STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
UNIVERSITY MEDICAL PARK )
OF TAMPA, LTD., )
)
Petitioner, )
)
vs. ) CASE NO. 84-0168
)
DEPARTMENT OF HEALTH AND )
REHABILITATIVE SERVICES, )
)
Respondent, )
and )
)
HUMANA OF FLORIDA, INC., )
d/b/a WOMEN'S HOSPITAL )
TAMPA; HILLSBOROUGH COUNTY )
HOSPITAL AUTHORITY d/b/a/ )
TAMPA GENERAL HOSPITAL )
and UNIVERSITY OF SOUTH )
FLORIDA, )
)
Intervenors. )
)
RECOMMENDED ORDER
Pursuant to notice, an administrative hearing was held before Stephen F. Dean, Hearing Officer with the Division of Administrative Hearings, from December 10 through 14, 1984, in Tampa, Florida.
This is an action under Section 120.57(I), Florida Statutes, to evaluate an application by University Medical Park, Ltd. (UMP), a Florida limited partnership, for a certificate of need (CON) to construct and operate a 130 bed acute care hospital providing obstetrical and gynecological services (OB and GYN, respectively), in Tampa, Hillsborough County, Florida. Florida's Department of Health and Rehabilitative Services (DHRS) denied the application. UMP filed a timely request for a de novo administrative hearing. The Department requested the Division of Administrative Hearings to conduct the formal hearing.
The Hillsborough County Hospital Authority d/b/a Tampa General Hospital (TGH), the University of South Florida (USF), and Humana of Florida, Inc. d/b/a Women's Hospital Tampa (Humana), have intervened in opposition to UMP's application. TGH is a large, nonprofit, full service hospital in Tampa. USF is a member institution of the state's university system which has as one of its schools a medical school. Humana is a private, for-profit corporation operating a women's specialty hospital in Tampa. The parties stipulated that TGH and Humana have standing to intervene and this order finds USF has standing.
The hearing in this action was conducted in Tampa on December 10-14, 1984.
All parties were represented by counsel.
APPEARANCES
For Petitioner: John W. Puffer, III, Esquire
James B. Murphy, Jr., Esquire Shackleford, Farrior, Stallings & Evans, Professional Association Post office Box 3324
Tampa, Florida 33601
For Respondent Douglas L. Mannheimer, Esquire DHRS: Culpepper, Turner & Mannheimer
Shine-Ferrell House
318 North Calhoun Street Post office Drawer 11300
Tallahassee, Florida 32302-3300
For Intervenor John H. French, Esquire Humana of Florida, James C. Hauser, Esquire Inc.d/b/a Women's Messers, Rhodes & Vickers Hospital,Tampa: 701 Lewis State Bank Bldg.
Post office Box 1876 Tallahassee, Florida 32302
For Intervenor John Radey, Esquire Hillsborough County Holland and Knight
Hospital Authority 315 Calhoun Street, Suite 600 d/b/a Tampa General Post Office Drawer 810 Hospital: Tallahassee, Florida 32302
and
Julia S. Chapman, Esquire Holland and Knight
600 North Florida Avenue Post office Box 1288 Tampa, Florida 33601
For Intervenor Steven D. Merryday, Esquire University of and Joseph H. Varner, III, Esq. South Florida Glenn, Rasmussen, Fogarty & Merryday
Tampa City Center, Suite 3100
201 North Franklin Street Post 0ffice Box 3333 Tampa, Florida 33601
At the final hearing, various witnesses testified and Petitioner's Exhibit Nos. Composite 1, 2, 3, Composite 4, 5, 9, 10, 11, 12, 13, 14, Composite 15, 16,
Composite 17A, Composite 23, 28, 29, 47, Composite 53, 58, DHRS's Exhibit Nos.
; Women's Exhibit Nos. 1 and 2, and Tampa General's Exhibit Nos. 1, 2,
Composite 5, 16, 18, 19 and Composite 20 were received into evidence.
The transcript of the final hearing was filed. References to the transcript will be denoted as (Tr. Vol. ). References to the exhibits will be indicated as (Party Ex. ).
ISSUE
The ultimate issue is whether the application of Petitioner, University Medical Park, for a certificate of need to construct a 130-bed acute care hospital in northern Hillsborough County, Florida should be approved.
The factual issues are whether a need exists for the proposed facility under the Department's need rule and, if not, are there any special circumstances which would demonstrate the reasonableness and appropriateness of the application notwithstanding lack of need.
The petitioner, while not agreeing with the methodology, conceded that under the DHRS rule as applied there is no need because there is an excess of acute care beds projected for 1989, the applicable planning horizon. The only real factual issue is whether there are any special circumstances which warrant issuance of a CON.
The parties filed post-hearing findings of fact and conclusions of law by March 18, 1985, which were read and considered. Many of those proposals are incorporated in the following findings. As indicated some were irrelevant, however, those not included on pertinent issues were rejected because the more credible evidence precluded the proposed finding.
Having heard the testimony and carefully considered the Proposed Findings of Fact, there is no evidence which would demonstrate the reasonableness and appropriateness of the application. It is recommended that the application be denied.
FINDINGS OF FACT
General
Petitioner is a limited partnership composed almost entirely of physicians, including obstetricians/gynecologists (OB/GYN) and specialists providing ancillary care, who practice in the metropolitan Tampa area. (Tr. Vol. 1, pp. 103-104).
Petitioner's managing general partner is Dr. Robert Withers, a doctor specializing in OB/GYN who has practiced in Hillsborough County for over thirty years. (Tr. Vol. 1, pp. 24- 26, 28-29.) Dr. Withers was a prime moving force in the founding, planning and development of University Community Hospital and Women's Hospital. (Tr. Vo1. 1, pp. 26-28, 73; Vol. 4, pp. 547-548.)
Petitioner seeks to construct in DHRS District VI a specialty "women's" hospital providing obstetrical and gynecological services at the corner of 30th Street and Fletcher Avenue in northern Hillsborough County and having 130 acute care beds. 1/ (Tr. Vol. 1, pp. 34, 74-75, Vol. 5, pp. 678-679, Northside Ex.-1, pp. 1-2, Ex.-4A.) The proposed hospital is to have 60 obstetrical, 66 gynecological and 4 intensive care beds. (Tr. Vol. 8, P. 1297, Northside Ex.-1 Table 17, Ex.-B.)
DHRS District VI is composed of Hardy, Highlands, Hillsborough, Manatee and Polk counties. Each county is designated a subdistrict by the Local Health Council of District VI. Pasco County, immediately north of Hillsborough, is located in DHRS District V and is divided into two subdistricts, east Pasco and west Pasco.
If built, Northside would be located in the immediate vicinity of University Community Hospital (UCH) in Tampa, Hillsborough County, Florida.
Less than 5 percent of the total surgical procedures at UCH are gynecologically related, and little or no nonsurgical gynecological procedures arc performed there. (Tr. Vol. 4, p. 550.) There is no obstetrical practice at UCH, although it has the capacity to handle obstetric emergencies.
The primary existing providers of obstetrical services to the metropolitan Tampa area are Tampa General Hospital (TGH) and Women's Hospital (Women's). (Tr. Vol. 1, p. 79, Northside Ex.-4, Tr. Vol. 7, pp. 1074-1075.)
TGH is a large public hospital located on Davis Islands near downtown Tampa. (Tr. Vol. 1, pp. 47-48, Vol. 8, pp. 1356, 1358.) TGH currently has a 35 bed obstetrical unit, but is currently expanding to 70 beds as part of a major renovation and expansion program scheduled for completion in late 1985. (Tr. Vol. 7, pp. 1049, 1095, Vol. 8, pp. 1367-1368, Vol. 10, P. 1674, Northside Ex.- 2, P. 3.) In recent years, the overwhelming majority of Tampa General's admissions in obstetrics at TGH have been indigent patients. (Tr. Vol. 1, P. 61, Vol. 8, pp. 1375- 1379; Vol. 9, P. 1451; TGH Ex.-3.)
Tampa General's internal records reflect that it had approximately 2,100 patient days of gynecological care compared with over 38,000 patient days in combined obstetrical care during a recent eleven month period. (TGH Ex.-3..)
Women's is a 192 bed "specialty" hospital located in the west central portion of the City of Tampa near Tampa Stadium. (Tr. Vol. 1, pp. 63-64, 66-67; Vol. 10 P. 1564; Northside Ex.-4.) Women's Hospital serves primarily private-pay female patients. (Vol. 1, pp. 79, 88-89; Vol. 6, pp. 892-893.)
Humana Brandon Hospital, which has a 16 bed obstetrics unit, and South Florida Baptist Hospital in Plant City, which has 12 obstetric beds, served eastern Hillsborough County. (Tr. Vol. 7, P. 1075; Northside Ex.-2, P. 3; Northside Ex.-4 and Tr. Vol. 1, P. 79; Northside Ex.-4.)
There are two hospitals in eastern Pasco County, which is in DHRS District V. Humana Hospital, Pasco and East Pasco Medical Center, each of which has a six bed obstetric unit. Both hospitals are currently located in Dade City, but the East Pasco Medical Center will soon move to Zephyrhills and expand its obstetrics unit to nine beds. (Tr. Vol. 1, pp. 108- 109; Tr. Vol. 7, P. 1075; Vol. 8, pp. 1278-1281; Northside Ex.-4.)
There are no hospitals in central Pasco County, DHRS District V. Residents of that area currently travel south to greater Tampa, or, to a lesser extent, go to Dade City for their medical services. (Tr. Vol. 2, pp. 266-267, 271-272; Vol. 7, p. 1038.)
Bed Need
There are currently 6,564 existing and CON approved acute care beds in DHRS District VI, compared with an overall bed need of 5,718 acute care beds.
An excess of 846 beds exist in District VI in 1989, the year which is the planning horizon use by DHRS in determining bed need applicable to this application. (Tr. Vol. 7, pp. 1046-1047, 1163, 1165-66; DHRS Ex.-1.) There is a net need for five acute care beds in DHRS District V according to the Department's methodology. (Tr. Yolk. 7, pp. 1066, 1165; DHRS Ex.-1.)
The figures for District VI include Carrollwood Community Hospital which is an osteopathic facility which does not provide obstetrical services. (Tr. Vol. 1, P. 158; Vol. 7, p. 1138; Vol. 8, P. 1291.) However, these osteopathic beds are considered as meeting the total bed need when computing a11 opathic bed need.
DHRS has not formally adopted the subdistrict designations of allocations as part of its rules. (Tr. Vol. 7, pp. 1017-1017, 1019; Vol. 8, pp. 1176, 1187.) Consideration of the adoption of subdistricts by the Local Health Council is irrelevant to this application. 2/
Areas of Consideration in Addition to Bed Need
Availability
Availability is deemed the number of beds available. As set forth above, there is an excess of beds. (Nelson, Tr. Vol. VII, P. 1192.)
Tampa General Hospital and Humana Women's Hospital offer all of the OB related services which UMP proposes to offer in its application. These and a number of other hospitals to include UCH, offer all of the GYN related services proposed by Northside. University Community Hospital is located 300 yards away from the proposed site of Northside. UCH is fully equipped to perform virtually any kind of GYN/OB procedure. Humana and UCH take indigent patients only on an emergency basis, as would the proposed facility. GYN/OB services are accessible to all residents of Hillsborough County regardless of their ability to pay for such services at TGH. (Williams, Tr. Vol. IX, P. 1469; Baehr, Tr. Vol. X, P. 1596; Splitstone, Tr. Vol. IV, P. 582; Hyatt, TGH Exhibit 19, P. 21.)
Utilization
Utilization is impacted by the number of available beds and the number of days patients stay in the hospital. According to the most recent Local Health Council hospital utilization statistics, the acute care occupancy rate for 14 acute care hospitals in Hillsborough County for the most recent six months was 65 percent. This occupancy rate is based on licensed beds and does not include CON approved beds which are not yet on line. This occupancy rate is substantially below the optimal occupancies determined by DHRS in the Rule. (DHRS Exhibit 4; Contis, Tr. Vol. VII, P. 1069.)
Utilization of obstetric beds is higher than general acute care beds; however, the rules do not differentiate between general and obstetric beds. 3/ Five Hillsborough County hospitals, Humana Women's, St. Joseph's, Tampa General, Humana Brandon, and South Florida Baptist, offer obstetric services. The most recent Local Health Council utilization reports indicate that overall OB occupancy for these facilities was 82 percent for the past 6 months. However, these computations do not include the 35 C0N-approved beds which will soon be available at Tampa General Hospital. (DHRS Exhibit 4).
There will be a substantial excess of acute care beds to include OB beds in Hillsborough County for the foreseeable future. (Baehr, Tr.w Vol. X, pp. 1568, 1594, 1597.) The substantial excess of beds projected will result in lower utilization.
In addition to excess beds, utilization is lowered by shorter hospital stays by patients. The nationwide average length of stay has been reduced by almost two days for Medicare patients and one day for all other patients due to a variety of contributing circumstances. (Nelson, Tr. Vol. VII, P. 1192; Contis, Tr. Vol. VII, P. 1102; Baehr, Tr. Vol. X, pp. 1583-84; etc.)
This dramatic decline in length of hospital stay is the result of many influences, the most prominent among which are: (1) a change in Medicare reimbursement to a system which rewards prompt discharges of patients and penalizes overutilization ("DGRs"), (2) the adaptation by private payers (insurance companies, etc.) of Medicare type reimbursement, (3) the growing availability and acceptance of alternatives to hospitalization such as ambulatory surgical centers, labor/delivery/recovery suites, etc. and (4) the growing popularity of health care insurance/delivery mechanisms such as health maintenance organizations ("HMOs"), preferred provider organizations ("PPOs"), and similar entities which offer direct or indirect financial incentives for avoiding or reducing hospital utilization. The trend toward declining hospital utilization will continue. (Nelson, Tr. Vol. VII, pp. 1192-98; Baehr, Tr. Vol. X, pp. 1584-86; etc.)
There has been a significant and progressive decrease in hospital stays for obstetrics over the last five years. During this time, a typical average length of stay has been reduced from three days to two and, in some instances, one day. In addition, there is a growing trend towards facilities (such as LDRs) which provide obstetrics on virtually an outpatient basis. (Williams, Tr. Vol. IX, P. 1456; Hyatt, Tr. Vol. IV, P. 644.)
The average length of stay for GYN procedures is also decreasing. In addition, high percentage of GYN procedures are now being performed on an outpatient, as opposed to inpatient, basis. (Hyatt, Tr. Vol. IV, P. 644, etc.)
The reduction in hospital stays and excess of acute care beds will lower utilization of acute care hospitals, including their OB components, enough to offset the projected population growth in Hillsborough County. The hospitals in District VI will not achieve the optimal occupancy rates for acute care beds or OB beds in particular by 1989. The 130 additional beds proposed by UMP would lower utilization further. (Paragraphs 7, 14, and 18 above; DHRS Exhibit 1, Humana Exhibit 1.)
Geographic Accessibility
Ninety percent of the population of Hillsborough County is within 30 minutes of an acute care hospital offering, at least, OB emergency services. TGH 20, overlay 6, shows that essentially all persons living in Hillsborough County are within 30 minutes normal driving time not only to an existing, acute care hospital, but a hospital offering OB services.
Petitioner's service area is alleged to include central Pasco County. Although Pasco County is in District V, to the extent the proposed facility might serve central Pasco County, from a planning standpoint it is preferable to have that population in central Paso served by expansion of facilities closer to them. Hospitals in Tampa will become increasingly less accessible with increases in traffic volume over the years.
The proposed location of the UMP hospital is across the street from an existing acute care hospital, University Community Hospital ("UCH"). (Splitstone, Tr. Vol. IV, P. 542.) Geographic accessibility is the same to the proposed UMP hospital and UCH. (Smith, Tr. Vol. III, P. 350; Wentzel, Tr. Vol. IV, p. 486; Peters, Tr. Vol. IX, P. 1532.)
UCH provides gynecological services but does not provide obstetrical services. However, UCH is capable of delivering babies in emergencies. (Splitstone, Tr. Vol. IV, p. 563.) The gynecological services and OB capabilities at UCH are located at essentially the same location as Northside's proposed site. Geographic accessibility of OB/GYN services is not enhanced by UMP's proposed 66 medical-surgical beds. The accessibility of acute care beds, which under the rule are all that is considered, is essentially the same for UCH as for the proposed facility.
As to geographic accessibility, the residents of Hillsborough and Pasco Counties now have reasonable access to acute care services, including OB services. The UMP project would not increase accessibility to these services by any significant decrease.
C. Economic Accessibility
Petitioner offered no competent, credible evidence that it would expand services to underserved portions of the community. Demographer Smith did not study income levels or socioeconomic data for the UMP service area. (Smith, TR. Vol. III, pp. 388, 389.) However, Mr. Margolis testified that 24 percent of Tampa General's OB patients, at least 90 percent of who are indigents, came from the UMP service area. (Margolis, Tr. Vol. X, P. 1695.)
The patients proposed to be served at the Northside Hospital are not different than those already served in the community. (Withers, Tr. Vol. II, P. 344.) As a result, Northside Hospital would not increase the number of underserved patients.
Availability of Health Care Alternative
An increasing number of GYN procedures are being performed by hospitals on an outpatient basis and in freestanding ambulatory-surgical centers. An ambulatory-surgical center is already in operation at a location which is near the proposed UMP site. In fact, Dr. Hyatt, a UMP general partner, currently performs GYN procedures at that surgical center. (Withers, Tr. Vol. I, P. 150; Hyatt, Tr. Vol. IV, pp. 644, 646. Ambulatory surgical centers, birthing centers and similar alternative delivery systems offer alternatives to the proposed facility. Existing hospitals are moving to supply such alternatives which, with the excess beds and lower utilization, arc more than adequate to preclude the need for the UMP proposal. (Nelson, Tr. Vol. VII, P. 1204, 1205, 1206; Williams, Tr. Vol. IX, pp. 1453, 1469; Contis, Tr. Vol. VII, pp. 1154; Contis, Tr. Vol. VII, pp. 1151, 1154.)
Need for Special Equipment & Services
DHRS does not consider obstetrics or gynecology to be "special services" for purposes of Section 381.494(6)(c)6, Florida Statutes. In addition, the services proposed by UMP are already available in Hillsborough and Pasco Counties. (Nelson, Tr. Vol. VII, pp. 1162, 1210.)
Need for Research & Educational Facilities
USF currently uses Tampa General as a training facility for its OB residents. TCH offered evidence that the new OB facilities being constructed at Tampa General were designed with assistance from USF and were funded by the Florida Legislature, in part, as an educational facility. (Powers, Tr. Vol. IX, P. 1391; Williams, Tr. Vol. IX, pp. 1453-1455.)
The educational objectives of USF for OB residents at Tampa General are undermined by a disproportionately high indigent load. Residents need a cross section of patients. The UMP project will further detract from a well rounded OB residency program at Tampa General by causing Tampa General's OB Patient mix to remain unbalanced. (Williams, Tr. Vol. IX, P. 1458; Margolis, Tr. Vol. X, P. 1695.)
UMP offered no evidence of arrangements to further medical research or educational needs in the community. (Nelson, Tr. Vol. VII, P. 1213.
UMP's proposed facility will not contribute to research and education in District VI.
Availability of Resources
Management
UMP will not manage its hospital. It has not secured a management contract nor entered into any type of arrangement to insure that its proposed facility will be managed by knowledgeable and competent personnel. (Withers, Tr. Vol. I, p. 142.) However, there is no alleged or demonstrated shortage of management personnel available.
Availability of Funds For Capital and Operating Expenditures
The matter of capital funding was a "de novo issue," i.e., evidence was presented which was in addition to different from its application. In its application, Northside stated that its project will be funded through 100 percent debt. Its principal general partner, Dr. Withers, states that this "figure is not correct." However, neither Dr. Withers nor any other Northside witness ever identified the percentage of the project, if any, which is to be funded through equity contributions except the property upon which it would be located. (UMP Exhibit 1, p. 26; Withers, Tr. Vol. I, P. 134.)
The UMP application contained a letter from Landmark Bank of Tampa which indicates an interest on the part of that institution in providing funding to Northside in the event that its application is approved. This one and one half year year old letter falls short of a binding commitment on the part of Landmark Bank to lend UMP the necessary funds to complete and operate its project and is stale. Dr. Withers admitted that Northside had no firm commitment as of the date of the hearing to finance its facility, or any commitment to provide 1196 financing as stated in its application. (UMP Exhibit I/Exhibit Dr. Withers, Tr. Vol. I, P. 138.)
Contribution to Education
No evidence was introduced to support the assertion in the application of teaching research interaction between UMP and USF. USF presented evidence that no such interaction would occur. (Tr. Vol. IX, P. 1329.) The duplication
of services and competition for patients and staff created by UMP's facility would adversely impact the health professional training programs of USF, the state's primary representative of health professional training programs in District VI. (Tr. Vol. IX, pp. 1314-19; 1322-24; 1331-1336.)
Financial Feasibility
The pro forma statement of income and expenses for the first two years of operation (1987 and 1988) contained in the UMP application projects a small operating loss during the first year and a substantial profit by the end of the second year. These pro formas are predicated on the assumption that the facility will achieve a utilization rate of 61 percent in Year 1 and 78 percent in its second year. To achieve these projected utilization levels, Northside would have to capture a market share of 75-80 percent of all OB patient days and over 75% of all GYN patient days generated by females in its service area. (UMP, Exhibit 1; Withers, Tr. Vol. I, P. 145, Dacus; Tr. Vol. V, P. 750-755.)
These projected market shares and resulting utilization levels are very optimistic. It is unlikely that Northside could achieve these market shares simply by making its services available to the public. More reasonable utilization assumptions for purposes of projecting financial feasibility would be 40-50 percent during the first year and 65 percent in the second year. (Margolis, Tr. Vol. X, P. 1700; Baehr, Tr. Vol. X, pp. 1578, 1579, 1601.)
UMP omitted the cost of the land on which its facility is to be constructed from its total project cost and thus understates the income necessary to sustain its project. Dr. Withers stated the purchase price of this land was approximately $1.5 million and it has a current market value in excess of $5 million. (Withers, Tr. Vol. I, pp. 139, 140.)
Dr. Withers admitted that the purchase price of the land would be included in formulating patient charges. As a matter of DHRS interpretation, the cost of land should be included as part of the capital cost of the project even if donated or leased and, as such, should be added into the pro formas. UMP's financial expert, Barbara Turner, testified that she would normally include land costs in determining financial feasibility of a project, otherwise total project costs would be understated (Withers, Tr. Vol. I, P. 141; Nelson, Tr. Vol. VII, pp. 1215, 1216; Turner, Tr. Vol. X, P. 1714.)
In addition, the pro formas failed to include any amount for management expenses associated with the new facility. Dr. Withers admitted UMP does not intend to manage Northside and he anticipates that the management fee would be considerably higher than the $75,000 in administrator salaries included in the application. (Withers, Tr. Vol. I, pp. 143, 144.)
Barbara Turner, UMP's financial expert, conceded that the reasonableness of the percent UMP pro formas is predicated on the reasonableness of its projected market share and concomitant utilization assumptions. These projections are rejected as being inconsistent with evidence presented by more credible witnesses.
The UMP project, as stated in its application or as presented at hearing, is not financially feasible on the assumption Petitioner projected.
VIII.
Impact on Existing Facilities
Approval of the UMP application would result in a harmful impact on the costs of providing OB/GYN services at existing facilities. The new facility would be utilized by patients who would otherwise utilize existing facilities, hospitals would be serving fewer patients than they are now. This would necessarily increase capital and operating costs on a per patient basis which, in turn, would necessitate increases in patient charges. (Nelson, Tr. Vol. VII, pp. 1217-1219; Baehr, Tr. Vol. X, P. 1587.)
Existing facilities are operating below optimal occupancy levels. See DHRS Exhibit 4.
The Northside project would have an adverse financial impact on Humana, Tampa General Hospital, and other facilities regardless of whether Northside actually makes a profit. See next subheading below.
The Northside project would draw away a substantial number of potential private-pay patients from TGH. Residents of the proposed Northside service area constitute approximately 24 percent of the total number of OB patients served by TGH. The Northside project poses a threat to TGH's plans to increase its non- indigent OB patient mix which is the key to its plans to provide a quality, competitive OB service to the residents of Hillsborough County. (Nelson, Tr. Vol. VIII, P. 1225; Margolis, Tr. Vol. X, P. 1695.)
Impact Upon Costs and Competition
Competition via a new entrant in a health care market can be good or bad in terms of both the costs and the quality of care rendered, depending on the existing availability of competition in that market at the time.
Competition has a positive effect when the market is not being adequately or efficiently served. In a situation where adequate and efficient service exists, competition can have an adverse impact on costs and on quality because a new facility is simply adding expense to the system without a concomitant benefit. (Baehr, Tr. Vol. X, p. 1650.)
Competition among hospitals in Hillsborough County is now "intense and accelerating." (Splitstone, Tr. Vol. IV, p. 558.)
Tampa General is at a competitive disadvantage because of its indigent case load and its inability to offer equity interests to physicians in its hospital. (Blair, Tr.
Vol. VI, pp. 945, 947-948); Powers, Tr. Vol. IX, P. 1405.)
Tampa General Hospital is intensifying its marketing effort, a physician office building under construction now at Tampa General is an illustration of Tampa General's effort to compete for private physicians and patients. (Powers, Tr. Vol. IX, pp. 1405-1406.) The whole thrust of Tampa General's construction program is to increase its ability to compete for physicians. (Nelson, Tr. Vol. VII, P. 1224; Powers, Tr. Vol. IX, p. 1442.) The Tampa General construction will create new competition for physicians and patients. (Contis, Tr. Vol. VII, p. 1099.)
Patients go to hospitals where their doctors practice, therefore, hospitals generally compete for physicians. (Splitstone, Tr. Vol. IV, P. 563; Blair, Tr. Vol. VI, pp. 898, 928.) Because many of the UMP partners are obstetricians who plan to use Northside exclusively, approval of the Northside project would lessen competition. (Popp, TGH Exhibit 18, P. 11.)
It is feasible for Tampa General to attract more private pay OB patients. (Williams, Tr. Vol. IX, pp. 1460- 1461.) At its recently opened rehabilitation center, Tampa General has attracted more private pay patients. (Powers, Tr. Vol. IX, pp. 1393-1396.) USF OB residents at Tampa General are planning to practice at Tampa General. (Williams, Tr. Vol. IX, pp. 1460-1461.) The state-of-the-art labor, delivery, recovery room to be used at Tampa General will be an attractive alternative to OB patients. (Williams, Tr. Vol. IX, pp. 1460- 1461); Popp, TGH Exhibit 18, p.26)
IX. Capital Expenditure Proposals
The proposed Northside hospital will not offer any service not now available in Tampa. (Hyatt, TGH Exhibit 19, p. 21).
CONCLUSIONS OF LAW
The Division of Administrative Hearings enters this order pursuant to the provisions of Section 120.57(1), Florida Statutes. DHRS has authority to issue or deny certificates of need pursuant to Section 381.493, et seq., the "Health Facilities and Health Services Planning Act."
Intervention of USF
The standing of the intervenor USF remains among the legal issues to be determined. Petitioner's CON application A for a certificate of need is assessed under criteria set forth in Sections 381.494(6)(c), Florida Statutes. An entity whose "substantial interests will be affected by proposed agency action" has standing to intervene in an administrative hearing. See Sections 120.52(11)(b), Florida Statutes. To satisfy the "substantial interests" requirement, persons seeking intervention must allege an "injury in fact" that is in the "zone of interests" protected by the proceeding. See, Arrrico Chemical Company V. Department of Environmental Regulation, 406 So.2d 478 (Fla. 2d DCA 1981).
USF has alleged that construction of UMP's facility would substantially interfere with USF's statutory duty to construct and operate fully accredited schools of medicine and nursing. USF has alleged the necessary injury in fact.
Dr. Denis Cavanagh's uncontroverted testimony establishes that construction of UMP's facility would deprive the USF's Cancer Center of patients, unnecessarily duplicate services offered to the Cancer Center, increase the demand for and deprive the Cancer Center of skilled professionals, and adversely impact the financial feasibility of the Cancer Center. These types of injury confer standing. See, University Community Hospital v. HRS, 6 FALR 3223 (April 23, 1984); Humana, Inc.d/b/a Kendall Community Hospital V. HRS, FALR 1782-A (July 11, 1983); Collier Medical Center, Inc.V. HRS, 5 FALR 2069-A (August 26, 1983) aff'd, 10 Fla. Law Weekly 133, 462 So.2d 83 (1st DCA 1985);
Suncoast/ Metropolitan General Hospital V. Hills, 5 FALR 2160 (August 15, 1983); Medfield Corporation d/b/a Seven Rivers Community Hospital V. HRS,5 FALR 1955-A (August 1, 1983). As the holder of a CON with plans to complete its facility in 1985, USF has standing to intervene in this proceeding. See, Suncoast/Metropolitan General Hospital V. HRS. 5 FALR 2160 (August 15, 1983).
Dr. Denis Cavanagh's testimony establishes that construction of UMP's facility would interfere in the development of USF's ability to educate and train medical and nursing students at the Cancer Center. The interference with the development or operating of USF's schools of medicine and nursing by the proposed project is an injury within the zone of interests protected by the CON statute. USF has standing to intervene in this proceeding.
2. Petitioner's CON Application
Petitioner's CON application is assessed under criteria set out in Section 381.494(6)(c), Florida Statutes and which states Rule 10-5.11(23), Florida Administrative Code, the manner in which need for additional acute beds is determined for each DHRS district in the State.
As determined prior to final hearing in an order dated November 8, 1984, it must be concluded that:
Rule 10-5.11(23), Florida Administrative Code, is applicable to UMP's application for a certificate of need even though no final sub-districts have been adopted by rule. See, Humana V. DHRS, 6 FALR 1776 (Final Order, 1983).
Rule 10-5.11(23), Florida Administrative Code, contains the exclusive and controlling numerical bed need methodology applicable in this proceeding and evidence of any other numerical bed need methodologies or formulas is not relevant in this proceeding. Turro V. DHRS, 458 So.2d 345 (Fla 1st DCA 1984).
Regardless of numerical bed need calculated under Rule 10-5.11(23), Florida Administrative Code, applicants for a certificate of need are allowed to present evidence of extraordinary circumstances that could show need, in accordance with Rule 10-5.11(23), Florida Administrative Code, and Section 381.494(6)(c), Florida Statutes.
The uniform methodology set forth in Rule A 10-5.11(23) is not the subject of challenge here. In addition, osteopathic beds are included in determining whether allopathic bed need is met. The legislature has adopted a statute, which has been strictly construed by the courts, requiring separate consideration of osteopathic facilities when determining need and availability of medical facilities in an area. Section 381.494(2), Florida Statutes (Supp. 1984); see Gulf Coast Hospital V. Department of Health and Rehabilitative Services, 424 So.2d 86 (Fla. 1st DCA 1982); Rainbow Community Hospital, Inc.v. Department of Health and Rehabilitative Services, 453 So.2d 1200 (Fla. 1st DCA 1984).
The facts reveal there are 846 more acute care beds in DHRS District VI than are projected to be needed in l989. There is no need for additional acute care beds, to include OB/GYN beds, in District VI under methodology of Rule 10-5.11(23), Florida Administrative Code.
3. Consideration of Special Circumstances
Despite the lack of need under Rule 10-5.11(23), Florida Administrative Code, DHRS may issue a certificate of need under special or extraordinary circumstances "when the criteria, other than bed need, as provided
in Section 381.494(6)(c), Florida Statutes, demonstrate need." Rule 10- 5.11(23)(b), Florida Administrative Code. While DHRS will not "normally" approve an application in the absence of demonstrated bed need under the rule methodology, extraordinary or special circumstances such as research or service to underserved groups, may justify a CON. UMP has attempted to demonstrate several "extraordinary circumstances" which would justify the project in spite of a lack of numeric bed need.
Accessibility
UMP has suggested that existing hospitals are inaccessible. As to geographic accessibility, DHRS has a standard requiring that "acute care hospital beds should be available and accessible within an automobile travel time of 30 minutes under average travel conditions to at least 90 percent of the population in an urban area subdistrict." See Rule 10-5.11(23)(i)(1), Florida Administrative Code. No credible evidence was offered which showed that there was a lack of geographic accessibility now or in the future. Northside would be no more accessible than the University Community Hospital which is located in the same area as the proposed site and which has available and accessible acute care hospital beds and offers GYN care and emergency obstetrical service.
If accessibility of OB services is considered alone, Northside would not provide additional accessibility. The evidence did not establish that less than 90 percent of the population was within 30 minutes average travel time to an existing acute care facility providing OB service. No geographical accessibility problem exists for OB services.
Service to the Underserved
Another special consideration is whether Northside would extend UMP'S proposed service to medically underserved and indigent patients. UMP's proposed project would adversely affect the available services to underserved (indigent) groups. UMP proposes to serve only a negligible number of indigents, but would pull private pay patients from TGH. This increases the cost of services at TGH adversely impacting service by TGH to the entire community.
4. Financing
The applicant has not adduced sufficient proof of the availability of capital and commitment of operating resources as required by Rule 10-5.11(23), Florida Administrative Code.
5. Contribution to Education
There was no proof the proposed hospital would enhance education and clinical training. There was evidence the proposed project would adversely impact programs at the USF medical school.
6. Financial Feasibility
The UMP project, as stated in its application or as presented at hearing, is not financially feasible at the rate projected. In order to achieve even financial feasibility, UMP would have to substantially increase its charges to levels which are comparable to, if not greater than, charges for existing providers at a similar point in time. There is no economic advantage to the project.
7. Competition
Competition for private pay patients will be enhanced by these changes and Northside's entrance into the market will hurt TGH's efforts. TGH's continued ability to handle indigent patients is dependent upon TGH's attracting more private pay patients. Northside will not handle significant numbers of indigent patients but will compete for private pay patients. Assuming indigent cases will be a continuing community health care cost, placing the burden solely on TGH will ultimately have an adverse impact on community medical cost.
The unfunded costs of indigent cases which Tampa General now shifts to private pay patients by increasing private pay charges to reflect costs of serving indigents will increase if private pay patients decrease. Other hospitals can increase their charges but hold their charges under TGH's. An increase in charges at Tampa General cause the community medical costs to increase by a multiple of the Tampa General increase. These increases by other hospitals have little relationship to increases in costs of service. (Powers, Tr. Vol. IX, pp. 1385- 1386, 1428.) An improved patient mix at Tampa General with more private pay patients is important for the entire community. UMP would take private pay patients away.
UMP has suggested that its proposed hospital will enhance competition and thus warrant its approval. The evidence suggests that there is an excess of beds and strong competition for patients. Under these circumstances, it is more likely that NS would add to health care costs.
8. Capital Expenditure Proposals
This requirement is only applicable when the applicant proposes to provide a new service. Northside does not propose providing any new service.
9. Conclusions
UMP bears the burden to prove its entitlement to a CON. UMP failed to show a need for added acute care beds. UMP also failed to demonstrate that any of the exceptional factors are present to such a decree that additional acute care beds, to include OB beds, are warranted. Based upon the evidence presented, UMP's proposal is a potentially harmful and unnecessary duplication of existing facilities and services. The CON requested by UMP is not supported by the facts presented.
Petitioner having failed to prove the need for additional acute care beds to include OB beds or some special circumstance which would warrant approval of the proposed project, it is recommended that its application for a CON be DENIED.
DONE and ORDERED this 25th day of June, 1985, in Tallahassee, Florida
STEPHEN F. DEAN
Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32399-1550
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 25th day of June, 1985.
ENDNOTES
1/ DHRS includes obstetrics and gynecological beds within she generic classification of acute care services in applying Rule 10-5.11(23), Florida Administrative Code, to determine bed need. (Tr. Vol. 7, pp. 1159-1160.) The Rule quantifies district-wide need for acute care beds based on a DHRS service district. (Tr. Vol. 7, P. 1160.)
2/ Petitioner's proposed findings in paragraphs 20-25 are rejected as being irrelevant and because the more credible evidence supports the findings in Respondent's proposed findings in paragraphs 9-18 which are presented as alternative findings in Annex A. If deemed relevant Annex A should become the findings of fact, paragraph 16a-j.
3/ Consideration of the availability of OB/GYN services alone is contrary to the interpretation of DHRS of Rule 10-5.11(23)(i) to preclude service specific (0B/GYN as opposed to acute care generally) accessibility considerations. (Nelson, Tr. Vol. VII, p. 1269.)
4/ If the subdistrict portion of the Rule were applied, there would be 40 excess obstetrical beds in Hillsborough County in the year 1989.
COPIES FURNISHED:
John W. Puffer, III, Esquire James B. Murphy, Jr., Esquire Shackleford, Farrior, Stallings &
Evans, Professional Association Post Office Box 3324
Tampa, Florida 33601
Douglas L. Mannheimer, Esquire Culpepper, Turner & Mannheimer Shine-Ferrell House
318 North Calhoun Street Post Office Drawer 11300
Tallahassee, Florida 32302-3300
John H. French, Esquire James C. Hauser, Esquire Messers, Rhodes & Vickers 701 Lewis State Bank Bldg. Post Office Box 1876 Tallahassee, Florida 32302
John Radey, Esquire Holland and Knight
315 Calhoun Street, Ste. 600 Post Office Drawer 810 Tallahassee, Florida 32302
Julia S. Chapman, Esquire Holland and Knight
600 North Florida Avenue Post Office Box 1288 Tampa, Florida 33601
Steven D. Merryday, Esquire
and Joseph H. Varner, III, Esquire Glenn, Rasmussen, Fogarty
& Merryday
Tampa City Center, Ste. 3100
201 North Franklin Street Post Office Box 3333 Tampa, Florida 33601
David Pingree, Secretary Department of Health and Rehabilitative Services 1323 Winewood Blvd.
Tallahassee, Florida 32301
ANNEX A - ALTERNATIVE FINDINGS
Local Health Plan
16a. Each DHRS service district has a Local Health Council comprised of health care providers, health care purchasers, and nongovernmental health care consumers. Each local health council is charged with the responsibility of developing a local health plan which reflects the health needs of that district. Sections 381.493(p) and 38l.494(7)(b)1, Florida Statutes. (Nelson, Tr. Vol.
VII, pp. 1173-1174)
16b. DHRS is required by Section 381.494(6)(c)1, Florida Statutes, to utilize appropriate elements of local health plans in reviewing applications for certificates of need. Section 381.494(8)(a), (c) also mandate review based in accordance with A the local health plan. DHRS interprets these statutory mandates to require the consideration of a relevant locally-adopted health plan even though such plan has not yet been adopted as rule under Section 381.494(7)(b)1, Florida Statutes. (Nelson, Tr. Vol. VII, P. 1188)
16c. Local health councils subdivide their respective districts in accordance with DHRS guidelines. Each of the five counties comprising District VI (Hardee, Highlands, Hillsborough, Manatee, and Polk) were designated as subdistricts by the District Local Health Council two years ago. (Contis, Vol. VII, pp. 1013, 1022)
16d. These subdistricts were designated by utilizing DHRS guidelines and by taking into account localized factors such as patient utilization patterns, etc. The Local Health Council made a policy decision that the utilization of the counties in District VI as its respective subdistricts was the most rational way to begin to plan for acute care services in the District. These subdistrict designations have been adopted as a part of the District VI Local Health Plan and have been accepted and approved by DHRS. (Contis, Tr. Vol. VII, pp. 1032, 1036; Nelson, Tr. Vol. VII, P. 1175)
16e. Rule 10-5.11(23) authorizes each local health council to allocate the district bed need produced by the Rule among its respective subdistricts. The Local Health Council for District VI has developed a methodology for making such allocations among its five subdistricts. This methodology is based on a formula driven by historic utilization rates for each subdistrict; i.e., the allocation of beds to a given subdistrict is predicated on that subdistrict's historic utilization as a percentage of utilization in the district as a whole. (Contis, Tr. Vol. VII, pp. 1052-59)
16f. Application of the Local Health Council methodology to the DHRS bed allocation for District VI pursuant to the Rule, reduced by the number of licensed and CON-approved beds, in each subdistrict, indicates that Hillsborough County will have an excess of 745 acute care beds in 1989. Forty of these excess beds will be obstetrical beds. DHRS has accepted the Local Health Council allocations for its subdistricts. (Contis, Tr. Vol. VII, P. 1060, 1067; Nelson, Tr. Vol. VII, P. 1175; DHRS Exhibits 2 and 3)
16g. Although District VI is the only relevant service district in terms of the applicability of the Rule, UMP's proposed service area includes portions of Pasco County located in DHRS's District V. DHRS computation of bed need for District V per the Rule indicates a net need for only five medical/surgical beds. (DHRS Exhibit 1; Nelson Tr. Vol. VII, p. 1165)
16h. The Local Health Council for District V has designated East Pasco County as a subdistrict. That Council's methodology for allocating district need among its subdistricts is identical to the methodology utilized by the District VI Council. The product of that methodology indicates that the East Pasco County subdivision will have an excess of 21 medical/surgical beds and a need for one OB bed in 1989. (DHRS Exhibits 1, 5; Contis Tr. Vol. VII, P. 1065)
16i. The District VI Local Health Council determined in its Local Health Plan that acute care facilities in its Hillsborough County subdistrict are accessible to at least 90 percent of the population of the subdistrict within the requisite thirty minutes' drive. This determination is predicated on studies performed by the Local Health Council staff as well as the personal knowledge of members of the Council. (Contis, Tr. Vol. VII, pp. 1081; Nelson, Vol. VII, pp. 1180, 1183) The Local Health Plan therefore indicates that Hillsborough County does not fall into either of the exceptions contained in Rule 10-5.11(23)(i) in that acute care services are, in fact, available to 90 percent of the population within 30 minutes driving time and the subdistrict is substantially overbedded according to the Local Health Council allocation of the district bed need. As such, the Rule precludes the consideration of bed need on a subdistrict basis in the instant proceeding. (Nelson, Tr. Vol. VII, pp. 1172, 1178, 1183)
16j. The UMP application is not consistent with the applicable Local Health Plan because the Plan indicates a substantial surplus of both medical/surgical and obstetric beds in DHRS District VI and in Hillsborough County will exist in 1989.
================================================================= AGENCY FINAL ORDER
=================================================================
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
UNIVERSITY MEDICAL PARK OF TAMPA, LTD.,
Petitioner,
vs. CASE NO. 84-0168
CON NO. 2669
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES,
Respondent,
and
HUMANA OF FLORIDA, INC., d/b/a WOMEN'S HOSPITAL TAMPA; HILLSBOROUGH COUNTY HOSPITAL AUTHORITY d/b/a TAMPA GENERAL HOSPITAL, and UNIVERSITY OF SOUTH FLORIDA,
Intervenors.
/
FINAL ORDER
This cause came on before me for the purpose of issuing a final agency order. The hearing officer assigned by the Division of Administrative Hearings (DOAH) in the above-styled cause submitted a Recommended Order to the Department of Health and Rehabilitative Services (HRS). A copy of that Recommended Order is attached hereto as Exhibit A. Exceptions were filed by Respondent, Department of Health and Rehabilitative Services, and by Petitioner, University Medical Park of Tampa, LTD.
RULING ON EXCEPTIONS
Acute care beds located in osteopathic facilities are appropriately considered when computing acute care bed need. This inclusion is not contrary to the provisions of Section 381.494(2) Florida Statutes (1984 Supplement) which does not talk about beds at all. Likewise, Gulf Coast Hospital v. Department of Health and Rehabilitative Services 424 So2d 85 (Florida 1st DCA, 1982) only directs that "the needs of osteopaths and their patients for osteopathic facilities be recognized as a factor in the certification process" id at 93.
The "special circumstances" referred to in University Community Hospital v. Department of Health and Rehabilitative Services, No. 84-965, 10 F.L.W. 1318 (Florida 2nd DCA May 22, 1985) were that the recipients of the Certificate of Need (CON) proposed to serve a percentage of patients from Latin America. These patients would not be considered in the need methodology which is based upon
Florida population projections and so beds awarded to serve them should not be included in the inventory for purposes of computing need. Northside's 1st, 22nd and 23 exceptions are denied. HRS' exception 2nd and 3rd are granted.
Section 381.494(6)(c)(1) and 381.494(8)(a) and (c) Florida Statutes mandate review based in accordance with the local health plan. The alternative facts of Annex A, paragraph 16a-j are proven under the record and relevant to these proceedings. HRS' exception 1 is granted. Northside's 2nd exception is denied.
There is no discrepancy between finding 6 which states University Medical Park of Tampa, Ltd. has no obstetrical practice at UCH and finding 18 which states UCH offers gynecological related services. There is competent substantial evidence to support the finding of fact at paragraph 18. Northside's 3rd exception is denied.
There is competent substantial evidence to support the finding of fact at paragraph 20. The reference in footnote 3 is to show that the rules do not differentiate between general and obstetric beds. If Northside wishes to attack the acute care bed inventory, it should do so by requesting the agency to change the inventory, and if it is substantially affected by the agency decision, request a 120.57 hearing contesting the agency decision. Northside's 4th exception is denied.
Paragraphs 21, 22, 23, 24, 25 and 26 are based upon competent substantial evidence. Northside's 5th exception is denied.
The fact that geographic inaccessibility may have existed in the past for some types of services in some areas does not mean that all of the conditions warranting grants would warrant a grant in this case. There is competent substantial evidence supporting the finding of fact at paragraphs 27-
31 of the recommended order. Physician referrals are often motivated by considerations other than access. Northside's 6th exception is denied.
By inclusion of the finding of fact at paragraph 32, third sentence, the hearing officer has ruled on admissibility which was resolved at hearing. The finding is consistent with Northside's assertion that 90 percent of all of Tampa General's OB patients were indigent. Northside's 7th exception is denied.
The finding of fact at paragraph 33 is based upon competent substantial evidence. Northside's 8th exception is denied.
The finding of fact at paragraph 34 is based upon competent substantial evidence. Northside's 9th exception is denied.
Paragraphs 35, 37, 40, are based upon competent substantial evidence. Northside's 10th, 11th and 12th exceptions are denied.
Paragraphs 41 and 42 of the recommended order are based upon competent substantial evidence and Northside's 13th and 14th exceptions are denied.
Paragraphs 41 and 42 of the recommended order are based upon competent substantial evidence and Northside's 13th and 14th exceptions are denied.
Paragraph 43, second sentence is based upon competent substantial evidence. Northside's 15th exception is denied.
Northside, as the applicant, has the burden of proving that it meets all statutory and rule criteria and is entitled to a CON. See Florida Department of Transportation v. J.W.C. Company, Inc. 396 So2d 778 (Florida 1st DCA 1981). The findings of fact at paragraphs 44-52 of the recommended order are based upon competent substantial evidence. Rule 10.5.11(23) F.A.C. requires that the department consider applications for acute care hospitals beds in context with all applicable statutory and rule criteria. Northside's 16, 26 and
28 exceptions are denied.
The hearing officer has addressed competition in paragraphs 57-62. There is competent substantial evidence to support the findings of fact at paragraph 53-56 of the recommended order. Northside's 17th exceptions is denied.
The findings of fact at paragraph 57-61 of the recommended order are based upon competent substantial evidence. The effects of competition have been addressed. Northside's 18th and 29th exceptions are denied.
USF has standing to intervene in the proceedings. Northside's 19th and 27th exceptions are denied.
Rule 10-5.11.23 is applicable to this proceeding. Northside was not precluded from presenting evidence of extraordinary circumstances that could show need. A balanced consideration must include an examination of such circumstances. However, Northside did not prove the existence of extraordinary circumstances and Rule 10-5.11(23) is the exclusive numerical bed need methodology. Riverside's 20th and 21st exceptions are denied.
The accessibility standard of Rule 10.5.11(23)(i) must be considered, however, the record shows no accessibility problem or substantial subdistrict need. Rule 10-5.11(23)(i)(3). Northside failed to prove lack of geographic accessibility or lack of service accessibility to any traditionally undeserved group. Northside's 24th and 25th exceptions are denied.
Northside's 30th, 31st, 32nd, 33rd, and 34th exceptions are denied.
FINDINGS OF FACT
The findings of fact set forth in the recommended order are adopted and incorporated by reference as the findings of fact herein; except, for the reasons set forth in the conclusions of law, paragraph 16 of the findings of fact is specifically deleted and Annex A of the recommended order adopted and incorporated by reference as findings of fact paragraph 16a-j.
CONCLUSIONS OF LAW
Paragraphs 1, 2, 4, 5, 6, 7, 8, and 11-22 are adopted and incorporated by reference as the conclusions of law herein. Additionally, the following paragraph is added as paragraph 3 of the conclusions of law.
"3. Footnote 2 to paragraph 16 contained in the findings of fact in the recommended order states "If deemed relevant Annex A should become the findings of fact, paragraph 16a-j." Annex A is deemed relevant.
Paragraph 9 of the conclusions of law contained in the recommended order is modified to read:
"9. The uniform methodology set forth in Rule 10-5.11(23) is not the subject of challenge here. In addition, osteopathic beds are included in determining whether allopathic bed need is met. The legislature has adopted a statute, which has been strictly construed by the courts, requiring the need for osteopathic acute care hospitals to be determined on the basis of the need for, and availability of osteopathic services and acute care hospitals. Chapter 84-
544 Section 987 Special A Session Laws. See Gulf Coast Hospital v. Department of Health and Rehabilitative Services, 424 So.2d 86 (Fla. 1st DCA 1982); Rainbow Community Hospital, Inc. v. Department of Health and Rehabilitative Services, 453 So2d 1200 (Fla. 1st DCA 1984).
Paragraph 10 of the conclusions of law contained in the recommended order is adopted, however, footnote 4 to paragraph 10 of the conclusions of law contained in the recommended order is specifically deleted.
Based upon the foregoing, it is
ADJUDGED that the application of University Medical Park of Tampa, LTD. for a Certificate of Need 2669 to construct and Operate a 130-bed acute care hospital providing obstetrical and gynecological services is denied.
DONE and ORDERED this 1st day of November, 1985, in Tallahassee, Florida.
DAVID H. PINGREE
Secretary
A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF HRS, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES.
COPIES FURNISHED:
James W. Puffer, III, Esq. James B. Murphy, Jr., Esquire
Shackleford, Farrior, Stallings & Evans, P.A.
Post Office Box 3324 Tampa, Florida 33601
Douglas L. Mannheimer, Esquire Culpepper, Turner, & Mannheimer Shine-Ferrell House
318 North Calhoun Street Post Office Box 11300
Tallahassee, Florida 32302-3300
James H. French, Esquire James C. Hauser, Esquire Messers, Rhodes & Vickers 701 Lewis State Bldg.
Post Office Box 1876 Tallahassee, Florida 32302
John Radey, Esquire Holland & Knight
315 Calhoun Street, Ste. 600 Post Office Drawer 810 Tallahassee, Florida 32302
Julia S. Chapman, Esquire Holland & Knight
600 North Florida Avenue Post Office Box 1288 Tampa, Florida 33601
Steven D. Merryday, Esquire Joseph H. Varner, III, Esquire Glenn, Rasmussen, Fogarty
& Merryday
Tampa City Center, Suite 3100
201 North Franklin Street Post Office Box 3333 Tampa, Florida 33601
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a copy of the foregoing was sent to the above-named people by U.S. Mail, at 3:30 pm o'clock, this 5th day of November, 1985.
LESLEY MENDELSON, Agency Clerk Assistant General Counsel Department of Health and
Rehabilitative Services 1323 Winewood Blvd.
Building One, Suite 407 Tallahassee, Florida 32301 904/488-2381
| Issue Date | Proceedings |
|---|---|
| Feb. 09, 1987 | Final Order filed. |
| Jun. 25, 1985 | Recommended Order sent out. CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Nov. 01, 1985 | Agency Final Order | |
| Jun. 25, 1985 | Recommended Order | Petitioner didn't prove need for additional acute-care beds or any special circumstances which would warrant a Certificate of Need (CON). |
