STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

MEDICAL CENTER HOSPITAL (LARGO), )

)

Petitioner, )

)

vs. )

)

DEPARTMENT OF HEALTH AND )

REHABILITATIVE SERVICES, ) CASE NO. 84-2618

)

Respondent, )

and )

) METROPOLITAN GENERAL HOSPITAL, )

)

Applicant. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, K. N. Ayers, held a public hearing in the above- styled case on April 15, 1985, at Clearwater, Florida.

APPEARANCES

For Petitioner: Thomas M. Beason, Esquire

The Perkins House, Suite 100

118 North Gadsden Street Tallahassee, Florida 32301

For Respondent: David Gauldin, Esquire

Department of Health and Rehabilitative Services

1323 Winewood Boulevard

Tallahassee, Florida 32301

For Metro Charles Luckie, Jr., Esquire General: Post Office Drawer 1047

Dade City, Florida 34297-1047

By Petition for Formal Proceedings dated July 13, 1984, Medical Center Hospital, Petitioner, contests the issuance to Metropolitan General Hospital, Applicant, by the Department of Health and Rehabilitative Services (DHRS), Respondent, of Certificate of Need No. 2570 to authorize the establishment of an adult cardiac catheterization laboratory at that facility. Petitioner has standing to contest the issuance of this certificate of need.

At the hearing Applicant submitted the information upon which DHRS granted the certificate of need, and rested. This evidence consisted of Exhibits 1

through 5. Thereafter, DHRS called one witness, Petitioner called four witnesses, Applicant called two witnesses, and 17 additional exhibits were admitted into evidence.

In the Prehearing Stipulation submitted by the parties Petitioner contends that the application of Metropolitan General is inconsistent with statutory provisions 381.494(6)(c)1, 2, 3, 4, 5, 6, 7, 8, 9, and 12 and 381.494(6)(d)1, 2,

and 3, Florida Statutes; however, the brunt of the evidence submitted is that under the need methodology established by DHRS in Rule 1O-5.11(15)(a), Florida Administrative Code, no need can be shown for the proposed facility. Evidence that an adverse economic impact of the proposed unit on the cardiac catheterization laboratory operated by Petitioner will result if the application is granted was also presented and was unrebutted. No evidence was presented to show the facility proposed by the Applicant would do more than reduce the profitability of the Petitioner unless it raised charges for other services provided. Accordingly, the findings and conclusions herewith submitted are limited to the need for the cardiac catheterization laboratory for which Metropolitan General Hospital is seeking a certificate of need.

Proposed findings have been submitted by the parties. To the extent those findings are included herein, they are adopted; otherwise, they are rejected as not supported by the evidence, are based upon assumptions differing from those used herein, or are immaterial, cumulative, or unnecessary to the conclusions reached.

FINDINGS OF FACT

1. The initial application for a CON to operate an adult cardiac catheterization laboratory by Metropolitan General Hospital was denied by DHRS in the State Agency Action Report dated June 28, 1983 (Exhibit 2). This denial was based upon a projected use of 2,704 cardiac catheterization procedures in 1985 and four cardiac catheterization facilities in operation in District V, the service area which comprises Pinellas and Pasco Counties. The need methodology rule provides that an additional cardiac catheterization laboratory will not be approved if it reduces the average volume of procedures per lab performed in the district below 600 adult procedures based on the projected need in the service area. With a projected need of 2,704, an additional cardiac catheterization lab would reduce the average below the 600 figure.

   
   

2. The four hospitals which have approved cardiac catheterization facilities in this district are: All Children's, Medical Center, Morton F. Plant, and St. Anthony's. All Children's is a pediatric hospital adjacent to Bayfront Medical Center Hospital. All Children's is authorized a pediatric cath lab in which adult patients are treated. Most of these patients come from Bayfront and the cardiac cath procedures are done on an out-patient basis. The number of cardiac cath procedures being performed at All Children's Hospital has increased every year since 1980 and the increase has been due primarily to the increase in the number of adult cardiac cath procedures performed. Adult procedures at this lab outnumber children's cardiac cath procedures by approximately three to one. In 1983, 536 adult cardiac cath procedures were performed at All Children' s Hospital.

   
   

3. St. Anthony's Hospital has a cardiac cath lab in which 301, 327, and

   300 adult cardiac caths were performed in the years 1981, 1982, and 1983, respectively. In Medical Center Hospital's cardiac cath unit more than 900 cardiac caths were performed in 1984 and the number has increased annually since the lab was installed.

4. In disapproving Metropolitan General's application DHRS counted All Children's cardiac cath lab as an adult cardiac cath lab. When it was pointed out that All Children's cardiac cath lab is approved as a pediatric cardiac cath lab and that is the only cardiac cath lab at All Children's Hospital, DHRS recounted the number of existing cardiac cath labs in the district, did not include the cardiac cath lab at All Children's, found that a need for a total of four units exists in this district, and approved the CON for Metropolitan General. Medical Center protested and this hearing followed.

   
   

5. Prior to the granting of this CON to Metropolitan General for a cardiac cath lab, correspondence between DHRS and Morton F. Plant Hospital culminated in DHRS advising Morton F. Plant that it could establish a second cardiac cath lab without going through the CON process if the total cost of the project did not exceed $695,285 (Exhibit 20). Pursuant to this "authorization" Morton F. Plant is proceeding to equip and operate a second cardiac cath lab.

   
   

6. In awarding the CON to Metropolitan General, this "second" cardiac cath lab at Morton F. Plant was not counted by DHRS. Counting two labs at Morton F. Plant and not counting All Children's lab' leaves four adult cardiac cath labs in the district.

   
   

7. DHRS' witnesses testified that an inspection of the facility at All Children's Hospital revealed only one cardiac cath lab. Because this hospital is a pediatric hospital, because the cardiac cath lab was "grandfathered in" without having to go through the CON process, and because the hospital administrators stated that priority would be given to children over adults in the cardiac cath lab, DHRS concluded not to count All Children's as having an adult cardiac cath lab.

   
   

8. Metropolitan General Hospital is an osteopathic hospital. David Dietrick, D.O., is a cardiologist on the staff of Metropolitan General and of Medical Center. He presently performs 125-150 cardiac cath procedures per year and all are now performed at Medical Center Hospital. If a CON to operate a cardiac cath lab is granted to Metropolitan General, Dietrick will move all of the cardiac cath procedures he now does at Medical Center to Metropolitan General. The procedures performed by Dr. Dietrick at Medical Center represent about four percent of the hospital's 350 million gross revenues per year.

   
   

9. Medical Center recently completed renovation of its cardiac cath lab and the installation of the latest state of the art equipment. This lab is located in the vicinity of the radiology department in which equipment is provided to do angiographic procedures. These procedures are similar to cardiac cath procedures but are done in the arms, legs, abdomen, etc., rather than in the heart. Because of the similarity of equipment and procedures and the heavy demand for cardiac cath procedures at Medical Center Hospital, the early appointments in the radiology lab are reserved for cardiac cath procedures and on average one such procedure per day is performed in the radiology lab. A total of 926 cardiac cath procedures were performed at Medical Center in 1984. If the current rate for 1985 of 90 per month continues throughout the year, a total of almost 1,100 cardiac cath procedures will be performed at Medical Center Hospital in calendar 1985.

   
   

   CONCLUSIONS OF LAW

   
   

10. The Division of Administrative Hearings has jurisdiction over the parties to, and the subject matter of, these proceedings.

11. Rule 1O-5.11(15)(1), Florida Administrative Code, provides the following formula shall be used to determine need for cardiac cath labs two years following application for authority. Nx = Uc + Px where Nx equals the number of cathe- terization procedures projected to be delivered in year X. Uc = 1981 use rate (number of procedures per 100,000 population) in the service area. Px projected population in the service area in year X. If we use 1987 for year x (two years from the hearing), take over all use rate for 1981 (from Exhibit 2) of 2.37, a forecast of 1987 population of 1,095,333 (from BEBR and Exhibit 16) and applying these figures to the formula, we have 1,095,333 x 2.37/1000 2595 procedures projected in District V in 1987. Adding a fifth adult cardiac cath lab would reduce the average procedures per lab to below 600.

    
    

12. Not including in the number of existing labs a cardiac cath lab in which over 500 adult procedures have been performed annually for the past two years, yet including the number of cardiac caths performed in that unit to determine use rate from which projected cardiac caths are determined appears more inconsistent than including in this count of labs a proposed lab for which no CON is required or has been applied for. Yet that is the posture in which this case is presented for decision.

    
    

13. Morton F. Plant's proposed second cardiac cath lab is being counted as an existing or approved cardiac cath lab although there is no requirement the lab become operational within a specified time or the right to operate such a second lab will be lost, which would happen if a CON to operate the lab had been granted. Such a situation creates an uncertainty upon which sound health care planning cannot be based.

    
    

14. On the other hand the fact is undisputed that at All Children's Hospital a significant number of cardiac caths are performed on adults. In fact, adult cardiac caths performed there outnumber children's cardiac caths three to one. If such a facility is not counted in determining whether additional cardiac cath labs are needed in the district, an excess number of labs may be approved which will redound, in the long run, to the detriment of all. It is further noted that the adult cardiac caths performed at All Children's Hospital exceed the cardiac caths performed at St. Anthony's Hospital by more than 50 percent, yet St. Anthony's cardiac cath lab is counted as an adult cardiac cath lab bat All Children's is not. Although but one cardiac cath lab exists at All Children's, no valid reason has been presented for not counting this as an adult cardiac cath lab as well as a pediatric cardiac cath lab. Because other adult cardiac cath labs may not qualify as pediatric cardiac cath labs, it does not follow that the cardiac cath lab at All Children's is not, in fact, an adult cardiac cath lab.

    
    

15. Perhaps the error, if that it be, in not counting All Children's cardiac cath lab as an existing adult cardiac cath lab in this service area is offset by counting the ephemeral second cardiac cath lab at Morton F. Plant Hospital although no CON has been, or will be, issued to operate such a lab and there is no requirement placed upon Morton F. Plant to proceed in putting this lab into operation promptly or lose the right to operate a second cardiac cath lab.

    
    

16. Although DHRS in the Prehearing Stipulation supports granting the requested CON to Metropolitan General Hospital, the testimony of DHRS' witness is that, if the application came to him for review under the facts as disclosed at this hearing, he would recommend denial of the application.

17. From the foregoing it is concluded that Metropolitan General Hospital has failed to show, by a preponderance of the evidence, that a need exists for an additional adult cardiac catheterization laboratory in District V comprising Pasco and Pinellas Counties. It is

RECOMMENDED that Certificate of Need No. 2570 issued to Metropolitan General Hospital be rescinded.

ENTERED this 21st day of May, 1985, at Tallahassee, Florida.

K. N. AYERS 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 21st day of May, 1985.

COPIES FURNISHED:

Thomas M. Beason, Esquire MOYLE, JONES & FLANIGAN, P.A.

Suite 100, The Perkins House

118 North Gadsden Street Tallahassee, Florida 32301

Charles Luckie, Jr., Esquire Post Office Drawer 1047

Dade City, Florida 34297-1047

David Gauldin, Esquire Department of Health and

Rehabilitative Services 1323 Winewood Boulevard

Tallahassee, Florida 32301

David H. Pingree, Secretary Department of Health and

Rehabilitative Services 1321 Winewood Boulevard

Tallahassee, Florida 32301

Docket for Case No: 84-002618

Orders for Case No: 84-002618