STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

HILL-GUTHRIE PROPERTIES, )

)

Petitioner, )

)

vs. ) CASE NO. 83-0610

)

DEPARTMENT OF HEALTH AND )

REHABILITATIVE SERVICES, )

)

Respondent. )

)

RECOMMENDED ORDER

This case was heard on September 10, 1984, by R. L. Caleen Jr., hearing officer with the Division of Administrative Hearings, in Nicevi1le, Florida. The parties were represented by counsel.

APPEARANCES

For Petitioner: F. Philip Blank, Esquire

241 E. Virginia Street Tallahassee, Florida 32301

For Respondent: Louise Jeroslow, Legal Intern and

Qualified Representative

318 North Calhoun Street Tallahassee, Florida 32301

INTRODUCTION

On October 15, 1982, Petitioner, HILL-GUTHRIE PROPERTIES ("HILL-GUTHRIE"),

applied to the Respondent, Department of Health and Rehabilitative Services ("HRS"), for a certificate of need (CON), to construct a 120-bed nursing home in Niceville, Florida, to serve the Okaloosa County area. At final hearing, the application was amended, without objection, by HRS.

On January 28, 1983, HRS preliminarily denied HILL-GUTHRIE'S application.

After HILL-GUTHRIE timely requested a formal hearing pursuant to Section 120.57(1), Florida Statutes, HRS referred this case to the Division of Administrative Hearings for assignment of a hearing officer.

Final hearing was set for June 1, 1983. On May 6, 1983, the parties jointly moved for a continuance pending adjudication of an administrative challenge to Rule 10-5.11(21), Florida Administrative Code, which contains HRS's nursing home bed-need methodology. The motion was granted and the case was continued. On March 8, 1984, HRS asked to reset the hearing, since the administrative rule challenge had been dismissed on February 3, 1984. By agreement of the parties, hearing was then reset for September 10, 1984.

At final hearing, HILL-GUTHRIE presented, in support of its application, the testimony of James R. Fulmer, accepted as an expert in nursing home need and financial feasibility; Gail Buck, accepted as an expert in health care planning and financial feasibility; Don Butts, Administrator of Twin Cities Hospital in Niceville, Florida, who was accepted as an expert in health care, including diagnostic-related guidelines; Robert S. Ellis, M.D., a local physician; Marguerite Seals, a Niceville resident; Jessie A. Edge, councilwoman for the City of Niceville; Barbara Davis, a resident of Seminole; Velma Strickland, Discharge Planning Coordinator at Crestview Community Hospital; and Jerry Brown and Bill Jordan, councilmen for the City of Niceville. HILL-GUTHRIE'S Exhibit Nos. 1-8 and Public Exhibit Nos. 1-3 were received in evidence. HRS presented, in support of its denial, the testimony of Reid Jaffe, who was accepted as an expert in health care planning and CON review. HRS Exhibit Nos. 1-5 were received in evidence.

By pre-hearing stipulation, the parties agreed that the HILL-GUTHRIE application satisfies the statutory and rule criteria contained in Section 381.494(6)(c)3. through 8., 10., 11., and 13., Florida Statutes, and Rule 10-

5.11(1), (2), (4), and (7) through (12)(a), Florida Administrative Code. At issue is whether the application satisfies the criteria contained in Section 381.494(6)(c)1., 2., 9., and 12., Florida Statutes, and Rule 10- 5.11(3), (5), (6), and (12)(b), Florida Administrative Code.

The transcript of hearing was filed on November 13, 1984. The parties submitted posthearing proposed findings of fact by December 4, 1984.' Each proposed finding has been considered and ruled on, either directly or indirectly, in this Recommended Order, except where proposed findings have been rejected as subordinate, cumulative, immaterial or unnecessary.

Based on the evidence adduced at hearing, the following facts are determined:

FINDINGS OF FACT

I. BACKGROUND

1. HILL-GUTHRIE, also known as Hill Guthrie Realty Company, is a wholly- owned subsidiary of First American Corporation, in Huntsville, Alabama. During the past 17 years, First American Corporation has developed, owned, and operated approximately 80 nursing homes and health care facilities.

   
   

2. On October 15, 1982, HILL-GUTHRIE filed an application with HRS for a CON to construct and operate a community nursing home in the City of Niceville, in Okaloosa County, Florida. The original application sought authorization for a 120-bed nursing home, to be known as "Twin Cities Health Facility." Estimated cost of construction was $3,180,000. By its "State Agency Action Report," dated January 28, 1983, HRS preliminarily denied the application, stating:

   
   

   The proposed project is not consistent with Chapter 10-5.11, Florida Administrative Code, Nursing Home Bed Need Methodology.

   
   

   A need does not exist to add any nursing home beds to Okaloosa County through 1985. There are 70 approved but not constructed beds in

   the county. The bed need methodology produces an excess of 10 nursing home beds in the county through 1985. (emphasis included)

   
   

   [Respondent's Ex. 3.]. HILL-GUTHRIE contested the denial, resulting in this proceeding.

   
   

3. At final hearing, HILL-GUTHRIE amended its earlier application, reducing the number of nursing home beds, from 120 to 60. Other changes to the application were made to reflect the reduction in beds. The estimated cost of construction was reduced from $3,180,000 to $1,780,000. [Petitioner's Ex. 2]. HRS did not seek a continuance or additional time to evaluate the newly amended application. Rather, it represented that it was prepared to proceed.

   
   

   II.

   
   

   APPLICATION OF THE NURSING HOME BED-NEED METHODOLOGY

   
   

4. Both parties agree that HILL-GUTHRIE'S application is governed by the licensing criteria contained in Rule 10-5.11(21) Florida Administrative Code, and Section 381.494(6)(c), Florida Statutes. Generally, the rule provides that applications for community nursing home beds will be considered "in context with applicable statutory and rule criteria"; that applications will "not normally [be] approve[d] . . . if approval . . . would cause the number of community beds in that departmental service district to exceed the number of beds calculated by the methodology described in [the rule]"; and that this methodology, consisting of several numerical formulae, will be used to evaluate applications "in addition to relevant statutory and rule criteria." Section 5.11(21)(a), (b), Fla. Admin. Code. The statute being implemented, Section 381.494(6)(c), Florida Statutes, enumerates a myriad of criteria, including availability, accessibility, extent of utilization, quality of care and adequacy of like and existing health care services in the area to be served. Section 381.494(6)(c), Fla. Stat. (1983). It has been construed to require a balanced consideration of these factors. HRS cannot ignore some factors and emphasize others. 1/

   
   

   The HRS methodology--consisting of formulae which do not take into account all criteria listed in the statute--comports with this requirement by incorporating, by reference, all other relevant statutory or rule criteria, and recognizing that new beds may be permitted even though such approval would cause the number of beds to exceed the number allowed by the formulae. Section 5.11(21)(a), (b), Fla. Admin. Code.

   
   

5. The HRS bed need methodology, at least that part consisting of the various formulae, establishes a 3-step analysis. First, theoretical bed need for the relevant district and sub-district is calculated using an area's particular poverty ratio, a statewide bed-need ratio of 27 beds per 1,000 elderly population, and the area's elderly population projected three years into the future. "Existing and approved" beds in the sub-district area are then subtracted to arrive at the number of additional beds needed in the district and sub-district. In the instant case, it is undisputed that this first step in the analysis is satisfied. The formulae, when "run," indicate a 1987 theoretical bed-need of at least 250 additional beds in District 1, the relevant district, and 58 additional beds in Okaloosa County, the relevant sub-district. Respondent's Ex. 1, 2). The remaining two steps involve applying current and prospective utilization formulae. When, as here, both district and subdistrict show a theoretical need for additional beds, a specific bed need/availability

   relationship is identified, which correlates with specific current and prospective utilization thresholds. Section 5.11(21)(e)1., (f), (g), Fla. Admin. Code. Normally, if both thresholds are satisfied, "need" is indicated and the application approved. If either threshold is not met, thus indicating "no need," HRS must decide whether, on balance, this failure is outweighed by favorable findings under other criteria made relevant by rule or statute. If so, approval is justified, or even required.

   
   

6. HRS describes this inquiry as one of determining whether there are unusual, or extenuating and mitigating circumstances in a case which would justify approving an application, notwithstanding failure to satisfy the formulae.

   
   

7. In the instant case, the applicable utilization thresholds are that average current utilization rate in the sub-district must exceed 85 percent, and any additional beds must not cause the prospective utilization rate in the sub- district to drop below 80 percent. Section 10-5.11(f), (g), Fla. Admin. Code. [Respondent's Ex. 1.] According to the June, 1984 HRS Semiannual Census Report, the nursing home bed utilization rate for Okaloosa County was 97.1 percent from October, 1983 through March, 1984. More recent nursing home data filed with HRS, on a quarterly basis, indicates a current utilization rate of 96.5 percent. Thus, using either data base, the 85 percent current utilization threshold is satisfied--a conclusion agreed to by both parties.

   
   

8. The prospective utilization threshold, however, permits additional beds only to the point at which further beds would drop the sub-district prospective utilization rate below 80 percent. HILL-GUTHRIE, using the HRS Semiannual Census Report, the number of existing and approved beds in the sub-district, and the projected elderly population, concludes that the sub-district (Okaloosa County) could be allowed an additional 16 beds before the prospective utilization falls below 80 percent. HRS, using the quarterly census data, finds need for an additional 13 beds. As conceded by the HRS expert--the 3-bed difference is insignificant. More importantly, as both parties agree, the granting of HILL-GUTHRIE'S 60-bed application would drop the projected utilization rate below the required 80 percent. (A nursing home of less than 60 beds is not considered financially feasible.) Thus, the formulae indicate "no- need" for the proposed 60-bed nursing home. The inquiry, then, must turn to whether failure to satisfy the formulae is, on balance, outweighed by other rule or statutory criteria, or extenuating and mitigating circumstances unique to this case.

   
   

   III.

   
   

   APPLICATION OF OTHER STATUTORY AND RULE CRITERIA

   
   

9. The HRS bed-need formulae are useful tools to evaluate CON applications: they are objective, abstract, and can be applied with ease; they enhance consistency, uniformity, and predictability of decision. But these formulae are rudimentary, inexact tools which, though useful, are incomplete. They do not take into account numerous criteria which, by statute and rule, also apply to CON applications. For instance, they do not take into account, in any direct and meaningful way, factors such as financial feasibility, accessibility, quality of care, efficiency, and impact on cost of care. See, Section 10- 5.11(3), (5), (6), and (2)(b), Fla. Admin. Code; Section 381.494(6)(c)1., 2., 9., and 12., Fla. Stat. (1983). It is the measurement of HILL-GUTHRIE'S application by these criteria which is at issue here.

10. The power of HRS to find that failure to satisfy the formulae is outweighed, or overridden, by other factors is not at issue. HRS has, in the past, granted numerous CON's (despite failure to satisfy the formulae) based on favorable findings under other criteria, such as accessibility. Petitioner's Ex.`s 3, 5, 7, 53. Without a bona fide evidentiary basis, agencies cannot treat similarly situated applicants in an inconsistent manner. 2/

    
    

    A.

    
    

    Accessibility of Existing Nursing Homes To Niceville Area Residents

    
    

11. Currently, four nursing homes providing a total of 355 beds--are located in Okaloosa County (the relevant sub-district). The majority of these beds (295) are found in three of the nursing homes located in the more heavily populated and faster growing coastal area of the county. The remaining beds

    (60) are located in a nursing home in Crestview, a city north of Niceville, in the central part of the county. This nursing home has an additional 60 beds which have been under renovation for a considerable time. HRS has no projected completion date for this renovation. The date of completion is, apparently, a matter within the sole discretion of the nursing home and its contractors.

    
    

12. The Crestview nursing home primarily serves residents of the northern and central portion of Okaloosa County. Since it is the northernmost nursing home in the county, it also receives patients from South Alabama.

    
    

13. Existing nursing homes in the county have a high rate of utilization. Occupancy rates in the four existing nursing homes average 97.1 percent for the six month period ending March, 1984; 96.5 percent for the six months ending June, 1984. Recent data compiled by the Local Health Council indicate a 98.8 percent utilization rate for the nine months preceding hearing. Nursing home occupancy rates in adjoining counties approach 95 percent, no doubt contributing to the high rate of utilization in Okaloosa County

    
    

14. Some nursing homes have lengthy waiting lists. 3/ One patient, although ninth on the waiting list, has waited 3 years for placement in the Westwood Nursing Home, located in the coastal part of the county. The Crestview nursing home has a waiting list of more than 60 persons, making it unlikely

    that-- even after the renovations are completed--further beds will be available.

    
    

15. It is reasonably anticipated that the recently enacted Medicare hospital reimbursement system, based on diagnostic-related guidelines (DRG's), will increase the demand for nursing home beds, thereby aggravating the shortage. With Medicare hospital payments tied to the diagnosis of illness, rather than the length of patient stay, hospitals will have increased economic incentives to discharge patient earlier. Some local hospitals have had to retain patients, who no longer require acute care, because nursing home beds are unavailable.

    
    

16. At Crestview Community Hospital, hospital patients have had to wait or face delays of from one week to 63 days during the period from May to August, 1984. During that time period, 43 patients were eligible for nursing home placement. Eleven spent a combined total of 271 hospital days awaiting placement. Three of the 11 were eventually discharged, but (at time of hearing) were still awaiting placement. At Twin Cities Hospital, in Niceville, two or three patients (at time of hearing) required but could not obtain nursing home

    placement. In August, 1984, five patients were ready for early discharge, but could not be placed in nursing homes because of crowded conditions. In May, 1984, three Twin Cities Hospital patients were placed in a Panama City nursing home, over one and one half hours travel time from Niceville, because of crowded local conditions. Local physicians have had similar difficulties finding nursing home placements during the past year. Robert S. Ellis, M.D., a Niceville physician, could not obtain prompt nursing home placement for from eight to ten of his patients. They faced waits ranging from ten days to two months. Many of his patients were finally placed in nursing homes outside the county; recently, he had no choice but to place a patient in a Gulf Breeze nursing home, approximately 50 miles away. He has never been successful in placing a patient in the Crestview nursing home, primarily because Crestview residents are given priority consideration. His experience is shared by other local physicians.

    
    

17. Existing nursing homes in the county are a considerable distance from Niceville. Given the existing road system and traffic conditions in the coastal area, it has become increasingly burdensome for Niceville residents to visit their friends and relatives in coastal nursing homes. Frequent visits and contacts with friends and relatives is recognized as beneficial to nursing home residents. It is important that residents maintain their ties to the community, and their relationships with friends and relatives outside the nursing home.

    For Niceville residents, it takes 20-30 minutes to drive to nursing homes located in the coastal area, 45 minutes to drive to the Crestview nursing home.

    
    

18. This burden, which affects nursing home residents as well as their families and friends, is real and significant. It is established not only by the testimony of area physicians, hospital administrators, and Niceville residents, but it is convincingly corroborated by the testimony of three Niceville city council members, and by petitions signed by over 480 elderly citizens in the Niceville area. [Public Ex.'s 1-3].

    
    

19. The HRS bed-need formulae do not take geographic accessibility of existing nursing homes into account, and no minimum access/travel time has been established by rule. Before adoption of the bed-need formulae, HRS had relied on a 30-minute standard set by the Local Health Council. A health care expert who, in 1982, conducted the HRS public hearing on the HILL- GUTHRIE application concluded that access times (for Niceville area residents) to existing nursing homes bordered on or exceeded this ad hoc 30-minute standard. HRS has not established, by competent evidence, a travel/access standard for use in this proceeding.

    
    

20. More importantly, HRS concedes that initial denial of the HILL-GUTHRIE application is due, in large part, to the delay in completing renovations to the Crestview nursing home which, when complete, will provide an additional 60 beds. [Transcript, p. 232]. As conceded by HRS's expert and sole witness, if the 60 renovated beds were available, they would "probably be well utilized." [Transcript, p. 232]. (Given the lengthy witness list, it is likely that, within a short time, the additional 60 beds would be filled.) The expert further concluded that, should the 60 beds be filled, the bed-need formulae would indicate need" and--provided other standards were met--HRS would be able to approve the HILL-GUTHRIE application. [Transcript, p. 234].

    B.

    
    

    Financial Feasibility

    of the Proposed Nursing Home

    
    

21. The proposed nursing home is financially feasible, both in the short and long-term. The revised total cost of the nursing home is 51,780,000, which is reasonable, given the nature and size of the project. It will be 100 percent financed through the issuance of industrial revenue bonds at an interest rate of

    14 percent over 30 years. The assets of the parent company, First American Corporation, would be available, if needed, to help construct and operate the nursing home.

    
    

22. Projected utilization of the nursing home during the first year will be 81 percent Medicaid, 5 percent Medicare, and 14 percent private pay. [Petitioner's Ex. 2]. Occupancy is projected to reach 97 percent by the fifth month of operation, and would be supported, in part, by increased demand for nursing home beds resulting from implementation of DRG's. These projections are based on HILL-GUTHRIE's experience in northwest Florida, and are accepted as reasonable.

    
    

23. Pro forma statements for the first and second years of operation show a net operating profit, beginning in the ninth month, and continuing through the second year. For overall operations during the first year, a net loss of

    $40,082 is projected; in the second year, a net gain of $122,200 is projected. [Petitioner's Ex. 2]. These projections--together with equipment and construction costs, staffing patterns and personnel budget, square footage and space requirements--are accepted as reasonable, and have not been refuted by HRS. If approved, HILL-GUTHRIE's proposed nursing home should be constructed and available for occupancy by the end of 1985.

    
    

    C.

    
    

    Impact (of the Proposed Nursing Home) On Cost of Health Care, and Efficiency and Utilization of

    Existing Nursing Homes

    
    

24. Construction of the proposed nursing home should help relieve the existing financial burden on hospital acute care patients who, because of lack of available nursing home beds, must remain in hospitals, where daily charges far exceed those of nursing homes. Similarly, hospitals would less likely have to absorb the cost of Medicare patients (beyond DRG payment limits) because nursing home beds were unavailable. Hospitals, with their highly specialized staffs, could be used more efficiently, in that patients not requiring acute medical care would not be retained in acute care beds.

    
    

25. The proposed nursing home, if constructed, should not adversely impact existing nursing homes in the county. With present occupancy rates in excess of

    95 percent, with waiting lists and increasing demand for nursing home beds, no significant drop in occupancy rates should occur.

    
    

26. The only evidence HRS presented on possible adverse impact was a conditional statement made by its health care expert:

    
    

    If there were a surplus of beds, nursing homes might be forced to increase the rates to their

    private `pay' patients . . . they may have to try to cover their expenses. (e.s.)

    
    

    [Transcript, p. 186].

    
    

    The evidence, however, indicates that there will not be a surplus of beds. Furthermore, at hearing, no opposition to the proposed nursing home was offered by any existing nursing home in the county.

    
    

    D.

    
    

    Balancing the Factors

    
    

27. On balance, HILL-GUTHRIE's failure to satisfy all aspects of the bed- need formulae is outweighed by favorable findings made under other criteria equally applicable by rule and statute. In particular, nursing homes in the county are overcrowded, and--without the proposed facility--most likely will continue to be so. There are no nursing homes in Niceville and it is a significant hardship for Niceville residents to visit their friends and relatives in existing nursing homes. Such visits are a positive benefit to nursing home residents. Construction of the proposed nursing home would reduce costs now imposed on hospitals and their patients due to lack of available nursing home beds, and would not adversely impact the occupancy rates of existing nursing homes.

    
    

    CONCLUSIONS OF LAW

    
    

28. The Division of Administrative Hearings has jurisdiction over the parties and subject matter of this proceeding. Section 120.57(1), Fla. Stat. (1983).

    
    

29. Section 120.57(1) proceedings, such as this, are de novo proceedings intended to formulate final agency action, not to review prior action or action taken preliminarily. McDonald v. Dept. of Banking and Finance, 346 So.2d 569 (Fla. 1st DCA 1977). The applicant has the burden of proving entitlement to a license. Fla. Dept. of Transportation v. JWC Company, Inc., 396 So.2d 778 (Fla. 1st DCA 1981). A CON is a license within the meaning of Section 120.52(1), Florida Statutes.

    
    

30. The parties have stipulated that all statutory criteria have been met by the applicant except those criteria contained in Subsections 381.494(6)(c)1., 2., 9., and 12., which provide as follows:

    
    

    1. The need for the health care facilities and services and hospices being proposed in relation to the applicable district plan of state health plan adopted pursuant to Title XI of the Public Health Service Act, except in emergency circumstances which pose a threat to the public health.

    2. The availability, quality of care, effi- ciency, appropriateness, accessibility, extent of utilization, and adequacy of like and existing health care services and hospices in the applicant's health service area.

9. The immediate and long-term financial feasibility of the proposal.

12. The probable impact of the proposed pro- ject on the cost of providing health ser- vices 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 renova- tions and the financing and delivery of health services which foster competition and serve as to promote quality assurance and cost effectiveness.

The corresponding rules, which implement these statutory provisions, are found in Rules 10-5.11(3), (5), (6), and (12)(a), Florida Administrative Code.

An additional criterion is imposed by Rule 10-5.11(21), which contains the nursing home bed-need formulae.

1. In determining whether to grant or deny a CON, HRS must consider the application in the context of all relevant statutory and rule criteria. Even though HRS, by rule, impliedly accords great weight to the nursing home bed-need formulae, this is but one criterion among many. Failure to satisfy the formulae must be balanced against findings made under other criteria of rule and statute. As already mentioned, the formulae do not take into account several of the factors. See, Dept. of Health and Rehabilitative Services v. Johnson and Johnson, 447 So.2d 361, 363 (Fla. 1st DCA 1984). By its past decisions, HRS has recognized that consideration of other factors--outside of the formulae--may justify granting a CON, despite failure to satisfy the bed-need formulae.

   
   

2. Indeed, HRS authority to grant a CON despite failure to satisfy the formulae has been used to uphold the rule against attack. In a recent administrative challenge of the nursing home formulae, the petitioner argued that the bed-need formulae were invalid because they focused undue attention on a single statutory criterion, to the exclusion of others. In upholding the rule, the hearing officer pointed to language in the rule referencing other statutory and rule criteria; and to language stating that the bed-need formulae are used "in addition" to other statutory and rule criteria. She also noted that the rule used the term "normally" with respect to disapproval if the formulae are not satisfied. The hearing officer concluded:

   
   

   In short, contrary to the intentions of the challengers, the [bed-need] rule does not preclude the consideration of special cir- cumstances or other mandated standards or criteria for review for Certificate of Need applications for nursing home facilities.

   
   

   Health Care and Retirement Corporation of America, et al., v. Dept. of Health and Rehabilitative Services, DOAH Case No. 83- 2260R, entered February 3, 1984.

   
   

3. In the instant case, HILL-GUTHRIE has sustained its burden and proved its entitlement to a CON. When considered in light of the criteria contained in Section 381.494(6)(c), Florida Statutes, and Rule 10-5.11(3), (5), (6), (12)(a), and (21), it is concluded that the CON application should be granted. Failure to satisfy the bed-need formulae of Rule 10-5.11(21) is outweighed by favorable

findings made under other criteria equally applicable by rule and statute. Or, when placed in phraseology preferred by HRS, it is concluded that mitigating and extenuating circumstances are sufficient to justify issuance of the CON. The proposed 60-bed nursing home in Niceville is "needed" within the meaning of the statute. Existing nursing homes are overcrowded, and, in large part, geographically inaccessible to residents in the Niceville area. Without the proposed nursing home, the existing burden placed on hospitals, acute care patients, and persons seeking nursing home placement, together with nursing home residents and their families and friends who wish to visit, will only worsen.

The proposed nursing home is financially feasible, and will not adversely impact the occupancy rates or charges of existing nursing homes in the area. HILL- GUTHRIE has shown, by convincing evidence, that travel times and distances imposed on Niceville area residents who wish to visit their friends and relatives in existing nursing homes are unreasonable and burdensome. If HRS has a countervailing travel/time standard which refutes this conclusion, it has not been adopted by rule. Neither has it been articulated, nor its factual premises proved and subjected to scrutiny in this proceeding. These are the unavoidable costs an agency incurs when formulating policy through adjudication. See, McDonald v. Dept. of Banking and Finance, supra; Anheuser-Busch, Inc. v. Dept. of Business Regulation, 393 So.2d 1177 (Fla. 1st DCA 1981); Barker v. Board of Medical Examiners, 428 So.2d 720 (Fla. 1st DCA 1983).

RECOMMENDATION

Based on the foregoing, it is RECOMMENDED:

That HILL-GUTHRIE's application for a CON to build and operate a 60-bed nursing home in Niceville, Florida, be granted.

DONE and ORDERED this 16th day of January, 1985, in Tallahassee, Florida.

R.L. CALEEN, JR. Hearing Officer

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 16th day of January, 1985

ENDNOTES

1/ See, Department of Health and Rehabilitative Services v. Johnson and Johnson Home Health Care, Inc., 447 So.2d 361 (Fla. 1st DCA 1984).

2/ C.f. Amos v. Department of Health and Rehabilitative Services, 444 So.2d 43 (Fla. 1st DCA 1983); Section 120.68(12)(d), Fla. Stat. (1983).

3/ The HRS bed-need formulae do not take waiting lists into account.

COPIES FURNISHED:

Louise Jeroslow, Esquire

318 N. Calhoun St. Tallahassee, Florida 32301

F. Philip Blank, Esquire

241 E. Virginia St. Tallahassee, Florida 32301

Docket for Case No: 83-000610

Orders for Case No: 83-000610