STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

SUWANNEE COUNTY, FLORIDA, )

)

Petitioner, )

)

vs. ) CASE NO. 86-3901

) DEPARTMENT OF BANKING AND FINANCE, )

)

Respondent, )

and )

) TALLAHASSEE MEMORIAL REGIONAL ) MEDICAL CENTER, )

)

Intervenor. )

)

RECOMMENDED ORDER

Pursuant to notice, a formal hearing was held in this cause on February 10, 1987, in Live Oak, Florida, before the Division of Administrative Hearings, by its duly designated Hearing Officer, Diane K. Kiesling.

APPEARANCES

For Petitioner: James W. Prevatt, Jr., Esquire

Post Office Box 8

Live Oak, Florida 32060

For Respondent: Walter W. Wood, Esquire

The Capitol, Suite 1302 Tallahassee, Florida 32301

For Intervenor: Jesse F. Suber, Esquire

Post Office Box 1049 Tallahassee, Florida 32302

ISSUE

The issue in this cause is whether the prerequisites of Section 154.314, Florida Statutes, have been met. That section governs withholding of funds due to the county under revenue sharing or tax-sharing in order to forward said funds to a regional referral hospital to compensate the hospital for services rendered to an out-of-county indigent patient. Specifically, the parties stipulated and agreed that all prerequisites had been met except whether Tallahassee Memorial Regional Medical Center exhausted its administrative and legal remedies, as provided in Chapter 120, prior to certifying to the Comptroller's Office the amount due from Suwannee County.

Suwannee County presented the testimony of Frank C. Davis and had one exhibit admitted in evidence. The Department of Banking and Finance

(Department) had one exhibit admitted into evidence. Tallahassee Memorial Regional Medical Center (TMRMC) had six exhibits admitted into evidence.

The Department waived the filing of a proposed order. Suwannee County and TMRMC submitted proposed findings of fact and conclusions of law. All proposed findings of fact and conclusions of law have been considered. A ruling has been made on each proposed finding of act in the Appendix attached hereto and made a part of this Recommended Order.

FINDINGS OF FACT

1. TMRMC is a regional referral hospital located in Tallahassee, Leon County, Florida.

   
   

2. From May 15, 1985, to July 2, 1985, TMRMC provided medical care to Doris M. Cherry. The total bill for these services was $68,182.75.

   
   

3. On July 10, 1985, TMRMC wrote to Suwannee County and requested reimbursement in the amount of $3,827.83 for the treatment rendered to Doris M. Cherry. This amount represented the maximum reimbursement which can be sought under Section 154.306, Florida Statutes. Reimbursement is limited to payment for 12 days of services at the per diem reimbursement rate currently in effect for the regional referral hospital under the medical assistance program to the needy under Title XIX of the Social Security Act.

   
   

4. On July 23, 1985, Suwannee County, through its county coordinator, Frank C. Davis, refused TMRMC's request for payment and disputed whether the patient was entitled to the benefits under Chapter 154, Part IV. The letter from Suwannee County did not advise TMRMC of its right to request a formal hearing pursuant to Chapter 120 and it did not provide a point of entry as required in Rule 28-5.111(1), Florida Administrative Code.

   
   

5. On December 20, 1985, TMRMC wrote to Suwannee County requesting an administrative proceeding to determine the issues and liability of Suwannee County to TMRMC for the claimed services. TMRMC also filed a formal Request for Hearing. TMRMC requested that the matter be referred to the Division of Administrative Hearings for a hearing to be conducted according to Section 120.57(1), Florida Statutes.

   
   

6. Suwannee County failed to take any action on TMRMC's Request for Hearing. In an abundance of caution, TMRMC again wrote to Suwannee County on January 17, 1986, pointing out that no response had been received to the Request for Hearing and again requesting a hearing. TMRMC attached a copy of the Request for Hearing to this letter. As evidenced by the return receipt, the Board of County Commissioners received this letter on January 22, 1986.

   
   

7. Suwannee County neither granted nor denied TMRMC's Request for Hearing. Instead, Suwannee County chose to ignore the request. The February 4, 1986, meeting of the Suwannee County Board of Commissioners shows that the Board voted unanimously to wait before responding to the request. No response was ever made.

   
   

8. Suwannee county did not give written notice to TMRMC of their decision to ignore the request for hearing.

9. TMRMC took no judicial action by mandamus or certiorari to enforce its right to a hearing. Further, TMRMC did not petition the District Court of Appeal for review of this matter.

   
   

10. After waiting several months for a response from Suwannee County, on August 13, 1986, TMRMC certified to the Division of Accounting and Auditing, Comptroller's Office, the sum of $3,827.83 to be withheld from revenue-sharing or tax- sharing funds allocated to Suwannee County.

    
    

11. The Department of Banking and Finance sent Its Notice of Intent to Withhold Funds to the Board of County Commissioners of Suwannee County on August 29, 1986. It was only in response to this action by the Comptroller's Office, acting through the Department of Banking and Finance, that Suwannee County requested a formal hearing. By its Request for Formal Hearing, Suwannee County attempted to raise and litigate the eligibility of Doris M. Cherry to the benefits of Chapter 154, Part IV. However, it is undisputed that these disputed issues the fact cannot be litigated in this proceeding because this hearing is limited in scope to determine only, if the prerequisites of Section 154.314, Florida Statutes, have been satisfied. Tallahassee Memorial Regional Medical Center, et al., v. Lewis, 399 So.2d 106 (Fla. 1st DCA 1981).

    
    

    CONCLUSIONS OF LAW

    
    

12. The Division of Administrative Hearings has jurisdiction over the subject matter and the parties to this action. Section 120.57(1), Florida Statutes.

    
    

13. This controversy arises under the Florida Health Care Responsibility Act, Sections 154.301-154.316, Florida Statutes. The scope of this hearing is controlled by Tallahassee Memorial Regional Medical Center, et al., v. Lewis,

399 So.2d 106 (Fla. 1st DCA 1981). Pursuant to this case, a hearing such as this one is limited to determination of whether the prerequisites for withholding of revenue-sharing or tax-sharing funds have been met. These prerequisites are:

1. Whether the responsible county received a statement of services rendered at the

   hospital;

2. Whether the county had failed to dispute the claim within 60 days after receipt of

   the statement, or, if it did so,

3. Whether administrative and legal remedies, as provided in Chapter 120, had been exhausted, and 30 days had elapsed since the exhaustion of all administrative and legal remedies.

1. The parties are in agreement that the first two prerequisites had been met and that the only issue remaining for determination in this proceeding is whether TMRMC has exhausted all administrative and legal remedies, as provided in Chapter 120, and 30 days has elapsed since the exhaustion of these remedies.

   
   

2. The Florida Health Care Responsibility Act is unusual in that it contemplates two separate hearings. Section 154.312 sets forth the procedure for settlement of disputes over entitlement of the patient to benefits under the Act. Section 154.312 provides:

   All disputes between a county and a regional referral hospital shall be resolved by order as provided in Chapter 120.

   
   

   As contemplated in the act, once disputes are resolved as specified in Section 154.312, the regional referral hospital may seek payment for the costs of the services rendered from the Comptroller pursuant to Section 154.314. Section

   154.314 provides:

   
   

   In the event payment for the costs of services rendered by a regional referral hospital is not received from the responsible county within sixty days of receipt of a statement for services rendered, or if the payment is disputed and said payment is not received from the responsible county within thirty days of the date of exhaustion of all administrative and legal remedies, as provided in Chapter 120, the hospital shall certify the amount due to the Comptroller, who shall forward the amount delinquent to the appropriate regional referral hospital from any funds due to the county under any revenue-sharing or tax-sharing fund established by the state, except as otherwise provided by the State Constitution.

   
   

3. Pursuant to Section 154.312, TMRMC requested an administrative hearing on two separate occasions. Suwannee County failed to acknowledge TMRMC's request for an administrative hearing and failed to act on TMRMC's request, contrary to Section 120.57(1)(b)1, Florida Statutes. The failure of Suwannee County to act on TMRMC's request for an administrative hearing did not constitute final agency action on the part of Suwannee County sufficient to entitle TMRMC to judicial review. Specifically, Chapter 120.68, Florida Statutes, and Rule 28-5.201, Florida Administrative Code, require an agency to give written notice to all parties of action taken on a petition, stating with particularity the reasons for the action. Additionally, any final action taken by an agency on a petition must advise the parties in writing regarding their entitlement to judicial review. Here, Suwannee County's failure to take any action did not give rise to any entitlement or right of TMRMC to judicial review.

   
   

4. Suwannee County had two opportunities to resolve its disputes with TMRMC pursuant to the procedure set forth in Section 154.312. Suwannee County failed to provide an administrative hearing to resolve these disputes and failed or refused to resolve the disputes by order as provided in Chapter 120.

   
   

5. TMRMC took all actions and avenues available to it to exhaust its administrative and legal remedies as provided in Chapter 120. TMRMC did not petition any court for a writ of mandamus or writ of certiorari to review the county's failure to act. However, such actions would be judicial remedies provided for in Chapter 120 and therefore not administrative or legal remedies. TMRMC did exhaust all of its administrative and legal-remedies as provided in Chapter 120.

   
   

6. Suwannee County refused to take the actions necessary to resolve the disputes. Clearly, Suwannee County intended to stonewall TMRMC's attempts to recover for the services rendered to the patient. Suwannee County had no

   intention of settling the disputes through the proper proceedings but instead determined to keep TMRMC from proceeding by simply refusing to do anything.

   
   

7. To require TMRMC to expend considerable sums on judicial actions which may or may not have ultimately resulted in the requested hearing, would be contrary to the purposes of the Florida Health Care Responsibility Act. The costs to the hospital of taking such actions would defeat the purposes of the act in that very little of the services provided are subject to benefits under the Act. For example, in this case, the total bill for services was $68,182.75, yet the maximum.which TMRMC can even hope to recover from the county is

   $3,827.88. To permit Suwannee County to place numerous roadblocks and impediments in TMRMC's way in order to make it economically unreasonable for the hospital to continue to press its claims, would be antithetical to the purposes of the Act.

   
   

8. By failing to provide the administrative resolution mandated by Section 154.312, Suwannee County waived its right to further contest the entitlement of the patient and the regional referral hospital to benefits. To conclude otherwise, would be to reward Suwannee County for its failure and refusal to comply with the Florida Health Care Responsibility Act. Accordingly, it is further concluded that TMRMC had exhausted all of its administrative and legal remedies, as provided in Chapter 120 and had therefore properly certified the amount due to the Comptroller. It is further concluded that thirty days had elapsed since the exhaustion of all administrative and legal remedies, before TMRMC certified the amount due to the Comptroller.

RECOMMENDATION

Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Banking and Finance enter a final order

determining that all prerequisites to Section 154.314, Florida Statutes, had been met and forward the amount certified to the Tallahassee Memorial Regional Medical Center from the revenue-sharing or tax-sharing funds due to Suwannee County.

DONE AND ENTERED this 12th day of March, 1987, in Tallahassee, Florida.

DIANE K. KIESLING

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 12th day of March, 1987.

APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-3901

The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the proposed findings of fact submitted by the parties in this case.

Specific Rulings on Proposed Findings of Fact Submitted by Petitioner Suwannee County

1. Proposed findings of fact 1, 3, and 4 are rejected as unnecessary.

2. Proposed finding of fact 11 is rejected as being unsupported by the competent, substantial evidence.

3. Each of the following proposed findings of fact are adopted in substance or as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the proposed findings of fact: 2(11); 5(1); 6(2); 7(3); 8(4); 9(5); 10(6); 12(9); and 13(10).

Specific Rulings on Proposed Findings of Fact Submitted by Intervenor, TMC

1. Proposed finding of fact 8 is rejected as being argumentative and conclusory.

2. Each of the following proposed findings of fact are adopted in substance or as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the proposed finding of fact: 1(3); 2(4); 3(4); 4(4); 5(5 and 6); 6(7); 7(8); 9(10); and 10(9).

COPIES FURNISHED:

Walter W. Wood, Esquire Office of the Comptroller The Capitol, Suite 1302 Tallahassee, Florida 32301

Jesse F. Suber, Esquire Post Office Box 1049 Tallahassee, Florida 32302

Ernest A. Sellers, Esquire James W. Prevatt, Jr., Esquire Post Office Box 8

Live Oak, Florida 32060

Honorable Gerald Lewis Comptroller, State of Florida The Capitol

Tallahassee, Florida 32301

Docket for Case No: 86-003901

Orders for Case No: 86-003901