STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
COMPREHENSIVE HOME HEALTH )
CARE, INC., )
)
Petitioner, )
)
vs. ) CASE NO. 89-4885
)
DEPARTMENT OF HEALTH AND )
REHABILITATIVE SERVICES, )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, Jane C. Hayman, held a formal hearing in the above-styled case on December 11, 1989 in Tallahassee, Florida.
APPEARANCES
For Petitioner: Rose Marie Marty
Vice President
Comprehensive Home Health Care, Inc.
7270 N.W. 12th Street Miami, Florida 33126
For Respondent: Richard A. Patterson, Esquire
Department of Health and Rehabilitative services 2727 Mahan Drive
Tallahassee, Florida 32308
STATEMENT OF THE ISSUES
The issue presented is whether Petitioner's application for a certificate of need to establish a hospice with a six (6) bed component to be located in Dade County, Florida, should be approved.
PRELIMINARY STATEMENT
This matter began in March, 1989, when Petitioner, Comprehensive Home Health Care, Inc., filed an application for a certificate of need seeking approval to establish a six (6) bed hospice program in Dade County, Florida, particularly in western portions of Dade County. Dade County is in Respondent's, Department of Health and Rehabilitative Services', District XI.
The application, notice of intent to deny, and request for hearing were each timely filed, as stipulated by the parties.
Respondent denied Petitioner's application based on Respondent's determination that Petitioner failed to meet the statutory and rule criteria for the issuance of a certificate of need for a hospice component. Thereafter, Petitioner requested a formal hearing under Section 120.57(1), Florida Statutes (1987), to contest the Respondent's decision.
At the formal hearing, Petitioner presented the testimony of two witnesses. Petitioner was granted leave to file a late filed deposition of the testimony of one additional witness. The deposition of said witness was filed on January 2, 1990.
Petitioner also offered five exhibits, four of which were received into evidence. Ruling on the fifth exhibit, Petitioner's exhibit 3, was reserved pending receipt of the deposition. The exhibit is received into evidence as hearsay, and is addressed in a separate Order entered this same date.
Respondent presented the testimony of one witness who was qualified as an expert in health planning. In addition, Respondent offered six exhibits which were received into evidence.
The transcript of the hearing was filed on December 22, 1989, and each party timely filed proposed recommended orders on January 2, 1990. A ruling has been made on each proposed finding of fact, and is reflected in the Appendix to this Recommended Order.
FINDINGS OF FACT
The Parties
Since 1975, Petitioner, Comprehensive Home Health Care, Inc., has been serving the elderly population of Dade County, primarily working with the Hispanic community to provide skilled nursing services and the services of physical therapy, speech pathology, occupational therapy, home health aide and medical social services. Petitioner currently provides its services as a home health care agency licensed by the Department.
Respondent, Department of Health and Rehabilitative Services (Department), is a state agency which is responsible for administering Section 381.701 through 381.715, Florida Statutes, the "Health Facility and Services Development Act", under which applications for certificates of need (CON) are filed, reviewed and either granted or denied by the Department.
Petitioner currently does not participate in an approved hospice program.
Two hospice programs are licensed by the Department to serve Dade County: Catholic Hospice, Inc., and Hospice, Inc. Neither entity chose to intervene in the instant proceeding.
The Application
On or about March 27, 1989, Petitioner filed an application with the Department for a CON to implement a six (6) bed hospice service in Dade County, Florida, with no capital expenditure. The application was designated as CON Number 5871. No public hearing was requested. After the submittal of an omissions response, the Department deemed the application complete on May 16, 1989. The application was reviewed as the sole applicant in its batching cycle After review of the application, the Department issued its intent to deny the application in its state agency action report (SAAR) on June 29, 1989.
In the application, Petitioner proposes to establish a not-for-profit, full service hospice which includes a six (6) bed inpatient component with beds to be located in the Northwest, Central West and Southwest Dade County, Florida, in three of the following hospitals:
AMI Kendall Regional Medical Center Coral Gables Hospital
North Gables Hospital Palmetto Hospital
Pan American Hospital Westchester Hospital
In addition to relying on its application as meeting pertinent statutory and rule criteria- Petitioner asserts that the application demonstrates mitigating and extenuating circumstances which would allow the approval of the application even if the numeric need prescribed by rule were not demonstrated by the application. Further, the application states that Hospice, Inc., as the only provider in Dade County, has a monopoly on the market in Dade County. Petitioner also intends to concentrate on providing service to the Hispanic population and those individuals suffering from AIDS.
The application was not presented in the format which the Department usually receives applications for certificate of need. The usual format was not made part of the record in this proceeding. However, the application, as supported at hearing, shows Petitioner's desire to provide hospice services to the residents of Western Dade County. The witnesses testifying on behalf of Petitioner were Teresa Corba Rodriguez, Roger Lane and Rose Marie Marty. Ms. Rodriguez is an experienced registered nurse who worked for Hospice, Inc., from November, 1987, through June, 1989. She is currently employed at Victoria Hospital. Mr. Lane is the director of information and referral at Health Crisis Network in Miami, and Ms. Marty is the Vice President of Petitioner.
The Department's primary bases for issuance of its intent to deny the application were the lack of need for additional inpatient hospice beds, and the failure to document sufficiently certain statutory and rule criteria, as discussed in the following paragraphs. The Department offered the testimony of Elizabeth Dudek, who is an employee of the Department, and is an expert in health planning.
Compliance with Statutory Criteria
In its proposed recommended order, the Department acknowledged that only six statutory criteria in Section 381.705(1), Florida Statutes (1987) are at issue, in addition to Rule 10-5.011(1)(j), Florida Administrative Code.
State Health Plan
Although the State Health Plan was not offered into evidence, the Department through testimony and the SAAR indicates that the Application conforms to the State Health Plan.
Local Health Plan
The applicable Local Health Plan is represented by the plan entitled, "1988 District XI Certificate of Need Allocation Factors", adopted on March 3, 1988. This plan, as it relates to hospice services, is composed of a Subsystem Description, a statement of Issues and of Recommendations. The SAAR chose to base its determination of Petitioner's compliance with the local health plan on an evaluation of whether the application fulfilled the several preferences within the recommendations portion of this plan. In so doing, the Department determined in its SAAR that the Petitioner was in partial compliance.
The first preference reads as follows "Preference should be given to applicants having a workable plan for training and maintaining a corps of volunteers." Petitioner demonstrated its consistency with this preference by utilizing volunteers who are bilingual and who will assist in performing the clerical, visitation, counseling, public relations and community awareness aspects of the program. Petitioner also intends to rely on the volunteer efforts of the servicing hospital, churches, schools, community functions, educational efforts and media to enhance community awareness about the program.
The second preference reads as follows, "Preference should be given to those applicants who propose to provide care for the indigent and medically needy." Petitioner demonstrated its consistency with this preference by proposing to provide ten (10) percent of its total patient day for Medicaid recipients, and five
(5) percent of its total patient days to the medically indigent, at least, during the first year of operation.
The third preference reads as follows, "Preference should be given to those applicants who propose a commitment to serving persons with AIDS." Petitioner demonstrated its consistency with this preference by stating both in the application and through the testimony of its witnesses that it intends to serve the ever-increasing number of patients diagnosed with AIDS. Further, it is one of Petitioner's long range objectives to seek funding sources and grants to provide additional services to AIDS patients.
The fourth preference reads as follows: "Preference should be given to those applicants who can demonstrate or have entered contractual agreements with other community agencies to ensure a continuum of care far those in need." Petitioner's application is consistent with this preference by its claim that the hospitals set forth in paragraph 6 intend to participate in the program, and should supplement the home health care system which Petitioner currently maintains. However, no competent proof was offered in support of the proposed arrangements.
The fifth preference reads as follows: "Preference should be given to those applicants who have developed specialized innovative services to special sub-population in need within the District." Petitioner demonstrated its partial consistency with this preference by showing its intent to service patients with AIDS, the elderly and the Hispanic sub-populations of Dade County. However, Petitioner failed to show that the service it would provide was different from the service provided by the existing hospices in Dade County, other than the intended geographical location of Petitioner's proposal. Siting in Western Dade County on its own was not shown to be a specialized, innovative offering.
The sixth preference reads as follows: "Preference should be given to those applicants who will address specific needs of the culturally diverse minority populations in the District." Petitioner demonstrated its consistency with this preference by showing that it intends to serve the elderly, ethnic minorities, victims of AIDS, and the indigent populations of Dade County. Each of the groups Petitioner has singled out are indeed minority population groups within Dade County, and are elements of, and contribute to the cultural diversity of the area.
The seventh preference reads as follows: "Preference should be given to those applicants who propose to have health care personnel on call during night and weekend hours." Petitioner demonstrated its consistency with this preference by showing its intent to provide for home care up to24 hours a day, 7 days a week, to control its patients' symptoms and respond to emergencies as needed.
The eighth preference reads as follows: "Preference should be given to applicants who build quality assurance methods into the proposed program." Petitioner demonstrated its consistency with this preference by expressing its plan to install a quality assurance program which will include clinical records review by a registered nurse, ongoing clinical record review, and utilization review.
On balance, the Petitioner's application is consistent with the Local Health Plan.
Availability, Accessibility and Extent of Utilization
Currently there are two hospices that serve the District. The two are located in the Eastern portions of the County. Petitioner intends to locate its beds in the Northwest and Southwest portions of Dade County, whereas the existing beds are housed in the Northeast and Southeast parts of the County. Thus, Petitioner's proposed beds are more geographically accessible to the residents of Western Dade County, which the application asserts is the fastest growing area of the County. By providing beds in the Western portion of the District, and in locations different from the existing beds, Petitioner would make the hospice services in the District more geographically accessible.
Hospice, Inc., is currently licensed for twenty- five
(25) beds, of which only between fourteen (14) to sixteen (16) are operable. The record is silent as to the availability of the
thirty (30) beds approved for Catholic Hospice, Inc. The record does not indicate why the approved beds are not in service, or how the beds requested by Petitioner would improve the availability of hospice service in the District.
Quality of Care, Efficiency, Appropriateness and Adequacy
The Application suggested that patients suffering from acquired immune deficiency syndrome (AIDS) are underserved, and that Petitioner will fulfill that need. Testimony offered by Petitioner sought to establish that some patients suffering from AIDS, and those of Hispanic origin, had been refused service by the existing hospices, and made vague reference to some credit problems which Hospice, Inc., had experienced If proven, the statements might impact on the quality of care, efficiency, appropriateness and adequacy; however, without a more direct showing this testimony is not considered, substantial, or credible. As to other references concerning the quality of care, efficiency, appropriateness and adequacy, the record is again silent.
Availability and Best Use of Resources
Petitioner currently operates as a home health care agency. The hospice program would be an extension of the existing service offered by Petitioner and targeted to serve the Hispanic, elderly and terminally ill patients within the District, utilizing existing and voluntary personnel.
Without demonstrating more about the current operations, and proof of the market demand for the proposed services, a determination of the best use of resources cannot be made.
Financial Feasibility
The application projects a financially sound forecast in the short-term through 1991 starting with $75,000 available. The Department through testimony and in the SAAR recognized the short- term financial feasibility of the project. However, the record is silent on financial projections past 1991. Accordingly, a determination of the long-term financial feasibility of the proposal has not been shown.
Effects on Competition
Petitioner asserted that eligible patients were not being served by the existing facilities, as discussed in above paragraph 24. To the extent these underserved patients exist and were to be provided for by the proposed program, the offering
might have an impact on the costs of providing health services in the District. However, as discussed in paragraph 24, the evidence presented did not support Petitioner's claim.
Compliance with Rule Criteria
Rule 10-5.011(1)(j), Florida Administrative Code, sets forth the Department's methodology for calculating the numeric need for hospice services within a particular service area. Dade County is the pertinent service area for the evaluation of the application. The methodology provides a formula by which the total number of hospice patients for the planning horizon, in this case January, 1991, are to be estimated. The formula takes the cancer mortality rate in the district, and factors in a certain percentage to allow for any other types of deaths, and then factors in considerations of both long-term, and short-term hospital stays to yield the projected number of beds which will be needed in the horizon year.
For the batching cycle in which Petitioner's application was reviewed, the projected bed need is fifty-nine (59). From that figure, the number of approved beds is subtracted. At the time Petitioner submitted its letter of intent, the inventory of licensed beds in the District indicated that Catholic Hospice, Inc. was approved for thirty (30) beds, and Hospice, Inc., for twenty-five (25) beds. In other words, the inventory of licensed approved beds applicable to this application is fifty-five (55) beds. Thus, the numeric need for the pertinent batching cycle is four (4) beds.
As referenced in paragraph 5, Petitioner requested approval for six (6) hospice beds. The application contains no request for approval of less than six (6) beds, nor did Petitioner raise the issue of a partial award.
The Department does not normally approve an application when numeric need is not met unless, in the instance of a request for hospice services, mitigating and extenuating circumstances are proven by demonstrating the following: (1) documentation that the population of the service area is being denied access to existing hospices because the existing hospices are unable to provide service to all persons in need of hospice care and service, and,
(2) documentation that the proposed hospice would foster cost containment, discourage regional monopolies and promote competition for all providers in the health service area.
Hospice Inc., frequently maintains a waiting list for its hospice beds; however, the reason or reasons for the list was not demonstrated. The census of the hospice beds at Catholic
Hospice, Inc., was not discussed at the hearing, or in the application.
All of Petitioner's witnessed testified that they believed that the existing hospices were unavailable to potential patients in need of hospice service who lived in the Western portion of the District because the existing hospices were located in the Eastern portion of the District. The travel time from the Southern portion of the District to the Northernmost existing facility can require up to two and one-half hours. The witnesses asserted that the patients and their families do not wish to travel for that period of time to receive the services or to visit patients in the existing hospices. However, no patient or family member testified that the travel time or location of the existing hospice were a hindrance to care. The testimony presented concerning the patients and their families is not competent or corroborated by competent evidence.
Further, Petitioner's witnesses asserted that doctors who had treated patients eligible for hospice service had told the witnesses that the physicians hesitated to refer the patients to the existing hospices because the doctors might not have staff privileges at the hospitals which house the existing beds. Again, no physicians were available to corroborate the statements of the witnesses or offer competent testimony in support of these assertions.
Although Hospice, Inc., is Licensed for twenty- five
(25) beds, it has chosen to operate only between fourteen (14) to sixteen (16) of those beds. The reasons Hospice, Inc., has chosen not to operate all of its licensed beds were not offered in the record.
The District has the largest number of AIDS diagnosed cases of any county in Florida. The number of cases in the District is doubling, more or less on a yearly basis. The incidence of AIDS cases adds to the number of person in need of hospice care in the District. Rule 10-5.011(1)(j) does not single out AIDS-related deaths in its calculation; however, deaths from other than cancer are factored into the formula. Again, no competent testimony was presented that the existing hospices were unable to serve patients suffering from AIDS.
The methodology set out in Rule 10-5.011(1)(j) determines the initial need for hospice within the District. Once a hospice has been approved, it can increase the number of beds that it has without certificate of need approval as long as the hospice keeps a patient mix of twenty (20) percent inpatient to eighty (80) percent outpatient.
The factors asserted in findings 33-37 would go to show mitigating and extenuating circumstances, if proven by competent substantial proof. However, from the evidence presented, it cannot be determined that the existing hospices are unable to provide service to those in need of hospice care.
The evidence presented to document that the proposal would foster cost containment, discourage regional monopolies, and promote competition is discussed in paragraphs 25-28 above, and is lacking in substance to show the premise raised here.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties to, and the subject matter of these proceedings. Section 120.57(1), Florida Statutes.
As the applicant for a Certificate of Need (CON), Petitioner bears the burden of establishing, by competent substantial evidence, its entitlement to a (ON to operate a hospice program. Boca Raton Artificial Kidney Center v. DHRS, 475 So.2d 260 (Fla. 1st DCA 1985). 1/ specifically, it must meet the criteria set forth in Section 381.705, Florida Statutes, and Rule 10-5.011(1)(j), Florida Administrative Code, based on a balanced consideration of all matters enumerated therein. Balsam v. Department of Health and Rehabilitative services, 486 So.2d 1341, 1349 (Fla. 1st DCA 1986); St. Joseph's Hospital v. DHRS, et.
all., 536 So.2d 346 (Fla. 1st DCA 1988). The weight to be given to each criterion is not fixed, but varies depending on the facts of each-case. Collier Medical Center, Inc. v. DHRS, 462 So.2d 83 (Fla. 1st DCA 1985); North Ridge General Hospital, Inc. v. NME Hospitals, Inc. and DHRS, 478 So.2d 1138 (Fla. 1st DCA 1985
Balanced Consideration of Criteria
Section 381.705, Florida Statutes, and Rule 10- 5.011(1)(j), Florida Administrative Code, outline the criteria which the Petitioner must prove it meets to qualify for an award of the requested certificate of need.
Although each of the criteria, outlined in the above provisions are considered in reaching the determination of need, the Department in its proposed recommended order raised only certain of the statutory criteria and the provisions of Rule 10- 5.011(1)(j) as being at issue.
Rule 10-5.011(1)(j) initially sets out the methodology for the determination of the numeric need for hospice beds in the district for the batching cycle in which the application was reviewed. Here, the numeric need was four (4) beds. Petitioner
requested approval for six (6) bed's which would exceed numeric need. If proposed, the Department does consider a request for partial approval, i.e., a request, in the alternative, for four beds. Here, such a was not made. Without a request for partial approval by the Petitioner and documentation to establish the effect of the reduced number on the other relevant criteria, the Department's failure to initiate and grant a partial award is not error.
However, Rule 10-5.011(1)(j) provides an alternative method of approval when the numeric need is insufficient. In text, this provision of the rule provides:
Mitigating and extenuating circumstances which must be met for the department to issue a Certificate of Need for a proposed new hospice even though the previously described need determination methodology does not clearly indicate need are:
Documentation that the population of the proposed service area is being
denied access to hospice service in that existing hospices within the proposed service area are unable to provide service to all persons in need of hospice care and services.
Documentation that approval of
such proposed hospice would foster cost containment, discourage regional monopolies and promote competition for all providers in the health service area.
Breaking these provisions down into elements of proof, one finds that subparagraph 2.a. of the subject rule requires a showing of the following:
Inability of
Existing hospices
Within the service area
To provide hospice service to all persons within the service area
The relevant service area is Dade County. In its application, Petitioner pointed out that it intended to provide service to certain subdistricts within the Department's District XI. However, the proof demonstrated that the relevant service area for consideration is the entirety of Dade County. This is not to say that the argument of Petitioner as to geographic accessibility of
its proposed service is not relevant; it is merely stated to indicate the parameters of the service area for consideration of the determination of need is Dade County. Within Dade County, a demonstration of the inability of existing hospices to provide hospice service is required. The proof did not address the provision of service by the two existing hospices in the area, either their inability or ability to provide the service.
Testimony was presented by the Petitioner relating to a waiting list maintained by Hospice, Inc. However, the reason or extent of the waiting list was not demonstrated. Also, mention was made that Hospice, Inc., had experienced credit problems. However, the testimony was hearsay and uncorroborated by competent, substantial evidence. Accordingly, Petitioner failed to demonstrate its compliance with Rule 10-5.D11(1)(j)2.a.
Subparagraph 2.b. of the subject rule requires documentation that approval of the proposal would encourage the following:
cost containment
discouragement of regional monopolies
competition for all providers.
To meet the requirement of this subparagraph 2.b. all three of the above criteria must be demonstrated.
The proof offered to support compliance with subparagraph 2.b. of the subject rule was, as noted in paragraph
40 of the Findings of Fact section herein, lacking in substance. As to cost containment, no demonstration of costs was made on which an evaluation could be conducted. As to discouragement of regional monopolies, there was no showing that a monopoly existed which would require discouragement. Lastly, as to the competition for all providers, Petitioner offered some elements which might begin an analysis of competition. Evidence concerning the lack of supply of service by existing hospices was offered by a showing of the existence of vacant beds and a waiting list for the vacant beds. However, any evidence as to demand for service was defeated by the demonstration of lack of numeric need. Without a more detailed showing of the current situation and market factors, a conclusion as to the effects of a new proposal on competition with existing hospice providers cannot be made. Further, the proof was silent as to the market structure of other health care providers. thus, the competitive effect of the proposal on all providers has not been demonstrated.
Petitioner failed to demonstrate the existence of mitigating and extenuating circumstances and to overcome the lack of numeric need.
The statutory criteria at issue are found in Section 381.705(1)(a),(b),(h),(i),(l) and (2)(a) and read as follows:
The department shall determine the reviewability of applications and shall review applications for
certificate-of-need determinations If or health care facilities and services, hospices, and health maintenance organizations in context with the following criteria:
The need for the health care facilities and services and hospices being proposed in relation to the applicable district plan and state health plan, except in emergency
circumstances which pose a “threat to the public health.
The availability, quality of care, efficiency, appropriateness, accessibility, extent of utilization,
and adequacy of like and existing health care services and hospices in the service district of the applicant.
***
The availability of resources, including health manpower, management personnel, and funds for capital and operating expenditures, for project accomplishment and operation; the effects the project will have on clinical needs of health professional training programs in the service district; the extent to which the services will be accessible to schools for health professions in the service district for training purposes if such services are available in a limited number of facilities; the availability of alternative uses of such resources for the provision of other health services; and the extent to which the proposed services will be accessible to all residents of the service district.
The immediate and
financial feasibility of the proposal
***
the probable impact of the proposed project on the costs providing health services proposed by the applicant, upon consideration of factors including, but not limited to,
the effects of competition on she supply of health services being proposed and improvements or innovations in the financing and delivery of health services which foster competition and service to promote quality assurance and cost-effectiveness.
In cases of capital expenditure proposals for the provision of new health services to inpatients, the department shall also reference each of the following in its findings of fact:
(a) 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.
No capital expenditures were anticipated by the application or proposed by Petitioner. Accordingly, Section 381.705(2)(a) is not applicable here.
Petitioner did show specific elements of certain of the statutory criteria. Particularly, the project is consistent with both the state and local health plans and would enhance the geographic accessibility of hospice services in the District.
Compliance with the planning instruments in place is indeed an important factor and an admirable showing. Willingness to assist in the alleviation of the occasional traffic snarls for those in pain is also most noteworthy.
However, on balance, the lack of proof of mitigating and extenuating circumstances combined with, again, the lack of competent substantial proof of the remaining essential elements at issue outweighs the showings demonstrated.
Based on the foregoing Findings of Fact and Conclusions of Law, it is:
RECOMMENDED that the Department of Health and Rehabilitative Services issue a Final Order which denies CON Application Number 5871.
DONE AND ENTERED in Tallahassee, Leon County, Florida,, this 13th day of February, 1990.
JANE C. HAYMAN
Hearing Officer
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-1550
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 13th day of February, 1990.
ENDNOTES
1/ At the hearing, Petitioner noted a statement in the Issues of the local health plan which states, "There is no data available at this time to determine the effectiveness of hospice programs in the District in terms of geographic access, ethics patterns or other unmet community needs." It was Petitioner's assertion that the local health council recognized the lack of data concerning hospice programs and questioned how it could provide the data if the local health council could not. This argument does not have merit here since as previously stated the burden is on the Petitioner to generate the competent substantial evidence necessary to prove its entitlement to the certificate of need. To do so, Petitioner must provide the proof necessary to demonstrate the criteria addressed above.
APPENDIX TO THE RECOMMENDED ORDER IN CASE NO. 89-4885
The following are my specific rulings on all findings of fact proposed by both parties:
Findings proposed by Petitioner:
Accepted, in part, in paragraph 8 and 9; rejected, in part, as argumentative.
Accepted, in part, in paragraphs 7, and 32; rejected, in part, as argumentative.
Accepted, in part, paragraphs 29 - 40; rejected, in part, as not supported by competent, substantial evidence.
Rejected, in part, as not supported by competent, substantial evidence and argumentative; however, the subparts are addressed individually without consideration of the introductory phrase to paragraph 4 which was rejected.
Accepted in paragraph 30.
Accepted in paragraphs 30 and 23.
Rejected as argumentative and not supported by competent, substantial evidence.
Rejected as argumentative and not supported by competent, substantial evidence.
Rejected as argumentative and not supported by competent, substantial evidence.
Rejected as argumentative and not supported by competent, substantial evidence.
Accepted, in part, in paragraph 22; rejected, in part, as not supported by competent, substantial evidence.
Rejected as not supported by competent, substantial evidence.
Rejected as not supported by competent, substantial evidence.
Accepted in paragraph 22.
Rejected as not supported by competent, substantial evidence.
Rejected as argumentative and not supported by competent, substantial evidence.
Accepted, in part, in paragraph 37; rejected, in part, as argumentative.
Rejected as not supported by competent, substantial evidence.
Rejected as argumentative.
Accepted in part, rejected as not supported by competent, substantial evidence.
Accepted in paragraph 13.
Accepted in paragraph 14.
Accepted in paragraph 15.
Rejected as not supported by competent, substantial evidence.
Accepted in part in paragraph 17 and rejected in part as not supported by competent, substantial evidence.
Accepted in paragraph 18.
c.7 Accepted in paragraph 19.
c.8. Accepted in paragraph 20.
Rejected as not supported competent, substantial evidence.
Rejected as not supported by competent, substantial evidence. Findings proposed by Respondent:
Accepted in paragraph 5.
Accepted in paragraph 9.
Accepted in paragraph 9.
Accepted in paragraphs 29 and 32.
Accepted in paragraph 29.
Accepted in paragraph 30.
Rejected as argumentative.
Accepted in paragraphs 12-21.
Accepted, in part, in paragraphs 22 -28; rejected, in part, as not supported by the competent, substantial evidence.
Accepted in paragraphs 25 and 26.
Accepted in paragraph 27.
Accepted in paragraph 28.
Rejected as argumentative.
Rejected as procedural matter and is addressed in the Preliminary Statement section of this recommended order.
Rejected as conclusion of law.
COPIES FURNISHED:
Richard A. Patterson, Esquire Department of Health and
Rehabilitative Services 2727 Mahan Drive
Fort Knox Executive Center Tallahassee, Florida 32308
Francisco W. Marty, President 7270 NW 12th Street
Penthouse 6
Miami, Florida 33126
Sam Power, Agency Clerk Department of Health and Rehabilitative Services
1323 Winewood Boulevard
Tallahassee, Florida 32399-0700
John Miller, General Counsel Department of Health and
Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, Florida 32399-0700
| Issue Date | Proceedings |
|---|---|
| Feb. 13, 1990 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Mar. 12, 1990 | Agency Final Order | |
| Feb. 13, 1990 | Recommended Order | Petitioner failed to present the existence of mitigating circumstances to overcome their lack of numeric need and failing to prove remaining essential elements |
