STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
EAST COAST HOSPITAL, INC. ) d/b/a ORMOND BEACH HOSPITAL, )
)
Petitioner, )
)
vs. ) CASE NO. 80-850
)
DEPARTMENT OF HEALTH AND )
REHABILITATIVE SERVICES, )
)
Respondent, )
)
and )
) DAYTONA BEACH GENERAL HOSPITAL, ) INC., )
)
Intervenor. )
)
RECOMMENDED ORDER
A hearing was held in the above captioned matter, after due notice, on September 8-12, October 6-10, 1980, and January 12-13, 1981, at Daytona Beach, Florida, before the undersigned Hearing Officer.
APPEARANCES
For Petitioner: Bernard H. Dempsey, Jr., and
Karen L. Goldsmith, Esquires Suite 610 Eola Office Center 605 East Robinson Street Orlando, Florida 32801
For Respondent: Eric J. Haugdahl, Esquire
Department of Health and Rehabilitative Services
1323 Winewood Boulevard Building One, Suite 406 Tallahassee, Florida 32301
For Intervenor: S. LaRue Williams, and
Glenn R. Padgett, Esquires Kinsay, Vincent, Pyle, Williams
and Tumbleson
52 South Peninsula Drive Daytona Beach, Florida 32018
ISSUE PRESENTED
Whether Petitioner's application for a Certificate of Need for a 50-bed addition to the Ormond Beach Hospital should be approved, pursuant to Chapter 381, Florida Statutes.
This case involves petitioner's application for a certificate of need to expand, renovate, and consolidate ancillary service areas, and a 50-bed addition to its hospital. Respondent approved the application and issued a certificate of need for all aspects of the project except the 50-bed addition which it found would be inconsistent with the current health systems plan of Health Systems Agency of Northeast Florida, Inc., and because it determined that there was not a need for the additional beds in Volusia County. Petitioner filed its request for a Chapter 120 hearing. Thereafter, Intervenor Daytona Beach General Hospital, Inc., an orthopedic hospital located in Daytona Beach, petitioned for and was granted intervention in the proceeding over the objection of petitioner.
During the course of the extensive hearing in this case, 15 witnesses testified in behalf of Petitioner, two were called by respondent, and four by the Intervenor. Eighty-seven exhibits were admitted in evidence. Exhibit 68 was withdrawn by stipulation of the parties.
FINDINGS OF FACT
Petitioner is a licensed 81-bed non-profit osteopathic general acute care hospital located at 264 South Atlantic Avenue, Ormond Beach, Florida. It is located on a site of approximately 4.6 acres bordered by Highway A1A on the east and Ormond Parkway on the north. The hospital plant consists of three buildings which have been joined together. One is a one-story dietary building that was originally a restaurant. A two-story building was built in 1970, and a one-story structure was built in 1954 and added to in 1960 and 1967. Other buildings owned by the hospital are adjacent residential homes on the premises which are used for storage, laundry, and other purposes. (Testimony of Hull, Exhibits 1-2, 13, 30, 59, 70)
By a series of letters commencing on January 25, 1979, Petitioner advised Respondent's Office of Community Medical Facilities and the Health Systems Agency of Northeast Florida Area 3, Inc. (HSA) of its intent to expand and modernize its hospital and increase bed capacity. The last letter of intent was dated July 24, 1979. On September 21, 1979, Petitioner submitted its Certificate of Need Project Review Application to Respondent which included a request to increase the hospital's bed capacity from 81 to 161 beds. By letter of September 25, 1979, Respondent requested further information and, on December 11, 1979, Petitioner complied with the request and revised its application to seek only 50 additional beds. The proposed expansion and modernization plan included construction of a two-story addition to provide approximately 39,500 additional square feet, and renovation of approximately 22,000 square feet. Completion of the project would raise the hospital's total square footage of 39,350 to approximately 79,000 square feet. Incident to its request for additional beds, Petitioner proposes to initiate a 6-bed obstetrical unit at the hospital. (Exhibits 1-2, 7, 45-48)
Petitioner's application was considered by various components of the HSA in January 1980, which resulted in a report and recommendations on the application which was filed with Respondent on February 25, 1980. During the course of the HSA's consideration of Petitioner's application at its several levels, representatives of Petitioner and the Intervenor appeared at the various
meetings and presented their respective views regarding the application. The HSA report recommended approval of Petitioner's application for the renovation of its existing facilities and ancillary services, and approval of 44 additional beds. It further recommended that the state should take actions necessary to delicense a like number of beds within Petitioner's service area. The recommendation of 44 instead of 50 beds resulted from a finding that the proposed 6-bed obstetrical unit was not needed in the community in view of the probability that osteopathic physicians would likely be granted obstetric privileges in the future at allopathic facilities as a result of the enactment of legislation prohibiting the discrimination by particular provider professions against osteopathic physicians. The HSA found that although "Goal" DTS 1 in its Health Service Plan (HSP) which is used as a "guide" for health planning called for less than 4.3 acute care hospital beds per 1000 population with an overall average annual occupancy rate of at least 80 percent by 1984 in Health Service Area 3, it could approve additional beds for opening prior to 1984 if "extraordinary circumstances" exist as identified in "Goal" EA 2. It further found that Area 3 then had 5255 civilian acute care hospital beds, or a rate of
5.4 beds per 1000 population, with an average occupancy of 61 percent, and that, therefore, approval of additional beds, without cause, would be contrary to "Goal" DTS 1. However, the agency determined that extraordinary circumstances existed in Petitioner's case due to the fact that it had been operating for the past several years at an average occupancy of near or above 90 percent and that within its service area there existed in excess of 200 licensed medical surgical beds which were not staffed or used. The HSA therefore concluded that the situation denied ready access to acute care facilities to the citizens residing in Petitioner's service area. The HSA also considered that approval of the project would improve the effective and geographic distribution of beds and patient and physician accessibility in Volusia County because it was the only hospital located on the beach peninsula. It further found that the great number of elderly patients living in Volusia County and seasonal population fluctuations due to large numbers of tourists living in the area could be denied access to inpatient facilities if the project was not approved. As other extenuating factors, the HSA report stated that Petitioner had been granted prior certificates of need to expand its bed capacity, but that they had expired prior to implementation, that its inpatient facilities were antiquated, that denial of the beds would serve to deny access to patients of osteopathic facilities, and that federal law (PL 96-79) recognized that the need for additional or expanded osteopathic facilities should be determined on the basis of the need for and availability in the community for such services and facilities. (Testimony of Floyd, Hull, Exhibits 4, 8-12, 14, 59)
By letter of March 28, 1980, Respondent's Administrator, Office of Community Medical Facilities, informed Petitioner that its application for certificate of need to expand, renovate and consolidate ancillary service areas at a total project cost of four million dollars was approved, and Certificate of Need Number 1236 was attached. The letter further advised petitioner that the proposed 50-bed addition was denied as being inconsistent with the current Health Systems Plan of the HSA, that there was not a need for the additional 50 beds in Volusia County as evidenced by facts contained in an attached State Agency Action Report, and that the extraordinary circumstances upon which the HSA recommended approval were not valid as evidenced by the same report. However, the referenced report was not submitted in evidence at the hearing, nor was any testimony adduced as to the rationale for the agency decision. By letter of May 28, 1980, Petitioner requested Respondent to increase the amount of the issued certificate of need to ten million dollars due to anticipated additional costs of construction and, by letter of July 24, 1980, Respondent advised Petitioner that the "cost over-run" had been approved and an amended
copy of the Certificate of Need Number 1236 reflecting the additional cost was attached. (Testimony of Hull, Exhibits 57-58)
Volusia County has eight hospitals of which six are allopathic and two are osteopathic. There are five hospitals in the Daytona Beach/Ormond Beach "coastal area" of the county which include Petitioner, Intervenor Daytona Beach General Hospital, Inc. (osteopathic), Ormond Beach Memorial Hospital, Daytona Community Hospital, and Halifax Hospital Medical Center. Two other hospitals in the county are Fish Memorial and West Volusia located in Deland. The remaining hospital is Fish Memorial at New Smyrna Beach.
Petitioner is the only hospital on the beach peninsula which is connected to the mainland by several drawbridges. Daytona Beach General Hospital and Ormond Beach Memorial Hospital are located on the mainland in the northern "coastal area" several miles in distance from Petitioner. The remaining two hospitals in the area are within an average of 30 minutes driving time from Petitioner except during the peak tourist season of February to July each year, or when undue delays are experienced at the drawbridges.
The HSA recognizes Petitioner's health service area to be Volusia County. In June 1979, the eight hospitals in Volusia County had a total of 1675 licensed beds, of which 1395 were open and staffed for use. Of the 378 osteopathic beds, only 178 were open and staffed. Occupancy of the licensed beds during the period July 1978 to June 1979 ranged from a low of 13.8 percent for Daytona Beach General Hospital to a high of 92 percent for Petitioner. The average occupancy of all licensed hospital beds was 51.2 percent. For the month of July, 1980, 1418 beds were open and staffed with 65.2 percent occupancy.
Fish Memorial Hospital of New Smyrna Beach has a certificate of need for an additional 45 beds. In June 1979, all of Petitioner's licensed beds were staffed, but only 97 of Daytona Beach General Hospital's 297 licensed beds were staffed and available for use. Its patient population, however, has increased during the past year.
In July 1978, Volusia County had a population of approximately 230,000 and therefore had about 7 acute care beds per 1,000 population. The 1980 preliminary census figures for the county showed the population to be 249,434 and it is projected that the final census figures will increase from one to two percent which would place the county population at between 252,000 and 254,000. If the higher figure is utilized, the bed ratio for the county at the present time would still be over 6 beds per 1,000 population.
It is projected that the population of Volusia County will increase to 275,900 by 1984. If the current 1675 licensed beds remain the same, there would then be approximately 6 beds per 1,000 population.
Approximately 25 percent of the Volusia County population consists of individuals who are 65 years of age or older whereas only some 9 percent of the population in the other six counties in HSA Area 3 are in that category. Although the HSA's plan arrived at its goal of 4.3 beds per 1,000 population for Area 3 in accordance with federal guidelines which allowed for adjustments in areas with referral hospitals, high tourism rates, and areas with greater than
12 percent of the population being 65 years of age or older, no further adjustment was made for Volusia County in spite of the fact that the Area 3 rate of about 13 percent of elderly population is about half that of the county. Further, the seasonal fluctuation as a result of tourists was not quantified on the basis of available statistics. However, in its justification for the 4.3 beds goal, the HSP makes note of the fact that Volusia County has 22 percent
more patients per day during the high tourist months than during the lowest occupancy months of he year. On an average day in 1979, 73,000 tourists were in Volusia County which equated to approximately an additional 30 percent of the county population of 240,421. During the year 1979-80, about 22 percent of Petitioner's patients were residents of places other than Volusia County.
However, there are no available statistics on the numbers of such persons who were inpatients. Most of the tourists seek only outpatient treatment for sunburn and minor injuries, although some undergo surgery during the months they are visiting the coastal area. (Testimony of Schwartz, Floyd, Smith, Hull, Clapper, Exhibits 3, 5-6, 18-26, 29, 51)
Petitioner's application reflected that its 81 licensed beds were then utilized as medical/surgical (69 beds), intensive care (6 beds), and pediatrics (6 beds). The proposed additional 50 patient beds would be utilized as medical/surgical (29), intensive care (6), progressive care (4), pediatrics (3), obstetrical (6), and isolation (2). However, subsequent to filing its application, Petitioner discontinued its pediatric ward, and created 3 additional medical/surgical beds from the 6 former pediatric beds. (Testimony of Hull, Exhibit 2)
The need for six additional intensive care beds and the initiation of a four-bed progressive care unit is to eliminate the past practice of prematurely transferring intensive care patients to other patient beds due to an insufficient number of intensive care beds. Such transfers required the conversion of semi-private into private rooms with additional equipment and nursing care which also reduced the total number of available beds within the hospital. Transfers of this nature were made extensively during the past fiscal year. (Testimony of Hull, Schwartz, Nargelovic, D'Assaro, Exhibit 2)
The request in the application for two beds to serve as isolation rooms is based upon the fact that petitioner does not maintain any such rooms at the present time and it requires them to meet acceptable standards of health care. Currently, when isolation is necessary, a semi-private room is converted for the single patient requiring isolation, thus reducing the number of available beds. (Testimony of Schwartz, Hull, Nargelovic, Exhibit 2)
Petitioner's request to establish a six-bed obstetrical unit is based upon its claim that such a unit is necessary to properly provide patients of osteopathic physicians with such a service and to provide full health care services which would not only attract new physicians to the hospital, but also enable Petitioner to conduct an intern training program. In addition, Petitioner is of the opinion that such a unit is necessary to provide service to patients living on the peninsula because the closest hospital providing obstetrical care is Halifax Hospital which is located on the mainland. The other obstetrical units are located at Fish Memorial Hospital at New Smyrna Beach and West Volusia Hospital at Deland which are some thirty miles away and do not conduct approved intern or residence programs for osteopathy. Halifax Hospital restricts staff privileges to those physicians who have met American Medical Association criteria and, therefore, osteopathic physicians generally are not eligible to utilize the obstetrical unit there. The HSA found that Petitioner projected 375 deliveries in its proposed obstetrics department during the third year of operation. The agency's HSP goal DTS 4.2 provides that no additional obstetrical departments should be approved in Volusia County until each existing department in the county is performing at least 1,000 deliveries annually. Only Halifax Hospital exceeds the 1,000 annual delivery standard.
The HSA disapproved the requested obstetrical beds based upon its view that obstetrical beds at Halifax Hospital would eventually become available for use
by osteopathic physicians. (Testimony of Schwartz, Hull, Rees, Exhibit 2-3, 6, 14, 54-55)
Petitioner primarily bases its request for the additional 29 medical/surgical beds on the fact that it is the only hospital on the peninsula, has extreme seasonal demands placed on it by tourist population, and that the hospital census has been over 92 percent average occupancy during the past fiscal year. At times, the hospital has been filled to capacity, and has found it necessary to use "hall beds" to meet the need for emergency admissions. The crowded conditions have necessitated frequent delays in patient admissions or the referral of patients to other hospitals. A patient occupancy rate averaging 80-85 percent is normally acceptable, but Petitioner experiences a certain amount of inefficiency and lessened quality of care when over 80 percent of its beds are occupied. This is reflected in the difficulty of staffing and providing support services, and possible premature patient discharge.
(Testimony of Schwartz, Hull, D'Assaro, Draper, Mason, Shoemaker, Exhibits 2, 51, 69)
Although approximately 80 percent of Petitioner's patients reside in the coastal area of Volusia County, only some 29 percent reside in the northeastern part of the county where Petitioner's hospital is located. Petitioner currently has 27 osteopathic physicians on its staff, 18 of whom admit their patients principally to Ormond Beach Hospital and 7 admit there exclusively. Nineteen of the osteopathic physicians have staff privileges at other hospitals. Twenty-four allopathic physicians have staff privileges at Ormond Beach Hospital, but most are specialty consultants who admit less than one percent of Petitioner's patients. (Testimony of Schwartz, Floyd, Hull, D'Assaro, Exhibits 16-17, 60, 67)
The quality of care provided patients at Ormond Beach Hospital is excellent, particularly in view of the antiquated physical plant and prevailing crowded conditions. These problems have led to the existence of a number of existing beds which do not conform to state fire, safety and other standards.
It is planned that the majority of the existing beds will be located in a new building to provide room in the present buildings for expansion of ancillary and support facilities. The hospital is accredited by the American Osteopathic Association and by the Joint Commission on Accreditation of Hospitals.
Accreditation by the Joint Commission indicates that a hospital provides an excellent standard of Health care. (Testimony of Draper, Boxx, Hull, Wisely, Mason, Shoemaker, D. Smith, Exhibits 1-2, 28-42, 49-50, 71-77)
Petitioner is an osteopathic hospital whose Board of Directors is composed of osteopathic physicians. There are no physical differences between allopathic and osteopathic hospitals with the minor exception that the latter utilizes a table for manipulative therapy for some 20 to 30 percent of the patients. The primary difference between the two concepts is philosophical in nature. Osteopathy emphasizes a "wholistic" approach to medicine which stresses the importance of the musculoskeletal structure and manipulative therapy in the maintenance and restoration of health. It is family practice-oriented with about 75 percent of osteopathic physicians engaged in general practice rather than specialty medicine. Emphasis is placed upon personal attention by the physician to the patient. These factors produce a certain amount of patient preference for treatment in an osteopathic facility. (Testimony of Floyd, Schwartz, Wisely, Hull, Mason, Shoemaker, D. Smith, D'Assaro, Exhibit 78)
Although the bylaws of two of the three allopathic hospitals located in the coastal area of Volusia County have recently been amended to permit
osteopathic physicians to obtain staff privileges, certain vestiges of prior discrimination still exist due to the fact that hospital control is exercised by allopathic physicians, and that board certification is required which excludes many osteopathic physicians. The third hospital, Halifax, requires board certification in an American Medical Association approved specialty or residence program. As a consequence, only one osteopathic physician is on its staff. (Testimony of Draper, Hull, Porth, Helker, Rees, D. Smith, Exhibits 54, 63, 66)
Daytona Beach General Hospital, Inc. is the other osteopathic hospital in the area which is located on the mainland several miles away from Ormond Beach Hospital. It has 297 licensed beds, but only 107 were staffed and open for use in July 1980. Its rate of occupancy in June 1979 was 13.8 percent of the licensed beds. The hospital has experienced past difficulties due to a substandard physical plant and inadequate staffing in certain areas. Although many osteopathic physicians decline to admit patients to the hospital, they generally agree that the standard of care is adequate, except for critical care cases. The hospital has sought in the past to attract additional patients by accepting staff applications from qualified area physicians. Daytona Beach General is accredited by The American Osteopathic Association and has pending an application for accreditation by the Joint Commission on Accreditation of Hospitals. (Testimony of Draper, Wisely, Boxx, Hull, D. Smith, Clapper, Solomon, Exhibits 27, 29-80)
Petitioner has exerted efforts to acquire licensed hospital beds from other area hospitals to alleviate its shortage, but has been unsuccessful. Hospitals are reluctant to give up licensed beds even though they are not currently being utilized because they normally anticipate a need for them in future years. Although Daytona Beach General Hospital has been the subject of negotiations for sale with various entities, including Petitioner, in recent years, they have not been successful. None of the hospitals, including Petitioner, desires to share space in other hospitals due to the resulting lack of control over operations and procedures. Petitioner held a certificate of need for 84 beds in 1976 which it was forced to relinquish when it received a certificate of need for the proposed purchase of Daytona Beach General Hospital. (Testimony of Boxx, Hull, Porth, Hilker, Clapper, Rees, Draper, Exhibits 15, 28, 21-37, 43-44, 55-56)
It is estimated that the renovation and expansion of Ormond Beach Hospital will take from 18 to 24 months to complete. Approval of additional beds will result in dividing construction expenses among a greater number of patients, thus lowering costs of health care. On the other hand, without the addition of hospital beds, an increase in patient costs is to be expected. The addition of new beds will be a positive factor in Petitioner's recruitment of osteopathic physicians to the area and in initiating an intern training program. It should also serve to increase Petitioner's competitive position among other area hospitals and provide a better quality of care for its patients.
(Testimony of Draper, Boxx, Hull, D. Smith, Clapper)
CONCLUSIONS OF LAW
Petitioner's application for a certificate of need was processed by the HSA and Respondent Department of Health and Rehabilitative Services under the Health Facilities and Health Services Planning Act, Section 381.493 et seq Florida Statutes (1979). Subsequent to their consideration of Petitioner's application, the Act was amended by Chapter 80-187, Laws of Florida, which reflected new criteria designed to strengthen competitive forces in the health services industry and to require consideration of the quality of care and
efficiency of like and existing health care services in the applicant's health service area. (Sections 381.493(2) and 381.494(6)(c)2, F.S.)
Section 381.493 expresses the general legislative intent to stimulate the establishment and continuous reevaluation of community oriented health goals, assist in the rational examination of alternate methods of achieving such goals, and to aid in their achievement in the most effective means possible within the limits of available resources. It seeks to eliminate unnecessary duplication of health services and to provide those services not currently available or insufficiently provided within the community. As noted above, it also shows the legislative intent to strengthen competitive forces in the health service industry.
The Act requires that health care facilities file application for a certificate of need in certain instances, including the addition of beds by new construction or alteration of existing facilities, for an increase in licensed bed capacity, or capital expenditures by hospitals of $150,000 or more. (Section 381.494(1), F.S.)
Section 381.494 provides that the health systems agencies shall review applications for certificates of need and make findings of fact based on specified criteria and recommendations to Respondent as the State Health Planning Agency for issuance or denial of the application in its entirety or for identifiable portions of the total project. Respondent is then required to review the application "in context with" the same criteria considered by the HSA, administrative rules, and the recommendations made by the HSA, after which it determines whether to issue or deny the certificate of need in whole or part. The applicable provisions of Chapter 381 (1979) have been implemented by Respondent in Chapter 10-5, Florida Administrative Code.
Petitioner's proposed capital expenditure to expand and renovate its facility has been previously approved by Respondent's issuance of a certificate of need, except for the proposed 50 acute-care bed addition to the facility. Accordingly, the sole issue addressed in this proceeding is whether or not the bed addition should be approved or denied. In this respect, Respondent further delineated the contested issue in its letter of proposed denial which stated that the bed addition was inconsistent with the current health systems plan of the Health Systems Agency of Northeast Florida, Inc., that there was not a need for the additional 50 beds in Volusia County, and that the extraordinary circumstances upon which the HSA recommended approval were not valid. There was little or no contest concerning Petitioner's need for additional acute care beds presently and in the future. The thrust of the opposition by Respondent and the Intervenor to granting the application is simply that the health service area of Volusia County is presently "over-bedded" and approval of additional beds would merely exacerbate the problem. Both opponents contend that certificates of need should be issued on the basis of total community rather than institutional need. Petitioner, on the other hand, asserts that its present shortage of beds severely limits its ability to provide quality osteopathic medical needs of the community, and to institute an intern training program designed to attract osteopathic physicians to the area. It further points out that all reasonable alternatives have been employed at its facility to alleviate its shortage of beds, and that to deprive it of additional beds will increase patient costs through denial of income from that source. Finally, Petitioner contends that despite recent legislation to eliminate discrimination against osteopathic physicians, such discrimination still exists in Volusia County which prevents them from gaining full staff privileges or otherwise to have an opportunity to
freely practice osteopathic medicine and its accompanying philosophy at allopathic hospitals in the health service area.
The pertinent statutory criteria for consideration in resolving the issue presented are set forth in subsection 381.494(6)(c), as follow:
The Health Systems Agency shall review applications for certificate of need determinations for health care facilities and services in context with the following criteria:
The need for health care facilities and services. . .being proposed in relation to the applicable health systems plan, annual implementation plan, and state health plan, adopted pursuant to Title XV of the Public Health Service Act. . .
The availability, quality of care, efficiency, appropriateness, accessibility, extent of utilization, and adequacy of like and existing health care services in the applicant's health service area.
6. The need for research and educational facilities, including. . .institutional
training programs for doctors of osteopathy. . . at the. . .internship, and residency training levels.
The needs and circumstances of those entities which provide a substantial portion of their services or resources, or both, to individuals not residing in the health service area in which the entities are located or an adjacent health service area.
The probable impact of the proposed project on the cost of providing health services proposed by the applicant, upon consideration of factors including, but not limited to, the effects of competition on the supply of health services being proposed and the improvements or innovations in the financing and delivery of health services which foster competition and service to promote quality assurance and cost effectiveness.
The evidence establishes that there is currently an excess of acute care beds in Volusia County when considered in the light of the HSA's goal to achieve less than 4.3 beds per 1,000 population and an overall average annual occupancy rate of at least 80 percent in Health Service Area 3 by 1984. Although the HSA report did not specify the anticipated bed needs in 1984, its health service plan indicates that it anticipates the rate of bed to population in that year will be 4.9 percent due to expected population increases. The 4.3 percent goal was arrived at taking into consideration area statistics as to age of residents and a subjective consideration of tourist population. The agency plan, however, permits approval of additional hospital beds if specified
extraordinary circumstances exist as identified in another of its goals. It was
in this context that the HSA determined that Petitioner's application conformed to its health service plan.
Its finding that the more than 200 licensed beds in Petitioner's service area which were not being staffed or used denied ready access to acute care facilities by local residents is not considered justifiable. There was no showing that the population was being denied access to hospitals other than that of Petitioner except during a short period of the peak tourist influx into the area.
Similarly, the agency finding that approval of the project would improve the effective and efficient geographic distribution and patient and physician accessibility is unwarranted. Although Petitioner Ormond Beach Hospital is the only hospital on the peninsula, there is adequate access between that area and the mainland. In fact, most of Petitioner's staff physicians and the majority of its patients have offices or reside on the mainland, and experience no particular difficulty in traveling back and forth.
The third "extraordinary circumstance" cited by the HSA was that the high percentage of elderly residents in Volusia County and the significant tourist population during high occupancy months would be denied access to medical services due to the fact that Petitioner is the only hospital on the beach to provide services to tourists and because a large number of elderly residents live in retirement communities on the peninsula. Although the fact of the existence of greater numbers of those categories of persons perhaps should warrant an increased percentage of bed need in Volusia County, again the mere fact that Ormond Beach Hospital is located on the peninsula and generally must turn away patients, does not constitute denial of access to other hospitals which are not over-crowded and can reasonably be reached in a short time. It is further noted that the majority of tourists who seek medical services during their sojourn in the Daytona Beach area usually require out-patient rather than in-patient services. The approved certificate of need provides for expansion of its emergency and out-patient facilities.
It is therefore concluded that the above factors utilized by the HSA in approving Petitioner's request for additional beds are not supported by the evidence.
Subsection 381.494(6)(c) provides that applications for certificate of need determinations shall be reviewed "in context with" the various criteria set forth therein. There is no mandate that an application stand or fall based upon the fact that it does not meet a particular criterion. Accordingly, the mere fact that Petitioner's application has been found not to coincide with the HSA's Health Service Plan does not necessarily require disapproval. As heretofore found, the plan is recognized to be only a guide which projects certain goals to be achieved, if possible, over a five-year period. The HSA report also contained what were termed "extenuating circumstances" which supported the application. Among these was recognition that recent legislation in Florida prohibited discrimination in terms of staff privileges between MD's and osteopathic physicians, and stated that "the realities of the situation are that both throughout Florida and the nation as a whole, osteopathic physicians practice mainly at osteopathic facilities and MD's practice primarily at allopathic institutions." The agency therefore found that denial of additional beds to Petitioner which is operating at maximum capacity would effectively serve to deny access to acute care beds to the patients of the osteopathic physicians who practice within the hospital. The report indicated also its awareness that another osteopathic hospital in the community should be able to
help assure access to osteopathic services, but that for some reason, osteopathic physicians and patients constantly demanded that in-patient services be provided at petitioner's facility.
Section 381.494(2) provides as follows:
(2) OSTEOPATHIC FACILITIES.--
When an application is made for a certificate of need to construct or expand an osteopathic facility, the need for such facility shall be determined on the basis of the need for and availability of osteopathic services and facilities in the community.
Chapter 395, Florida Statutes, dealing with hospital licensing, provides in Section 395.0653 that any licensed hospital in acting upon applications for staff membership or professional clinical privileges shall not deny the application, inter alia, of a qualified doctor of osteopathy licensed under Chapter 459 solely because the applicant is licensed under that chapter.
In the light of the above statutory provisions, it can be seen that the intent of the legislature is to assure that sufficient osteopathic services and facilities are provided in a community. The evidence shows that although progress has been made in Volusia County toward removing any past discrimination against osteopaths, the largest hospital in the area still maintains a policy of exclusion. Although there is not a significant physical distinction between osteopathic and allopathic facilities, nevertheless the osteopathic philosophy of treatment, which is intertwined with the physician/patient relationship, is a significant factor in the selection by both the physician and the patient of place of treatment. It is true that Daytona Beach General Hospital has an ample number of rooms to take the overflow from Petitioner's facility. However, the reluctance of the majority of the osteopathic physicians to utilize such facilities is based on the fact that the quality of care which can be achieved at that institution is somewhat lower than that which is available at Ormond Beach Hospital. Certainly, if Daytona Beach General was more fully utilized, the cost of maintaining its excess beds probably could result in an overall reduction in community patient costs. However, it would be extremely shortsighted to restrict and reduce the amount and quality of services which can be offered by a successful, thriving hospital on that future possibility. Further, the offsetting reduction in costs which could accrue to patients at Petitioner's facility would serve to counter the other cost to some degree.
The studies undertaken by Petitioner clearly establish a need for additional beds. The bed addition is considered to be an integral and necessary part of the already approved modernization and expansion program. When taking into consideration the new statutory criteria of "quality of care" and "efficiency," and the existing "extent of utilization" criterion of like and existing health care services in the applicant's health service area, plus the new emphasis on strengthening competitive forces in the health services industry, it is evident that the Petitioner's request is justified and should be approved to a reasonable extent. In this connection, it is noted that Petitioner has discontinued its pediatric ward and by so doing has added three medical/surgical beds from conversion of existing pediatric beds. Additionally, it had requested three new pediatric beds in its application. Because the evidence fails to establish Petitioner's need for an obstetrical unit of six beds, it thus appears that Petitioner's needs consist of 26 medical/surgical
beds, 6 ICU beds, 4 PCU beds, and 2 isolation beds, for a total of 38 additional acute care beds.
The issues presented in this case illustrate the sometimes conflicting considerations of the necessary goal of containing accelerating health costs, and yet meeting and providing for specific community health needs. To achieve this need, the pertinent Act does not demand that a determination of approval or denial be predicated upon a single criterion or upon a ritualistic, and sometimes inaccurate and unrealistic mathematical formula. Instead, a complete assessment of the needs of a particular area and facility must be made and weighed in the light of the peculiar circumstances of the community. In this case, it is concluded that Petitioner's application should be approved to the extent noted above.
Posthearing submissions by the parties have been fully considered and those portions which have not been adopted herein are considered either to be unnecessary, irrelevant, or unwarranted in law or fact and are specifically rejected.
That the application of Petitioner for a certificate of need for a 50 acute-care bed addition to its facility be approved in part for 38 additional acute-care beds.
DONE and ENTERED this 6th day of April, 1981, in Tallahassee, Florida.
THOMAS C. OLDHAM
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 6th day of April, 1981.
COPIES FURNISHED:
Eric J. Haugdahl, Esquire Department of HRS
1323 Winewood Boulevard
Tallahassee, Florida 32301
Bernard H. Dempsey, Jr., Karen L. Goldsmith, Esquires Suite 610 Eola Office Center 605 East Robinson Street Orlando, Florida 32801
L. LaRue Williams, and Glenn R. Padgett, Esquires
Kinsay, Vincent, Pyle, Williams
and Tumbleson
52 South Peninsula Drive Daytona Beach, Florida 32018
Honorable Alvin Taylor Secretary, Department of HRS 1323 Winewood Boulevard
Tallahassee, Florida 32301
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AGENCY FINAL ORDER
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STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
EAST COAST HOSPITAL, INC. d/b/a ORMOND BEACH HOSPITAL,
Petitioner,
vs. CASE NO. 80-850
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES,
Respondent,
and
DAYTONA BEACH GENERAL HOSPITAL, INC.,
Intervenor.
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FINAL ORDER
The Department of Health and Rehabilitative Services, having received a Recommended Order entered in this proceeding by Hearing Officer Thomas C. Oldham, dated, April 6, 1981, and having reviewed the complete record and being otherwise well advised in the premises makes the following determinations:
The Findings of Fact contained in the findings section of the attached Recommended Order are determined to be correct and are adopted herein as part of this Final Order by reference.
The Conclusions of Law contained in the Recommended Order are adopted insofar as they are consistent with this Final Order and such Conclusions of Law are as follows:
CONCLUSIONS OF LAW
Petitioner's application for a certificate of need was processed by the Health Systems Agency of Northeast Florida Area 3, Inc. (HSA) and Respondent Department of Health and Rehabilitative Services under the Health Facilities and Health Services Planning Act, Section 381.493 et seq Florida Statutes (1979). Subsequent to their consideration of Petitioner's application, the Act was amended by Chapter 80-187, Laws of Florida, which reflected new criteria designed, in part, to require consideration of competitive forces in the health services industry, and the quality of care, efficiency and appropriateness of like and existing health care services in the applicant's health service area. (Sections 381.493(2) and 381.494(6)(c)2, F.S.)
Section 381.493 expresses the general legislative intent to stimulate the establishment and continuous reevaluation of community oriented health goals, assist in the rational examination of alternate methods of achieving such goals, and to aid in their achievement in the most effective means possible within the limits of available resources. It seeks to eliminate unnecessary duplication of health services and to provide those services not currently available or insufficiently provided within the community. It also shows the legislative intent to strengthen competitive forces in the health service industry.
The Act requires that health care facilities file application for a certificate of need in certain instances, including the addition of beds by new construction or alteration of existing facilities, for an increase in licensed bed capacity, or capital expenditures by hospitals of $150,000 or more. (Section 381.494(1), F.S.)
Section 381.494 provides that the HSAs shall review applications for certificates of need and make findings of fact based on specified criteria, and based on this review the HSAs make recommendations to Respondent as the State Health Planning Agency for issuance or denial of the application in its entirety or for identifiable portions of the total project. Respondent is then required to review the application "in context with" the same criteria considered by the HSA, administrative rules, and the recommendations made by the HSA, after which it determines whether to issue or deny the certificate of need in whole or part. The applicable provisions of Chapter 381 (1979) have been implemented by Respondent in Chapter 10-5, Florida Administrative Code.
Petitioner's proposed capital expenditure to expand and renovate its facility has been previously approved by Respondent's issuance of a certificate of need, except for the proposed 50 acute-care bed addition to the facility. Accordingly, the sole issue addressed in this proceeding is whether or not the bed addition should be approved or denied. In this respect, Respondent further delineated the contested issue in its letter of proposed denial which stated that the bed addition was inconsistent with the needs expressed in current health systems plan of the HSA, that there was not a need for the additional 50 beds in Volusia County, and that the extraordinary circumstances upon which the HSA recommended approval were not valid. There was little or no contest concerning Petitioner's individual need for additional acute-care beds presently and in the future. The thrust of the opposition by Respondent and the Intervenor to granting the application is simply that the health service area of Volusia County is presently "over-bedded" and approval of additional beds would merely exacerbate the problem. Both opponents contend that certificates of need should be issued on the basis of total community rather than institutional need. Petitioner, on the other hand, asserts that its present shortage of beds
severely limits its ability to provide quality osteopathic medical needs of the community, and to institute an intern training program designed to attract osteopathic physicians to the area. It further asserts that all reasonable alternatives have been employed at its facility to alleviate its shortage of beds, and that to deprive it of additional beds will increase patient costs through denial of income from that source. Finally, Petitioner contends that despite recent legislation to eliminate discrimination against osteopathic physicians, such discrimination still exists in Volusia County which prevents them from gaining full staff privileges or otherwise to have an opportunity to freely practice osteopathic medicine and its accompanying philosophy at allopathic hospitals in the health service area.
The pertinent statutory criteria for consideration in resolving the issue presented are set forth in subsection 381.494 (6)(c), as follows:
The Health Systems Agency shall review applications for certificate of need determinations for health care facilities and services. . .in context with the following criteria:
The need for health care facilities and services. . .being proposed in relation to the applicable health systems plan, annual implementation plan, and state health plan, adopted pursuant to Title XV of the Public Health Service Act. . .
The availability, quality of care, efficiency, appropriateness, accessibility, extent of utilization, and adequacy of like and existing health care services. . . in the applicant's health service area.
The need for research and educational facilities, including. . .institutional training programs for doctors of osteopathy
. . .at the. . .internship, and residency training levels.
The needs and circumstances of those entities which provide a substantial portion of their services or resources, or both, to individuals not residing in the health service area in which the entities are located or an adjacent health service area.
The probable impact of the proposed project on the cost of providing health services proposed by the applicant, upon consideration of factors including, but not limited to, the effects of competition on the supply of health services being proposed and the improvements or innovations in the financing and delivery of health services which foster competition and service to promote quality assurance and cost effectiveness.
The evidence establishes that there is currently an excess of acute care beds in Volusia County when considered in the light of the HSA'S goal to achieve less than 4.3 beds per 1,000 population and an overall average annual
occupancy rate of at least 80 percent in Health Service Area 3 by 1984. Although the HSA report did not specify the anticipated bed needs in 1984, its health systems plan indicates that it anticipates the ratio of beds to population in that year will be 4.9 beds per 1,000 population due to expected population increases. The 4.3 goal was arrived at by taking into consideration
area statistics as to age of residents and a subjective consideration of tourist population. The HSA plan, however, permits approval of additional hospital beds if specified extraordinary circumstances exist as identified in another of its goals. It was in this context that the HSA determined that Petitioner's application conformed to its health service plan.
The HSA finding that the more than 200 licensed beds in Petitioner's service area which were not being staffed or used denied ready access to acute care facilities by local residents is not considered justifiable. There was no showing that the population was being denied access to hospitals other than that of petitioner except during a short period of the peak tourist influx into the area.
Similarly, the HSA finding that approval of the project would improve the effective and efficient geographic distribution and patient and physician accessibility is unwarranted. Although Petitioner Ormond Beach Hospital is the only hospital on the peninsula, there is adequate access between that area and the mainland. In fact, most of Petitioner's staff physicians and the majority of its patients have offices or reside on the mainland, and experience no particular difficulty in traveling back and forth.
The third "extraordinary circumstance" cited by the HSA was that the high percentage of elderly residents in Volusia County and the significant tourist population during high occupancy months would be denied access to medical services due to the fact that Petitioner is the only hospital on the beach to provide services to tourists and because a large number of elderly residents live in retirement communities on the peninsula. Although the fact of the existence of greater numbers of those categories of persons perhaps should warrant an increased percentage of bed need in Volusia County, again the mere fact that Ormond Beach Hospital is located on the peninsula and generally must turn away patients, does not constitute denial of access to other hospitals which are not over-crowded and can reasonably be reached in a short time. It is further noted that the majority of tourists who seek medical services during their sojourn in the Daytona Beach area usually require outpatient rather than inpatient services. The approved certificate of need provides for expansion of its emergency and outpatient rather than inpatient services.
It is therefore concluded that the above factors utilized by the HSA in approving Petitioner's request for additional beds are not supported by the evidence.
Subsection 381.494(6)(c) provides that applications for certificate of need determinations shall be reviewed "in context with" the various criteria set forth therein. There is no mandate that an application stand or fall based upon the fact that it does not meet any single criterion. Accordingly, the mere fact that Petitioner's application has been found not to coincide with the HSA's Health Systems Plan does not necessarily require disapproval.
It should be noted that the function of the HSA Plan is for it to be used as a guide by the HSA in reviewing applications for certificate of need determinations in order to enable the HSA to make its recommendation to the Respondent. The HSA report also contained what were termed "extenuating
circumstances" which supported the application. Among these was recognition that recent legislation in Florida prohibited discrimination in terms of staff privileges between MD's and osteopathic physicians, and stated that "the realities of the situation are that both throughout Florida and the nation as a whole, osteopathic physicians practice mainly at osteopathic facilities and MD's practice primarily at allopathic institutions." The HSA therefore found that denial of additional beds to Petitioner which is operating at maximum capacity would effectively serve to deny access to acute care beds to the patients of the osteopathic physicians who practice within the hospital. The report indicated also the HSA's awareness that another osteopathic hospital in the community should be able to help assure access to osteopathic services, but that for some reason, osteopathic physicians and patients constantly demanded that inpatient services be provided at Petitioner's facility.
Section 381.494(2) provides as follows:
(2) OSTEOPATHIC FACILITIES.--
When an application is made for a certificate of need to construct or expand an osteopathic facility, the need for such facility shall be determined on the basis of the need for and availability of osteopathic services and facilities in the community.
Chapter 395, Florida Statutes, dealing with hospital licensing, provides in Section 395.0653 that any licensed hospital in acting upon applications for staff membership or professional clinical privileges shall not deny the application, inter alia, of a qualified doctor of osteopathy licensed under Chapter 459 solely because the applicant is licensed under that chapter.
In the light of the above statutory provisions, it can be seen that the intent of the legislature is to assure that sufficient osteopathic services and facilities are provided in a community. The evidence shows that although progress has been made in Volusia County toward removing any past discrimination against osteopaths, the largest hospital in the area still maintains a policy of exclusion. Although there is not a significant physical distinction between osteopathic and allopathic facilities, nevertheless the osteopathic philosophy of treatment, which is intertwined with the physician/patient relationship, is a significant factor in the selection by both the physician and the patient of place of treatment. It is true that Daytona Beach General Hospital has an ample number of rooms to take the overflow from Petitioner's facility. However, the majority of the osteopathic physicians are reluctant to utilize such facilities. Certainly, if Daytona Beach General was more fully utilized, the lower costs associated with maintaining fewer excess beds could result in an overall reduction in community patient costs. However, increased utilization will not occur unless more osteopathic physicians utilize the facility.
The studies undertaken by Petitioner clearly establish the high level of utilization of Petitioner'S facility, resulting in a need for additional beds. The bed addition is considered to be by the Petitioner an integral and necessary part of the already approved modernization and expansion program. When taking into consideration the new statutory criteria of "quality of care"
and "efficiency", and the existing "extent of utilization" criterion of like and existing health care services in the applicant's health service area, plus the new emphasis on strengthening competitive forces in the health services industry, there is evidence that the Petitioner's request is justified and should be approved to a reasonable extent. In this connection, it is noted that
Petitioner has discontinued its pediatric ward and by so doing has added three medical/surgical beds from conversion of existing pediatric beds. Additionally, it had requested three new pediatric beds in its application. Because the evidence fails to establish Petitioner's need for an obstetrical unit of six beds, it thus appears that Petitioner's needs consist of 26 medical/surgical beds, 6 ICU beds, 4 PCU beds, and 2 isolation beds, for a total of 38 additional acute-care beds.
The decision to approve or disapprove an application for a certificate of need should not be made based on any single criterion. Instead, a complete assessment of the needs of a particular area must be made and weighed in the light of the circumstances of the community. In this case, it is concluded that Petitioner's application should be approved to the extent noted above.
Posthearing submissions by the parties have been fully considered and those portions which have not been adopted herein are considered either to be unnecessary, irrelevant, or unwarranted in law or fact and are specifically rejected.
EXCEPTIONS TO THE RECOMMENDED ORDER
The exceptions to the Recommended Order submitted by the Petitioner and the Intervenor have been considered by the Department of Health and Rehabilitative Services. The Department makes the following rulings on each of the submitted exceptions.
Intervenor's Exceptions Paragraph 5
With regard to paragraph 5, Intervenor takes exception to the statement of the Petitioner's position to the extent that those views are in any way implied to be those of the Hearing Officer. A review of the record in particular the introductory statements made by the Petitioner indicate paragraph 5 to be a summation of the lengthy assertions made by the Petitioner in its statement of claim.
Intervenor asserts it would be incongruous for the Respondent to grant additional beds to Petitioner because Respondent has failed to adequately implement and apply existing legislation designed to eliminate discrimination against osteopathic physicians if such discrimination in fact exists. Section 395.0653, Florida Statutes, states:
A. Any hospital licensed under this chapter in considering and acting upon applications for staff membership or professional clinical privileges shall not deny the application of a qualified. . . doctor of osteopathy licensed under 459. . . for such staff membership or professional clinical privileges within the scope of his expected respective licensure solely because the applicant is licensed under any of said chapters.
The testimony does not establish that any osteopathic physicians were denied hospital privileges solely because they were osteopathic physicians,
thus, it is not incongruous for Respondent to grant additional beds to Petitioner. The bylaws of three allopathic hospitals indicated a restriction on the admission of doctors based on educational requirements which restrictions have the effect of excluding many osteopathic physicians. However, these bylaws per se do not deny staff privileges based on the physicians' licensure under Chapter 459.
Paragraph 6
Intervenor indicates in his exceptions that four criteria contained in Section 381.494(6)(e) should be included in paragraph 6. This Final Order acknowledges that the statutory requirement states as follows:
In cases of capital expenditure proposals for the provision of new health services to inpatients, the agency shall also reference each of the following in its findings of fact:
That less costly, more efficient, or more appropriate alternatives to such patient services are not available and the development of such alternatives have been studied and found not practicable.
That existing inpatient facilities providing inpatient services similar to those proposed are being used in an appropriate and efficient manner.
In the case of new construction, that alternatives to new construction for example, modernization or sharing arrangements have been considered and have been eliminated to the maximum extent practicable.
That patients will experience serious problems in obtaining inpatient care of the type proposed, in the absence of the proposed new service. . .
The existence of these criteria does not change the outcome of this Final Order.
Paragraph 8
The Intervenor contends that the expertise of the Respondent in applying the enabling legislation gives greater weight to the applicable health systems plan than to the other criteria. This is an erroneous conclusion and it is unsupported by any facts. The existence of the HSA's plan which is used as a guide by the HSA in making its recommendation to Respondent does not as a matter of law indicate that Respondent places greater weight on the HSA plan than other criteria. Additionally, there are no facts in the record to support the conclusion that Respondent gives greater weight to the applicable HSA plan than to other criteria. It is equally erroneous to assume that the legislature is aware of the manner in which Respondent applies the implementing legislation or that any legislative intent could be drawn from the absence of a statement in the statute indicating the relative weight to be given to the various criteria.
Paragraph 9
Intervenor's contention in paragraph 9 indicates these are not conclusions of law offered by Intervenor but in fact proposed findings of fact. Basically,
Intervenor contends that the Petitioner is not an osteopathic hospital and as such should not gain the benefit of the language set forth in Section 381.494(2), Florida Statutes. In paragraphs 13 and 14 of the Findings of Fact contained in this Order it is clear that the Petitioner is accredited by the American Osteopathic Association. Also, the Petitioner has a Board of Directors composed of osteopathic physicians. These Findings of Fact preclude a conclusion of law that Section 381.494(2) does not apply to Petitioner.
The Intervenor next contends that the addition of Section 395.065(3), Florida Statutes, passed in 1979 impliedly repeals the preference granted to osteopathic facilities by Section 381.494(2). It is clear there are basic philosophical differences between osteopathic and allopathic medicine.
Intervenor's contention would seem to be that by passage of Section 395.065(3) the legislature intended to abolish this distinction between osteopathic and allopathic hospitals. It is clear that this is not the case. Section 381.494(2) recognizes the uniqueness of osteopathic facilities and requires that this uniqueness be considered in determining the need and availability of medical services in the community. That the legislature subsequently passed Section 395.065(3) to eliminate discrimination against osteopathic physicians in allopathic hospitals merely serves to further this recognition of the distinction between these two branches of medicine. The Intervenor further takes exception to the statement and the Conclusion of Law that "the studies undertaken by Petitioner clearly establish a need for additional beds." Intervenor wishes to insert the word "desire" in place of the word "need". The Final Order has changed the language referred to by the Intervenor in paragraph
9 so that it now reads, "The studies undertaken by Petitioner clearly establish a high level of utilization of Petitioner's facility, resulting in the need for additional beds." This is a correct statement of the Petitioner's position and an accurate statement of the facts in relation to Petitioner's individual facility.
Paragraph 10
The Intervenor would substitute a lengthy Conclusion of Law which results in a denial of the Petitioner's proposed 50 bed addition. It should be noted that the language of paragraph 10 in the Final Order differs to a substantial extent to that contained in the Recommended Order although it reaches the same conclusions, that is, the Petitioner's proposed bed addition should be granted to the extent of 38 additional acute-care beds.
This Final Order rejects Intervenor's Conclusion of Law for paragraph 10 since Intervenor has based this conclusion on different criteria than that utilized by the Department and the Hearing Officer in his recommended Order. The weight given to the criteria also differed between Intervenor, the Hearing Officer and the HSA resulting in different conclusions.
Conclusion
The Intervenor next contends that the case of Sacred Heart Hospital of Pensacola v. Department of Health and Rehabilitative Services has a direct bearing on this decision. The Intervenor apparently would conclude that the Department is bound in its decision in this case by the decision it made in Sacred Heart. It is clear that the same criteria can be applied in two different cases which present two different factual situations so that the decisions that are reached are not identical. This is the situation presented here. There are factual distinctions between this case and the Sacred Heart case including the important distinction pertaining to the needs for an
osteopathic facility as well as the findings pertaining to competition, efficiency, quality of care, and appropriateness of the service presently being provided. The Final Order therefore rejects this exception presented by the Intervenor.
Petitioner's Exceptions
Petitioner contends that the evidence shows that there are no obstetrical beds available for osteopathic physicians to deliver babies within the Ormond Beach area thus obligating the Hearing Officer to recommend the granting of the six beds sought for obstetrical purposes. The Findings of Fact in this Order contradict this conclusion that there are no obstetrical beds available for osteopathic physicians to deliver their babies. Please note in paragraph 9 that Halifax Hospital is available to those osteopathic physicians who meet the requirement set forth by the hospital. No where in any of the criteria set forth in Chapter 381 is a hearing officer obligated to recommend the granting of beds even assuming there are no available obstetrical beds for osteopathic physicians. All relevant criteria must be considered in a decision to recommend or deny the granting of beds and no particular decision is mandated by the statute.
Petitioner contends that it intended to initiate a pediatric unit specializing in the care of children and that evidence adduced at the hearing shows that such a unit is needed in the Volusia County community. Reference is made to the Findings of Fact in paragraph 7 of this Order which recognize the conversion of the former pediatric ward to three additional medical/surgical beds. That Petitioner intended to initiate a pediatric unit is not dispositive of either a question of law or a question of fact. Paragraph 8 of the Findings of Fact contained in this Order establishes a need for intensive care and progressive care beds requested. Paragraph 9 of the Findings of Fact of this Order establishes the need for 2 beds to serve as isolation rooms. The elimination of the 6 bed pediatric ward indicates the emphasis placed on the need for medical/surgical beds by the Petitioner and eliminates the need for granting 3 of the requested 29 medical/surgical beds. The need in the community of an additional 3 pediatric beds requested by the Petitioner has not been established through the evidence induced at the hearing.
THEREFORE, IT IS ORDERED AND ADJUDICATED that the Department's denial of a Certificate of Need for a 50 bed addition to Petitioner's facility is disapproved and that the Hearing Officer's Recommended Order of granting a 38 bed addition to Petitioner's facility consisting of 26 medical/surgical beds, 6 ICU beds, 4 PCU beds and 2 isolation beds be approved.
DONE AND ORDERED this 20th day of May, 1981 in Tallahassee, Florida.
ALVIN J. TAYLOR, Secretary Department of Health and
Rehabilitative Services 1321 Winewood Boulevard
Tallahassee, Florida 32301
(904) 488-7721
COPIES FURNISHED:
Eric J. Haugdahl, Esquire Department of HRS
1323 Winewood Boulevard
Tallahassee, Florida 32301
Bernard H. Dempsey, Jr., and Karen L. Goldsmith, Esquires Suite 610 Eola Office Center 605 East Robinson Street Orlando, Florida 32801
L. LaRue Williams, and Glenn R. Padgett, Esquires
Kinsay, Vincent, Pyle, Williams and Tumbleson
52 South Peninsula Drive Daytona Beach, Florida 32018
Thomas C. Oldham Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
Gary G. Clarke
Deputy assistant Secretary for Health planning and Development
Department of Health and Rehabilitative services
1321 Winewood Boulevard
Tallahassee, Florida 32301
| Issue Date | Proceedings |
|---|---|
| May 26, 1981 | Final Order filed. |
| Apr. 06, 1981 | Recommended Order sent out. CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| May 20, 1981 | Agency Final Order | |
| Apr. 06, 1981 | Recommended Order | Petitioner's application for Certificate of Need (CON) should be granted only in part due to cost considerations and need considerations. |
