vs. )
) DEPARTMENT OF HEALTH AND ) REHABILITATIVE SERVICES and ) LAKEVIEW CENTER, INC., )
) CASE NO. 88-1224
Intervenor. )
Pursuant to notice, final hearing in the above-styled case was held on December 7-8, 1988 in Pensacola, Florida, and December 9, 1988, in Tallahassee, Florida, before William F. Quattlebaum, Hearing Officer of the Division of Administrative Hearings.
Robert S. Cohen, Esquire Haben & Culpepper, P.A. Post Office Box 10095 Tallahassee, Florida 32302
Robert D. Newell, Esquire Newell & Stahl, P.A.
Richard A. Patterson, Esquire Assistant General Counsel
No appearance was made on behalf of HCA West Florida Regional Medical Center.
The issue presented for consideration is whether certificate of need (CON) 5260 should be issued to Lakeview Center for construction of a specialty hospital to operate a 24 bed intensive residential treatment program in Escambia County. A second issue is whether the Petitioner has standing to challenge the proposed award of the CON.
Lakeview Center, Inc. applied to the Department of Health and Rehabilitative Services for a certificate of need to operate a 33 bed short term psychiatric hospital and a 24 bed specialty hospital to be licensed as an intensive residential treatment program for children and adolescents. Following review of the application, the Department of Health and Rehabilitative Services gave notice of intent to partially grant the application as to the 24 bed intensive residential treatment program specialty hospital. Lakeview does not contest the denial of the portion of the CON application relating to the short term psychiatric hospital.
Following notice of the DHRS determination, Gulf Coast Hospital, now known as Harbour Oaks Hospital, requested formal administrative hearing. HCA West Florida Regional Medical Center petitioned for, and was granted, leave to intervene in the cases, but made no appearance at the hearing and filed no proposed recommended order. Pursuant to Rule 22I-6.022, Florida Administrative Code, the petition to intervene, filed by HCA West Florida Regional Medical Center, is hereby dismissed.
At the hearing, Harbour Oaks Hospital presented the testimony of Philip C. Braeuning, Brian D. Russo, and Todd Estroff. Harbour Oaks Hospital exhibits 1-3 were admitted into evidence. Lakeview Center presented the testimony of Morris Eaddy, Vivian Lee Riley, Jonathan M. Cherry, Dave Robinson, Paul Rawlings, James
A. Coleman, Jr., Kathy Loskamp and Johnny L. Bilbrey, Jr. Lakeview Center exhibits 1-10 and 13-16 were admitted into evidence. The Department of Health and Rehabilitative Services presented the testimony of Sharon Gordon-Girvin and had exhibits 11-12 (jointly identified with Lakeview Center's exhibits) admitted into evidence.
Prior to the hearing, the parties filed a prehearing stipulation as to agreed facts which are referenced in the findings of fact. The parties further stipulated as to specific statutory criteria at issue, which are referenced in the conclusions of law contained herein.
A transcript of the hearing was filed on January 25, 1989. The parties filed proposed recommended orders on February 27, 1989. The proposed findings of fact are directly or indirectly ruled upon in this Recommended Order and in the Appendix which is attached and hereby made a part of this Recommended Order.
Lakeview Center, Inc. ("Lakeview"), on or about September 14, 1987, applied to the Department of Health and Rehabilitative Services ("DHRS"), for a certificate of need (CON) to construct a 24 bed specialty hospital, operating as an intensive residential treatment program (IRTP), and a 33 bed short term
psychiatric hospital. The parties stipulated that Lakeview's application was timely filed and properly deemed complete by DHRS, the state agency authorized to consider, and approve or deny, such applications.
The application was designated by DHRS as CON 5260. Lakeview's application was comparatively reviewed by DHRS with another CON application for a short term psychiatric hospital, subsequently denied, which is not at issue in this proceeding. The proposed location is within DHRS service district I.
On January 20, 1988, DHRS gave notice of intent to grant partial approval of the Lakeview application for the establishment and construction of the 24 bed specialty hospital/IRTP.
As defined by section 395.002(8), Florida Statutes, an IRTP for children and adolescents is a specialty hospital which provides 24 hour care, and which has the primary functions of diagnosis and treatment of patients under the age of 18 having psychiatric disorders, in order to restore such patients to an optimal level of functioning.
There are no IRTP beds operating or which have received CON approval in DHRS service district one.
Lakeview currently operates a 12 bed residential treatment program for children and adolescents which is licensed by DHRS as a child care facility. Lakeview has provided such treatment for approximately five years. The program has moved from one location to another, as Lakeview has attempted to provide more suitable surroundings, but the program remains inadequately housed. The present facility, which is frequently completely occupied, is housed in a leased residence, located on approximately five acres in Pensacola. The facility costs
$18,000 annually in rent, and the cost escalates yearly. Lakeview proposes to purchase the property, to convert the existing building into kitchen, office and recreational space, and to construct two new buildings, each housing twelve residents of the program.
The residential treatment program essentially serves as a group home for persons aged twelve through seventeen. The program provides 24 hour supervision, psychiatric counseling, crisis intervention, and family counseling. The majority of the residents housed in the facility are diagnosed with various types of behavior or conduct disorders. They have difficulties with relationships and with authority figures. They may exhibit symptoms of depression. The average length of stay in the facility is approximately 12 months.
Lakeview receives approximately one-half its annual revenue from state and federal contracts, approximately one-third through client fees, and the remainder from local government contracts or charitable contributions. All of the residents of the facility at the time of the administrative hearing were referred to the facility by the local DHRS office, and payment is made to Lakeview by DHRS.
The DHRS pays to Lakeview $129 per patient per day for each patient referred to the facility by DHRS. The rate includes room, board, and all services provided as part of treatment. The payment is less than half the total expenses incurred by Lakeview in providing such treatment.
Lakeview Center has in the past operated at a deficit and projects that such deficits will continue. The losses incurred by the residential treatment facility are a contributing factor in Lakeview's deficit problem.
Lakeview anticipates that 12 of the residents would remain state funded, and that the remaining 12 would be funded by private resources. Only two patients with private payment resources, such as insurance, have been admitted to the Lakeview residential adolescent treatment facility since it began operations.
Lakeview does not need the CON for expansion of the facility as it is currently licensed. Lakeview's application for the CON is related to its interest in operating as a specialty hospital so as to gain access to private insurance reimbursement.
Lakeview does not have sufficient ability to construct the new facility without an increase in the amount Lakeview is able to collect from private insurers. Lakeview claims that insurers are apparently unwilling to pay for treatment provided by Lakeview in its current configuration, but supposedly would pay for treatment provided in a specialty hospital setting. Lakeview asserts that expansion of the service and licensure as a specialty hospital would fiscally stabilize the service and create cash flow sufficient to build the new facility. As to the present facility, Lakeview has not attempted to negotiate reimbursement contracts with insurers, apparently because, even if insurers would agree to provide payment, the facility is not sufficiently attractive to prospective residents.
In order to become licensed by DHRS as a specialty hospital, an IRTP for children and adolescents must become appropriately accredited and must meet minimum standards developed by DHRS under the agency's hospital licensing authority. Because the relevant law requires issuance of an appropriate CON prior to application for licensure as a specialty hospital, it is necessary for Lakeview to first obtain a CON prior to making application for licensure as a specialty hospital.
Lakeview was first established in 1954 as a child guidance clinic. Lakeview now serves as a full service community mental health facility operating as a not-for-profit private corporation. A board of directors, consisting of community residents, oversees the operation. In addition, five advisory councils assist the board in setting policy and direction. Lakeview annually participates in the preparation and development of the DHRS alcohol, drug abuse and mental health plan for District I. Lakeview is appropriately accredited by the Joint Commission on Accreditation of Healthcare Organizations, and is further accredited by the Commission on Accreditation of Rehabilitative Facilities. The disorders treated by Lakeview at the residential treatment facility are classified in the Diagnostic and Statistical Manual of Mental Disorders, a standard reference source, as psychiatric disorders.
The planned facility would clearly be more suitable for an IRTP than the current location. A common problem in residential treatment facilities is "behavior feeding", wherein the unacceptable behavior displayed by a resident encourages other residents to exhibit unacceptable behavior. Lakeview's current facility promotes behavior feeding because the residents share bedrooms and are otherwise in close quarters during much of the day. The new construction would offer the ability to provide private rooms and separate facilities for male and female residents. There will be a seclusion room for residents who need to be removed for a period of time due to behavioral incidents. The facility would be
accessible for handicapped persons, unlike the current building. Further, the planned facility would provide residents with more acceptable living arrangements which are related to the dignity and self-esteem they are able to develop.
Harbour Oaks Hospital ("Harbour Oaks") is a private, for-profit psychiatric hospital located on five acres of property near Ft. Walton Beach. Harbour Oaks was formerly known as Gulf Coast Hospital, but in mid-1988, the name was changed to avoid confusion with a like-named facility located nearby.
Harbour Oaks is licensed to operate 49 short-term psychiatric beds, 10 substance abuse beds, and 20 long-term psychiatric beds. Harbour Oaks operates the 20 long-term beds as a residential treatment program, however, they are not separately licensed as such. Harbour Oaks services are provided in an institutional-type facility, as opposed to the residential-type setting proposed by Lakeview.
Harbour Oaks generally does not accept nonpaying patients and refers such persons elsewhere. There are occasions where Harbour Oaks will treat an unfunded patient, but such patients are usually admitted with insurance benefits which expire while the patient is hospitalized. The amount of insurance available to a patient is considered by Harbour Oaks when the course of treatment is planned.
The psychiatric disorders addressed by both Lakeview's proposed facility and Harbour Oaks existing hospital are essentially similar. However, there are distinctive symptoms which indicate that appropriate treatment of the disorders may be substantially different and should be delivered in different settings. The Joint Commission on Accreditation of Healthcare Organizations distinguishes between long term psychiatric hospitalization and residential psychiatric care. Inpatient psychiatric care is generally defined as a hospital-based program providing intensive services and supervision on a 24 hour basis, while residential programs are less structured and located in dormitory or similar housing facilities.
Patients for whom an IRTP would be appropriate are generally in touch with reality and are aware of their behavior. They are generally able to function with a degree of independence. Lakeview provides a homelike residence with therapy available. The proposed facility would have no locks or physical restraints which would prevent a resident from leaving the building. The building remains open. There is 24 hour supervision available. Residents are able to administer their own medication, which is given to the resident in a single unit dosage when appropriate. About one-third of the residents in Lakeview at the time of the hearing were receiving medication. They assist in meal preparation and housekeeping tasks. Education is provided in community schools. Residents earn points for acceptable behavior. Sufficient points enable residents to leave the facility with no supervision for personal activities. The responsibilities assigned to residents are designed to teach basic living skills and promote individual responsibility.
Patients for whom long-term psychiatric hospitalization, such as Harbour Oaks provides, are not aware of their behavior and may be out of contact with reality. They are more dependent on an externally imposed structure. Harbour Oaks provides treatment in a psychiatric hospital environment. Harbour Oaks wards are generally locked. About 75% of Harbour Oaks' patients receive medication, which is always administered to them. Medications are delivered six times daily. Meals are prepared by hospital staff and are served to patients in
the hospital cafeteria. Housekeeping is provided. Harbour Oaks patients receive their education at the hospital. There is limited freedom of movement outside the facility. Window screening is designed to prevent removal by residents who may attempt to leave the facility. Residents are not permitted to leave the facility without accompaniment. Beds are constructed so as to permit the use of restraining devices. Personal care items are usually locked away from the residents who may access the items twice daily.
In short, because Harbour Oaks residents are less able to function independently than are Lakeview patients, Harbour Oaks provides a more structured program than does Lakeview. In each case, the success of the treatment depends, in large measure, to the appropriateness of the treatment provided for each specific patient. Some patients may need the support and therapy found in the more restrictive environment of Harbour Oaks; others may benefit from the personal responsibility demanded by a less restrictive facility such as at Lakeview. Testimony asserting that Harbour Oaks provided treatment essentially similar to the Lakeview proposal was not persuasive.
Harbour Oaks asserted that it could suffer a loss of patients were Lakeview Center to become licensed as a specialty hospital, because patients who could have been admitted to Harbour Oaks may be referred to Lakeview. The impact on daily occupancy was suggested to be from seven to nine patients. A loss of patients could substantially impact the operation of Harbour Oaks, resulting from lost revenue as patients are treated elsewhere. Harbour Oaks asserts that it may have to increase rates as overhead costs are borne by fewer patients. Staff members who are currently assigned to the unit could be transferred or terminated. Further Harbour Oaks claims that the quality of treatment it provides would be impacted because, in a situation where group therapy is utilized, the reduced size of the group could negatively affect the quality of interaction between patients. However, Harbour Oaks provided no substantive analysis of facts or of the hospital's operation which would indicate that the assertions made at the hearing were supported, and the testimony was not persuasive.
The DHRS has no rule methodology for establishing need for IRTP's. The agency asserts that the guideline it uses to determine whether an application for CON to construct an IRTP should be approved or denied is that every service district should have at least one facility. Further, in considering the need for the proposed Lakeview facility, DHRS considered information submitted by the agency's local operations, as well as expressions of support for the proposal from local mental health advisory councils. Although the evidence supporting the number of IRTP beds needed in district one was scant, the projected occupancy rate offered by Lakeview is reasonable and indicates that at least 24 IRTP beds are needed in the district.
One of the goals of the 1985-87 Florida State Health Plan is to provide mental health services in the least restrictive setting appropriate for the type of services to be provided. Policy development is directed towards providing a continuum of high-quality, cost effective service providers. The Lakeview proposal envisions provision of services in a facility which is substantially less restrictive than other service providers. Provision of such services in an IRTP would be less expensive than the provision of such services from a full-service psychiatric hospital. The Lakeview application conforms to the need expressed in the state plan.
The local plan addresses the deficits in the availability of care in the district and expresses the intention to provide, within the district
boundaries, all necessary services within the continuum of care. In that no IRTP currently operates within the district, the Lakeview proposal is consistent with the need expressed in the local plan.
Approval of the Lakeview project would increase the availability of IRTP's to residents of DHRS service district I, since there is no such facility in the district. There are no like and existing services in the district, and no suitable alternatives to the type of treatment proposed. Although Harbour Oaks provides treatment to persons who are in need of services, the Harbour Oaks facility and program of treatment is clearly different than that which would be available at Lakeview.
Based on Lakeview's long record of providing quality of care to persons in need of services, it is reasonable to expect that Lakeview could provide appropriate quality of care at the intensive residential treatment center. Lakeview has received awards for excellence in service provided to children, of which the 12 existing adolescent residential treatment beds are one part. Further, Lakeview's reputation is such that it is reasonable to expect that an acceptable quality of care is, and will continue to be, provided to persons referred for treatment.
Lakeview's ability to utilize professional staff it currently employs offer a positive economic benefit to the IRTP operation. There are no state- mandated professional staff levels at IRTP's. Projected staffing levels and salaries are based upon Lakeview's current staff and salary structure. The Lakeview projections are reasonable. Harbour Oaks asserted that the Lakeview projection of nursing care costs was unreasonably low, but the evidence did not support the assertion.
By stipulation, the parties agreed that the proposal was financially feasible in the immediate term, but that the long term feasibility of the project remained at issue.
Lakeview projects that the average census in the 24 bed facility would be 23 patients. The Lakeview projections are based upon the current operation, as well as from information gleaned from interviews with area physicians, employers, and intake personnel. There was no evidence to indicate that the projection is not reasonable.
Of the 23, Lakeview projects that ten would be state-funded, two would be unfunded or "indigent", three would be privately funded, and eight would be privately insured. The projection is based upon current experience and the interviews with area referral resources, and is reasonable.
The projected occupancy rates assume utilization of 75% at the first month with one additional resident monthly. Based upon current experience and area referral resources, such occupancy projection is reasonable.
The evidence indicates that Lakeview's assumptions and projections are reasonable and that the project is feasible over the long term. The evidence which would indicate to the contrary was not persuasive.
There was Information presented related to CHAMPUS benefits and the availability of CHAMPUS as a funding resource for Lakeview.
Testimony was offered which would indicate that, on occasion, CHAMPUS- funded patients, who would be appropriate for treatment at Lakeview's IRTP, have
been referred to distant facilities. Because CHAMPUS distinguishes between residential treatment facilities and long-term psychiatric facilities, such patients are not appropriate for placement in Harbour Oaks.
Lakeview attempted to indicate that CHAMPUS, a government-related insurer, would qualify the intensive residential treatment center for benefits after it was licensed by the state as a specialty hospital. The evidence indicates that Lakeview could become eligible for qualification as an IRTP by CHAMPUS and that such qualification will enable Lakeview to receive reimbursement from CHAMPUS.
Harbour Oaks attempted to establish that, even if CHAMPUS were to qualify Lakeview for reimbursement, such reimbursement would be capped at a level insufficient to support Lakeview's fiscal projections. The evidence is unclear as to what the actual rate of reimbursement available from CHAMPUS would be, assuming that Lakeview becomes accepted for payment, and did not establish that the level of reimbursement which Lakeview could receive would be inadequate. The CHAMPUS regulations in evidence appear to indicate that CHAMPUS payments will exceed the amount at which Harbour Oaks suggests reimbursement will be capped.
It is reasonable to expect that CHAMPUS reimbursement, which would constitute a part of Lakeview's anticipated funding base, will provide a level of payment sufficient to support Lakeview's financial projections.
The impact of the Lakeview project on other area providers should be minimal. There are no like service providers which would be impacted by a loss of patients. Although Harbour Oaks asserted that it could lose as many as nine patients from the average daily census to the Lakeview facility, there was little evidence beyond the assertion which would support a finding to that effect. Harbour Oaks has conducted no study or review which would support the assertion. Further, the treatment methodologies provided at the two facilities are so different as to suggest that patients who would be appropriately placed at one facility would be inappropriate for the other.
Lakeview provides services to persons who for financial reasons would otherwise not receive treatment. In excess of 60% of the persons receiving psychological or psychiatric treatment have incomes below the poverty level. Additionally, Lakeview provides short term counseling services at essentially no cost to the people seeking such counseling. Lakeview clients are charged based upon their ability to pay. A sliding scale system provides for fee discounts of up to 90% to low income persons. In the past year, Lakeview had gross billings of approximately $9,500,000 of which $2,250,000 was netted, after discounts and other adjustments. The Lakeview proposal would not alter the provision of services to such persons in need, although Lakeview intends to fill the 12 additional beds in the intensive residential treatment center with privately funded patients who are able to pay higher fees.
The Lakeview proposal is projected to cost between $775,000 and
$800,000. The projection, based upon the market, construction costs and equipment needs, is reasonable. There was no credible evidence which would indicate otherwise.
There are no like and existing facilities in DHRS service district I, other than the currently existing beds at Lakeview, which are generally fully occupied, accordingly patients will experience serious problems in obtaining inpatient care of the type proposed, in the absence of the proposed new service.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties to and subject matter of this proceeding. Section 120.57(1), Florida Statutes.
In relevant part, section 381.709(5)(b), Florida Statutes, provides that existing health care facilities have standing to initiate administrative proceedings upon a showing that an established program will be substantially affected by the issuance of a certificate of need to a competing proposed facility within the same district. The evidence does not establish that Harbour Oaks will be substantially affected by the award of the CON to Lakeview Center. Although Harbour Oaks asserted that it would experience a loss of up to nine patients from the average daily census due to the operation of the IRTP at Lakeview Center, the evidence does not support the assertion. In fact, the evidence indicates that the treatment methodology utilized by Harbour Oaks, and the proposed type of treatment to be provided at Lakeview Center, are so different as to suggest that it would be inappropriate to admit a person needing Harbour Oaks-type care to Lakeview Center, or to admit a person needing Lakeview Center-type care to Harbour Oaks. While a facility of one type may be substantially affected, and therefore have standing to challenge the award of a CON to another provider, in this case, the evidence does not establish that Harbour Oaks will, in fact, be affected by the Lakeview operation. Harbour Oaks has not established standing to participate as a party in this proceeding.
The applicant has the burden to demonstrate that it is entitled to the certificate of need. Florida Department of Transportation v. J.W.C. Co., 396 So.2d 778 (Fla. 1st DCA 1981). A balanced consideration of applicable statutory and rule criteria must be made. Humana, Inc. v. Department of Health and Rehabilitative Services, 469 So.2d 889 (Fla. 1st DCA 1985). Such consideration requires that varying weight be accorded each criterion depending on the facts of each case. Collier Medical Center, Inc. v. Department of Health and Rehabilitative Services, 462 So.2d 83 (Fla. 1st DCA 1985). Based upon consideration of the applicable criteria as related to the facts of the case, the applicant has met the burden of establishing that it is entitled to award of the CON.
In relevant part, section 381.705, Florida Statutes, and Rule 10- 5.011(1)(b), Florida Administrative Code, direct the focus of the agency analysis towards specific criteria which are to be considered in making a determination regarding this application for a CON.
Section 381.705(1)(a), Florida Statutes, requires consideration of the need for the proposed facility in relation to the applicable district plan and state health plan. The evidence indicates that the proposed facility conforms to the policies expressed in the district and state plans. Although there was no evidence to suggest what the total IRTP bed need for DHRS district one would be, the occupancy projections made as part of Lakeview's application are reasonable and demonstrate need for at least 24 IRTP beds in the district.
Section 381.705(1)(b), Florida Statutes, requires consideration of the availability, quality of care, efficiency, appropriateness, accessibility, extent of utilization, and adequacy of like and existing health care services in the service district of the applicant. There are no like and existing health care services in the district. Although the Petitioner asserted that like services are currently being provided in its facility, the evidence indicates
that Harbour Oaks Hospital is dissimilar to the proposed Lakeview facility, and that the courses of treatment are substantially distinctive.
Section 381.705(1)(c), Florida Statutes, requires consideration of the previous record and current ability of the applicant to provide quality of care. The evidence established that Lakeview Center is capable of providing an acceptable level of quality of care.
Section 381.705(1)(d), Florida Statutes, requires consideration of the availability and adequacy of other health care facilities in the service district of the applicant which may serve as alternatives for those proposed by the applicant. While Harbour Oaks may serve as an alternative to the applicant, in that Harbour Oaks provides treatment for similar disorders to patients, the treatment methodologies suggest that it may be inappropriate to do so. There is no adequate alternative to the proposed Lakeview IRTP.
Section 381.705(1)(e), Florida Statutes, requires consideration of probable economies and improvements in service that may be derived from operation of joint, cooperative, or shared health care resources. Lakeview's ability to share resources with other programs operating within Lakeview Center should provide economic benefits to the applicant.
Sections 381.705(1)(f), (g), and (h), Florida Statutes, were, by stipulation of the parties, agreed to be inapplicable to this proceeding.
Section 381,705(1)(i), Florida Statutes, requires consideration of the immediate and long term financial feasibility of the proposal. By stipulation, the parties agreed that the proposal was financially feasible in the immediate term, but that the long term feasibility of the project remained at issue. The evidence indicates that the project is feasible in the long term. Financial projections were supported by evidence and found to be reasonable. Evidence to the contrary was not sufficiently based upon fact to indicate otherwise.
Sections 381.705(1)(j) and (k), Florida Statutes, were, by stipulation of the parties, agreed to be inapplicable to this proceeding.
Section 381.705(1)(l), Florida Statutes, requires consideration of the probable impact of the proposed project on the costs of providing health services, including the effects of competition on the supply of health services being proposed and the improvements or innovations in the financing and delivery of health services which foster competition and service to promote quality assurance and cost-effectiveness. The evidence suggests that the Lakeview IRTP facility could have a positive impact on competition and cost-effective operation of other providers, however, the evidence was limited and does not establish that the Lakeview proposal would substantially impact costs of providing health services in DHRS district one.
Section 381.705(1)(m), Florida Statutes, was, by stipulation of the parties, agreed to be inapplicable to this proceeding.
Section 381.705(1)(n), Florida Statutes, requires consideration of the applicant's past and proposed provision of health care services to Medicaid patients and the medically indigent. Lakeview has provided an acceptable level of such care in the past. While Lakeview intends to fill the 12 additional beds included in this project with privately funded patients, there should be no impact on the provision of care to underfunded or unfunded patients.
Section 381.705(2), Florida Statutes, requires that, in cases of capital expenditure proposals for the provision of new health services to inpatients, consideration be given to the following factors:
That less costly, more efficient, or more appropriate alternatives to such inpatient services are not available and the development of such alternatives has been studied and found not practicable. The evidence did not suggest that there are more appropriate alternatives to the Lakeview project.
That existing inpatient facilities providing inpatient services similar to those proposed are being used in an appropriate and efficient manner. There are no existing IRTP services similar to those proposed.
In the case of new construction, that alternatives to new construction have been considered and have been implemented to the maximum extent practicable. The Lakeview construction is a reasonable use of the current facility. The cost of the proposed new construction is likewise reasonable.
That patients will experience serious problems in obtaining inpatient care of the type proposed, in the absence of the proposed new service. In that there are no IRTP beds such as the type proposed by Lakeview Center, patients will be unable to obtain appropriate care of the type proposed in the absence of the Lakeview Center project.
Section 381.705(2)(e), Florida Statutes, was, by stipulation of the parties, agreed to be inapplicable to this proceeding.
Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health and Rehabilitative Services enter
a Final Order dismissing the petition of Gulf Coast (now Harbour Oaks) Hospital and issuing certificate of need 5260 to Lakeview Center.
DONE and ENTERED this 1st day of June, 1989, in Tallahassee, Florida.
WILLIAM F. QUATTLEBAUM
Filed with the Clerk of the Division of Administrative Hearings this 1st day of June, 1989.
APPENDIX CASE NO. 88-1224
The following constitute rulings on proposed findings of facts submitted by the parties.
The proposed findings of fact jointly filed by Lakeview Center and DHRS are accepted as modified in the Recommended Order except as follows:
10. Rejected. The referenced testimony does not support the assertion that Harbour Oaks "does not accept adolescents that are state funded".
12. Rejected. Irrelevant as to application of Lakeview, not comparative review of competing applications.
37. Rejected insofar as characterization of weight of evidence.
43. Rejected. Irrelevant as to application of Lakeview, not comparative review of competing applications.
47. Rejected, restatement of testimony.
49. Rejected insofar as characterization of weight of evidence.
79. Rejected as to restatement of prehearing stipulation provisions which are in evidence as Hearing Officer's exhibit.
The proposed findings of fact filed by Harbour Oaks are accepted as modified in the Recommended Order except as follows:
4. Rejected, restatement of testimony.
21. Rejected as to assertion that Lakeview must identify specific insurers or must negotiate for payment In present facility, irrelevant to whether application meets criteria.
24. Rejected as to representation that CON/licensure are not required for CHAMPUS certification, irrelevant.
34. Rejected. No evidence to support assertion that Harbour Oaks would lose patients to Lakeview if proposed project was operational.
Robert S. Cohen, Esq. Haben & Culpepper, P.A. Post Office Box 10095 Tallahassee, Florida 32302
Robert D. Newell, Esq. Newell & Stahl, P.A.
Richard A. Patterson, Esq. Assistant General Counsel
Donna H. Stinson, Esq.
Moyle, Flannigan, Katz, Fitzgerald, & Sheehan, P.A. The Perkins House, Suite 100
Gregory L. Coler, Secretary Department of Health and
