STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
HUMHOSCO, INC. d/b/a HUMANA HOSPITAL BRANDON, et al., | ) ) | ||
) | |||
Petitioners, | ) | ||
) | |||
vs. | ) Case | Nos. | 90-6905 |
) | 90-6906 | ||
DEPARTMENT OF HEALTH AND | ) | 90-6907 | |
REHABILITATIVE SERVICES, | ) | 90-6908 | |
) | 90-6909 | ||
Respondent, | ) | 90-6910 | |
) | 90-6911 | ||
and | ) | 90-6912 | |
) | |||
HILLSBOROUGH COUNTY HOSPITAL | ) | ||
AUTHORITY, et al., | ) | ||
) | |||
Intervenors. | ) | ||
)
RECOMMENDED ORDER
These consolidated cases were heard by Eleanor M. Hunter, the Hearing Officer designated by the Division of Administrative Hearings, from May 14 - 17;
21 - 24; and 28 - 31, 1991, in Tallahassee, Florida.
APPEARANCES
For Petitioners: James C. Hauser, Esquire George Matlock, Esquire Foley & Lardner
101 North Monroe Street Suite 1050
Post Office Box 508
Tallahassee, Florida 32302-0508
For Respondent: Thomas R. Cooper, Esquire Edward G. Labrador, Esquire Department of Health and Rehabilitative Services 2727 Mahan Drive
Tallahassee, Florida 32308
For Intervenor Stephen K. Boone, Esquire
Adventist Health John Koda, Esquire
System/Sunbelt, Boone, Boone, Klingbeil
Inc.: Boone & Roberts, P.A. Post Office Box 1596 Venice, Florida 34284
For Intervenor All Charles A. Stampelos, Esquire Children's Hospital, Gerald B. Sternstein, Esquire Inc.: McFarlain, Sternstein, Wiley
& Cassedy, P.A.
215 South Monroe Street Suite 600
Tallahassee, Florida 32301
For Intervenor Florida David Watkins, Esquire Hospital Association: Patricia Renovitch, Esquire
Robert C. Downie, Esquire Oertel, Hoffman, Fernandez & Cole, P.A.
2700 Blair Stone Road Suite C
Post Office Box 6507 Tallahassee, Florida 32314-6507
For Intervenor Florida Kenneth D. Kranz, Esquire Medical Center Ltd.: Eric B. Tilton, Esquire
Eric B. Tilton, P.A.
241B East Virginia Street Tallahassee, Florida 32301
For Intervenors Lakeland Jonathan L. Rue, Esquire Reginal Medical Center, Parker, Hudson, Rainer & Dobbs Inc., and Association of 1200 Carnegie Building Voluntary Hospitals of 133 Carnegie Way
Florida, Inc.: Atlanta, Georgia 30303
For Intervenor Jay Adams, Esquire Plantation General 418 East Virginia Street Hospital: Tallahassee, Florida 32301
For Intervenor South F. Philip Blank, Esquire Broward Hospital D. Lance Langston, Esquire District: F. Philip Blank, P.A.
204B South Monroe Street Tallahassee, Florida 32301
For Intervenors St. Ivan Wood, Esquire
Anthony's Hospital, St. Baker & Hostetler, McCutchen, Mary's Hospital, and St. Black
Joseph's Hospital: 600 Travis
2100 Texas Commerce Tower Houston, Texas 77002
For Intervenor The John Radey, Esquire
Tampa General Hospital: Elizabeth McArthur, Esquire
Aurell, Radey, Hinkle & Thomas
101 North Monroe Street Suite 1000
Post Office Drawer 11307 Tallahassee, Florida 32302
For Intervenor Cynthia S. Tunnicliff, Esquire University Community Loula Fuller, Esquire Hospital: Carlton, Fields, Ward,
Emmanuel, Smith & Cutler, P.A.
215 South Monroe Street Suite 410
Post Office Drawer 190 Tallahassee, Florida 32302
STATEMENT OF THE ISSUES
Whether Petitioners (collectively referred to as "Humana") are entitled to exemptions from the Certificate of Need ("CON") Law, to establish certain services at their facilities, pursuant to Subsection 381.713(1)(b), Florida Statutes (1989), (a provision which was repealed by Chapter 91-282, Laws of Florida).
Whether Intervenors have standing to contest the exemption requests of Humana.
PRELIMINARY STATEMENT
Petitioners are the license-holders of eight Humana hospitals. They filed eight separate exemption requests in June 1990, to establish certain services at those hospitals, pursuant to Subsection 381.713(1)(b), Florida Statutes. That statute provided.
Health maintenance organizations.--A certificate of need shall not be required for the offering of an inpatient institutional health service, the acquisition of major med- ical equipment, or the obligation of a capital expenditure by an entity described in para- graph (a) or paragraph (b), if an application for exemption from review has been submitted
in such form, manner, and content as prescribed by the department and has been approved by the department for:
* * *
(b) A health care facility which:
Primarily provides inpatient health services;
Is leased with at least 15 years remaining in the term of the lease or is controlled, di- rectly or indirectly, by a health maintenance organization or a combination of health mainten- ance organizations which has in its service area
an enrollment of at least 50,000 individuals; and
Is geographically located so that service shall be reasonably accessible to such enrolled individuals.
Florida Administrative Code Rule 10-5.005, also provided, in relevant part,
(1) Certain projects are exempted from certi- ficate of need review pursuant to subsections 381.706(3) and 381.713(1), F.S. The applicant shall file a request for exemption ... and
provide documentation to justify the request. A request for exemption is not subject to the batching requirements specified under Rule
10-5.008, F.A.C., and may be submitted at any time.
(2) * * *
(a) The applicant shall provide ... a written notice to include the name of the health care facility, home health agency or hospice involved, the legal name of the license holder, a statement of the services to be provided, the location of the project, the costs, and the proposed licensed bed capacity of the health care facility, if applicable.
Pursuant to Subsection 381.713(1), Florida Statutes, only certain types of services are exempt from the requirement of a CON when offered by a heath maintenance organization (HMO). Exempt services are "institutional health services", defined in Subsection 381.702(13), Florida Statutes, as follows:
(13) "Institutional health service" means a health service which is provided by or through a health care facility and which entails an
annual operating cost of $500,000 or more. * * *
An institutional health service is distinguished from a "tertiary health service", which is defined, in Subsection 381.702(20), Florida Statutes, as
... a health service which, due to its high level of intensity, complexity, specialized or limited applicability, and cost, should be limited to and concentrated in, a limited number of hospitals to ensure the quality, availability, and cost-effectiveness of such service. Examples of such service include,
but are not limited to, organ transplantation, specialty burn units, neonatal intensive care units, comprehensive rehabilitation, and medical or surgical services which are experimental or developmental in nature to the extent that the provision of such services is not yet within
the commonly accepted course of diagnosis or treatment for the condition addressed by the given service. The department shall establish by rule a list of all tertiary health services.
On September 14, 1990, the Respondent Department of Health and Rehabilitative Services (HRS) issued its decisions on all eight exemption requests. HRS approved the exemption request for the establishment of inpatient cardiac catheterization by Humana Hospital Pembroke Pines, Inc. at Humana Hospital Pembroke Pines (Humana Pembroke), limiting the service to enrollees of Humana's HMO, Humana Medical Plan, Inc. (HMP). HRS notified Humhosco, Inc. d/b/a Humana Hospital Northside (Humana Northside) that an inpatient MRI device was not included within the definition of major medical equipment and could be purchased without approval of a CON or an exemption. HRS denied the requests for other services at Humana Pembroke and Humana Northside, and for all services proposed at the other six Humana hospitals.
Humana's Petitions for Formal Administrative Hearings were filed timely challenging the denial of the exemption requests for all services proposed at the eight Humana Hospitals, other than MRI at Humana Northside and inpatient cardiac catheterization at Humana Pembroke, and challenging the limitation of providing the Pembroke service only to HMP enrollees.
Thirteen entitities (two hospital associations and eleven hospitals), filed petitions to intervene in the consolidated Humana cases. In addition to supporting HRS' determination that seven of the hospitals were not HMO controlled, some of the Intervenors also challenged the HRS preliminary approval of inpatient cardiac catheterization services at Humana Pembroke. Humana filed responses opposing all petitions to intervene. The previously assigned Hearing Officer entered an Order Denying All Petitions to Intervene on December 12, 1990, and a Recommended Order on January 14, 1991, denying Intervenors' Motion to Reconsider the Order of December 12, 1990. On January 28, 1991, HRS issued an Order Granting Intervention. On June 3, 1991, Adventist Health System/Sunbelt, Inc. ("Adventist") filed a Notice of Voluntary Dismissal.
At formal hearing, Petitioners presented the testimony of nineteen witnesses and offered exhibits 1-69, all of which were received in evidence, except exhibits 40, 42, 48, and 61 which were excluded as sanctions for discovery violations. HRS presented the testimony of two witnesses and offered exhibits 1-20, which were received in evidence. Intervenors jointly presented the testimony of three witnesses and offered exhibits 3, 7, 8, 14-19, 23, 24, 26-84, all of which were received in evidence, except exhibit 64 which was excluded as irrelevant. Intervenors separately presented the testimony of fourteen witnesses, and offered 12 exhibits which were recived in evidence.
A transcript of the proceeding was filed with the Division of Administrative Hearings on July 1, 1991. Proposed Findings of Fact and Conclusions of Law were filed on August 27, 1991. HRS also filed a Motion to Extend the Length of HRS' Proposed Recommended Order, which is granted. Humana also filed a Motion and a Renewed Motion to Award Attorneys' Fees and Costs Against Adventist, to which Adventist filed a Response on September 9, 1991, which is denied. See, Conclusion of Law 3.
FINDINGS OF FACT
Petitioners
Humhosco, Inc. d/b/a Humana Hospital Brandon (Humana Brandon) in Hillsborough County applied for CON exemption to initiate open heart surgery services.
Humhosco, Inc. d/b/a Humana Hospital Northside (Humana Northside) in St. Petersburg, Pinellas County, applied for a CON exemption to initiate open heart surgery and inpatient MRI services.
Humana of Florida, Inc. d/b/a Humana Hospital St. Petersburg (Humana St. Petersburg), in Pinellas County applied for a CON exemption to establish a Level II neonatal intensive care unit (NICU).
Humana of Florida, Inc. d/b/a Humana Hospital Pasco (Humana Pasco) in Dade City, Pasco County, applied for CON exemption to initiate inpatient cardiac catheterization.
Humana of Florida, Inc. d/b/a Humana Hospital Bennett (Humana Bennett) in Plantation, Broward County applied for a CON exemption for a Level II NICU.
Community Hospitals of Humana, Inc. d/b/a Humana Hospital Cypress (Humana Cypress) in Pompano Beach, Broward County applied for CON exemption to perform inpatient cardiac catheterization procedures, and for substance abuse and psychiatric beds.
Community Hospital of The Palm Beaches, Inc. d/b/a Humana Hospital Palm Beaches (Humana Palm Beaches) in Palm Beach County applied for a CON exemption to perform inpatient cardiac catheterization procedures.
Humana Hospital Pembroke Pines, Inc. d/b/a Humana Hospital Pembroke Pines (Humana Pembroke) in Broward County applied for CON exemptions for open heart surgery, inpatient cardiac catheterization, Level II NICU, psychiatric and comprehensive rehabilitation beds.
Intervenors
Adventist Health System/Sunbelt, Inc. (Adventist) filed a Notice of Voluntary Dismissal on June 3, 1991.
Florida Hospital Association (FHA) is a trade association of approximately 225 hospitals in the State of Florida.
The Association of Voluntary Hospitals of Florida, Inc. (AVHF) is a not-for-profit corporation representing approximately 90 private and public not- for-profit hospitals in the State of Florida.
All Children's Hospital (ACH), a 144-bed children's specialty hospital with Level II and Level III NICU beds, is a Regional Perinatal Intensive Care Center (RPICC) located in St. Petersburg in HRS District 5 for Pinellas/Pasco Counties.
Florida Medical Center, Ltd. (FMC) is a 459-bed acute care hospital in HRS District 10, Broward County, at which services include inpatient cardiac catheterization, open heart surgery, and short term psychiatric services.
Lakeland Regional Medical Center (LRMC) is an 897-bed acute care hospital, located in Polk County in HRS District 6, with a range of cardiac services, including open heart surgery.
Plantation General Hospital (Plantation), a general acute care hospital in HRS District 10, Broward County, offers cardiac catheterization and Level II NICU among its procedures and programs.
South Broward Hospital District (SBHD), a legislatively-created special taxing district, operates a 737-bed Memorial Hospital in HRS District 10, Broward County, at which its services include open heart surgery, inpatient cardiac catheterization, Level II and III neonatal intensive care, short-term inpatient psychiatric treatment, and inpatient comprehensive rehabilitation.
St. Anthony's Hospital is a 434-bed community hospital in St. Petersburg, Pinellas County, which is in HRS District 5, and offers inpatient cardiac catheterization.
St. Joseph's Hospital is a 649-bed facility in Tampa, Hillsborough County, which is in HRS District 6, and provides inpatient cardiac catheterization and open heart surgery.
St. Mary's Hospital, a 378-bed general, acute-care hospital in West Palm Beach, Florida, offers Level II and III NICU, and inpatient cardiac catheterization.
Hillsborough County Hospital Authority, operates Tampa General Hospital (Tampa General) in HRS District 6, with 1,024 beds and a range of cardiac services, including open heart surgery.
University Community Hospital (UCH) is located in HRS District 6, and is an existing provider of open heart surgery.
Standing
Adventist failed to present evidence of standing.
FHA members include all of the petitioners and intervenors in this case.
AVHF members include at least one member providing the same service in the same HRS District as the services which the eight Humana hospitals seek to establish by the exemption requests.
ACH is an existing provider of Level II NICU in HRS District 5, the same service in the same area as proposed in the exemption request of Humana St. Petersburg.
FMC provided 10% of its cardiac services in 1990 to HMP enrollees and is an existing provider of inpatient cardiac catheterization, open heart surgery, and short term psychiatric services in HRS District 10, which are, in part, the subjects of the Humana Cypress and Pembroke exemption requests.
At LRMC, from October 1, 1989 through September 30, 1990, 163 open heart surgeries, 215 cardiac catheterizations, 22 angioplasties, and 1,434 other cardiology procedures were performed on patients discharged to zip codes included by Humana Brandon in its service area for its exemption request for open heart surgery.
Plantation is an existing provider in HRS District 10 of inpatient cardiac catheterization, for which Humana Cypress requested exemption, and Level II NICU, for which Humana Bennett requested exemption, and both of which services are included in the Humana Pembroke exemption request.
SBHD estimates the range of patients lost, as a result of approval of the exemption requests of Humana Pembroke and Humana Bennett, at between 25-344 cardiac catheterizations, 58-434 open heart surgeries, up to 232 substance abuse treatments, between 8-352 comprehensive rehabilitations, 25-1933 short-term inpatient psychiatric, and 58-1354 neonatal patients.
St. Anthony's provides inpatient cardiac catheterization in St. Petersburg and Southern Pinellas County, the same service in an overlapping service area as proposed in the Humana Pasco exemption request.
St. Joseph's service areas for inpatient cardiac catheterization and open heart surgery overlap those in the exemption requests of Humana Pasco for cardiac catheterization, and overlap those of Humana Brandon and Humana Northside for open heart surgery.
St. Mary's is a Humana Care Plan provider for inpatient cardiac catheterization, in a service area overlapping that proposed for inpatient cardiac catheterization by Humana Palm Beaches, and for NICU at Humana Bennett, since St. Mary's is one of the designated statewide Regional Perinatal Intensive Care Centers.
Tampa General is under contract to Humana HMO, PPO and insurance subscribers, and provided 116 open heart surgeries to patients included within the service area of the Humana Brandon exemption request, and projects its loss of gross revenue at $1.5 million from the approval of the Humana Brandon exemption request for open heart surgery.
At UCH, which has a service area within the area proposed for open heart surgery at Humana Brandon, twenty open heart surgeries in fical year 1990, and forty open heart surgeries in the first six months of 1991 were performed on HMP enrollees, the latter generating approximately $2 million in gross revenues.
Amendment of Applications for Exemption (Costs)
The June 1990 Humana exemption requests failed to include the costs of the services proposed, as required by Florida Administrative Code 10- 5.005(2)(a).
HRS reviewed the requests, failed to notify Humana of the omission of cost data, and failed to cite the absence of that data as a basis for its decisions.
The cost of services is included implicitly within the statutory criterion for review of exemption requests, because cost may be a factor in distinguishing between services which are or are not available by exemption.
Tertiary and Inpatient Institutional Health Services or Beds
Subsection 381.702(20), Florida Statutes, defining "tertiary health services" was enacted subsequent to the HMO exemption in Subsection 381.713(1), Florida Statutes, without any concurrent, material amendment of the latter.
NICU and comprehensive rehabilitation are included in Subsection 381.702(2), Florida Statutes, as examples of tertiary health services.
Open heart surgery is included within the definition of tertiary health services in Florida Administrative Code Rule 10-5.002(66).
Inpatient cardiac catheterization is an inpatient institutional health service.
Short-term inpatient psychiatric and substance abuse services are included in "alcohol treatment, drug abuse treatment and mental health services" as defined in Subsection 381.702(9), Florida Statutes.
Because they are within the definition of "health services" but not within the definition of "tertiary services", short-term inpatient pschiatric and substance abuse are also included within the definition of "institutional health services" which may be exempt from CON regulation if all other provisions of the HMO exemption provision are met.
Certain inpatient institutional health services, such as substance abuse and psychiatric services are authorized by the issuance of licenses designating the number of approved beds which may be used in offering the service.
Need methodology and physical plant requirements are factors which differ in the requirements for services offered in approved licensed beds.
The HMO exemption provision encompasses inpatient services provided in licensed bed inventories, in the phrase "inpatient institutional health services."
Nature and Control of Facilities
Each of the eight Humana hospitals are health care facilities, as defined in Subsection 381.702(7), Florida Statutes.
Each of the eight Humana hospitals are licensed acute care hospitals which primarily provide inpatient health services, as required by Subsection 381.713(1)(b)1., Florida Statutes (1989).
Humana Pembroke
Humana Pembroke Pines, Inc. was incorporated in December 1989. It acquired the assets of Pembroke Pines General Hospital, pursuant to an asset sale and purchase agreement, the performance of which was guaranteed by Humana, Inc.
Humana Medical Plan, Inc. (HMP), an HMO, is a wholly-owned subsidiary of Group Health Insurance, Inc., which in turn is a wholly-owned subsidiary of Humana, Inc. Although HMP acquired 100% of the stock in Humana Pembroke Pines, Inc., documents filed with state and federal agencies, other than HRS and the Department of Insurance, continued to list Humana, Inc. as the insured or controlling entity.
Humana first indicated to HRS that the acquisition of Pembroke Pines General Hospital would be made by Humana Hospital Pembroke Pines, Inc., with a possible change of ownership to another Humana subsidiary, and subsequently notified HRS that the acquiring subsidiary would be HMP.
Based on Humana's notice that the acquisition would not result in a change in beds or services, HRS determined that the acquisition of Pembroke Pines was not reviewable under CON requirements.
An internal memorandum dated February 1, 1990, indicates that Humana planned to take advantage of the HMO exemption request prior to the acquisition of Pembroke Pines General Hospital, but did not report its plans to HRS.
On March 2, 1990, HRS issued a license to Humana Hospital Pembroke Pines, Inc.
There is no evidence to support the assumption that HRS would not have approved the acquisition of Humana Pembroke, or that Humana's plans to utilize the HMO exemption would have invoked CON review of the acquisition and resulted in a denial of the acquisition.
Humana Pembroke is controlled directly or indirectly by HMP, the Humana HMO, as required by Subsection 381.713(1)(b)2.
Enrollment of 50,000 Individuals Within the Service Area
Subsection 381.713(1)(b)2., Florida Statutes, required the enrollment of at least 50,000 enrollees within the HMO's service area.
The term "service area" is not used in the statute on CON application review criteria. Rather that statute, in Section 381.705, Florida Statutes, uses the term "service district", which is defined in Subsection 20.19(7), Florida Statutes, as the organizational components of HRS.
The term "service area" is also not used in Subsection 641.47(3), Florida Statutes; that statute defines the area in which an HMO does business as an approved "geographic area".
The HMO service area, under the exemption provision, is the HMO's geographic area, because the requirement in subsection (2), that the HMO have 50,000 enrollees, otherwise would be indistinguishable from the requirement in subsection (3), that the facility's access area have 50,000 enrollees.
HMP's appoved service area includes Broward, Dade, Flagler, Hillsborough, Orange, Osceola, Palm Beach, Pasco, Pinellas, Seminole and Volusia Counties, and approximates 400,000 enrollees.
Facility Geographically Located So That Service Is Reasonably Accessible To The 50,000 Enrollees
Accessibility standards for various services are established for CON applications by rules.
There is no reason to distinguish between the standards used for the determination of accessibility to health services within the CON application process and the standards applicable to making that same determination within the CON exemption request process.
Florida Administrative Code Rule 10-5.011(1)(o)6. establishes a standard of 45 minutes maximum ground travel time under average travel conditions for access to inpatient psychiatric services, which is the equivalent of a 15-mile radius for Humana Pembroke.
Humana Pembroke's exemption request, filed in June 1990, as up-dated in July, identified 55,592 enrollees within a 15-mile radius of the hospital. This enrollment data was given by zip code in Attachment 3B for inpatient cardiac catheterization and in Attachment 3D for short term inpatient psychiatric services. 1/ In its September 1990 CON application for inpatient cardiac catheterization, which has the slightly longer travel time of one hour, Humana Pembroke identified a service area with zip codes which would include only 21,375 of the 55,592 enrollees.
When compared to enrollment data for the same zip codes in Humana's Exhibit 41, the most recent data available, enrollment in Humana Pembroke's zip codes for inpatient cardiac catheterization services and short term inpatient psychiatric services equals 27,083 HMP members, although one zip code, 33154, does not appear on Exhibit 41. Even accepting Humana's assertion that 321 enrollees reside in zip code 33154, total enrollment would equal 27,404.
Humana has failed to demonstrate that Humana Pembroke is geographically located so as to be reasonably accessible to provide either inpatient cardiac catheterization or short term inpatient psychiatric services to 50,000 HMP enrollees.
Limitation of Service to HMO Enrollees
HRS preliminarily determined that Humana Pembroke's exemption request for inpatient cardiac catheterization services should be granted but that the service should only be available to HMP members.
The text of subsection 381.713(1)(b), Florida Statutes, does not however restrict the provision of services to HMO enrollees, and the fact that a minimum number of enrollees must be in the service area to maximize the utilization of the service by enrollees does not compel such a conclusion.
Subsection 381.713(1)(a), Florida Statutes, is a similar exemption provision which requires the enrollment of 50,000 individuals in an HMO's service area and a reasonably accessible facility, but also requires that 75% of reasonably expected patients be HMO enrollees.
The Legislature was, therefore, obviously aware of the issue, yet in the applicable subsection failed to include any provision conditioning CON exemption approved upon provision of services only to HMO enrollees.
Exemption Requests Based On Voting Trust Agreements
Humana Pasco, Humana Palm Beaches, and Humana Cypress requested exemption approval to establish various inpatient institutional health services based on the control of those facilities by HMP by virtue of a voting trust agreement.
The license-holder of Humana Pasco, Humana of Florida, Inc., is a wholly owned subsidiary of Humana, Inc.
The license-holder of Humana Palm Beaches, Community Hospital of the Palm Beaches, Inc., is a wholly owned subsidiary of Humana, Inc.
The license-holder of Humana Cypress, Community Hospitals of Humana, Inc., is a wholly owned subsidiary of Humana, Inc.
On behalf of Humana Pasco, Humana Palm Beaches, and Humana Cypress, Humana, Inc., entered into Voting Trust Agreements (Agreements) designating HMP, the Humana HMO, as trustee, but did not report the change of control to state and federal agencies.
The Agreements, dated May 29, 1990, have identical substantive provisions.
The term of the Agreements is ten years, terminating May 28, 2000, with a provision that Humana, Inc. may not unilaterally terminate the Agreements, although Humana, Inc. subsequently offered to terminate one of the agreements.
Each Agreement authorizes HMP to hold and vote the shares of stock of the respective Humana, Inc. subsidiary.
Each Agreement obligates HMP to vote the shares in the best interest of Humana, Inc. and the applicable wholly-owned subsidiary.
Each Agreement requires HMP to pay over all profits and dividends to Humana, Inc., with all convenient speed.
Each Agreement provides that without the consent of Humana, Inc., HMP shall not increase or reclassify capital stock; sell, lease or exchange all or substantially all property or assets; or vote to consolidate, merge, or dissolve the Humana, Inc. subsidiaries.
The Agreements provide that the trustee accepts the specified responsibilities, but recite no compensation.
The Humana hospitals, including Humana Pasco, Humana Palm Beaches, and Humana Cypress, have chief operating officers who are known as executive directors, who report to HMP Vice-Presidents, but the executive directors receive incentive compensation for maximizing hospital utilization, as do all their superiors throughout the chain of command, up to and including the president of Humana Inc.
Humana Pasco, Humana Palm Beaches, and Humana Cypress pay management fees to Humana, Inc., as does HMP, and are directly owned by corporate entities which have the same officers and directors as HMP.
By virtue of the voting trust agreement, HMP votes the shares of stock in Humana Pasco, Humana Palm Beaches, and Humana Cypress, but no operational changes in the facilities have resulted from the establishment of the voting trust agreements.
HMP, as voting trustee, has control of the assets of Humana Pasco, Humana Palm Beaches, and Humana Cypress.
HMP is an HMO with in excess of 50,000 enrollees in its service area. See, Findings 60 and 61, above.
The standard for determining if a proposed service is geographically accessible for 50,000 enrollees is the same as that established in the rules for CON applications for the same service. See, Findings 62 and 63, above.
Humana Pasco.
Humana Pasco's exemption request for inpatient cardiac catheterization asserted that 74,225 HMP enrollees reside within one hour's travel time of the facility.
The applicable travel time standard for inpatient cardiac catheterization subject to CON review is one hour, under Florida Administrative Code Rule 10-5.032.
Areas within a forty-mile radius of Humana Pasco are within one-hour average travel time of the facility.
The zip codes for enrollees in the Humana Pasco exemption request are substantially different from those included within its service area in a 1987 CON application and from Hospital Cost Containment Board data on actual utilization of the facility.
Humana failed to demonstrate that 50,000 HMP enrollees have geographic accessibility for inpatient cardiac catheterization services to Humana Pasco, based on the applicable travel time standard of one hour. 2/
Humana Palm Beaches.
In the June 7, 1990 Humana Palm Beaches' exemption request for inpatient cardiac catheterization services, Humana asserted that there were 58,268 HMP enrollees within a 40-mile radius, or one-hour average travel time of the facility.
In the July 31, 1990 submission of corrected information, Humana's attachment 3a asserts that 50,592 HMP enrollees reside in areas within 45 miles of Humana Palm Beaches. 3/
Humana's Exhibit 41, a computer printout of enrollees for May 1990, demonstrates that the enrollees in the zip codes listed on attachment 3a of the July submission equal 49,894 HMP members.
Although not determinative of enrollment in the service area, HMP's reports to the Department of Insurance on enrollment in Palm Beach County and the Hospital Cost Containment Board data on zip codes with greater than 5% actual utilization of Humana Palm Beaches also show fewer than 50,000 enrollees.
Humana attempted to assert that its enrollment figures are constantly increasing. Because the number of HMP members is so close to 50,000, that assertion becomes significant.
A comparative review of the individual zip code enrollments asserted in Attachment 3A to the Humana Palm Beaches' July submission to those in Humana Exhibit 41 demonstrates that some zip codes lost members, presumably due to changing residential patterns. Therefore, it is impossible to make a general assumption that HMP's growth in membership is evenly distributed across zip codes within an area geographically accessible to a hospital.
Humana has failed to establish that 50,000 enrollees have geographic access to Humana Palm Beaches for inpatient cardiac catheterization services using the one-hour travel time standard for CON review.
Humana Cypress.
Humana asserted that 50,962 HMP enrollees are geographically accessible to Humana Cypress for inpatient cardiac catheterization, or within the one-hour travel time or 15 miles, although its September 1990 CON application for the same service defines an area including approximately half that number.
Humana asserted that 68,412 HMP enrollees are geographically accessible to Humana Cypress for inpatient substance abuse and short term inpatient psychiatric services, or within the 45-minute travel time or a 15-mile radius, although its September 1989 CON applications for the same services encompass an area with approximately 41,000 of the enrollees.
When zip codes in the exemption requests are compared to Humana's exhibit 41, a computer printout of enrollees for May 1990, 4/ the enrollees in the zip codes submitted in the exemption request for inpatient cardiac catheterization total 50,581 and those submitted in the exemption requests for inpatient substance abuse and short term inpatient psychiatric services total 67,812. 5/
Humana has established that Humana Cypress is geographically accessible to provide inpatient cardiac catheterization to 50,000 HMP enrollees under the one-hour travel time requirement.
Humana has established that Humana Cypress is geographically accessible to 50,000 HMP enrollees under the 45 minute travel time requirement for short term inpatient psychiatric and inpatient substance abuse services.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over this matter. Subsections 120.57(1) and 381.709(5), Florida Statutes, and Ch. 91-282, Laws of Florida.
Standing. FHA and AVHF have standing to intervene to represent the substantial interests of the members of the associations. Adventist has no standing to intervene, having failed to demonstrate any interest at hearing and having subsequently filed a Notice of Voluntary Dismissal. All of the other hospital intervenors have established standing to intervene as existing providers of the same services in the same HRS district and service area as proposed in a least one of the eight Humana hospital CON exemption requests. Each Intervenor hospital has demonstrated that one of its established programs will be substantially affected, if the exemption is granted. Each has standing under Subsection 381.709(5)(b), Florida Statutes. Some intervenor hospitals, FMC, LRMC, SBHD, Tampa General, and UCH, also presented specific percentages or absolute numbers of procedures which could be affected, and/or projected revenue losses to demonstrate immediate economic injury-in-fact which would arise from the approval of one or more of the Humana applications. Whether or not they have quantified the extent of the effect on their substantial interests, the injury of the Intervenors will suffer falls within the zone of interests the CON statutes create. Each of the hospitals has a statutorily protected interest in ensuring that the entire CON regulatory scheme is not distorted, as it could be, by an erroneous approval of an exemption request. The right to participate in proceedings affecting an existing provider's substantial interest is not extinguished because the magnitude of the effect on an existing provider is not proven. The extent of the impact is not a criterion used when determining an applicant's entitlement to an exemption. Neither is an impact of a particular magnitude required for a competitor to obtain standing to object to exemption from CON review, as distinct from obtaining standing to object to a competitor's CON application for a particular institutional health service.
Motion to Award Attorneys' Fees. Humana seeks the award of attorney's fees against Adventist for its participation in this case, based on Adventist's having filed a Notice of Voluntary Dismissal after the conclusion of the formal hearing. It is impossible to conclude that Adventist's petition to intervene initially was "frivolous" as that term is used in Subsection 120.57(1)(b)5, because HRS initially granted Adventist's petition to intervene. It is similarly impossible to conclude that Adventist should have ceased participation in the proceedings at some earlier time, or to apportion fees and costs among Intervenors, in light of the previous Hearing Officer's orders requiring Intervenors to cordinate discovery, primarily to avoid undue burden to Humana.
Application Amendment (Cost). Humana's exemption requests were defective for failure to include costs of proposed services, as required by Florida Administrative Code Rule 10-5.005. In this case, that defect is not fatal for two reasons. First, the interest in having CON applications deemed complete at a time certain and in not permitting substantial amendments thereafter does not exist in a process which is not governed by batching cycles and is not a comparative review process. Second, the cost of services is not, in this instance, necessary in the review of these exemption requests. Cost is one factor in determining which services are available by exemption. For the services requested by Humana, that determination can be made by reference to statutes and rules, without an analysis of the cost of the services. For these reasons, the Motion to Dismiss and Renewed Motion to Dismiss the Humana Petitions, filed by Plantation, are denied. The Motions to Exclude Proffered Testimony On Costs are denied.
Teritiary Health Services. NICU, open heart, and comprehensive rehabilitation services are tertiary services, not institutional health services. By subsequent enactment of a statute distinguishing between institutional health services and tertiary services, without amendment of the exemption statute, the Legislature limited the scope of services available pursuant to the HMO exemption process to institutional health services.
Institutional Health Services. The definition of health services, as a sub-category of institutional health services, includes alcohol, drug abuse, and mental health services, as defined in Subsection 381.702(9). Therefore, psychiatric and substance abuse services are services which may be exempt from the CON review process when other criteria of the HMO exemption provision are met. Similarly, there was competent, substantial evidence to support the conclusion that inpatient cardiac catheterization is a "diagnostic, curative, or rehabilitative" service, and is, therefore, also a health service subject to exemption under the HMO exemption provision.
Licensed Beds vs. Services. The position taken by HRS and Intervenors that services which require designated licensed beds are not subject to the HMO exemption is rejected. The language of the exemption statute authorizing "inpatient" services, when applied to psychiatric and substance abuse, would be impossible to implement if a facility could not convert beds to accommodate those services.
Humana Pembroke. It is entirely speculative whether HRS would or would not have determined the acquisition of Humana Pembroke reviewable under the CON process, if HRS had been informed accurately that Humana Pembroke was planning simultaneously to file an HMO exemption request, as a result of the acquisition. In addition, there is no basis in the record to assume that the acquisition of Pembroke would, in any event, not have been approved. There is
also no basis in the record to determine that HRS has taken any action to invalidate the acquisition. Therefore, HMP, a Humana HMO, is the owner of, and as such is in control of Humana Pembroke. HMP has a ten-county approved geographic area to offer services within the state, which includes well in excess of the minimum requirement of 50,000 enrollees. However, without using zip codes which are also within the area claimed as geographically accessible to Humana Cypress and Humana Palm Beaches for the same services, Humana Pembroke does not have more that 50,000 HMP enrollees within one hour average travel time to the hospital.
No provision in statutes or rules addresses the issue of overlapping geographic areas. Humana takes the position that each exemption request could have been filed at different times and not be available for comparison. That position ignores the fact that HRS could treat subsequent applications on behalf of the same HMO as if services for previously included enrollees had already been provided at another facility controlled by the same HMO. Although the Legislature did not explicitly provide that an HMO facility have sufficient enrollees exclusively within its proposed service area, the arguments of HRS and intervenors are persuasive that the requirement is implicit in the statutory scheme. The requirement of a minimum number of enrollees is obviously intended to maximize use of a service at an HMO facility by HMO members. Enrollees in need of inpatient services will, at any time, be a finite number of persons who will choose among available facilities. An interpretation of the statute which permits HMO facilities owned by the same HMO to compete with each other to serve the minimum number of enrollees required to obtain a CON exemption defeats the purpose of requiring a minimum number of enrollees in each facility's access area. This is particularly true in view of Humana's position, which is accepted, that services approved under an exemption request are not limited to use by HMO members.
Humana Pasco, Humana Palm Beaches, and Humana Cypress Hospitals. The Voting Trust Agreements, by which Humana, Inc., has established HMP as trustee for Humana, Inc. and the corporate owners of the hospitals are valid. Under Florida law, a trust agreement is not invalid due to the absence of consideration, the absence of a provision for the payment of fees to the trustee or, in effect, because the trustee waives both consideration and compensation. Finally, a trust agreement is not invalid because the directors and officers of the corporate trustee and beneficiaries are the same individuals, nor because a potential conflict of interest exists between the purposes of the corporations. See State of Delaware ex. rel. Gebelein v. Belin, 456 So.2d 1237 (Fla. 1st DCA 1984). Therefore, as valid trusts, the agreements transferred legal title of the hospitals and their assets to HMP.
Intervenors and HRS raised substantial issues concerning whether the voting trust agreements vest indirect control of Humana Pasco, Humana Palm Beaches, and Humana Cypress in Humana, Inc., or its wholly-owned subsidiary HMP. They argue persuasively that the purposes for establishing an HMO exemption are in conflict with the objectives of a for-profit hospital corporation with utilization incentives for management. The Legislature did not, however, explicitly or implicitly avoid the possibility of such a conflict of interest nor did it disqualify an HMO from the exemption provision based on its corporate structure or the manner in which it gains control of a hospital facility. It could have done so by giving a specific statutory definition to the term "control" in the context of the CON exemption provision. In light of the ordinary meaning of the word, it is impossible to conclude that the trustee of a valid voting trust does not control the trust assets, i.e., the hospital facilities.
Humana Pasco's list of enrollees is not supported by any competent substantial evidence.
Humana Palm Beaches' exemption request when compared to only available underlying computer printout is inconsistent with the enrollment numbers on the exemption request. Based on the computer printout, Humana Palm Beaches is geographically accessible to fewer than 50,000 HMP enrollees.
Humana Cypress is located so that it is geographically accessible to in excess of 50,000 HMP enrollees.
Based upon the foregoing Findings of Fact and Conclusions of Law, it is recommended that a Final Order be entered
Dismissing the Petition to Intervene filed by Adventist based on its Notice of Voluntary Dismissal;
Denying the exemption requests of Humana Brandon for open heart surgery, Humana Northside for open heart surgery, Humana St. Petersburg for Level II NICU, and Humana Bennett for Level II NICU, Humana Pembroke for open heart surgery and Level II NICU, because those services are tertiary services, not institutional health services.
Denying the exemption request for inpatient cardiac catheterization and short-term inpatient psychiatric services at Humana Pembroke for failure to establish geographic accessibility to 50,000 HMP enrollees.
Denying the exemption requests of Humana Pasco and Humana Palm Beaches for failure to establish that 50,000 HMO enrollees have reasonable access to inpatient cardiac catheterization services at these facilities.
Granting the exemption request of Humana Cypress for inpatient cardiac catheterization, short term inpatient psychiatric services, and inpatient substance abuse services, without limiting the provision of services to HMP enrollees.
RECOMMENDED this 14th day of October, 1991, at Tallahassee, Florida.
Eleanor M. Hunter 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 14th day of October, 1991.
ENDNOTES
1/ Humana was unable to provide a computer printout in support of the July submission, stating that it was misplaced or lost at the time the custodian of the report was transferred to another office.
2/ Humana's Exhibit 40, which Humana asserted would have supported the enrollment figures for the Humana Pasco, was not received into evidence. The exhibit, dated June 2, 1990, was prepared in the office of Humana's Director of Membership Services, who testified that he was personally involved in the development of the data. It contained information which had been the subject of numerous discovery requests and motions to compel.
Humana was not ordered to produce the information contained in Exhibit 40 based on the March 22, 1991 affidavit of Director of Membership Services, stating that the information could not be produced in the form requested without substantial burden.
Humana's explanations, first, that there was confusion over the terms "options" and "plans", and, second, that the document might have been lost or misplaced until immediately prior to the formal hearing are not credible and are rejected.
3/ See, note 1, above. 4/ See, note 1, above.
5/ There was no explanation for the fact that Humana's Cypress exemption requests, both with zip codes within 15 miles, differ. In fact, Attachment 3B for the shorter travel time of 45 minutes for substance abuse listed nine more zip codes than those in Attachment 3A for the one-hour travel time for inpatient cardiac catheterization.
APPENDIX TO RECOMMENDED ORDER, CASE NOS. 90-6905; 90-6906; 90-6907; 90-6908; 90-6909; 90-6910; 90-6911 and 90-6912
Rulings on findings proposed by Florida Hospital Association:
1. Adopted in relevant part in Finding of Fact 10.
2 and 3. Subordinate to Finding of Fact 23.
4 and 5. Adopted in Finding of Fact 23.
Rulings on findings proposed by Association of Voluntary Hospitals of Florida, Inc.:
Adopted in relevant part in Finding of Fact 11.
Subordinate to Finding of Fact 11.
Rejected as not relevant.
Adopted in Preliminary Statement.
Adopted in Finding of Fact 24.
Adopted in part in Findings of Fact 5, 24 and 29.
7 - 11. Adopted in part in Findings of Fact 8 and 24.
12 and 13. Adopted in part in Findings of Fact 6 and 24.
Adopted in Findings of Fact 7, 19 and 24.
Adopted in Findings of Fact 1, 14, 20 and 24.
Adopted in Findings of Fact 2 and 24.
Adopted in Findings of Fact 3 and 24.
Adopted in Findings of Fact 4, 17 and 24.
Adopted in Findings of Fact 14, 16, 17, 19 and 20.
20 - 22. Subordinate to Conclusions of Law 2.
Rulings on findings proposed by All Children's Hospital, Inc.:
1 - 4. Adopted in Preliminary Statement.
5. Subordinate to Preliminary Statement.
6 and 7. Adopted in relevant part in Finding of Fact 12.
Rejected as not relevant.
Adopted in relevant part in Finding of Fact 12.
Subordinate to Finding of Fact 12.
11 and 12. Adopted in Finding of Fact 12.
13 and 14. Subordinate to Finding of Fact 12.
Subordinate to Finding of Fact 25.
Adopted in Finding of Fact 3.
Subordinate to Finding of Fact 25.
18 and 19. Subordinate to Conclusion of Law 2.
Rejected as not relevant.
Subordinate to Finding of Fact 12.
Subordinate to Conclusion of Law 2.
Subordinate to Finding of Fact 12.
24 and 25. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by Florida Medical Center:
1 - 3. Adopted in substance in Preliminary Statement. 4.
Adopted in substance in Finding of Fact 13.
Adopted in relevant part in Findings of Fact 13 and 26.
7 - 10. Adopted in relevant part in Finding of Fact 26.
Adopted in Finding of Fact 26.
Adopted in Conclusion of Law 2.
Subordinate to Conclusion of Law 2.
Adopted in Finding of Fact 13.
Adopted in Conclusion of Law 2.
16 - 18. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by Lakeland Regional Medical Center, Inc.:
Adopted in Findings of Fact 1 and 14.
Adopted in Finding of Fact 14.
3 - 8. Subordinate to Conclusion of Law 2.
Rejected as not relevant.
Adopted in Finding of Fact 27.
Subordinate to Finding of Fact 27.
Adopted in relevant part in Finding of Fact 27.
Subordinate to Finding of Fact 27.
Subordinate to Conclusion of Law 2.
Adopted in Conclusion of Law 27.
16 and 17. Subordinate to Conclusion of Law 2.
18. Subordinate to Finding of Fact 27 and Conclusion of Law 2.
19 - 26. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by Plantation General Hospital:
Adopted in Finding of Fact 8.
Adopted in Finding of Fact 5.
Adopted in Finding of Fact 6.
Adopted in Finding of Fact 28.
5 and 6. Subordinate to Finding of Fact 28.
7 and 8. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by South Broward Hospital District:
1 - 3. Adopted in Preliminary Statement.
4. Subordinate to Finding of Fact 29.
5 and 6. Adopted in relevant part in Finding of Fact 16.
7 - 10. Adopted in Finding of Fact 29.
Adopted in relevant part in Finding of Fact 29.
Subordinate to Finding of Fact 29.
Adopted in Finding of Fact 29.
14 and 15. Subordinate to Finding of Fact 29.
16. Adopted in Conclusion of Law 2.
Rulings on findings proposed by St. Anthony's Hospital:
Adopted in Finding of Fact 17.
Adopted in relevant part in Finding of Fact 17.
Rejected as not relevant.
4 and 5. Subordinate to Conclusion of Law 2.
Adopted in Finding of Fact 17.
Adopted in Finding of Fact 30.
Adopted in Findings of Fact 2 and 3.
Adopted in Finding of Fact 4.
Adopted in Finding of Fact 30.
11 - 13. Subordinate to Finding of Fact 30.
14. Subordinate to Preliminary Statement.
Rulings on findings proposed by St. Joseph's Hospital:
Adopted in Finding of Fact 18.
Subordinate to Finding of Fact 31.
3 - 5. Subordinate to Conclusion of Law 2.
6 and 7. Rejected as not relevant.
8 and 9. Subordinate to Conclusion of Law 2.
Adopted in Finding of Fact 18.
Adopted in Findings of Fact 1 and 31.
12 - 14. Adopted in Finding of Fact 31.
15 - 17. Subordinate to Finding of Fact 31.
18. Adopted in Preliminary Statement.
Rulings on findings proposed by St. Mary's Hospital:
Adopted in Finding of Fact 19.
Adopted in relevant part in Finding of Fact 19.
Adopted in Finding of Fact 19.
Rejected as not relevant.
5 and 6. Subordinate to Finding of Fact 32.
7 - 11. Subordinate to Finding of Fact 32 and Conclusion of Law 2.
12. Adopted in Preliminary Statement.
Rulings on findings proposed by Tampa General:
Adopted in Finding of Fact 20.
Adopted in Findings of Fact 20 and 33.
Adopted in relevant part in Finding of Fact 20.
4 - 6. Subordinate to Finding of Fact 33.
7. Subordinate to Conclusion of Law 2.
8 - 10. Subordinate to Finding of Fact 33.
Adopted in Finding of Fact 33.
Subordinate to Conclusion of Law 2.
Subordinate to Finding of Fact 33 and Conclusion of Law 2.
14 and 15. Subordinate to Conclusion of Law 2.
16. Adopted in relevant part in Finding of Fact 33.
17 and 18. Adopted in Finding of Fact 33.
Subordinate to Finding of Fact 33.
Subordinate to Conclusion of Law 2.
Adopted in Finding of Fact 33 and Conclusion of Law 2.
Rulings on findings proposed by University Community Hospital:
Adopted in Preliminary Statement and Finding of Fact 1.
Rejected as irrelevant.
Adopted in Preliminary Statement.
Adopted in Preliminary Statement and Finding of Fact 1.
Adopted in Preliminary Statement.
Adopted in Finding of Fact 21.
Adopted in Finding of Fact 1.
8 - 12. Adopted in Finding of Fact 34.
13 - 17. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by Humana on the issue of Intervenor's standing:
Adopted in Preliminary Statement.
Subordinate to Preliminary Statement.
3 and 4. Adopted in Preliminary Statement.
5. Subordinate to Preliminary Statement.
6 - 16. Rejected as not relevant.
Adopted, first phrase, in Finding of Fact 4. Rejected, second and third phrases.
Rejected as not relevant.
Subordinate to Findings of Fact 19 and 32.
20 - 22. Rejected as not relevant.
23. Rejected.
24 - 27. Rejected as not relevant.
Adopted, first phrase, in Finding of Fact 31. Rejected, second phrase, as not relevant.
Rejected as not relevant.
Rejected, first sentence, as not relevant. Adopted, second sentence, in Finding of Fact 28 and Conclusion of Law 2. Rejected, third and fourth sentence, as not relevant.
31 - 36. Rejected as not relevant.
Rejected.
Adopted in Finding of Fact 9.
Adopted in Finding of Fact 22.
40 - 44. Rejected as not relevant.
Rejected, first sentence, as not relevant. Rejected, second sentence.
Rejected, first sentence, as not relevant. Subordinate, second sentence, to Finding of Fact 26. Rejected, third sentence, as not relevant. Rejected, fourth sentence.
Rejected as not relevant.
Rulings of findings proposed by Humana:
1. Adopted | in | Preliminary Statement. | |||
2. Adopted | in | Finding of Fact 1. | |||
3. Adopted | in | Finding of Fact 4. | |||
4. Adopted | in | relevant part in Finding | of | Fact | 3. |
5. Adopted | in | Finding of Fact 2. | |||
6. Adopted | in | relevant part in Finding | of | Fact | 8. |
7. Adopted | in | Finding of Fact 7. | |||
8. Adopted | in | relevant part in Finding | of | Fact | 5. |
9. Adopted | in | relevant part in Finding | of | Fact | 6. |
10. Adopted | in | Preliminary Statement. | |||
Subordinate to Finding of Fact 61.
Adopted in Findings of Fact 60, 61 and 88.
Adopted in Findings of Fact 61 and 88.
Subordinate to Preliminary Statement.
Adopted in Conclusion of Law 4.
Adopted in Preliminary Statement.
Adopted in relevant part in Preliminary Statement.
Adopted in Preliminary Statement and Conclusion of Law 2.
Adopted in Preliminary Statement.
Rejected in Preliminary Statement and Finding of Fact 63.
Adopted in Preliminary Statement and Conclusion of Law 6.
22 - 27. Rejected as not relevant.
Adopted in Finding of Fact 41.
Subordinate to Finding of Fact 41.
30 - 32. Rejected as not relevant.
Adopted in relevant part in Findings of Fact 42 and 43.
Subordinate to Findings of Fact 42 and 43.
Subordinate to Finding of Fact 38.
36 - 39. Rejected as not relevant.
40. Adopted in Finding of Fact 47.
41 - 43. Adopted in Finding of Fact 48.
Adopted in Findings of Fact 48 - 51.
Adopted in relevant part in Findings of Fact 72 - 77.
Adopted in Findings of Fact 77 - 83.
Subordinate to Finding of Fact 86.
Rejected as not relevant.
Subordinate to Finding of Fact 87 and Conclusion of Law 9.
Subordinate to Conclusion of Law 9.
Subordinate in relevant part to Findings of Fact 73 - 76.
Rejected, first sentence, as not relevant. Subordinate, second and third sentences, in relevant part to Conclusion of Law 9.
Adopted in relevant part in Finding of Fact 87.
Subordinate to Findings of Fact 79 and 87.
Subordinate in relevant part to Preliminary Statement and Findings of Fact 84, 86 and 87.
Subordinate to Findings of Fact 86 and 87 and paragraph 2 of Conclusion of Law 9.
Adopted in Findings of Fact 57, 60, 61 and 88.
Rejected as cumulative.
Adopted in Findings of Fact 58 - 61.
Adopted in Finding of Fact 59.
Adopted in Findings of Fact 61 and 88.
Adopted in Preliminary Statement.
Adopted in relevant part in Findings of Fact 62 - 64, 89, 91 and 100.
Adopted in Findings of Fact 62, 63 and 89.
Rejected as not relevant.
Adopted in relevant part in Finding of Fact 98.
Adopted in relevant part in Footnote 2 of Finding of Fact 94.
Rejected, first sentence, as not relevant. Subordinate, second and third sentences, to Finding of Fact 57.
Adopted, first phrase, in Finding of Fact 1. Rejected, second phrase, as not relevant.
70 and 71. Rejected as not relevant.
Adopted in Findings of Fact 4 and 92.
Rejected in Findings of Fact 93 and 94.
Adopted in Finding of Fact 92.
Adopted, first phrase, in Finding of Fact 3. Rejected, second phrase, as not relevant.
76 and 77. Rejected as not relevant.
78. Adopted, first phrase, in Finding of Fact 2. Rejected, second phrase, as not relevant.
79 and 80. Rejected as not relevant.
Adopted in relevant part in Findings of Fact 8, 64 and 65.
Rejected in Findings of Fact 65 - 67.
Subordinate to Preliminary Statement.
Adopted, first sentence, in Finding of Fact 95. Rejected, second and third sentences in Finding of Fact 101.
Rejected in Finding of Fact 104.
Adopted, first phrase, in Finding of Fact 5. Rejected, remainder, as not relevant.
87 and 88. Rejected as not relevant.
Adopted in Findings of Fact 6 and 102.
Adopted, in substance, in Findings of Fact 105 and 106.
Subordinate to Findings of Fact 105 and 106.
Rejected in Findings of Fact 65, 93, 98 and 102.
Adopted in Finding of Fact 98.
94 - 98. Rejected as not relevant.
99. Subordinate to Findings of Fact 54, 73, 74 and 75.
100 and 101. Rejected as not relevant.
Adopted in relevant part in Findings of Fact 54, 73, 74 and 75.
Rejected as not relevant.
Adopted in relevant part in Finding of Fact 87.
Subordinate in relevant part to Finding of Fact 87.
Rejected as not relevant.
Subordinate to Finding of Fact 87.
108 and 109. Rejected as not relevant.
Adopted, first, third and fourth sentences, in Finding of Fact 55. Rejected, second and fifth sentences, in Finding of Fact 53.
Subordinate to Findings of Fact 53 and 55.
Rejected as not determined in Findings of Fact 52 - 55.
Rulings on findings proposed by Department of Health and Rehabilitative Services:
Adopted in Findings of Fact 1 - 8.
Subordinate to Finding of Fact 47.
3 - 5. Rejected as not relevant.
6 and 7. Subordinate to Conclusion of Law 9.
8 and 9. Rejected as not relevant.
Adopted in Findings of Fact 73 - 75.
Adopted in Findings of Fact 50 and 56.
12 - 14. Subordinate to Finding of Fact 50.
Adopted in Findings of Fact 1 and 2.
Adopted in Findings of Fact 3 - 5.
Adopted in Finding of Fact 7.
Adopted in Finding of Fact 6.
Adopted in Finding of Fact 8.
Adopted in Findings of Fact 54, and 73 - 75.
21 - 30. Subordinate to Findings of Fact 54 and 73 - 75.
Rejected as not relevant.
Rejected as not relevant, except as adopted in Findings of Fact 73 - 75.
Adopted in Findings of Fact 50 and 76.
Subordinate in relevant part in Findings of Fact 73 - 75.
Subordinate to Preliminary Statement.
Subordinate to Findings of Fact 80 and 82.
Adopted in relevant part in Finding of Fact 80 and Conclusion of Law 9.
38 and 39. Adopted in Finding of Fact 82.
Adopted in Finding of Fact 81.
Adopted in Finding of Fact 83.
Adopted in relevant part in Finding of Fact 85.
Subordinate in relevant part to Findings of Fact 73 - 75.
Subordinate to Finding of Fact 75.
Subordinate to Finding of Fact 73.
Rejected as not relevant.
Rejected, first sentence, as not relevant. Subordinate, second and third sentences, to Finding of Fact 82.
Subordinate in relevant part to Finding of Fact 50 and adopted in relevant part in Finding of Fact 84 and Conclusion of Law 9.
Rejected as not relevant.
Adopted in Finding of Fact 84.
51 - 54. Adopted in Finding of Fact 86.
Rejected as not relevant.
Adopted in Finding of Fact 84.
57 - 66. Subordinate to Finding of Fact 84.
Adopted, except last sentence, in relevant part in Findings of Fact 49 - 51.
Adopted, except last sentence, in relevant part in Findings of Fact 51 - 54.
69 - 72. Adopted, in relevant part, in Finding of Fact 50.
Rejected in Finding of Fact 56.
Adopted in Finding of Fact 76.
Subordinate to Finding of Fact 76.
Adopted, in relevant part, in Findings of Fact 50 and 85.
Adopted in relevant part in Findings of Fact 50 and 76.
78 and 79. Subordinate to Finding of Fact 76.
Rejected in substance in Finding of Fact 56.
Subordinate to Conclusion of Law 9.
Adopted in Preliminary Statement.
Adopted in Preliminary Statement and Findings of Fact 1 - 8.
Adopted in Preliminary Statement.
Adopted in Finding of Fact 41.
Adopted in relevant part in Findings of Fact 38 - 40.
Adopted in relevant part in Finding of Fact 43.
Adopted in Finding of Fact 39.
89 and 90. Adopted in Finding of Fact 40.
Adopted in Finding of Fact 39.
Subordinate to Finding of Fact 38.
Adopted in Finding of Fact 44.
Subordinate in relevant part to Finding of Fact 44.
Rejected in Finding of Fact 42.
Adopted, except last sentence, in Findings of Fact 44 and 45.
Adopted in Finding of Fact 45.
Rejected as not relevant.
99 and 100. Adopted in relevant part in Findings of Fact 66, 94 and 97.
Rejected as not relevant.
Adopted in substance in Finding of Fact 67.
Adopted in substance in Finding of Fact 97.
Rejected as not relevant.
105 - 107. Rejected in Finding of Fact 104.
108. Adopted in Findings of Fact 62, 63 and 89.
109 - 112. Rejected in Findings of Fact 62, 63 and 89.
113 and 114. Rejected as not relevant.
115. Adopted in relevant part in Finding of Fact 93.
116 - 118. Rejected as not relevant.
Rejected in Finding of Fact 101.
Rejected, first sentence, as not relevant. Adopted, second sentence, in Finding of Fact 65.
121 - 124. Rejected as not relevant.
125. Adopted in substance in Finding of Fact 93.
126 and 127. Rejected as not relevant.
Adopted in relevant part in Findings of Fact 102 and 103.
Adopted in substance in Finding of Fact 97.
Rejected, first sentence, as not relevant. Adopted, second sentence, in substance in Finding of Fact 94.
Rejected as not relevant.
Rejected in relevant part in Finding of Fact 105 and 106.
Rulings on findings proposed in Intervenors' Joint Proposed Recommended Order:
1. Adopted in Findings of Fact 1 - 8.
2 - 4. Subordinate to Preliminary Statement.
Adopted in Finding of Fact 50.
Adopted in Findings of Fact 72 - 74.
Adopted in Findings of Fact 50 and 72.
Adopted in Finding of Fact 77.
Subordinate to Preliminary Statement.
Adopted, first sentence, in substance in Finding of Fact 86.
Adopted in Finding of Fact 81.
Adopted in Finding of Fact 80.
Adopted in Finding of Fact 82.
Adopted, except for last sentence, in Finding of Fact 86.
Adopted in Finding of Fact 86.
Adopted, except for last sentence, in Finding of Fact 77.
Adopted, except for last sentence, in Finding of Fact 78.
18 and 19. Adopted in Finding of Fact 78.
Adopted, except last sentence, in Finding of Fact 78.
Rejected as not relevant.
Rejected in Finding of Fact 87.
Adopted in substance in Finding of Fact 84.
Adopted in substance in Finding of Fact 85.
Subordinate in relevant part to Finding of Fact 85.
Subordinate to Finding of Fact 85 and Conclusion of Law 9.
Subordinate to Conclusion of Law 9.
Adopted in Finding of Fact 85.
Subordinate in relevant part to Finding of Fact 85.
Adopted in Finding of Fact 85.
Rejected in Findings of Fact 56 and 87.
Subordinate to Finding of Fact 84.
Subordinate in relevant part to Finding of Fact 86.
Subordinate to Finding of Fact 85.
Subordinate to Finding of Fact 84.
Subordinate to Conclusion of Law 9.
Subordinate to Finding of Fact 33.
38 and 39. Subordinate to Conclusion of Law 9.
Adopted in relevant part in Finding of Fact 85.
Subordinate to Finding of Fact 85.
Subordinate to Findings of Fact 50, 72 - 74.
Rejected as not relevant.
Subordinate to Findings of Fact 50, 73 - 75.
Subordinate to Finding of Fact 81.
46 - 48. Subordinate to Finding of Fact 76.
49 - 52. Subordinate to Findings of Fact 50 and 76.
53. Rejected in Finding of Fact 87.
54 - 56. Subordinate to Findings of Fact 50 and 76.
Rejected in Finding of Fact 56.
Adopted in Finding of Fact 62.
Adopted in Findings of Fact 62 - 64, 89 - 92, 95, 96 and 102.
Subordinate in relevant part to Finding of Fact 90.
Subordinate in relevant part to Finding of Fact 95.
Subordinate in relevant part to Finding of Fact 65.
Subordinate to Finding of Fact 62.
Rejected in Finding of Fact 98.
Subordinate in substance in Finding of Fact 98.
Subordinate in Findings of Fact 65 and 93.
Subordinate to Finding of Fact 98.
68 and 69. Rejected in Finding of Fact 98.
70 - 73. Rejected as not relevant.
74 and 75. Adopted in substance in Finding of Fact 93.
76 - 79. Rejected as not relevant.
Adopted in substance in Finding of Fact 102.
Rejected as not relevant.
Subordinate to Finding of Fact 102.
83 - 85. Rejected as not relevant.
86. Adopted in substance in Finding of Fact 67.
87 - 89. Rejected as not relevant.
Subordinate to Finding of Fact 98.
Rejected in Finding of Fact 98.
92 and 93. Rejected in Findings of Fact 64, 92, 95, 102 and 103.
Adopted in relevant part in Footnote 2.
Adopted in relevant part in Findings of Fact 96, 97, and Footnotes 1, 3 and 4. Rejected in relevant part in Finding of Fact 103.
Rejected in substance in Findings of Fact 66, 99 and 104.
Rejected in relevant part in Findings of Fact 66, 100 and 104.
98 and 99. Rejected as not relevant.
Rejected as not relevant, except last sentence, adopted in Findings of Fact 24, 33 and 34.
Rejected as not relevant in Preliminary Statement.
102 and 103. Rejected as not relevant.
104. Adopted in Finding of Fact 94.
105 and 106. Rejected as not relevant.
107. Rejected in Finding of Fact 105.
108 and 109. Rejected in Finding of Fact 106.
110 and 111. Rejected as not relevant.
112 and 113. Adopted in Finding of Fact 67.
Rejected as not relevant.
Adopted in Finding of Fact 101.
Subordinate to Conclusion of Law 9.
Subordinate to Conclusion of Law 5.
Rejected in Finding of Fact 42.
Adopted in Finding of Fact 41.
Adopted in Findings of Fact 38 - 40.
121 and 122. Adopted in Finding of Fact 43.
Adopted in Finding of Fact 39.
Adopted in Finding of Fact 40.
Subordinate to Findings of Fact 39 and 40.
Subordinate to Finding of Fact 43.
Subordinate to Findings of Fact 39, 40 and 43.
Adopted in relevant part in Finding of Fact 39.
Subordinate to Findings of Fact 38 and 43.
Rulings on findings proposed in Intervenors' Joint Proposed Recommended Order on South Florida Market Issues:
Adopted in Findings of Fact 6 and 8.
Rejected as not relevant.
Subordinate to Preliminary Statement.
Subordinate to Findings of Fact 44 and 45.
Adopted in Findings of Fact 44 and 45.
Subordinate to Findings of Fact 44 and 45.
Adopted in Finding of Fact 44.
Subordinate to Finding of Fact 44.
Rejected in Finding of Fact 46.
Subordinate to Preliminary Statement.
Adopted in Finding of Fact 68.
Subordinate to Findings of Fact 69 and 70.
Rejected in Finding of Fact 71.
14 - 16. Subordinate to Preliminary Statement.
17. Adopted in Finding of Fact 50.
18 and 19. Subordinate to Finding of Fact 49.
Rejected as not relevant in Findings of Fact 54 and 55.
Adopted in relevant part in Finding of Fact 49.
Subordinate to Finding of Fact 49.
Subordinate to Finding of Fact 50.
Adopted in relevant part in Findings of Fact 49 and 51.
Subordinate to Finding of Fact 51.
Rejected as not relevant.
Adopted in relevant part in Finding of Fact 51.
Adopted in Finding of Fact 52.
Adopted in Finding of Fact 53.
Adopted in relevant part in Findings of Fact 49 and 50.
Adopted in Findings of Fact 49.
Adopted in Findings of Fact 52 and 54.
Adopted in relevant part in Finding of Fact 53.
34 and 35. Rejected in Finding of Fact 55.
36 and 37. Adopted in Preliminary Statement.
38. Subordinate to Preliminary Statement.
39 and 40. Rejected in Finding of Fact 56.
41 and 42. Rejected in Conclusion of Law 8.
43 and 44. Rejected in Conclusion of Law 9.
Adopted in Finding of Fact 50.
Rejected in Conclusion of Law 8.
Adopted in Finding of Fact 84.
Adopted in Finding of Fact 49.
Adopted in Finding of Fact 50.
Rejected in Conclusion of Law 8.
Rejected as not relevant.
Rejected in Conclusion of Law 8.
Rejected as not relevant.
Adopted in Finding of Fact 50.
Subordinate to Finding of Fact 50.
Rejected in Conclusion of Law 8.
Adopted in Finding of Fact 50.
Adopted in relevant part in Finding of Fact 50. Rejected, last sentence, as not relevant.
Adopted in Finding of Fact 50.
Adopted in relevant part in Findings of Fact 84 - 86.
Adopted in Finding of Fact 50. Rejected, last sentence, in Finding of Fact 56.
Rejected in Finding of Fact 56 and Conclusion of Law 8.
COPIES FURNISHED:
James C. Hauser, Esquire George Matlock, Esquire Foley & Lardner
101 North Monroe Street Suite 1050
Post Office Box 508 Tallahassee, FL 32302-0508
Thomas R. Cooper, Esquire Edward G. Labrador, Esquire Department of Health and
Rehabilitative Services 2727 Mahan Drive
Tallahassee, FL 32308
Stephen K. Boone, Esquire John Koda, Esquire
Boone, Boone, Klingbeil Boone & Roberts, P.A.
Post Office Box 1596 Venice, FL 34284
Charles A. Stampelos, Esquire Gerald B. Sternstein, Esquire McFarlain, Sternstein, Wiley
& Cassedy, P.A.
215 South Monroe Street Suite 600
Tallahassee, FL 32301
David Watkins, Esquire Patricia Renovitch, Esquire Robert C. Downie, Esquire Oertel, Hoffman, Fernandez
& Cole, P.A.
2700 Blair Stone Road Suite C
Post Office Box 6507 Tallahassee, FL 32314-6507
Kenneth D. Kranz, Esquire Eric B. Tilton, Esquire Eric B. Tilton, P.A.
241B East Virginia Street Tallahassee, FL 32301
Jonathan L. Rue, Esquire Parker, Hudson, Rainer & Dobbs 1200 Carnegie Building
133 Carnegie Way Atlanta, GA 30303
Jay Adams, Esquire
418 East Virginia Street Tallahassee, FL 32301
F. Philip Blank, Esquire
D. Lance Langston, Esquire
F. Philip Blank, P.A. 204B South Monroe Street Tallahassee, FL 32301
Ivan Wood, Esquire
Baker & Hostetler, McCutchen, Black
600 Travis
2100 Texas Commerce Tower Houston, TX 77002
John Radey, Esquire Elizabeth McArthur, Esquire
Aurell, Radey, Hinkle & Thomas
101 North Monroe Street Suite 1000
Post Office Drawer 11307 Tallahassee, FL 32302
Cynthia S. Tunnicliff, Esquire Loula Fuller, Esquire
Carlton, Fields, Ward, Emmanuel, Smith & Cutler, P.A.
215 South Monroe Street Suite 410
Post Office Drawer 190 Tallahassee, FL 32302
Sam Power, Agency Clerk Department of Health and
Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, FL 32399-0700
John Slye, General Counsel Department of Health and
Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, FL 32399-0700
NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
All parties have the right to submit written exceptions to this Recommended Order. All agencies allow each party at least 10 days in which to submit written exceptions. Some agencies allow a larger period within which to submit written exceptions. You should contact the agency that will issue the final order in this case concerning agency rules on the deadline for filing exceptions to this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency that will issue the final order in this case.
=================================================================
AGENCY FINAL ORDER
=================================================================
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
HUMHOSCO, Inc. d/b/a HAMANA HOSPITAL BRANDON, et al., | ) ) | |
) | ||
Petitioners, | ) CASE NO.: | 90-6905 |
) | 90-6906 | |
vs. | ) | 90-6907 |
) | 90-6908 | |
DEPARTMENT OF HEALTH AND | ) | 90-6909 |
REHABILITATIVE SERVICES, | ) | 90-6910 |
) | 90-6911 | |
Respondent, | ) | 90-6912 |
) | ||
and | ) | |
) | ||
HILLSBOROUGH COUNTY HOSPITAL | ) | |
AUTHORITY, et al., | ) | |
) | ||
Intervenors. | ) |
)
FINAL ORDER
This cause came on before me for the purpose of issuing a final agency order. The Hearing Officer assigned by the Division of Administrative Hearings (DOAH) in the above-styled case submitted a Recommended Order to the Department of Health and Rehabilitative Services (HRS). A copy of the Recommended Order is attached hereto.
RULING ON EXCEPTIONS FILED BY HRS
The issue in these consolidated cases is whether petitioners' (collectively referred to as "Humana") are entitled to exemptions from certificate of need (CON) review for certain services under the statute (Section 381.713(1)) allowing exemptions for Health Maintenance Organizations (HMO).
Counsel maintains that both the Division of Administrative Hearings (DOAH) and the department lack jurisdiction over these proceedings except for Case Number 90-6906. In Case Number 90-6906 the department preliminarily approved an exemption.
Counsel bases his argument on Chapter 91-282, Section 15, Laws of Florida which repealed the HMO exemption provision. However, the repealer contains a saving clause which preserves any exemption granted on the basis of an application submitted prior to April 17, 1991. When the Administrative Procedure Act (APA) is invoked an agency's decision is rendered in a Section
Order. See Capeletti Brothers vs. State, 362 So2d 346 (Fla. 1st DCA
1978) for a discussion of preliminary, free-form decision making versus APA decision making. Humana submitted its application before April 17, 1991; thus, there is jurisdiction under the saving clause.
Counsel excepts to the conclusion expressed in findings of fact 56 and 87 and conclusion of law 9 that the Humana HMO (HMP) controlled the Humana hospitals, Humana Pembroke, Humana Pasco, Humana Palm Beaches and Humana Cypress for purposes of Section 381.713(1)(b), Florida Statutes (1989). Because the legislature did not define control the Hearing Officer declined to construe control as meaningful control. The mere existence of the voting trust was sufficient in the Hearing Officer's view. She expressed her lack of concern in conclusion of law 9 with the absence of consideration or payment to the trustee, the fact that the directors and officers of the trustee and beneficiaries are the same individuals, or conflict of interest between the purposes of the corporate trustee and beneficiary. The Hearing Officer implicitly concluded that nominal control was enough to trigger entitlement under the HMO exemption statute. This conclusion is rejected. Control means meaningful control, not nominal control based on a paper transaction designed for the purpose of obtaining an HMO exemption.
The following facts establish the lack of meaningful control by the Humana
HMO:
Each of the applicant facilities is owned by a corporation that is a
wholly-owned subsidiary of Humana, Inc., a for-profit hospital chain. Findings of fact 72 through 76. See also finding of fact 50. As owner of the stock in the applicant subsidiaries, Humana, Inc. entered into a voting trust agreement in similar form with its wholly-owned subsidiary HMP, a Humana HMO, as trustee. Finding of fact 76.
HMP, as trustee, was obligated to act under the voting trust agreements to vote the shares in the best interest of Humana, Inc. and was required to pay over all profits and dividends to Humana, Inc. with all convenient speed. Findings of fact 80 and 81.
The voting trust agreements did not give HMP certain important powers such as the power to reclassify capital stock or the power to vote to consolidate, merge, or dissolve the entities that were subject to the voting trust agreements. Finding of fact 82.
The officers of the Humana hospitals seeking the exemptions have the same officers as HMP and Humana, Inc. so that the same people operate Humana, Inc., HMP, and the applicant Humana subsidiaries. See finding of fact 85. All of these officers receive incentive compensation for maximizing hospital utilization. Finding of fact 84.
Both people executing the voting trust agreements (Mr. Bossmeyer, in house counsel for Humana, executed the voting trust agreements for Humana, Inc.; Mr. Gramon, Humana Regional Vice President, executed for HMP) were not only officers of Humana, but also saw no change in control at the hospital level resulting from the agreements. 1/ Intervenors proposed finding 15 adopted by the Hearing Officer.
Applicants have executive directors who "receive incentive compensation for maximizing hospital utilization." Finding of fact 84.
Applicants' hospitals which were subject to the voting trust agreements had "no operational changes in the facilities" by reason of the voting trust agreements. Finding of fact 86.
The Hearing Officer's implicit acceptance of the conceit of nominal control by an HMO conflicts with the purpose of the HMO exemption, to encourage the development of HMOs and thereby achieve cost containment, fewer hospializations, more outpatient services and fewer specialists. Because there is no meaningful control by the Humana HMO, the applicants are not entitled to the HMO exemptions. Meaningful control is exercised by the parent, Humana, Inc. which is not an HMO. The Hearing Officer's findings regarding control are rejected as an incorrect conclusion of law.
Next, counsel excepts to the Hearing Officer's findings and conclusions concerning whether the HMO exemption is applicable to inpatient psychiatric and substance abuse services. These services were sought for Humana Cypress and Humana Pembroke. The HMO exemption statute is applicable to "institutional health services." Section 381.713(1), Florida Statutes (1989). Going to the definitions Section 381.702, an "institutional health service" is a health service provided in a health care facility with an annual operating cost of at least $500,000, see subsection (13); a health service is a diagnostic, curative, or rehabilitative service specifically including substance abuse treatment and mental health services, see subsection (9). Thus, "institutional health service" is a subcategory of "health service." Based on the statutory definitions I conclude that psychiatric and substance abuse services may be approved under the HMO exemption statute.
Next, counsel excepts to the Hearing Officer's finding that the provision of services under an HMO exemption is not limited to the HMO's enrollees. Based on the HMO exemption statute, Section 381.713, I concur with the Hearing Officer. The applicants seek exemptions under subsection (b) which is silent on the issue. While not controlling, subsection (a) is very instructive.
Subsection (a) is applicable when an HMO itself seeks an exemption; subsection
(b) is applicable when a hospital controlled by an HMO seeks an exemption. Under subsection (a) an HMO may provide exempted services to persons not enrolled in the HMO. Up to 25% of patients expected to receive the exempted services may be persons not enrolled in the HMO. Logic dictates that if the Legislature intended to limit services to only HMO enrollees under subsection (b), it would have expressly stated the limitation. Therefore, I conclude that services exempted under subsection (b) are not limited to HMO enrollees.
Finally, counsel excepts to the Hearing Officer's conclusion that the rule prohibiting substantial amendments to CON applications during 120.57 proceedings is not applicable. Counsel relies on Section 10-5.010(2)(b), Florida Administrative Code. Section 10-5.010(2)(b) is expressly applicable to certificate of need applications subject to comparative review. Humana is not seeking a certificate of need, it seeks exemption from the requirement for a certificate of need. Additionally, its exemption applications are not subject to comparative review. Applications for exemptions are governed by Section 10- 5.005, Florida Administrative Code. This section is silent on the amendment issue. HRS and the intervenors seek the dismissal of this proceeding because Humana failed to provide required cost information in its initial applications. I conclude that the rule prohibiting amendment of CON applications is not applicable to the cost information provided in this proceeding. The Hearing Officer's denial of the motions to dismiss is affirmed.
RULING ON INTERVENORS' JOINT EXCEPTIONS
The exceptions on the meaning of control reiterate the department's exceptions on this subject. See the ruling on the department's exceptions. It is unnecessary to address the remaining exceptions due to the disposition reached in this Final Order.
RULING ON EXCEPTIONS FILED
BY SOUTH BROWARD HOSPITAL DISTRICT
See the ruling on the exceptions filed by HRS and the Intervenors.
RULING ON EXCEPTIONS FILED BY HUMANA
A threshold issue is whether Humana's exceptions were timely filed. The Recommended Order was rendered October 14, 1991. Ten days are allowed for the filing of exceptions. Section 10-2.035, Florida Administrative Code. Because a Recommended Order is served by mail five days is added. Section 28-5.103, Florida Administrative Code. Thus, absent an extension, the last day for filing exceptions would have been Tuesday, October 29, 1991. On page 33 of the Recommended Order all parties are advised that exceptions should be filed with the agency that will issue the Final Order.
Counsel for the department requested that the time for filing exceptions be extended to November 19, 1991. 2/ With the exception of Humana, all parties stipulated to the requested extension. The agency clerk granted the requested extension. Given the voluminous record, the extension was clearly appropriate.
Humana failed to file exceptions with the department on or before November 19, 1991. Upon inquiry by the agency clerk it was learned that Humana had inadvertently filed its exceptions at the Division of Administrative Hearings on November 19, 1991. The exceptions were then filed with the department on November 20, 1991, one day late. Because exceptions are not a jurisdictional pleading, an untimely filing may be excused on the basis of excusable neglect.
Hamilton County vs. Department of Environmental Regulation, Fla. 1st DCA Number 90-1718, dated October 10, 1991. The inadvertent filing at the Division of Administrative Hearings constitutes excusable neglect.
In exceptions 1 through 4 Humana objects to the Hearing Officer's conclusion that open heart surgery and neonatal intensive care services, Level II, are tertiary health services and thus can not be exempted under the HMO exemption statute. Tertiary health services, due to their high level of intensity, complexity and cost, are distinguished from institutional health services. Of particular relevance to whether tertiary services may be approved under the HMO exemption is the statutory mandate that such services should be "... concentrated in a limited number of hospitals to ensure the quality, availability, and cost effectiveness of such service". Section 381.702(20), Florida Statutes (1989). The Hearing Officer's conclusion is correct. Tertiary health services are not exempt from the requirement for a certificate of need.
The exceptions are denied.
Humana excepts to findings of fact 65 through 67 wherein the Hearing Officer found that Humana failed to prove that Humana Pembroke is located so that its requested services would be reasonably accessible to at least 50,000 HMO enrollees. The challenged findings are supported by competent, substantial evidence; therefore, the exception is denied. Heifetz vs. Department of Business Regulation, 475 So2d 1277, 1281 (Fla. 1st DCA 1985).
In exception 6, Humana challenges findings of fact 90 through 93 wherein the Hearing Officer found that Humana Pasco is not accessible to more than 50,000 HMO enrollees. The findings are supported by competent, substantial evidence; therefore, the exceptions are denied.
Likewise, Humana challenges findings of fact 95 through 97 that the 50,000 HMO enrollees threshold was not factually established as to Humana Palm Beaches. Again, the challenged findings are supported by competent, substantial evidence; therefore, the exceptions are denied.
Humana excepts to the legal conclusion that the intervenors have standing.
The exception is denied.
In its final exception, Humana maintains that the initial approval of cardiac catheterization for Humana Pembroke must be approved in this Final Order as a matter of law. Humana relies on the recent decision of the First District Court of Appeal in John A. McCoy vs. Department of Health and Rehabilitative Services, 16 FLW 2831. In McCoy a free-form approval was challenged by a competitor. Subsequently, the challenging party withdrew its request for a hearing. The Court held that the initial approval became final as a matter of law. The present case is distinguished in that Humana challenged the approval (it was a partial approval) and has never withdrawn the request for a hearing.
Humana did not withdraw its request for a hearing in its exceptions, nor has any pleading been received withdrawing the request for a hearing. Humana cannot have its cake and eat it too. The exception is denied.
FINDINGS OF FACT
The department hereby adopts and incorporates by reference the findings of fact set forth in the Recommended Order except where the findings included conclusions of law which are modified or rejected in this Final Order.
CONCLUSIONS OF LAW
The department hereby adopts and incorporates by reference the conclusions of law set forth in the Recommended Order except where inconsistent with the rulings on the exceptions.
Based upon the foregoing, it is
ADJUDGED, that all requests by Humana for HMO exemptions for various services for Humana Brandon, Humana Northside, Humana St. Petersburg, Humana Bennett, Humana Pembroke, Humana Pasco, Humana of the Palm Beaches, and Humana Cypress are DENIED.
DONE and ORDERED this 19th day of December 1991, in Tallahassee, Florida.
Robert B. Williams Secretary
Department of Health and Rehabilitative Services
by Deputy Secretary for Human
Services
ENDNOTES
1/ In response to a reguest for admissions Humana admitted that the applicant hospitals directly controlled the hospitals, not the Humana HMO. Intervenors Exhibits 33 and 34.
2/ Extensions of time for filing exceptions are normally stipulated to by counsel as a professional courtesy.
COPIES FURNISHED:
James C. Hauser, Esquire George Matlock, Esquire FOLEY & LARDNER
101 North Mornoe Street Suite 1050
Post Office Box 508 Tallahassee, FL 32302-0508
Thomas Cooper, Esquire Department of Health and Rehabilitative Services 2727 Mahan Drive, Suite 103 Fort Knox Executive Center Tallahassee, FL 32308
Stephen K. Boone, Esquire John Koda, Esquire
BOONE, BOONE, KLINGBEIL BOONE & ROBERTS, P. A.
Post Office Box 1596 Venice, FL 34284
Charles A. Stampelos, Esquire Gerald B. Sternstein, Esquire
McFARLAIN, STERNSTEIN, WILEY & CASSEDY, P. A.
Post Office Box 2174 Tallahassee, Fl 32316
David Watkins, Esquire Patricia Renovitch, Esquire Robert C. Downie, Esquire
OERTEL, HOFFMAN, FERNANDEZ & COLE, P. A.
Post Office Box 6507 Tallahassee, Fl 32314-6507
Kenneth D. Kranz, Esquire Eric B. Tilton, Esquire 241-B East Virgina Street Tallahassee, FL 32301
Jonathan L. Rue, Esquire PARKER, HUDSON, RAINER & DOBBS
1200 Carnegie Building
122 Carnegie Way Atlanta, GA 30303
Jay Adams, Esquire
418 East Virginia Street Tallahassee, FL 32301
F. Philip Blank, Esquire
D. Lance Langston, Esquire
F. PHILIP BLANK, P. A. Post Office Box 11608 Tallahassee, FL 32302
Ivan Wood, Esquire
BAKER & HOSTETLER, McCUTCHEN & BLACK
600 Travis
2100 Texas Commerce Tower Houston, TX 77002
John Radey, Esquire Elizabeth McArthur, Esquire
AURELL, RADEY, HINKLE & THOMAS
101 North Monroe Street Suite 100
Post Office Drawer 11307 Tallahassee, FL 32302
Cynthia S. Tunnicliff, Esquire Loula Fuller, Esquire
CARLTON, FIELDS, WARD, EMMANUEL SMITH & CUTLER, P. A.
215 South Monroe Street Suite 410
Post Office Drawer 190 Tallahassee, FL 32302
Eleanor M. Hunter Hearing Officer
DOAH, The DeSoto Building 1230 Apalachee Parkway
Tallahassee, FL 32399-1550
Jim Konish (FALR)
Florida Administrative Law Reports
114 Southeast 1st Street, #8 Post Office Box 385 Gainesville, FL 32602
Wayne McDaniel (PDRFM) Wendy Thomas (PDRF)
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a copy of the foregoing was sent the above named people by U. S. Mail this 19th day of December, 1991.
R. S. Power, Agency Clerk Assistant General Counsel Department of Health and
Rehabilitative Services 1323 Winewood Boulevard Building One, Room 407 Tallahassee, FL 32399-0700
(904)488-2381
A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF HRS, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.
================================================================= CORRECTED RECOMMENDED ORDER PAGES
=================================================================
State of Florida Sharyn L. Smith Division of Administrative Hearings Director
DeSoto Building, 1230 Apalachee Parkway Ann Cole Tallahassee, FL 32399-1550 Clerk
(904) 488-9675. SunCom: 278-9675
October 15, 1991
Sam Power, Agency Clerk Department of Health and
Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, Florida 32399-0700
Re: Corrected Recommended order in Humhosco, Inc. d/b/a Humana Hospital Brandon, et al. v.
Department of Health and Rehabilitative Services and Hillsborough County Hospital Authority, et al. DOAH Case Nos. 90-6905; 90-6906; 90-6907; 90-6908;
90-6909; 90-6910; 90-6911 and 90-6912
Dear Mr. Power:
Enclosed please find a copy of corrected pages of the Recommended Order.
Copies of this letter will serve to notify the parties that the Recommended Order has been corrected.
Sincerely,
Eleanor M. Hunter Hearing Officer
Enclosures
cc: James C. Hauser, Esquire Thomas R. Cooper, Esquire Stephen K. Boone, Esquire Charles A. Stampelos, Esquire David Watkins, Esquire Kenneth D. Kranz, Esquire Jonathan L. Rue, Esquire
Jay Adams, Esquire
F. Philip Blank, Esquire Ivan Wood, Esquire
John Radey, Esquire
Cynthia S. Tunnicliff, Esquire John Slye, General Counsel
CORRECTED PAGES:
acquisition. Therefore, HMP, a Humana HMO, is the owner of, and as such is in control of Humana Pembroke. HMP has a ten-county approved geographic area to offer services within the state, which includes well in excess of the minimum requirement of 50,000 enrollees. However, Humana Pembroke failed to establish that it is geographically located so as to be reasonably accessible to provide inpatient cardiac catheterization or short term inpatient psychiatric services to 50,000 HMP enrollees.
Humana Pasco, Humana Palm Beaches, and Humana Cypress Hospitals. The Voting Trust Agreements, by which Humana, Inc., has established HMP as trustee for Humana, Inc. and the corporate owners of the hospitals are valid. Under Florida law, a trust agreement is not invalid due to the absence of consideration, the absence of a provision for the payment of fees to the trustee or, in effect, because the trustee waives both consideration and compensation. Finally, a trust agreement is not invalid because the directors and officers of the corporate trustee and beneficiaries are the same individuals, nor because a potential conflict of interest exists between the purposes of the corporations. See State of Delaware ex. rel. Gebelein v. Belin, 456 So.2d 1237 (Fla. 1st DCA 1984). Therefore, as valid trusts, the agreements transferred legal title of the hospitals and their assets to HMP.
Intervenors and HRS raised substantial issues concerning whether the voting trust agreements vest indirect control of Humana Pasco, Humana Palm Beaches, and Humana Cypress in Humana, Inc., or its wholly-owned subsidiary HMP. They argue persuasively that the purposes for establishing an HMO exemption are in conflict with the objectives of a for-profit hospital corporation with utilization incentives for management. The Legislature did not, however, explicitly or implicitly avoid the possibility of such a conflict of interest nor did it disqualify an HMO from the exemption provision based on its corporate structure or the manner in which it gains control of a hospital facility. It could have done so by giving a specific statutory definition to the term "control" in the context of the CON exemption provision. In light of the ordinary meaning of the word, it is impossible to conclude that the trustee of a valid voting trust does not control the trust assets, i.e., the hospital facilities.
Humana Pasco's list of enrollees is not supported by any competent substantial evidence.
Humana Palm Beaches' exemption request when compared to only available underlying computer printout is inconsistent with the enrollment numbers on the exemption request. Based on the computer printout, Humana Palm Beaches is geographically accessible to fewer than 50,000 HMP enrollees.
Humana Cypress is located so that it is geographically accessible to in excess of 50,000 HMP enrollees.
RECOMMENDATION
Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered
Dismissing the Petition to Intervene filed by Adventist based on its Notice of Voluntary Dismissal;
Denying the exemption requests of Humana Brandon for open heart surgery, Humana Northside for open heart surgery, Humana St. Petersburg for Level II NICU, and Humana Bennett for Level II NICU, Humana Pembroke for open heart surgery and Level II NICU, because those services are tertiary services, not institutional health services.
Denying the exemption request for inpatient cardiac catheterization and short-term inpatient psychiatric services at Humana Pembroke for failure to establish geographic accessibility to 50,000 HMP enrollees.
Denying the exemption requests of Humana Pasco and Humana Palm Beaches for failure to establish that 50,000 HMO enrollees have reasonable access to inpatient cardiac catheterization services at these facilities.
Granting the exemption request of Humana Cypress for inpatient cardiac catheterization, short term inpatient psychiatric services, and inpatient substance abuse services, without limiting the provision of services to HMP enrollees.
DONE and ENTERED this 15th day of October, 1991, at Tallahassee, Florida.
Eleanor N. Hunter 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 15th day of October, 1991.
APPENDIX TO RECOMMENDED ORDER DOAH CASE Nos. 90-6905; 90-6906; 90-6907; 90-
6908; 90-6909; 90-6910; 90-6911 and 90-6912
Rulings on findings proposed by Florida Hospital Association:
1. Adopted in relevant part in Finding of Fact 10.
2 and 3. Subordinate to Finding of Fact 23.
4 and 5. Adopted in Finding of Fact 23.
Rulings on findings proposed by Association of Voluntary Hospitals of Florida, Inc.:
Adopted in relevant part in Finding of Fact 11.
Subordinate to Finding of Fact 11.
Rejected as not relevant.
Adopted in Preliminary Statement.
Adopted in Finding of Fact 24.
Adopted in part in Findings of Fact 5, 24 and 29.
7 - 11. Adopted in part in Findings of Fact 8 and 24.
12 and 13. Adopted in part in Findings of Fact 6 and 24.
Adopted in Findings of Fact 7, 19 and 24.
Adopted in Findings of Fact 1, 14, 20 and 24.
Adopted in Findings of Fact 2 and 24.
Adopted in Findings of Fact 3 and 24.
Adopted in Findings of Fact 4, 17 and 24.
Adopted in Findings of Fact 14, 16, 17, 19 and 20.
20 - 22. Subordinate to Conclusions of Law 2.
Rulings on findings proposed by All Children's Hospital, Inc.:
1 - 4. Adopted in Preliminary Statement.
5. Subordinate to Preliminary Statement.
6 and 7. Adopted in relevant part in Finding of Fact 12.
Rejected as not relevant.
Adopted in relevant part in Finding of Fact 12.
Subordinate to Finding of Fact 12.
11 and 12. Adopted in Finding of Fact 12.
13 and 14. Subordinate to Finding of Fact 12.
Subordinate to Finding of Fact 25.
Adopted in Finding of Fact 3.
Subordinate to Finding of Fact 25.
18 and 19. Subordinate to Conclusion of Law 2.
Rejected as not relevant.
Subordinate to Finding of Fact 12.
Subordinate to Conclusion of Law 2.
Subordinate to Finding of Fact 12.
24 and 25. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by Florida Medical Center:
1 - 3. Adopted in substance in Preliminary Statement. 4.
Adopted in substance in Finding of Fact 13.
Adopted in relevant part in Findings of Fact 13 and 26.
7 - 10. Adopted in relevant part in Finding of Fact 26.
Adopted in Finding of Fact 26.
Adopted in Conclusion of Law 2.
Subordinate to Conclusion of Law 2.
Adopted in Finding of Fact 13.
Adopted in Conclusion of Law 2.
16 - 18. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by Lakeland Regional Medical Center, Inc.:
Adopted in Findings of Fact 1 and 14.
Adopted in Finding of Fact 14.
3 - 8. Subordinate to Conclusion of Law 2.
Rejected as not relevant.
Adopted in Finding of Fact 27.
Subordinate to Finding of Fact 27.
Adopted in relevant part in Finding of Fact 27.
Subordinate to Finding of Fact 27.
Subordinate to Conclusion of Law 2.
Adopted in Conclusion of Law 27.
and 17. Subordinate to Conclusion of Law 2.
18. Subordinate to Finding of Fact 27 and Conclusion of Law 2.
19 - 26. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by Plantation General Hospital:
Adopted in Finding of Fact 8.
Adopted in Finding of Fact 5.
Adopted in Finding of Fact 6.
Adopted in Finding of Fact 28.
5 and 6. Subordinate to Finding of Fact 28.
7 and 8. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by South Broward Hospital District:
1 - 3. Adopted in Preliminary Statement.
4. Subordinate to Finding of Fact 29.
5 and 6. Adopted in relevant part in Finding of Fact 16.
7 - 10. Adopted in Finding of Fact 29.
Adopted in relevant part in Finding of Fact 29.
Subordinate to Finding of Fact 29.
Adopted in Finding of Fact 29.
14 and 15. Subordinate to Finding of Fact 29.
16. Adopted in Conclusion of Law 2.
Rulings on findings proposed by St. Anthony's Hospital:
Adopted in Finding of Fact 17.
Adopted in relevant part in Finding of Fact 17.
Rejected as not relevant.
and 5. Subordinate to Conclusion of Law 2.
Adopted in Finding of Fact 17.
Adopted in Finding of Fact 30.
Adopted in Findings of Fact 2 and 3.
Adopted in Finding of Fact 4.
Adopted in Finding of Fact 30.
11 - 13. Subordinate to Finding of Fact 30.
14. Subordinate to Preliminary Statement.
Rulings on findings proposed by St. Joseph's Hospital:
Adopted in Finding of Fact 18.
Subordinate to Finding of Fact 31.
3 - 5. Subordinate to Conclusion of Law 2.
6 and 7. Rejected as not relevant.
8 and 9. Subordinate to Conclusion of Law 2.
Adopted in Finding of Fact 18.
Adopted in Findings of Fact 1 and 31.
12 - 14. Adopted in Finding of Fact 31.
15 - 17. Subordinate to Finding of Fact 31.
18. Adopted in Preliminary Statement.
Rulings on findings proposed by St. Mary's Hospital:
Adopted in Finding of Fact 19.
Adopted in relevant part in Finding of Fact 19.
Adopted in Finding of Fact 19.
Rejected as not relevant.
and 6. Subordinate to Finding of Fact 32.
7. - 11. Subordinate to Finding of Fact 32 and Conclusion of Law 2.
12. Adopted in Preliminary Statement.
Rulings on findings proposed by Tampa General:
Adopted in Finding of Fact 20.
Adopted in Findings of Fact 20 and 33.
Adopted in relevant part in Finding of Fact 20.
- 6. Subordinate to Finding of Fact 33.
7. Subordinate to Conclusion of Law 2.
8 - 10. Subordinate to Finding of Fact 33.
Adopted in Finding of Fact 33.
Subordinate to Conclusion of Law 2.
Subordinate to Finding of Fact 33 and Conclusion of Law 2.
14 and 15. Subordinate to Conclusion of Law 2.
16. Adopted in relevant part in Finding of Fact 33.
17 and 18. Adopted in Finding of Fact 33.
Subordinate to Finding of Fact 33.
Subordinate to Conclusion of Law 2.
Adopted in Finding of Fact 33 and Conclusion of Law 2.
Rulings on findings proposed by University Community Hospital:
Adopted in Preliminary Statement and Finding of Fact 1.
Rejected as irrelevant.
Adopted in Preliminary Statement.
Adopted in Preliminary Statement and Finding of Fact
Adopted in Preliminary Statement.
Adopted in Finding of Fact 21.
Adopted in Finding of Fact l.
8 - 12. Adopted in Finding of Fact 34.
13 - 17. Subordinate to Conclusion of Law 2.
Rulings on findings proposed by Humana on the issue of Intervenor' s standing:
Adopted in Preliminary Statement.
Subordinate to Preliminary Statement.
and 4. Adopted in Preliminary Statement.
5. Subordinate to Preliminary Statement.
6 - 16. Rejected as not relevant.
Adopted, first phrase, in Finding of Fact 4. Rejected, second and third phrases.
Rejected as not relevant.
Subordinate to Findings of Fact 19 and 32.
- 22. Rejected as not relevant.
Rejected.
- 27. Rejected as not relevant.
Adopted, first phrase, in Finding of Fact 31. Rejected, second phrase, as not relevant.
Rejected as not relevant.
Rejected, first sentence, as not relevant. Adopted, second sentence, in Finding of Fact 28 and Conclusion of Law 2. Rejected, third and fourth sentence, as not relevant.
31 - 36. Rejected as not relevant.
Rejected.
Adopted in Finding of Fact 9.
Adopted in Finding of Fact 22.
40 - 44. Rejected as not relevant.
Rejected, first sentence, as not relevant. Rejected, second sentence.
Rejected, first sentence, as not relevant. Subordinate, second sentence, to Finding of Fact 26. Rejected, third sentence, as not relevant. Rejected, fourth sentence.
Rejected as not relevant.
Rulings of findings proposed by Humana:
Adopted in Preliminary Statement.
Adopted in Finding of Fact 1.
Adopted in Finding of Fact 4.
Adopted in relevant part in Finding of Fact 3.
Adopted in Finding of Fact 2.
Adopted in relevant part in Finding of Fact 8.
Adopted in Finding of Fact 7.
Adopted in relevant part in Finding of Fact 5.
Adopted in relevant part in Finding of Fact 6.
Adopted in Preliminary Statement.
Subordinate to Finding of Fact 61.
Adopted in Findings of Fact 60, 61 and 88.
Adopted in Findings of Fact 61 and 88.
Subordinate to Preliminary Statement.
Adopted in Conclusion of Law 4.
Adopted in Preliminary Statement.
Adopted in relevant part in Preliminary Statement.
Adopted in Preliminary Statement and Conclusion of Law 2.
Adopted in Preliminary Statement.
Rejected in Preliminary Statement and Finding of Fact 63.
Adopted in Preliminary Statement and Conclusion of Law 6.
- 27. Rejected as not relevant.
Adopted in Finding of Fact 41.
Subordinate to Finding of Fact 41.
- 32. Rejected as not relevant.
Adopted in relevant part in Findings of Fact 42 and 43.
Subordinate to Findings of Fact 42 and 43.
Subordinate to Finding of Fact 38.
- 39. Rejected as not relevant.
Adopted in Finding of Fact 47.
- 43. Adopted in Finding of Fact 48.
Adopted in Findings of Fact 48 - 51.
Adopted in relevant part in Findings of Fact 72 - 77.
Adopted in Findings of Fact 77 - 83.
Subordinate to Finding of Fact 86.
Rejected as not relevant.
Subordinate to Finding of Fact 87 and Conclusion of Law 9.
Subordinate to Conclusion of Law 9.
Subordinate in relevant part to Findings of Fact 73 - 76.
Rejected, first sentence, as not relevant. Subordinate, second and third sentences, in relevant part to Conclusion of Law 9.
Adopted in relevant part in Finding of Fact 87.
Subordinate to Findings of Fact 79 and 87.
Subordinate in relevant part to Preliminary Statement and Findings of Fact 84, 86 and 87.
Subordinate to Findings of Fact 86 and 87 and paragraph 2 of Conclusion of Law 9.
Adopted in Findings of Fact 57, 60, 61 and 88.
Rejected as cumulative.
Adopted in Findings of Fact 58 - 61.
Adopted in Finding of Fact 59.
Adopted in Findings of Fact 61 and 88.
Adopted in Preliminary Statement.
Adopted in relevant part in Findings of Fact 62 - 64, 89, 91 and 100.
Adopted in Findings of Fact 62, 63 and 89.
Rejected as not relevant.
Adopted in relevant part in Finding of Fact 98.
Adopted in relevant part in Footnote 2 of Finding of Fact 94.
Rejected, first sentence, as not relevant. Subordinate, second and third sentences, to Finding of Fact 57.
Adopted, first phrase, in Finding of Fact l. Rejected, second phrase, as not relevant.
70 and 71. Rejected as not relevant.
Adopted in Findings of Fact 4 and 92.
Rejected in Findings of Fact 93 and 94.
Adopted in Finding of Fact 92.
Adopted, first phrase, in Finding of Fact 3. Rejected, second phrase, as not relevant.
76 and 77. Rejected as not relevant.
78. Adopted, first phrase, in Finding of Fact 2. Rejected, second phrase, as not relevant.
79 and 80. Rejected as not relevant.
Adopted in relevant part in Findings of Fact 8, 64 and 65.
Rejected in Findings of Fact 65 - 67.
Subordinate to Preliminary Statement.
Adopted, first sentence, in Finding of Fact 95. Rejected, second and third sentences in Finding of Fact 101.
Rejected in Finding of Fact 104.
Adopted, first phrase, in Finding of Fact 5. Rejected, remainder, as not relevant.
87 and 88. Rejected as not relevant.
Adopted in Findings of Fact 6 and 102.
Adopted, in substance, in Findings of Fact 105 and 106.
Subordinate to Findings of Fact 105 and 106.
Rejected in Findings of Fact 65, 93, 98 and 102.
Adopted in Finding of Fact 98.
- 98. Rejected as not relevant.
99. Subordinate to Findings of Fact 54, 73, 74 and 75.
100 and 101. Rejected as not relevant.
Adopted in relevant part in Findings of Fact 54, 73, 74 and 75.
Rejected as not relevant.
Adopted in relevant part in Finding of Fact 87.
Subordinate in relevant part to Finding of Fact 87.
Rejected as not relevant.
Subordinate to Finding of Fact 87.
108 and 109. Rejected as not relevant.
Adopted, first, third and fourth sentences, in Finding of Fact 55. Rejected, second and fifth sentences, in Finding of Fact 53.
Subordinate to Findings of Fact 53 and 55.
Rejected as not determined in Findings of Fact 52 - 55.
Rulings on findings proposed by Department of Health and Rehabilitative Services:
Adopted in Findings of Fact 1 - 8.
Subordinate to Finding of Fact 47.
- 5. Rejected as not relevant.
6. and 7. Subordinate to Conclusion of Law 9.
8. and 9. Rejected as not relevant.
Adopted in Findings of Fact 73 - 75.
Adopted in Findings of Fact 50 and 56.
12 - 14. Subordinate to Finding of Fact 50.
Adopted in Findings of Fact 1 and 2.
Adopted in Findings of Fact 3 - 5.
Adopted in Finding of Fact 7.
Adopted in Finding of Fact 6.
Adopted in Finding of Fact 8.
Adopted in Findings of Fact 54, and 73 - 75.
21 - 30. Subordinate to Findings of Fact 54 and 73 - 75.
Rejected as not relevant.
Rejected as not relevant, except as adopted in Findings of Fact 73 - 75.
Adopted in Findings of Fact 50 and 76.
Subordinate in relevant part in Findings of Fact 73 - 75.
Subordinate to Preliminary Statement.
Subordinate to Findings of Fact 80 and 82.
Adopted in relevant part in Finding of Fact 80 and Conclusion of Law 9.
38 and 39. Adopted in Finding of Fact 82.
Adopted in Finding of Fact 81.
Adopted in Finding of Fact 83.
Adopted in relevant part in Finding of Fact 85.
Subordinate in relevant part to Findings of Fact 73 - 75.
Subordinate to Finding of Fact 75.
Subordinate to Finding of Fact 73.
Rejected as not relevant.
Rejected, first sentence, as not relevant. Subordinate, second and third sentences, to Finding of Fact 82.
Subordinate in relevant part to Finding of Fact 50 and adopted in relevant part in Finding of Fact 84 and Conclusion of Law 9.
Rejected as not relevant.
Adopted in Finding of Fact 84.
51 - 54. Adopted in Finding of Fact 86.
Rejected as not relevant.
Adopted in Finding of Fact 84.
57 - 66. Subordinate to Finding of Fact 84.
Adopted, except last sentence, in relevant part in Findings of Fact 49 - 51.
Adopted, except last sentence, in relevant part in Findings of Fact 51 - 54.
69 - 72. Adopted, in relevant part, in Finding of Fact 50.
Rejected in Finding of Fact 56.
Adopted in Finding of Fact 76.
Subordinate to Finding of Fact 76.
Adopted, in relevant part, in Findings of Fact 50 and 85.
Adopted in relevant part in Findings of Fact 50 and 76.
78 and 79. Subordinate to Finding of Fact 76.
Rejected in substance in Finding of Fact 56.
Subordinate to Conclusion of Law 9.
Adopted in Preliminary Statement.
Adopted in Preliminary Statement and Findings of Fact 1 - 8.
Adopted in Preliminary Statement.
Adopted in Finding of Fact 41.
Adopted in relevant part in Findings of Fact 38-40.
Adopted in relevant part in Finding of Fact 43.
Adopted in Finding of Fact 39.
89 and 90. Adopted in Finding of Fact 40.
Adopted in Finding of Fact 39.
Adopted in Finding of Fact 38.
Adopted in Finding of Fact 44.
Subordinate in relevant part to Finding of Fact 44.
Rejected in Finding of Fact 42.
Adopted, except last sentence, in Finding of Fact 44 and 45.
Adopted in Finding of Fact 45.
Rejected as not relevant.
99 and 100. Adopted in relevant part in Findings of Fact 66, 94 and 97.
Rejected as not relevant.
Adopted in substance in Finding of Fact 67.
Adopted in substance in Finding of Fact 97.
Rejected as not relevant.
105-107. Rejected in Finding of Fact 104.
108. Adopted in Findings of Fact 62, 63 and 89.
109 - 112. Rejected in Findings of Fact 62, 63 and 89.
113 and 114. Rejected as not relevant.
115. Adopted in relevant part in Finding of Fact 93.
116 -118. Rejected as not relevant.
Rejected in Finding of Fact 101.
Rejected, first sentence, as not relevant. Adopted, second sentence, in Finding of Fact 65.
121 - 124. Rejected as not relevant.
125. Adopted in substance in Finding of Fact 93.
126 and 127. Rejected as not relevant.
Adopted in relevant part in Findings of Fact 102 and 103.
Adopted in substance in Finding of Fact 97.
Rejected, first sentence, as not relevant. Adopted, second sentence, in substance in Finding of Fact 94.
Rejected as not relevant.
Rejected in relevant part in Finding of Fact 105 and 106.
Rulings on findings proposed in Intervenors' Joint Proposed Recommended Order:
1. Adopted in Findings of Fact 1 - 8.
2 - 4. Subordinate to Preliminary Statement.
Adopted in Finding of Fact 50.
Adopted in Findings of Fact 72 - 74.
Adopted in Findings of Fact 50 and 72.
Adopted in Finding of Fact 77.
Subordinate to Preliminary Statement.
Adopted, first sentence, in substance in Finding of Fact 86.
Adopted in Finding of Fact 81.
Adopted in Finding of Fact 80.
Adopted in Finding of Fact 82.
Adopted, except for last sentence, in Finding of Fact 86.
Adopted in Finding of Fact 86.
Adopted, except for last sentence, in Finding of Fact 77.
Adopted, except for last. sentence, in Finding of Fact 78.
18 and 19. Adopted in Finding of Fact 78.
Adopted, except last sentence, in Finding of Fact 78.
Rejected as not relevant.
Rejected in Finding of Fact 87.
Adopted in substance in Finding of Fact 84.
Adopted in substance in Finding of Fact 85.
Subordinate in relevant part to Finding of Fact 85.
Subordinate to Finding of Fact 85 and Conclusion of Law 9.
Subordinate to Conclusion of Law 9.
Adopted in Finding of Fact 85.
Subordinate in relevant part to Finding of Fact 85.
Adopted in Finding of Fact 85.
Rejected in Findings of Fact 56 and 87.
Subordinate to Finding of Fact 84.
Subordinate in relevant part to Finding of Fact 86.
Subordinate to Finding of Fact 85.
Subordinate to Finding of Fact 84.
Subordinate to Conclusion of Law 9.
Subordinate to Finding of Fact 33.
38 and 39. Subordinate to Conclusion of Law 9.
Adopted in relevant part in Finding of Fact 85.
Subordinate to Finding of Fact 85.
Subordinate to Findings of Fact 50, 72 - 74.
Rejected as not relevant.
Subordinate to Findings of Fact 50, 73 - 75.
Subordinate to Finding of Fact 81.
46 - 48. Subordinate to Finding of Fact 76.
49 - 52. Subordinate to Findings of Fact 50 and 76.
53. Rejected in Finding of Fact 87.
54 - 56. Subordinate to Findings of Fact 50 and 76.
Rejected in Finding of Fact 56.
Adopted in Finding of Fact 62.
Adopted in Findings of Fact 62 - 64, 89 - 92, 95, 96 and 102.
Subordinate in relevant part to Finding of Fact 90.
Subordinate in relevant part to Finding of Fact 95.
Subordinate in relevant part to Finding of Fact 65.
Subordinate to Finding of Fact 62.
Rejected in Finding of Fact 98.
Subordinate in substance in Finding of Fact 98.
Subordinate in Findings of Fact 65 and 93.
Subordinate to Finding of Fact 98.
68 and 69. Rejected in Finding of Fact 98.
70 - 73. Rejected as not relevant.
74 and 75. Adopted in substance in Finding of Fact 93.
76 - 79. Rejected as not relevant.
Adopted in substance in Finding of Fact 102.
Rejected as not relevant.
Subordinate to Finding of Fact 102.
83 - 85. Rejected as not relevant.
86. Adopted in substance in Finding of Fact 67.
87 - 89. Rejected as not relevant.
Subordinate to Finding of Fact 98.
Rejected in Finding of Fact 98.
92 and 93. Rejected in Findings of Fact 64, 92, 95, 102 and 103.
Adopted in relevant part in Footnote 2.
Adopted in relevant part in Findings of Fact 96, 97, and Footnotes 1, 3 and
4. Rejected in relevant part in Finding of Fact 103.
Rejected in substance in Findings of Fact 66, 99 and 104.
Rejected in relevant part in Findings of Fact 66, 100 and 104.
98 and 99. Rejected as not relevant.
Rejected as not relevant, except last sentence, adopted in Findings of Fact 24, 33 and 34.
Rejected as not relevant in Preliminary Statement.
102 and 103. Rejected as not relevant.
104. Adopted in Finding of Fact 94.
105 and 106. Rejected as not relevant.
107. Rejected in Finding of Fact 105.
108 and 109. Rejected in Finding of Fact 106.
110 and 111. Rejected as not relevant.
112 and 113. Adopted in Finding of Fact 67.
Rejected as not relevant.
Adopted in Finding of Fact 101.
Subordinate to Conclusion of Law 9.
Subordinate to Conclusion of Law 5.
Rejected in Finding of Fact 42.
Adopted in Finding of Fact 41.
Adopted in Findings of Fact 38 - 40.
121 and 122. Adopted in Finding of Fact 43.
Adopted in Finding of Fact 39.
Adopted in Finding of Fact 40.
Subordinate to Findings of Fact 39 and 40.
Subordinate to Finding of Fact 43.
Subordinate to Findings of Fact 39, 40 and 43.
Adopted in relevant part in Finding of Fact 39.
Subordinate to Findings of Fact 38 and 43.
Rulings on findings proposed in Intervenors' Joint Proposed Recommended Order on South Florida Market Issues:
Adopted in Findings of Fact 6 and 8.
Rejected as not relevant.
Subordinate to Preliminary Statement.
Subordinate to Findings of Fact 44 and 45.
Adopted in Findings of Fact 44 and 45.
Subordinate to Findings of Fact 44 and 45.
Adopted in Finding of Fact 44.
Subordinate to Finding of Fact 44.
Rejected in Finding of Fact 46.
Subordinate to Preliminary Statement.
Adopted in Finding of Fact 68.
Subordinate to Findings of Fact 69 and 70.
Rejected in Finding of Fact 71.
14 - 16. Subordinate to Preliminary Statement.
17. Adopted in Finding of Fact 50.
18 and 19. Subordinate to Finding of Fact 49.
Rejected as not relevant in Findings of Fact 54 and 55.
Adopted in relevant part in Finding of Fact 49.
Subordinate to Finding of Fact 49.
Subordinate to Finding of Fact 50.
Adopted in relevant part in Findings of Fact 49 and 51.
Subordinate to Finding of Fact 51.
Rejected as not relevant.
Adopted in relevant part in Finding of Fact 51.
Adopted in Finding of Fact 52.
Adopted in Finding of Fact 53.
Adopted in relevant part in Findings of Fact 49 and 50.
Adopted in Findings of Fact 49.
Adopted in Findings of Fact 52 and 54.
Adopted in relevant part in Finding of Fact 53.
34 and 35. Rejected in Finding of Fact 55.
36 and 37. Adopted in Preliminary Statement.
38. Subordinate to Preliminary Statement.
39 and 40. Rejected in Finding of Fact 56.
41 and 42. Rejected in Conclusion of Law 8.
43 and 44. Rejected in Conclusion of Law 9.
Adopted in Finding of Fact 50.
Rejected in Conclusion of Law 8.
Adopted in Finding of Fact 84.
Adopted in Finding of Fact 49.
Adopted in Finding of Fact 50.
Rejected in Conclusion of Law 8.
Rejected as not relevant.
Rejected in Conclusion of Law 8.
Rejected as not relevant.
Adopted in Finding of Fact 50.
Subordinate to Finding of Fact 50.
Rejected in Conclusion of Law 8.
Adopted in Finding of Fact 50.
Adopted in relevant part in Finding of Fact 50. Rejected, last sentence, as not relevant.
Adopted in Finding of Fact 50.
Adopted in relevant part in Findings of Fact 84 - 86.
Adopted in Finding of Fact 50. Rejected, last sentence, in Finding of Fact 56.
Rejected in Finding of Fact 56 and Conclusion of Law 8.
COPIES FURNISHED:
James C. Hauser, Esquire George Matlock, Esquire Foley & Lardner
101 North Monroe Street Suite 1050
Post Office Box 508 Tallahassee, FL 32302-0508
Thomas R. Cooper, Esquire Edward G. Labrador, Esquire Department of Health and
Rehabilitative Services 2727 Mahan Drive
Tallahassee, FL 32308
Stephen K. Boone, Esquire John Koda, Esquire
Boone, Boone, Klingbeil, Boone & Roberts, P.A. Post Office Box 1596
Venice, FL 34284
Charles A. Stampelos, Esquire Gerald B. Sternstein, Esquire
McFarlain, Sternstein, Wiley & Cassedy, P.A.
215 South Monroe Street Suite 600
Tallahassee, FL 32301
David Watkins, Esquire Patricia Renovitch, Esquire Robert C. Downie, Esquire
Oertel, Hoffman, Fernandez & Cole, P.A. 2700 Blair Stone Road
Suite C
Post Office Box 6507 Tallahassee, FL 32314-6507
Kenneth D. Kranz, Esquire Eric B. Tilton, Esquire Eric B. Tilton, P.A.
241B East Virginia Street Tallahassee, FL 32301
Jonathan L. Rue, Esquire Parker, Hudson, Rainer & Dobbs 1200 Carnegie Building
133 Carnegie Way Atlanta, GA 30303
Jay Adams, Esquire
418 East Virginia Street Tallahassee, FL 32301
F. Philip Blank, Esquire
D. Lance Langston, Esquire
F. Philip Blank, P.A. 204B South Monroe Street Tallahassee, FL 32301
Ivan Wood, Esquire
Baker & Hostetler, McCutchen, Black 600 Travis
2100 Texas Commerce Tower Houston, TX 77002
John Radey, Esquire Elizabeth McArthur, Esquire
Aurell, Radey, Hinkle & Thomas
101 North Monroe Street Suite 1000
Post Office Drawer 11307 Tallahassee, FL 32302
Cynthia S. Tunnicliff, Esquire Loula Fuller, Esquire
Carlton, Fields, Ward, Emmanuel, Smith & Cutler, P.A.
215 South Monroe Street Suite 410
Post Office Drawer 190 Tallahassee, FL 32302
Sam Power, Agency Clerk
Department of Health and Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, FL 32399-0700
John Slye, General Counsel
Department of Health and Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, FL 32399-0700
| Issue Date | Proceedings |
|---|---|
| Apr. 15, 1992 | AGENCY APPEAL, ONCE THE RETENTION SCHEDULE OF -KEEP ONE YEAR AFTER CLOSURE- IS MET, CASE FILE IS RETURNED TO AGENCY GENERAL COUNSEL. -ac |
| Dec. 20, 1991 | Final Order filed. |
| Nov. 19, 1991 | Humana's Joint Written Exceptions to Recommended Order filed. |
| Oct. 15, 1991 | Corrected Recommended Order sent out. |
| Oct. 14, 1991 | Recommended Order sent out. CASE CLOSED. Hearing held May 14-17, 21-24 & 28-31, 1991. |
| Sep. 10, 1991 | Humana's Response in Opposition to Plantation General Hospital's Renewed Motion to Dismiss filed. (From James Hauser) |
| Sep. 09, 1991 | Adventist Health System/Sunbelt, Inc.'s Response to Humana's Motion For Award of Attorneys' Fees and Costs filed. (From Steve Boone) |
| Sep. 03, 1991 | Substitute Page #2 for the Renewed Motion to Dismiss & Motion in Support of Dismissal; Cover Letter to EMH from J. Adams filed. |
| Aug. 29, 1991 | Letter to EMH from Charles Stampelos (Re: Enclosed copies of Pages 7 and 8 to Intervenors Joint Memorandum of Law Re: Tertiary Health Services filed on August 27, 1991) filed. |
| Aug. 27, 1991 | HRS' Proposed Recommended Order w/Appendix-A; (Respondent) Motion to Extend The Length of Respondent's Proposed Recommended Order filed. (From Thomas R. Cooper & Edward G. Labrador) |
| Aug. 27, 1991 | (FMC) Memorandum of Law Legislative History filed. (From Eric B. Tilton) |
| Aug. 27, 1991 | Florida Medical Center's Proposed Recommended Order Re Standing; Intervenors' Joint Proposed Recommended Order (Re: South Florida Market Issues filed. (From Kenneth Kranz) |
| Aug. 27, 1991 | Humana's Response in Opposition to Planation General Hospital's Motion To Dismiss filed. (From James Hauser) |
| Aug. 27, 1991 | Proposed Findings of Fact, Conclusions of Law and Recommended Order; Humana's Proposed Findings of Fact, Conclusions of Law and RecommendedOrder on Issue of Intervenors' Standing; Humana's Motion For Award ofAttorneys' Fees and C osts Against Adventist |
| Aug. 27, 1991 | Association of Voluntary Hospitals of Florida, Inc.'s Proposed Recommended Order as to its Standing; Lakeland Regional Medical Center, Inc.'s Proposed Recommended Order as to its Standing filed. |
| Aug. 27, 1991 | Intervenors Joint Proposed Recommended Order w/Appendix A; Tampa Generals Proposed Recommended Order as to its Standing filed. |
| Aug. 27, 1991 | Intervenors Joint Memorandum of Law Re: Tertiary Health Services; AllChildrens Hospital, Inc.'s Proposed Recommended Order: Standing; Florida Hospital Associations Proposed Recommended Order on Party Standing; Renewed Motion to Di smiss and Memorandum i |
| Aug. 27, 1991 | (Intervenor) South Broward Hospital Districts Proposed Recommended Order Re: Standing filed. |
| Aug. 27, 1991 | Memorandum of Law; Proposed Recommended Order filed. (from Cynthia S.Tunnicliff) |
| Aug. 27, 1991 | Intervenors' Joint Memorandum of Law Re: Impremissible Amendments; St. Mary's Hospital's Proposed Recommended Order-Standing; St. Joseph's Hospital's Proposed REcommended Order-Standing; St. Anthony's Hospital's Proposed Recommended Order-Standing rec'd |
| Jul. 12, 1991 | Notice of Emergency Hearing; Motion For Abeyance filed. (From Edward Labrador) |
| Jul. 12, 1991 | (Respondent) Motion For Extension of Time to file Proposed Recommended Order filed. (From Edward Labrador) |
| Jul. 01, 1991 | Transcript (21 Vols) filed. |
| Jun. 03, 1991 | Notice of Voluntary Dismissal filed. (from Steve Boone) |
| May 31, 1991 | Deposition of Bob Bissel; Deposition of Jerry Miller; Deposition of Jorge Nunez filed. |
| May 21, 1991 | Amended Notice of Hearing sent out. (hearing set for May 21-25, 1991 & May 28-31, 1991; Talla). |
| May 14, 1991 | CASE STATUS: Hearing Held. |
| May 14, 1991 | Petitioners' Response to UCH'S Motion to Compel and Imposition of Sanctions and Motion For Protective Order filed. (From James Hauser) |
| May 14, 1991 | HRS' Motion to Quash Subpoena Duces Tecum w/exhibits A&B filed. (FromThomas R. Cooper) |
| May 14, 1991 | (Intervenor) Motion to Dismiss filed. (From Jay Adams) |
| May 13, 1991 | Adventist Health System/Sunbel, Inc's Renewed Motion to Compel filed.(From Stephen K. Boone) |
| May 13, 1991 | Order Reserving Ruling On Adventist's Motion for Attorney's Fees sentout. |
| May 13, 1991 | (Intervenor) Motion to Compel & Attachments filed. (From Gerald B. Sternstein) |
| May 13, 1991 | Subpoena Duces Tecum filed. (From Jonathan L. Rue) |
| May 10, 1991 | Motion to Compel and Imposition of Sanctions w/Copy of Telephonic Deposition For Intervenors filed. (From Cynthia S. Tunnicliff) |
| May 09, 1991 | Humana's Notice of Taking Deposition filed. (From James Hauser) |
| May 09, 1991 | Humana's Responses to Hearing Officer's May 2, 1991 Disocvery Orders filed. (From James Hauser) |
| May 09, 1991 | Humana's Notice of Taking Deposition filed. (from James Hauser) |
| May 08, 1991 | Deposition of Rex Etheredge filed. |
| May 08, 1991 | Deposition of Priscilla L. Parrish filed. |
| May 07, 1991 | Order Rescheduling Formal Hearing sent out. (hearing set for May 14,1991; 9:30am). |
| May 07, 1991 | Order on South Broward Hospital District's Motion to Compel Discoverysent out. |
| May 07, 1991 | Order Denying Humana's Motion to Dismiss Adventist sent out. |
| May 07, 1991 | Humana's Motion to Invalidate/Motion For Protective Order From Noticeof Taking Deposition; Humana's Reply to Adventist's Response to Humana's Motion to Dismiss filed. (From George V. Matlock) |
| May 07, 1991 | St. Anthony's St. Josephs' and St. Marys' Final Witness and Exhibit List filed. (From Ivan Wood) |
| May 07, 1991 | Letter to John Radey from George V. Matlock (re: Telephone deposition) filed. |
| May 07, 1991 | Adventist Health System/Sunbelt, Inc.'s Response to Humana's Motion to Dismiss filed. (From Steve Boone) |
| May 07, 1991 | Affidavit of Dan Moen filed. |
| May 07, 1991 | Order Denying Motion for Rehearing sent out. |
| May 07, 1991 | Order on LRMC and AVHF'S Request for Admissions sent out. |
| May 06, 1991 | Humana's Response in Opposition South Broward Hospital District's Motion to Compel Discovery filed. (From James Hauser) |
| May 06, 1991 | Humana's Motion For Invalidation of, and Protection From, Notice of Taking Deposition Dces Tecum, And Renewed Motion to Invalidate Subpoena, Motion For Protective Order and Motion to Quash; Notice of Taking Deposition filed. |
| May 03, 1991 | Hillsborough County Hopsital Authority and All Children's Hospital, Inc.'s Response to Humana's Motion For Rehearing/Reconsideration of ORder Denying Motion to Server CASe no. 90-6906 and Motion For IndefiniteAbeyance of Remainder of Cases filed. |
| May 02, 1991 | Order Denying Motion for Rehearing/Reconsideration sent out. |
| May 02, 1991 | Order on Pending Discovery Matters sent out. |
| May 02, 1991 | Notice of Continuation of Deposition Duces Tecum w/Composite Exhibit-A filed. (From Philip Blank) |
| May 02, 1991 | Humana's Notice of Filing Exhibit "A" to Humana's Motion to Dismiss Adventist For Lack of Standing & attachment filed. (From James Hauser) |
| May 01, 1991 | Transcript (second vol) filed. |
| May 01, 1991 | Witness and Exhibit List Of Adventist Health System/Sunbelt, Inc. filed. (from Stephen K. Boone) |
| May 01, 1991 | South Broward Hospital District's Final Witness and Exhibit List filed. |
| May 01, 1991 | Humana's Motion to Dismiss Adventist For Lack of Standing; Florida Medical Center's Final Witness and Exhibit List; Humana's Final Witness and Exhibit List filed. |
| May 01, 1991 | Tampa General Potential Witness and Exhibit Lists; Final Witness and Exhibit Lists of Intervenor, University Community Hospital; south Broward Hospital District's Motion to Compel Discovery and Request to Expedite Response and Ruling w/exhibits A-C; Fin |
| Apr. 30, 1991 | Order of Reassignment sent out. (New HO = Hunter). |
| Apr. 30, 1991 | Humana's Motion For Rehearing on Its Motion to Quash Subpoenas Duces Tecum and Motion For Protective Order and Motion to Quash filed. (fromJames Hauser) |
| Apr. 30, 1991 | Humana's Motion For Rehearing/Reconsideration of Order Denying Motionto Sever Case no 90-6906 and Motion For Indefinite Abeyance of Remainder of Cases filed. (From James Hauser) |
| Apr. 30, 1991 | Final Witness and Exhibit Lists of Intervenor, Florida Hospital Association filed. (From W. David Watkins) |
| Apr. 30, 1991 | Notice of Taking Deposition & attachment filed. (From Cynthia Tunnicliff) |
| Apr. 30, 1991 | Subpoena Duces Tecum filed. (from Bruce MacLeod) |
| Apr. 29, 1991 | Order Granting Motion for Disqualification sent out. |
| Apr. 26, 1991 | Humana's Response to HRS' Motion to Compel; Humana's Notice of Service of Answers to LRMC and AAVHF'S First Interrogatories filed. (from James Hauser) |
| Apr. 26, 1991 | Humana's Motion For Disqualification w/exhibits A-F filed. |
| Apr. 26, 1991 | Humana's Written Response in Opposition to LRMC/AVHF Motion to Compelw/Appendix 1-3 filed. |
| Apr. 25, 1991 | Humana's Notice of Service of Answers to Florida Medical Center's First Set of Interrogatories; Humana's Notice of Service of Answers to Department of HRS' First Set of Interrogatories filed. |
| Apr. 25, 1991 | (2) Transcript (Telephone Conference dated 4/16&20/91) filed. |
| Apr. 25, 1991 | Notice of Filing w/Group Exhibit-A filed. (from Thomas D. Watry) |
| Apr. 25, 1991 | Order Denying Humana's Request for Additional Time to Respond to Motions to Compel and Order Denying Motion to Quash Subpoenas, Protective Order, and Motion to Quash sent out. |
| Apr. 24, 1991 | Humana's Motion to Quash Subpoenas Duces Tecum and Motion For Protective Order and Motion to Quash filed. |
| Apr. 24, 1991 | Humana's Notice of Its Intent to File Written Response in Opposition to Motion to Compel Within the Time Frame Provided by Rule 6.016, F.A.C., or in the Alternative, Humana's Motion For Reconsideration of Order Expediting Response Time to Motions to Com |
| Apr. 23, 1991 | Notice of Taking Deposition Duces Tecum & attachments filed. (From Philip Blank) |
| Apr. 22, 1991 | Order Denying Motion to Sever and Motion for Continuance sent out. (hearing set for May 13, 1991). |
| Apr. 22, 1991 | Notice of Filing; Deposition of Genn Bossmeyer; Deposition of Bruce Perkins filed. (from John Radey) |
| Apr. 22, 1991 | HRS' Motion to Compel; LRMC and AVHF'S Motion to Compel Disocvery Response to Humana's Objections to Discovery Requests, And Request to Expedite Response and Ruling w/exhibits A-C filed. |
| Apr. 22, 1991 | Notice of Administrative Reassignment of Cases sent out. (New HO = Hunter) |
| Apr. 19, 1991 | South Broward Hospital District's Response in OPpsoition to Humana's Emergency Motion For Rehearing/Reconsideration of April 15 Order, Motion to Sever Case no 90-6906, And Motion For Indefinite Abeyance of Remainder of Cases w/exhibits A&B filed. |
| Apr. 19, 1991 | (Respondent) Response to Humana's Emergency Motion For Rehearing/Reconsideration of April 15 Order, Motion to Sever Case No. 90-6906, And Motion For Indefinite Abeyance of Remainder of Case filed. |
| Apr. 19, 1991 | Response to Humana's Emergency Motion For Rehearing/Reconsideration of April 15 Order, Motion to Server Case No. 90-6906, and Motion For Indefinite Abeyance oif Remainder of Cases filed. (from Cynthia S. Tunnicliff) |
| Apr. 19, 1991 | Tampa General And All Children's Response to Emergency Motion For Rehearing/Reconsideration of Aprilo 15 Order, Motion to Sever Case NO. 90-6906, And Motion For Indefinite ABeyance of Remainder of Cases w/exhibits 1&2 filed. (From John Radey & Gerald B. |
| Apr. 19, 1991 | LRMC and AVHF'S Response in Opposition to Humana's Emergency Motion For Rehearing/Reconsideration of April 15 Order, Motion to Server Case no 90-6906 and Motion For Indefinite Abeyance of Remainder of Cases filed. |
| Apr. 19, 1991 | Florida Medical Center's Response to Humana's Motion to Server and Hold in Abeyance filed. |
| Apr. 19, 1991 | Plantation General Hospital, L. P.'S Response to Humana's Emergency Motion to Server Case No. 90-6906 and Motion For Indefinite Abeyance ofRemainder of Cases filed. (From Jay Adams) |
| Apr. 19, 1991 | Humana's Supplemental Response to HRS' Request For Production of Documents; Humana's Supplement Written Response to Florida Medical Center's Request to Produce; Humana's Supplmental Response to LRMC/AVHF FirstRequest for Productio n of Documents filed. |
| Apr. 19, 1991 | Adventist's Response to Humana's Motion to Sever Case No. 90-6906 filed. (From Steven Boone) |
| Apr. 18, 1991 | Notice (2); Motion For A Protective Order and to Quash Subpoenas Duces Tecum; Order; Motion in Support of Motion For a Protective Order andto Quash Subpoenas Duces Tecum & attachments filed. (From Marvin J. Hirn) |
| Apr. 17, 1991 | Notice of Hearing filed. (from James Hauser) |
| Apr. 17, 1991 | Subpoena Duces Tecum w/exhibit-A (5) filed. |
| Apr. 16, 1991 | Humana's Emergency Motion for Rehearing/Reconsideration of April 15 Order, Motion to Sever Case No. 90-6906, and Motion for Indefinite Abeyance of Reaminder of Cases filed. |
| Apr. 16, 1991 | Humana's Request for Immediate Hearing on Emergency Motion filed. |
| Apr. 16, 1991 | Humana's Response to Adventist's Two Motions to Compel filed. |
| Apr. 12, 1991 | Humana's Written Objections to Portions of the First Set of Interrogatories and Request For Production of Documents Served by Department ofHRS; Humana's Written Objections to Florida Medical Center's Discovery Request filed. (From James Hauser) |
| Apr. 12, 1991 | Humana's Amended Notice of Taking Deposition filed. (from James Hauser) |
| Apr. 11, 1991 | Objection to Motion Hearing filed. (From George V. Matlock) |
| Apr. 11, 1991 | Emergency Motion For Immediate Abatement of Discovery, For Order Compelling Discovery, For Continuance of Final Hearing, For Sanctions, andNotice of April 12 Motion Hearing w/exhibit-1 filed. (from Elizabeth McArthur) |
| Apr. 11, 1991 | Adventist Health System/Health, Inc.'s Motion to Compel and Response to Humana's Objections to Second Production Request filed. ( From Steve Boone) |
| Apr. 11, 1991 | CC Adventist Health System/Sunbelt, Inc.'s Motion to Compel and Response to Humana's Objections to Second Production Request filed. (From Steve Boone) |
| Apr. 11, 1991 | Humana's Written Objections to Portions of the First Set of Interrogatories and Request For Production of Dcouments Served by LRMC and AVHF; Human's Response to LRMC and AVHF First Request for Admissions filed. (From James Hauser) |
| Apr. 10, 1991 | Humana's Written Objections to Florida Medical Center's Discovery Request filed. (from James Hauser) |
| Apr. 10, 1991 | (South Broward) Notice of Taking Deposition filed. (From F. Philip Blank) |
| Apr. 09, 1991 | Order Requiring Compliance With Subpoenas for Deposition on April 15,1991 sent out. |
| Apr. 08, 1991 | Adventist Health System/Sunbelt, Inc.'s Motion to Compel and Responseto Humana's Objections to Discovery Requests & Exhibit-A filed. (From (From Steve Boone) |
| Apr. 08, 1991 | Notice of Hearing; Humana's Notice of Taking Depositions; Response inOpposition to Humana's Motion For Protective Order From April 15, 1991 Depositions w/exhibits A&B filed. |
| Apr. 05, 1991 | Notice of Taking Deposition filed. (John Radey) |
| Apr. 05, 1991 | Humana's Motion For Protective Order From April 15, 1991 Depositions w/exhibit-A filed. (From James Hauser) |
| Apr. 05, 1991 | (Intervenors) Notice of Taking Depositions Duces Tecum filed. |
| Apr. 04, 1991 | Humanas Supplemental Responses to Tampa Generals First Set of Interrogatories filed. |
| Apr. 01, 1991 | Humana's Notice of Filing of Clarification of Adventist Intervention filed. |
| Apr. 01, 1991 | Humana's Written Objections to the Second Request for Production of Documents Served by Adventist filed. |
| Mar. 25, 1991 | Affidavit of Bruce Macleod; Affidavit of Kenneth A. Grubb; Humanas Notice of Filing Affidavits in Support of Written Objections and Motion for Protective Order; Affidavit of Mark A. Laemmle filed. |
| Mar. 25, 1991 | Humanas Written Objections to Portions of The First Set of Interrogatories and Request for Production of Documents Served by Adventist filed. |
| Mar. 22, 1991 | Response to Humanas Objections and Motion for Protective Order Directed at University Community Hospitals Interrogatories; South Broward Hospital Districts Supplemental Response to Humana Discovery Motions filed. |
| Mar. 22, 1991 | Humanas Notice of Service of Answers to All Childrens Hospital, Inc.'s First Set of Interrogatories; Humanas Notice of Service of Answers to South Broward Hospital Districts First Set of Interrogatories; Humanas Notice of Service of Answers to Universit |
| Mar. 21, 1991 | Humanas Notice of Service of Answers to Tampa Generals First Set of Interrogatories filed. |
| Mar. 20, 1991 | Humana's Supplemental Memorandum of Law in Support of Objection to Discovery filed. |
| Mar. 15, 1991 | Humanas Objection to March 15 Motion Hearing (Exhibit A) filed. |
| Mar. 15, 1991 | Humanas Objection to March 15 Motion Hearing filed. |
| Mar. 14, 1991 | Notice of Hearing (March 15, 1991: 10:30 am: Tallahassee); South Broward Hospital Districts Response to Humana Discovery Motions; All Childrens Hospital, Inc.s Response to Humanas Discovery Objections and Motion filed. |
| Mar. 14, 1991 | Florida Medical Centers First Request to Humana for Production of Documents; Notice of Service of Interrogatories filed. |
| Mar. 13, 1991 | (Respondent) Notice of Service of Interrogatories; Department of Health and Rehabilitative Services First Request for Production of Documents to Humana filed. |
| Mar. 13, 1991 | LRMC and AVHF's First Requests for Admissions to Humana filed. |
| Mar. 12, 1991 | Notice of Hearing (March 15, 1991: 10:30 am: Tallahassee); Tampa General Motion to Compel and Response to Humana Discovery Motions filed. |
| Mar. 11, 1991 | LRMC and AVHF'S First Request for Production of Documents to Humana; Notice of Service of Interrogatories filed. |
| Mar. 08, 1991 | Humana's Motion to Extend the Time to Respond to All Children's Hospital, Inc.'s Interrogatories and Request for Production of Documents filed. |
| Mar. 08, 1991 | Humana's Motion to Extend the Time to Respond to University CommunityHospital, Inc.'s Interrogatories and Request for Production of Documents filed. |
| Mar. 08, 1991 | Humana's Motion to Extend The Time to Respond to South Broward Hospital District's Interrogatories and Request for Production of Documents filed. |
| Mar. 08, 1991 | Humana's Written Objections to, and Motion for Protective Order from,Portions of the First Set of Interrogatories and Request for Production of Documents Served by All Children's Hospital, Inc. filed. |
| Mar. 08, 1991 | Humana's Written Objections to, and Motion for Protective Order from,Portions of the First Set of Interrogatories and Request for Production of Documents Served by University Community Hospital ("UCH") filed. |
| Mar. 08, 1991 | Humana's Written Objections to, and Motion for Protective Order from,Portions of the First Set of Interrogatories and Request for Production of Documents served by South Broward Hospital District ("SBHD") filed. |
| Mar. 05, 1991 | Florida Medical Centers Preliminary Witness and Exhibit List filed. |
| Mar. 05, 1991 | Plantation General Hospitals Preliminary Witness and Exhibit List filed. |
| Mar. 04, 1991 | Preliminary Witness and Exhibit List of Intervenor, University Community Hospital filed. |
| Mar. 04, 1991 | Humana's Motion to Extend the Time to respond to Hillsborough County Hospital Authority's Interrogatories and Request for Production of Documents filed. |
| Mar. 04, 1991 | Humana's Preliminary Witness and Exhibit List filed. |
| Mar. 04, 1991 | Humana's Written Objection to, and Motion for Protective Order From, Portions of the First Set of Interrogatories and Request for Production of Documents Served by the Hillsborough County Hospital Authority ("Tampa General") filed. |
| Mar. 04, 1991 | Tampa General Preliminary Witness List filed. |
| Mar. 04, 1991 | South broward Hospital District's Preliminary Witness and Exhibit List filed. |
| Mar. 04, 1991 | LRMC and Avhf's Anticipated Witness List filed. |
| Mar. 04, 1991 | LRMC and AVHF's Anticipated Exhibit List filed. |
| Mar. 04, 1991 | HRS' Preliminary Witness and Exhibit Lists filed. |
| Mar. 04, 1991 | Preliminary Witness and Exhibits List for All Children's Hospital, Inc. filed. |
| Mar. 04, 1991 | (Intervenor) Preliminary Witness and Exhibit List of Adventist HealthSystem/Sunbelt, Inc. filed. |
| Mar. 01, 1991 | Witness and Exhibit Lists of Intervenor, FL Hospital Assoc. filed. |
| Mar. 01, 1991 | (Intervenor) Adventist Health System/Sunbelt, Inc.'s Second Request for Production of Documents to Humana filed. |
| Feb. 25, 1991 | Humana's Notice of Filing Deposition; cc: Deposition of Amy M. Jones & Exhibit 1-3 (for 90-6912) filed. |
| Feb. 21, 1991 | (Adventist) Notice of Service of Interrogatories filed. |
| Feb. 21, 1991 | Adventist Health System/Sunbelt, Inc.'s First Request for Production of Documents to Humana filed. |
| Feb. 19, 1991 | Order Granting Continuance and Rescheduling Hearing sent out. (hearing rescheduled for 5/13-24/91; at 9:00am; Talla) |
| Feb. 19, 1991 | Order Establishing Prehearing Procedure sent out. |
| Feb. 11, 1991 | (intervenor) Memorandum of Law on Party Status and Motion to Reconsider Continuance of Final Hearing (+ exh A-C) filed. |
| Feb. 07, 1991 | South Broward Hospital District's Memorandum of Law and Request For Reconsideration of Motion For Continuance filed.(From Terry Rigsby) |
| Feb. 07, 1991 | (Intervenor) Memorandum of Law on Party Status and Motion to Reconsider Continuance of Final Hearing w/Exhibits A&B filed. (From Steve Boone) |
| Feb. 07, 1991 | (Intervenor) Motion For Rehearing of The Hearing Officer's Order Denying Continuance; Memorandum of Law in Support of All Children's Hospital, Inc.'s Party Status filed. (From Charles Stampelos) |
| Feb. 07, 1991 | (Intervenor) Amended Notice of Taking Deposition Duces Tecum; Notice of Taking Depositions Duce Tecum filed. Thomas D. Watry) |
| Feb. 07, 1991 | (Intervenor) Notice of Taking Deposition Duces Tecum w/exhibit-A filed. (From Steve Boone) |
| Feb. 07, 1991 | HRS' Memorandum of Law filed. (From Ken F. Hoffman) |
| Feb. 07, 1991 | Motion to Expedite Responses to Discover and to Shorten Response Timeto This Motion; Memorandum of Law on Status of Intervenors and MotionFor Reconsideration of Order Denying Continuance; Notice of Service of Firs Interrogatorie s to Petitioner; Reque |
| Feb. 07, 1991 | (Tampa General) Notice of Taking Deposition; Tampa General's Memorandum Regarding Its Party Status and Motion to Reconsider Denial of Continuance filed. (From John Radey) |
| Feb. 07, 1991 | Florida Medical Center's Memorandum of Law When is An Intervenor A Party filed. (from Kenneth D. Kranz) |
| Feb. 07, 1991 | (Respondent) Notice of Taking Deposition Duces Tecum filed. (from Thomas R. Cooper & Edward G. Labrador) |
| Feb. 06, 1991 | All Children's Hospital, Inc.'s First Set of Interrogatories to The Humana Organization filed. |
| Feb. 06, 1991 | Order Denying Continuance sent out. |
| Feb. 06, 1991 | Humana's Motion for Protective Order & cover letter to VED from G. Matlock filed. |
| Feb. 06, 1991 | Emergency Motion to Expedite Responses to Discovery and to Shorten Response Time to This Motion filed. |
| Feb. 06, 1991 | Notice of Service of All Children's Hospital, Inc.'s First Set of Interrogatories to The Humana Organization filed. |
| Feb. 06, 1991 | All Children's Hospital, Inc.'s First Request for Production to The Humana Organization filed. |
| Feb. 06, 1991 | South Broward Hospital Districts First Request For Production of Documents to Humana; Notice of Service of Interrogatories; Emergency Motion to Expedite Responses to Discovery and to Shorten Response Time to This Motion filed. (From D. Lance Langston) |
| Feb. 06, 1991 | (All Children's Hospital) Notice of Taking Deposition(s) Duces Tecum (+ att A) filed. |
| Feb. 04, 1991 | Humana's Response in Opposition to Tampa General's Emergency Motion to Expedite Responses to Discovery filed. (From Jim Hauser) |
| Feb. 04, 1991 | Tampa General's Notice of Depositions filed. (From Elizabeth McArthur) |
| Feb. 04, 1991 | (Intervenors) Tampa General's Supplement to Joint Motion For Continaunce w/exhibits A&B filed. (From Elizabeth McArthur) |
| Feb. 04, 1991 | Humana's Response to Motion For Continuance filed. (From George V. Matlock) |
| Feb. 04, 1991 | Emergency Motion to Expedite Responses to Discovery and to Shorten Response Time to This Motion; Tampa General's First Request For Production to the Humana Organization; Notice of Service of Interrogatories filed. (From John Radey) |
| Feb. 01, 1991 | Notice of Appearance of Counsel filed. (From Jonathan L. Rue & ThomasD. watry) |
| Feb. 01, 1991 | Corrected Certificate of Service filed. (From Elizabeth McArthur) |
| Jan. 31, 1991 | Joint Motion for Continuance and Notice of Hearing & attachment filed. (From Elizabeth McArthur) |
| Jan. 29, 1991 | Order Granting Intervention filed. (From R. S. Power) |
| Jan. 25, 1991 | South Broward Hospital Districts Exceptions to Recommended Order of Dismissal of the Petitions to Intervene filed. (From D. Lance Langston) |
| Jan. 23, 1991 | Exceptions to Recommended Order of Florida Hospital Association, Inc.& attachment filed. (from Ken F. Hoffman) |
| Jan. 22, 1991 | Subpoena Duces Tecum filed. (From Jim Hauser) |
| Jan. 14, 1991 | Order of Consolidation of All Cases, Order Granting Leave to Amend Petitioners Complaints and Recommended Order of Dismissal of The Petitions to Intervene. Consolidated Cases are: 90-6905, 90-6906, 90-6907, 90-6908, 90-6909, 90-6910, 90-6911 and 90-6912 |
| Jan. 11, 1991 | (Petitioners) Amended Notice of Deposition Duces Tecum filed. (from Jim Hauser) |
| Jan. 10, 1991 | Humana's Joint Response in Opposition to Motion For Rehearing and Reconsideration of Order Denying Petitions to Intervene filed. (From Jim Hauser) |
| Jan. 09, 1991 | Memorandum to Jim Hauser, Neil H. Butler et al from Jonathan L. Rue (re: Motion For Rehearing and Reconsideration of Order Denying Petitions to Intervene and Request For Expedited Ruling) filed. |
| Jan. 08, 1991 | HRS' Response to Order to Show Cause filed. (From Thomas R. Cooper & Edward G. Labrador) |
| Jan. 04, 1991 | (Petitioners) Notice of Deposition Duces Tecum filed. (From James C. Hauser) |
| Jan. 04, 1991 | Motion For Rehearing and Reconsideration of Order Denying Petitions to Intervene and Request For Expedited Ruling w/exhibit A&B filed. (From Jonathan L. Rue et al) |
| Dec. 28, 1990 | Order to Show Cause sent out. |
| Dec. 26, 1990 | Order (All Petitions to Intervene DENIED) sent out. |
| Dec. 14, 1990 | Humana 's Response to HRS' Motion In Opposition to Amended Petition For Formal Hearing filed. (From J. C. Hauser) |
| Dec. 11, 1990 | Notice of Deposition Duces Tecum filed. (From J. C. Hauser) |
| Dec. 11, 1990 | (Petitioners) Notice of Cancellation of Depositions filed. (From J. C. Hauser) |
| Dec. 07, 1990 | Transcript (Motion Hearing) filed. |
| Dec. 07, 1990 | Adventist Health System/Sunbelt, Inc.'s Notice of Supplemental Authority filed. (from S. Boone) |
| Dec. 06, 1990 | Adventist Health System/Sunbelt, Inc.'s Memorandum in Support of Petitions For Leave to Intervene filed. (from S. Boone) |
| Dec. 04, 1990 | Letter to VED from K. F. Hoffman (re: Order Denying Motions to Dismiss in Case 90-6816) & attachment filed. |
| Dec. 04, 1990 | Notice of Taking Deposition filed. (From J. Hauser) |
| Dec. 04, 1990 | Humana's Consolidated Response in Opposition to Separate Petitions toIntervene Filed by St. Anthony's St. Mary's St. Joseph's FMC and Plantation filed. J. Hauser) |
| Nov. 30, 1990 | St. Anthony's Hospital Petition to Intervene; St. Joseph's Hospital Petition to Intervene; St. Mary's Hospital Petition to Intervene filed.(From I. Wood) |
| Nov. 30, 1990 | Humana's Notice of Supplemental Authority in Support of Response in Opposition to Petitions to Intervene & Appendix-A filed. (From J. Hauser) TAGGED. |
| Nov. 30, 1990 | LRMC'S Reply to Humana's Response in Opposition to Intervention filed. (From T. D. Watry) |
| Nov. 30, 1990 | Florida Medical Center's Petition to Intervene filed. (From K. D. Kranz) |
| Nov. 30, 1990 | Petition to Intervene filed. (From J. Adams) |
| Nov. 27, 1990 | Humana's Consoldiated Response in Opposition to Separate PEtitions toIntervene Filed by FHA, AVHF, Adventist. UCH, SBHD, All Children's and LRMC filed. (From J. Hauser) |
| Nov. 27, 1990 | Humana Motion to Reset Final Hearing filed. (From J. C. Hauser |
| Nov. 27, 1990 | HRS' Motion in Opposition to Amended Petitions For Formal Administrative Hearing w/exhibit-A filed. (From E. G. Labrador) |
| Nov. 21, 1990 | Motion to Interven by the Association of Voluntary Hospitals of Florida, Inc. filed. (From N. H. Butler & T. C. Nugent) |
| Nov. 21, 1990 | Letter to Parties of Record from VED (Re: Pending Motions and Petitions) sent out. |
| Nov. 21, 1990 | Notice of Hearing sent out. (hearing set for Feb. 13-15, 1991: 9:00 am: Tallahassee) |
| Nov. 20, 1990 | Humana's Response to Initial Order filed. (From J. Hauser) |
| Nov. 19, 1990 | (DHRS) Notice of Appearance as Co-Counsel filed. |
| Nov. 19, 1990 | Response to Initial Order filed.(From E. Labrador) |
| Nov. 15, 1990 | (FHA) Motion of Florida Hospital Association, Inc., For Leave to Intervene filed. (From Kenneth F. Hoffman) |
| Nov. 15, 1990 | (Petitioner) Petition For Leave to Intervene filed. (From Jeffery A. Boone) |
| Nov. 15, 1990 | Tampa Gerneral's Memorandum in Support of Petition to Intervene filed. (From Elizabeth McArthur) |
| Nov. 14, 1990 | Tamp Gereral's Petition to Intervene filed. (From John Radey) |
| Nov. 14, 1990 | Notice of Prehearing Conference (set for Dec. 3, 1990: 2:00 pm: Tallahassee) sent out. |
| Nov. 14, 1990 | Order of Consolidation sent out. Consolidated case are: 90-6905, 90-6906, 90-6907, 90-6908, 90-6909, 90-6910 and 90-6911 |
| Nov. 13, 1990 | (UCH) Petition to Intervene filed. (From Cynthia S. Tunnicliff) |
| Nov. 08, 1990 | Lakeland Regional Medical Center, Inc.'s Petition to Intervene w/exhibits A-E filed. (From Jonathan L. Rue) |
| Nov. 08, 1990 | Initial Order issued. |
| Nov. 07, 1990 | Humana's Request For Oral Argument filed. (From James C. Hauser) |
| Nov. 07, 1990 | Humana's Response in Opposition to Petition to Intervene w/Appendix-Afiled. (From James C. Hauser) |
| Nov. 02, 1990 | Notice; Humana's Petition for Formal Hearing; Agency action letter filed. |
| Oct. 30, 1990 | Notice; Humana's Petition for Formal Hearing; Agency action letter filed. |
| Issue Date | Document | Summary |
|---|---|---|
| Dec. 19, 1991 | Agency Final Order | |
| Oct. 14, 1991 | Recommended Order | HMO exemption for inpatient institutional, but not tertiary services; HMO control via voting agreement. |
