We are still talking apples and apples; only the FAA grants airspace privileges.