STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
COMMUNITY PSYCHIATRIC )
CENTERS OF FLORIDA, INC., )
)
Petitioner, )
)
vs. ) CASE No. 84-2825
) STATE OF FLORIDA, DEPARTMENT ) OF HEALTH AND REHABILITATIVE ) SERVICES, )
)
Respondent. )
)
RECOMMENDED ORDER
Notice was given and a formal Section 120.57(1), Florida Statutes, hearing was held before Charles C. Adams, Hearing Officer with the Division of Administrative Hearings. The first date of hearing was January 17, 1985, in Jacksonville, Florida. A concluding session of the hearing was conducted on January 31, 1985, in Tallahassee, Florida. This recommended order is being entered following the receipt and review of the transcript and in consideration of proposed recommended orders filed by the parties. In some instances the proposed recommended orders have formed the basis of facts found in the recommended order. Otherwise, those proposals have been rejected based upon the determination that they lacked credibility, were cumulative or subordinate to other facts found or were not part of the record in the present case.
APPEARANCES
For Petitioner: John H. Parker, Jr., Esquire
Thomas D. Watry, Esquire
PARKER, HUDSON, RAINER, DOBSON, and KELLY
1200 Carnegie Building
133 Carnegie Way Atlanta, Georgia 30303
Morgan L. Staines, Esquire Senior Assistant General Counsel
Community Psychiatric Centers, Inc. 2204 East Fourth Street
Santa Ana, California 92705
For Respondent: Amy Jones, Esquire
Assistant General Counsel Department of Health and
Rehabilitative Services 1323 Winewood Boulevard
Building 1, Suite 406
Tallahassee, Florida 32301
ISSUES
The issues for consideration are related to the question of the entitlement of Petitioner, Community Psychiatric Centers of Florida, Inc., to be granted a certificate of need to construct a 45-bed addition, and gymnasium at the site of its present freestanding psychiatric hospital facility in Jacksonville, Florida which is known as CPC St. Johns River & Hospital. See Section 381.494, Florida Statutes, and Rule 10-5, Florida Administrative Code.
FINDINGS OF FACT BACKGROUND
By application dated March 9, 1984, Petitioner, Community Psychiatric Centers of Florida, Inc., requested that the State of Florida, Department of Health and Rehabilitative Services grant a certificate of need under authority of Section 381.494, Florida Statutes, which would allow the Petitioner to add 45 psychiatric beds to an existing psychiatric and substance abuse facility located in Jacksonville, Florida. That facility is known as CPC St. Johns River Hospital. The estimated cost of the expansion was one million five hundred ninety seven thousand five hundred dollars. The expansion would include the addition of 10 short-term child or pediatric psychiatric beds; 15 short-term adolescent psychiatric beds, and 20 long-term adolescent psychiatric beds.
Other significant features of the project included the construction of a gymnasium to be used by patients residing in the existing facility and those who would be treated in the new addition. A copy of the certificate of need application may be found as Petitioner's exhibit number 14 admitted into evidence.
A state agency action report was made by HRS and the findings of that report may be found in HRS exhibit number 1, a copy of the state agency action report. The date of that report is June 23, 1984, and it recommends the denial of the project. In turn, the Petitioner was notified of the denial by correspondence of June 25, 1984, a copy of which may be found as HRS exhibit number 2, admitted into evidence. Having been denied the certificate, Petitioner requested a formal Subsection 120.57(1) Florida Statutes hearing. That request was timely and the formal hearing was conducted as described before.
Charter Medical-Jacksonville, Inc., an applicant in a previous review cycle or batch, had attempted to intervene in this proceeding. That intervention was denied and the decision denying the intervention is pending appeal in the First District Court of Appeals.
Taking the application as made, the parties to this action have stipulated that all applicable criteria involved in the review process have been satisfied with the exception of the criteria set forth in Rule 10-5.11(25), Florida Administrative Code, pertaining to short-term psychiatric beds and Rule 10- 5.11(26) Florida Administrative Code, pertaining to long-term psychiatric beds.
In determining the question of the need for the additional beds sought here, Petitioner and Respondent have been afforded the opportunity to discuss the significance of the recommended award of certificates of need to applicants in a previous review cycle, namely Charter Medical-Jacksonville, Inc., and Atlantic Treatment Center, Inc., DOAH Case No. 83-335, and consolidated cases. This discussion is in terms of the number of beds that have been arguably
preempted by the recommended grant of certificates of need to those other applicants in the same service district where Petitioner operates and intends to expand its services. The hearing in the previous batch had been concluded prior to the hearing dates for the present case, and the recommended order in that previous cycle was entered on March 19, 1985. That recommendation was to the effect that Charter be granted a certificate of need for the construction of a 64-bed psychiatric hospital in Jacksonville, Florida, which included 8 short- term psychiatric beds for children; 16 short-term psychiatric beds for adolescents, and 40 long-term psychiatric beds for adolescents. Additionally, a recommendation was made that Atlantic Treatment Center be allowed to construct a 50-bed psychiatric and substance abuse hospital in Daytona Beach, Florida. That hospital would include 10 beds for short-term psychiatric care for children; 5 beds for long-term psychiatric care for children; 15 adolescent beds for short- term psychiatric services; 15 adolescent beds for long-term psychiatric services and five adolescent short-term substance abuse beds.
HRS District IV, includes Jacksonville Duval County, Florida, which is located in subdistrict 1, of HRS District IV. Other counties in subdistrict 1 are Nassau, Baker, and Clay. Subdistrict 2 of HRS District IV includes St. Johns and Flagler Counties. Finally, the third subdistrict of HRS District IV is Volusia County, which includes Daytona Beach, Florida.
PETITIONER'S SERVICES
Community Psychiatric Centers, has twenty-four operational psychiatric or chemical dependency hospitals, including St. Johns River in Jacksonville, Florida. St. Johns River Hospital is licensed as a specialty hospital by the State of Florida, with the speciality being that of psychiatry and substance abuse. The Jacksonville facility is JCAH accredited in the specialty areas of psychiatry and substance abuse.
In its existing facility in Jacksonville, Petitioner offers sixty-six short-term psychiatric beds of which thirty of those beds are for adolescent patients and thirty-six of the beds are for adults. The remaining thirty-three beds are for the benefit of substance abuse patients. Twenty-seven of the adolescent psychiatric beds are used for routine short-term psychiatric care and the remaining three beds are used for seclusion of adolescent patients who have been admitted and who temporarily require a more secure environment. The normal stay of patients in the seclusion rooms is measured in hours. The seclusion rooms differ from the other patient rooms in that they are without furnishings, with the exception of a special bed which is securely mounted to the floor. The bathroom in the seclusion rooms may only be used by the patient with supervision of staff and are kept locked at other times. Due to limitations in the design of the facility those three seclusion rooms may not be utilized in the same fashion as the remaining twenty-seven patient rooms devoted to short-term psychiatric care for the benefit of adolescents. In a similar vein, of the thirty-six short-term psychiatric beds for adults, two of those beds are devoted to seclusion or isolation. Again, those two beds may not be converted for use in the fashion that the remaining thirty- four beds are used, i.e., day-to-day housing of patients in the treatment program. This limitation is also based on design problems in the facility. The units for adults and adolescent patients in the facility are separate programmatically and physically. In essence, there is no mixing of the adult and adolescent populations.
Petitioner's exhibits 4 and 4a depict the design of the present facility and the appearance of that facility if a new addition were constructed in accordance with a certificate of need. The building at present is a single-
story building. With the advent of the grant of a certificate of need an additional single story wing which connects with the present structure would be added to house new patients. The proposed gymnasium would be used to accommodate existing patients and the additional patients. The project also contemplates associated recreational facilities. Within the new wing, the adolescent and child- patients would he separated. Each new unit has available educational and activity areas as well as the private and semi- private rooms. By way of support there are nursing stations, storage facilities and general offices.
In the course of the hearing, through Petitioner's exhibit number 12 admitted into evidence, Petitioner suggested that this project could still be feasible if the number of short-term adolescent beds was reduced from fifteen to five beds, giving a total of thirty-five beds with a projected cost of one million two hundred and eighteen thousand five hundred and thirty dollars. This amendment to the certificate, if allowed, could be accommodated by changing the design of the floor plan to shorten the reach of the wing, through the deletion of those ten short- term adolescent beds. In effect, the outer wall of the furtherest reaching extent of the L-shaped wing would be moved. In turn, the other units would be rearranged in view of this change. Although not specifically referred to in the way of a possible amendment, the Hospital Development Specialist for the Petitioner, John F. Mercer, indicated that as a second alternative the number of long-term adolescent psychiatric beds could be reduced by ten and still allow the project to be viable. These alternative suggestions were not within the stipulation of the parties pertaining to review criteria. Therefore, should these alternative plans fail to comply with other applicable criteria, in addition to the aforementioned specific criteria related to short-term and long-term psychiatric beds, in theory, these project alternatives could be denied on additional grounds as well as the particular rules dealing with short-term and long-term psychiatric beds. Notwithstanding the provision of an opportunity to the Respondent to rebut the testimony related to the alternative suggestions and to conduct cross-examination of the principal witness of Petitioner, who spoke to the issue of the alternative bed numbers, Respondent did not offer any competing viewpoint of the issue of the propriety of awarding a certificate of need based upon the two alternative plans, except as to the specific rules for psychiatric beds. Consequently, Petitioner is seen to have sustained its position vis-a-vis applicable criteria related to the issuance of a certificate of need for the alternative configurations of thirty- five to forty- five beds, assuming its ability to satisfy the needs criteria for short-term and long-term psychiatric beds, per Rules 10-5.11(25) and (26), Florida Administrative Code, respectively.
SHORT TERM BEDS
For purposes of short-term psychiatric bed needs assessment, the populations within subdistrict 1 and roughly half of subdistrict 2, may be served by a facility located in Duval County. On the other hand, the population in subdistrict 3, Volusia County, is not within the forty five minute travel time contemplated in the accessibility portion of Rule 10-5.11(25), Florida Administrative Code.
At the time of the hearing there existed 346 licensed short-term psychiatric beds in District IV. An additional 24 beds have been recommended for approval in the proposed Charter facility in Jacksonville, and 25 beds in the proposed Atlantic Treatment Center facility in Daytona Beach, to benefit children and adolescents per the recommended order in DOAH Case No. 83- 355, and associated cases. The only licensed beds for the benefit of the younger
patients, which can now be found in HRS District IV, are the 30 adolescent beds in the Petitioner's facility. When those beds recommended for recognition in the DOAH Case No. 83-335, etc., are described as approved, then the total number of licensed and approved beds in HRS District IV is 395 short-term psychiatric beds.
As reflected in HRS exhibit number 1, the state agency action report related to this project, utilization of adult psychiatric services in the Petitioner's facility have ranged from a low of 39 percent in 1983 to as high as
60 percent in 1951 and 1982. By contrast, that exhibit shows the adolescent psychiatric unit, not including the ICU portion of that unit, with a 1981 utilization of 54 percent; 1982 , 51 percent; and 1983, 60 percent. In subdistrict 1, the overall percentage of occupancy for subdistrict 1, short-term psychiatric beds, was 70.7 percent for the reporting period October 1982 through September 1983. Again, these figures are taken from HRS exhibit number 1 admitted into evidence. In 1984 within the Petitioner's facility in the adolescent psychiatric units as a 1984 average for the calendar year, the percentage of occupancy for those 30 beds is 70.6 percent. The percentage of occupancy of all short-term psychiatric beds in the Petitioner's facility in that 1984 calendar year reporting period is less than 64.7 percent. This 1984 data comes from testimony of Ervin M. Funderburk, Jr., Administrator for St. Johns River and from Petitioner's exhibit number 5 admitted into evidence. In the last full reporting year, 1984, on two or three occasions as many as 13 adolescent patients have been placed upon a waiting list to receive short-term psychiatric services in the Petitioner's facility. Additional information about occupancy rates in the Petitioner's facility is found in Petitioner's exhibit number 14, at page 22, Table 6, showing occupancy rates beginning in the fiscal year 1981, through February 1984. Those rates range facility wide in the 50 percent and 60 percent bracket for the most part with a 94 percent occupancy in overall adolescent in the second quarter of 1983, and in December 1983, an 84 percent in adolescent psychiatric and 85 percent in adolescent ICU. In January, 1984 the adolescent psychiatric and ICU dropped back to 59 percent and in February, 1984 those two units within the adolescent short-term services went to
102 percent and 100 percent respectively.
The adolescent short-term psychiatric beds within the Petitioner's facility, other than those used as seclusion rooms, are full 25 percent to 30 percent of the time.
Having considered the presentation of the parties on the question of the appropriate planning horizon for beds sought, it is determined that the planning horizon is based upon projections for the entire year of 1989, and for one month of the year 1990. The one month of the year 1990 represents January, the month in which the final hearing was held in this case, projected five years into the future. This determination is made based upon uncertainty on the question of the effective date within 1990, at which the projected population for 1990 as found in the Petitioner's exhibit number 7, will be realized. Therefore, one-twelfth of the increase in population between 1989 and 1990 has been added to the projected population for 1989 to arrive at the overall population for HRS District IV at the end of January 1990. Using that approach approximately 1891 additional persons would be added into the projected population count for the district, attributable to the population increase for January 1990. Using the .35 per thousand standard for calculation this would add less than one bed to the overall bed count, rounded off to a one bed increase. Adding that one bed increase to the known 28 beds needed at the end of 1989, a total of 29 short-term psychiatric beds are shown as being needed at the end of January, 1990, taking into account the recommended order of a grant
of certificates of need to Charter and Atlantic Treatment Center for a total of
49 short-term psychiatric beds. In effect, the number 29 is the addition of the one bed to the figures depicted in HRS exhibit number 3 admitted into evidence. As demonstrated by the witness Gene Nelson, Administrator of the Office of Community Medical Facilities, Department of Health and Rehabilitative Services,
10 of those beds at the end of 1969 could be attributed to subdistrict 1, which is accessible to patients seeking short-term psychiatric services in the location where the Petitioner has its facility. Given the distribution of beds throughout the district, the subdistrict 2 constituted of St. Johns and Flagler Counties, has the least number of beds per population. Consequently, the remaining 18 beds in 1989 are best utilized for patients within that subdistrict. Petitioner affords access to some of those patients within the subdistrict 2, which for purposes of this recommended order is determined to be approximately half of that subdistrict. Therefore, in addition to the 10 beds for subdistrict 1, 9 beds in subdistrict 2 could be given to the Petitioner and satisfy the standards related to accessibility within a forty five minute driving time. If the 1 bed for January, 1990, were added to this total, the final calculation would be as many as 20 short-term psychiatric beds which could be located in the Petitioner's facility to serve patients within HRS District IV in the planning horizon.
On the subject of short-term psychiatric beds, Dr. George Michael Joseph and Dr. Pushpal L. Mehrotra, indicated the problem with placement of short-term psychiatric patients in Duval County where these physicians practice psychiatry. Their testimony does not take into account the advent of the Charter short-term psychiatric beds. On the other hand, their testimony about the difficulty of finding placements is considered in view of the waiting list previously mentioned in the recommended order. Dr. Joseph has had the experience of having to wait several weeks for the placement of a short-term adolescent psychiatric in patient.
LONG TERM BEDS
Petitioner's request for 20 long-term psychiatric beds is considered in keeping with the provisions set forth in Rule 10-5.11(26), Florida Administrative Code. Unlike the short-term psychiatric bed rule, there is no specific formula for determining the appropriate number of beds as a ratio of beds-to- population. There is a travel time component and an occupancy standard associated with that rule. The travel time relates to a two-hour driving time for the benefit of the population served. Having that in mind, as shown in this case, the Jacksonville area and Daytona Beach area need separate long-term psychiatric beds. Recognition has been given to that need through the recommended order in which the Charter facility in Jacksonville would receive 40 long-term psychiatric beds for the benefit of adolescent patients and the ATC facility in Daytona Beach would receive 20 long-term beds for child and adolescent patients. More specifically, on the topic of access, the Daytona Beach beds cannot be expected to serve 90 percent of the Jacksonville area population within a two-hour drive and the same would be true of a Jacksonville facility serving patients in the Daytona Beach area.
On the question of the occupancy standard, related to long-term psychiatric facilities, at present there are no long-term psychiatric beds in HRS District IV. If recognized, the Charter and ATC beds would constitute the first long-term psychiatric beds located in HRS District IV.
In support of its application for long-term psychiatric beds, for the benefit of adolescent patients, Petitioner relies upon the testimony of the
administrator at St. Johns River Hospital, and Drs. Joseph and Mehrotra. The testimony by the physicians identifies the disruptive effect that is caused by removing patients from the community and sending them to other parts of the country to receive needed long-term psychiatric care. When this occurs, essential family involvement in the patient's treatment program is severed making the patient's recovery more difficult. Where the family can commute to other communities to participate, this creates an imposition on the adult members of that family as well as other siblings. In some instances families will withdraw those minor patients from the treatment program due to the inconvenience or perceived inability to deal with the circumstance of long-term patient care outside of the Jacksonville community. Some patients at present are being sent away for long-term care to Atlanta, Georgia; Miami, Florida; Tarpon Springs, Florida, and to Texas. When the patient is transferred to these out-of-town facilities, the primary treating physician in Jacksonville no longer is involved in the active treatment of the patient, and the patient and the new physician in the out-of-town facility must begin anew the process of dealing with the patient's condition. Dr. Joseph corroborates the idea that a Daytona Beach facility does not satisfactorily meet the needs for long-term psychiatric care of adolescent patients in Jacksonville. Dr. Mehrotra agrees with Joseph that Daytona Beach is not an appropriate alternative for long-term psychiatric care for adolescent patients in Jacksonville. The treating physician would not follow the care of the long-term psychiatric patient in institutions outside of the Jacksonville area that are as far away as Daytona Beach, because of problems with access. To the extent that long-term treatment is not readily available in the Jacksonville area, there is a tendency for physicians to keep younger patients in short-term treatment programs for a greater length of time, thereby exacerbating the situation as it pertains to the placement of short-term patients who are waiting to use the beds that are being preempted by the extended stay of the present patients. Both physicians speak in terms of the advantage of a continuum of psychiatric care from short-term to long-term within the same institution. This is an advantage for the staff of the institution, the treating physician and the family. More importantly, this is an advantage to the patient in terms of acclimation to the environment within the facility.
In order of preference, continuation of a treatment program from a short-term to a long-term status is best accomplished within the same facility, followed in turn by long-term treatment in a separate facility within the same community after release from a short-term program, and finally, treatment in a long-term facility outside the community following participation in a short-term program.
Petitioner in its proposed recommended order, offered by its counsel has made reference to numerous aspects of the recommended order entered in DOAH Case No. 83-355, and consolidated cases, on the matter of evidence presented in furtherance of various requests for the recognition of long-term psychiatric beds for the benefit of child and adolescent patients and the associated methodologies utilized in identifying that need, as seen by those applicants. While an opportunity was afforded the parties to the present action, to present their proposed recommended orders with appreciation for the recommended "outcome" in the previous cases, that is, the number of short-term and long-term psychiatric beds as contemplated by that recommended order, no specific authorization was requested nor granted for the use of wholesale facts taken from that recommended order in DOAH case No. 83-355, and consolidated cases. Likewise, Petitioner did not ask in the course of the formal hearing in this cause that the record of those prior cases be adopted for the purpose of the recommended order in this cause. Therefore, use of those materials from the prior cases pertaining to evidence within that long-term psychiatric bed need discussion and in particular the use of methodologies offered by the applicants in those cases is not allowed in this recommended order. In addition,
Petitioner's remarks about the alleged approval of a certificate of need application filed by Daniel Memorial for the conversion of 45 residential beds to licensed long-term child and adolescent psychiatric beds, having not been part of the hearing record in this cause, is not considered. This refers to the alleged recognition of the application of Daniel Memorial for the aforementioned psychiatric beds, an application that was purportedly considered in a batch subsequent to the application offered by the present petitioner.
Petitioner, having failed to specifically identify the need for additional long-term psychiatric beds in the Jacksonville area, by theory of need, the record from the point of view of this Petitioner, is the testimony of Drs. Joseph and Mehrotra and the statement of the administrator of the Petitioner's facility, that long-term psychiatric beds are needed in some unspecified number. In keeping with the testimony of Gene Nelson, Administrator of the Office of Community Medical Facilities, Department of Health and Rehabilitative Services, that need for long-term psychiatric beds could be met by the previous applicants in DOAH Case No. 83-355 and consolidated cases. This speaks to the 40 long-term psychiatric beds recommended for adolescent patients who would be treated in the Charter facility in Jacksonville. On the basis of the record presented in this hearing, those beds are found to meet the need for adolescent patients within subdistrict 1 of HRS District IV, which includes the Jacksonville area for the January 1990 planning horizon. In this connection, the suggestion by Petitioner that it can meet the 80 percent requirement for occupancy at the conclusion of 3 years of operation of its long-term psychiatric beds for adolescent patients, is not accepted.
IN SUMMARY
Not being entitled to any long-term psychiatric beds, the availability of 20 short-term psychiatric beds at the point of the planning horizon ending in January, 1990, may only be of benefit to the Petitioner in the event that those
20 beds are deemed to be a financially feasible addition to its existing facility. While Respondent has conceded the matter of financial feasibility of a 45-bed addition as originally proposed, assuming the need for those 45 beds, that stipulation does not pertain to the financial feasibility of 20 beds. Likewise, discussion of the financial feasibility of a 35-bed configuration, as offered by Petitioner's expert, does not vouch for the financial feasibility of a 20 short-term bed addition to the existing facility. Adding the 20 beds would exhaust the need within that part of HRS District IV constituted of subdistrict
1 and roughly half of subdistrict 2. Consequently, occupancy rates within those
20 short-term psychiatric beds would be marginally sufficient at best, taking into account past occupancy in the existing short-term facility; the advent of a new short-term facility at Charter and the exhaustion of the total number of beds indicated as being available in the short-term psychiatric bed pool. These factors taken together with the uncertainty of the implications of the bed reduction below 35 beds puts in question Petitioner's ability to meet debt obligations and realize a profit in a configuration of 20 short-term psychiatric beds, which involves ancillary costs which are to be addressed through occupancy of the 20 beds, such as fixed staff and the portion of the cost of the gymnasium attributable to new bed additions. Therefore, Petitioner has failed in this record to show financial feasibility of this project, to include the gymnasium.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the subject matter and parties to this action, as contemplated by Section 120.57, Florida Statutes; Section 381.494, Florida Statutes, and Rule 10-5.11, Florida Administrative Code.
The Petitioner has made a timely request for formal hearing per Section 120.57(1), Florida Statutes.
Petitioner's exhibit numbers 12 and 14 are admitted into evidence.
While official recognition is afforded the recommendation as found in the consolidated hearing pertaining to DOAH Case Nos. 83-335, 83-477, 83-478, 84-1431 and 84-2300, that recognition does not extend to an adoption of the transcript of those proceedings nor detailed factual findings set forth in that recommended order. Respondent's participation, presentation and argument found within its proposed recommended order in those other actions does not promote any form of estoppel against Respondent in the present case. Finally, the proposed disposition of the pending certificate of need application by Daniel Memorial Hospital was not a matter presented in the final hearing nor is it the subject of a request to supplement this record, in which both parties are given
an opportunity to address the significance of any outcome in that certificate of need application by Daniel Memorial. Consequently, the Daniel Memorial certificate of need application is not addressed in this recommended order.
Review of the Petitioner's application for short-term and long-term psychiatric beds is made in accordance with Section 381.494(6)(c), Florida Statutes, and Rule 10-5.11(1) through (12), Florida Administrative Code, as applicable. Respondent had stipulated that a 45-bed configuration as proposed would meet all of the applicable criteria, with the exception of those criteria which are associated with need calculation as it is more specifically outlined in Rules 10-5.11(25) and (26), Florida Administrative Code, which later rules deal with the recognition of short-term and long-term psychiatric beds respectively. By facts found this circumstance would also apply to the two 35- bed configurations as described. Any configuration of the project which is a lesser number of beds than 35 does not bind the Respondent in terms of a stipulation that financial feasibility of the proposal has been satisfied or that need has been shown as contemplated by Rule 10-5.11(25) and (26), Florida Administrative Code.
By use of the short-term psychiatric bed Rule 10- 5.11(25), Florida Statutes, Petitioner has shown a need for 20 short-term psychiatric beds in the subdistrict 1 and portion of subdistrict 2 of HRS District IV which can be served by the Petitioner at the point of the planning horizon ending in January, 1990. This is in keeping with the needs assessment formula and accessibility requirements. The 20 short-term psychiatric beds would be the upper limit of beds needed in keeping with the bed need formula expressed in the subject rule in that the occupancy rates within the 20 short-term psychiatric beds which might be added to the Petitioner's facility, as envisioned by the subject rule would be marginal at best.
The long-term psychiatric bed assessment is pursuant to Rule 10- 5.11(26), Florida Administrative Code. As stated, no need formula is associated with this rule; however, need must be established. The evidence of record in this cause does not suffice to establish the need for the 20 long-term psychiatric beds sought by the Petitioner for use by adolescent patients. In
the absence of the proof of need, Petitioner's projected occupancy rates of better than 80 percent at the third year is rejected. That provision of the rule dealing with the 80 percent occupancy standard for ongoing long-term psychiatric facilities in District IV does not apply in that no existing facilities are found within HRS District IV. Nonetheless, if Charter were granted its Jacksonville facility, 40 long-term psychiatric beds would be put in place, which would be accessible to adolescent patients in the greater Jacksonville area. Accessibility requirements within a two-hour driving time could only be met by Charter or Petitioner. The Daytona Beach Atlantic Treatment long-term beds are inaccessible to Jacksonville long-term psychiatric patients.
Having reduced the number of beds from 45 to 20 beds in terms of the demonstrated need, the proof which Petitioner has offered in support of the financial feasibility of this project as envisioned by Chapter 381.494(6)(c)9., Florida Statutes and Rule 10-5.11(5), Florida Administrative Code, is not sufficient.
Upon consideration of the facts found and the conclusions of law reached, it is,
That a final order be entered which denies the Petitioner's request for the grant of a certificate of need for the addition of 45 psychiatric beds, or any lesser number, including short-term and long-term psychiatric beds, and the gymnasium identified in the proposal.
DONE and ENTERED this 22nd day of May, 1985, at Tallahassee, Florida.
CHARLES C. ADAMS
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 22nd day of May, 1985.
COPIES FURNISHED:
John H. Parker, Jr., Esquire Thomas D. Watry, Esquire PARKER, HUDSON, RAINER, DOBBS
& KELLY
1200 Carnegie Building
133 Carnegie Way Atlanta, Georgia 30303
Morgan L. Staines, Esquire Senior Assistant General
Counsel
Community Psychiatric Centers, Inc. 2204 East Fourth Street
Santa Ana, California 92705
David H. Pingree, Secretary Department of HRS 1323 Winewood Blvd.
Tallahassee, Florida 32301
David P. Gauldin, Esquire Assistant General Counsel Department of HRS
1323 Winewood Blvd.
Tallahassee, Florida 32301
| Issue Date | Proceedings |
|---|---|
| May 22, 1985 | Recommended Order sent out. CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| May 22, 1985 | Recommended Order | In the absence of proof of need for such facilities, it is recommended that the Certificate of Need (CON) for psychiatric beds and a patient-use gymnasium be denied. |
