STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
KENDALL HEALTHCARE GROUP, LTD., ) d/b/a KENDALL REGIONAL MEDICAL ) CENTER, )
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Petitioner, )
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vs. )
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AGENCY FOR HEALTH CARE ) ADMINISTRATION and WEST KENDALL ) BAPTIST HOSPITAL, INC., )
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Respondents. )
Case No. 03-2822CON
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MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC.,
Petitioner,
vs.
AGENCY FOR HEALTH CARE ADMINISTRATION and KENDALL HEALTHCARE GROUP, LTD., d/b/a KENDALL REGIONAL MEDICAL CENTER,
Respondents.
)
)
)
)
)
) Case No. 03-2954CON
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)
)
)
)
)
)
)
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WEST KENDALL BAPTIST HOSPITAL, ) INC., )
)
Petitioner, )
)
vs. )
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AGENCY FOR HEALTH CARE )
ADMINISTRATION, )
)
Respondent. )
Case No. 03-3096CON
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RECOMMENDED ORDER OF DISMISSAL
On January 14 and 15, 2004, in Tallahassee, Florida, a hearing was conducted on the issue of whether the Petitioner, Mount Sinai Medical Center of Florida, Inc., has standing to initiate the proceeding to challenge the issuance of CON 9675 by the Agency for Health Care Administration to Kendall Healthcare Group, Ltd. The hearing was conducted by David M. Maloney, Administrative Law Judge of the Division of Administrative Hearings.
APPEARANCES
For Petitioner Kendall Healthcare Group, Ltd, d/b/a Kendall Regional Medical Center:
Stephen A. Ecenia, Esquire
Rutledge, Ecenia, Purnell & Hoffman, P.A.
215 South Monroe Street, Suite 420 Post Office Box 551
Tallahassee, Florida 32302-0551
For Petitioner Mount Sinai Medical Center of Florida, Inc.: Geoffrey D. Smith, Esquire
Susan C. Hauser, Esquire Blank, Meenan & Smith, P.A.
204 South Monroe Street Post Office Box 11068
Tallahassee, Florida 32302-3068 For Petitioner West Kendall Baptist Hospital, Inc.:
Robert A. Weiss, Esquire Karen A. Putnal, Esquire
Parker, Hudson, Rainer & Dobbs, LLP The Perkins House, Suite 200
118 North Gadsden Street Tallahassee, Florida 32301
For Respondent Agency for Health Care Administration:
Tom R. Moore, Esquire
Agency for Health Care Administration 2727 Mahan Drive, Mail Station 3
Tallahassee, Florida 32308
ISSUE
Whether Mount Sinai Medical Center of Florida, Inc., has standing to initiate the proceeding in Case No. 03-2954CON to challenge the preliminary decision of the Agency for Health Care Administration to approve the application of Kendall Healthcare Group, Ltd., for a Certificate of Need authorizing the construction of an 80-bed satellite hospital in Dade County.
PRELIMINARY STATEMENT
On July 31, 2003, the Division of Administrative Hearings ("DOAH") received a notice from the Agency for Health Care Administration ("AHCA" or the "Agency"). The notice advised that AHCA had received a request for a formal administrative hearing from Kendall Healthcare, Ltd., d/b/a Kendall Regional Medical Center ("Kendall").
Attached to the notice was the request. Denominated "Petition for Formal Administrative Hearing Challenging Co- batched Applicant" it challenged an AHCA decision in favor of West Kendall Baptist Hospital, Inc. ("West Kendall Baptist"). The decision approved West Kendall Baptist's Application No. 9674 for a Certificate of Need ("CON") to establish a new acute
care hospital of 80 beds through de-licensure of 80 acute care beds at South Miami Hospital. The petition also referred to a CON application of Kendall's, Application No. 9675. The application, approved by AHCA, sought to establish a new acute care hospital of 80 beds through de-licensure of 80 acute care beds at Kendall Regional Medical Center.
The relief sought by Kendall's petition included "[t]hat Recommended and Final Orders be issued approving Kendall's CON application and denying West Kendall Baptist's application to the extent that the two applications are considered comparative, competitive and mutually exclusive . . . ." Kendall's
Petition, at 5.
The Agency's request that DOAH assign the matter to an administrative law judge to conduct all necessary proceedings under law was honored. The petition was assigned DOAH Case No. 03-2822CON. Administrative Law Judge Richard Hixson was designated by DOAH to conduct the proceedings. The case was subsequently transferred to the undersigned administrative law judge; shortly thereafter, it was set for hearing in
September and October of 2003 and an Order of Pre-hearing Instructions was issued.
In the meantime, Mount Sinai Medical Center of Florida, Inc., an existing provider of acute care hospital services in the same health planning district as Kendall and West Kendall
Baptist, had filed a petition for a formal administrative hearing with the Agency. The petition challenged only AHCA's decision to approve Kendall's CON application; it did not challenge the decision of approval of West Kendall Baptist's CON application.
The petition reached DOAH by way of a notice from AHCA similar to that in Case No. 03-2822CON. Administrative Law Judge Hixson was also designated to conduct the proceedings and ultimately the case, assigned Case No. 03-2954CON by DOAH, was transferred to the undersigned. Over the opposition of Mount Sinai, the two cases were consolidated by an Order entered August 26, 2003.
Shortly before the consolidation, Kendall moved that the proceeding be bifurcated into a "preliminary hearing as to Mount Sinai's standing [to be held in September of 2003] and otherwise continue the final hearing in this case to commence March 1, 2004." Motion filed August 20, 2003. Mount Sinai responded in Case No. 03-2954CON in opposition. The motion was granted and the "standing" portion of the hearing was set for September 29 and 30, 2003, with the remainder of the hearing, if necessary, to commence on March 1, 2004.
On August 25, 2003, West Kendall Baptist's petition for an administrative hearing filed with the Agency on August 11, 2003, arrived at DOAH attached to a notice from AHCA similar to the
notices filed in the other two cases. By its petition, West Kendall Baptist challenged the approval of Kendall's CON. The undersigned was ultimately designated to conduct the proceedings and the case, assigned DOAH Case No. 03-3096CON, was consolidated with the other two.
The "standing" portion of the case was continued several times, once at the urging of Mount Sinai. West Kendall Baptist agreed to a continuance until January on the condition that a decision on whether it would be recommended that Mount Sinai be determined to have standing or not (not necessarily a recommended order) would be issued by January 30, 2004. The condition was accepted by the administrative law judge in light of an earlier order that granted a continuance and that stated that a decision on the issue of standing might be announced prior to issuance of a recommended order in the case. See Order, November 12, 2003.
The case proceeded to hearing on January 14, 2004, at
1:00 p.m. and concluded on January 15, 2004. Kendall presented the testimony of Gene Nelson, an expert in health planning; Victor Maya, an expert in hospital administration; and Elizabeth Ann Tonkin, an expert in nursing administration and health care recruitment. Kendall offered sixteen exhibits, marked for identification sequentially as Kendall 1-16. All were admitted into evidence. Mount Sinai presented the live
testimony of Daniel Sullivan, an expert in health planning and health care finance. Mount Sinai offered ten exhibits, marked for identification sequentially as Mount Sinai 1-10. All were admitted into evidence. The Agency presented the testimony of Jeffrey N. Gregg, an expert in health planning and Florida CON review, and offered one exhibit. West Kendall Baptist did not present any evidence or cross examine any witnesses during the hearing.
A portion of the transcript was declared sealed and remains under seal subject to a confidentiality agreement filed by Mount Sinai. The portion of the transcript was filed under seal and remains under seal subject to the agreement.
Proposed Recommended Orders were filed timely by Kendall, Mount Sinai and AHCA on January 29, 2003. Kendall also filed a memorandum and AHCA's proposed order was interwoven with analysis and argument referred to as its brief. An Order was issued on January 30, 2003, announcing the decision of the administrative law judge to recommend that Mount Sinai be determined to lack standing to initiate the administrative proceedings of Case No. 03-2954CON.
This Recommended Order on the issue of Mount Sinai's standing follows.
FINDINGS OF FACT
The Parties
Mount Sinai owns and operates two acute care hospitals under a single license. The two comprise over 900 licensed beds, 575 of which are operational. Mount Sinai's main campus is the site of a general acute care hospital located in the incorporated area of Miami Beach, on the eastern edge of Miami- Dade County. Its second campus, located about one mile north of Mount Sinai, is that of the Miami Heart Institute, acquired by Mount Sinai in 2000.
One of six statutory teaching hospitals in the state and a regional tertiary care center, Mount Sinai offers a variety of general acute care and tertiary services. These include open heart surgery and related procedures. Mount Sinai is also a "safety net" provider of hospital services for the Miami-Dade County community.
Kendall is a 412-bed acute care hospital located at the intersection of Bird Road and 117th Avenue that serves west Miami. In addition to general acute care services, it provides tertiary services such as open heart surgery and neurosurgery.
Approximately 95% of the patients and physicians at Kendall are of Hispanic origin. So is most of the administrative team at the hospital. English and Spanish are most commonly spoken at the hospital. (Tagalog can also be
heard in the hospital because of the presence of nurses from the Philippines.)
West Kendall Baptist, Inc. ("West Kendall Baptist"), is an affiliate of Baptist Hospital of Miami, an existing provider of acute care services in western Miami-Dade County. The applicant for CON 9674 to establish a 80-bed acute care satellite hospital in western Miami-Dade County, West Kendall Baptist Hospital, is a party to these consolidated proceedings by virtue of Kendall's petition in Case No. 03-2822CON and its own petition in Case No. 03-3096CON. West Kendall Baptist is not a party in Case No. 03-2954CON and did not take an active role in the proceedings with regard to Mount Sinai's standing to initiate the proceeding. The site of its proposed hospital is approximately three miles from the proposed site for Kendall's proposed satellite hospital.
The Agency for Health Care Administration is the state agency authorized to evaluate and render final determinations on Certificate of Need applications in Florida.
The West Kendall Area
Bounded on the west by the Everglades, the West Kendall Area of Dade County is generally recognized as the area south of Bird Road, west of the Florida Turnpike and north of Southwest 216th Street.
The area is served primarily by four hospitals. The hospital with the most market share in West Kendall is Baptist. South Miami Hospital, Inc. ("South Miami"), is the second largest provider of acute care hospital services to West Kendall residents. Kendall is a close third, providing approximately the same volume of patient days to the service area population as South Miami. The fourth hospital that provides any significant level of patient days to residents of West Kendall is Jackson Memorial Hospital South ("Jackson South").
There are no other hospitals based on market share that are significant providers of services to residents of West Kendall.
The Applications
Kendall filed CON Application No. 9675 to construct a satellite hospital (the "Tamiami Hospital") to provide general acute care services in the West Kendall Area. To that end, Kendall has placed a deposit on land located at 137th Avenue and 120th Street approximately five miles from the site of Kendall.
The application calls for the de-licensure of 80 beds at Kendall so that there will be no net increase in beds in the health planning district with the establishment of the satellite hospital. Kendall's purpose in seeking the establishment of the 80-bed satellite hospital is two-fold. It will accommodate the population growth in the proposed service area. It will also
alleviate delays in gaining access to hospital services caused by traffic congestion in the Kendall area.
The Tamiami Hospital will offer general acute care hospital services, but not tertiary services.
Three miles from the proposed site of Tamiami Hospital is the proposed site of the Baptist satellite hospital, the subject of West Kendall Baptist's application, CON Application No. 9674. Like Kendall, West Kendall Baptist's application is for a new 80-bed hospital to serve the West Kendall area. Just as in the case of Kendall, West Kendall Baptist's new hospital would not add new beds to the service district. The beds would be transferred from Baptist South, an underutilized hospital to help decompress Baptist, a hospital presently experiencing high utilization.
In projecting utilization, each applicant assumed that the other would not be approved.
The utilization projections of West Kendall Baptist were based on the assumption that 85% of its patient volume would be generated from patients who reside in West Kendall but are currently being served at Baptist's other area hospitals. The projections of Kendall were based on the assumption that the majority of the patient volume would be generated from taking market share away from Baptist's existing facilities and the
further assumption that Baptist would not also have a simultaneous approval of a new hospital.
The Motivation for Mount Sinai's Challenge
Mount Sinai challenges Kendall's application on the supposition that if both of the Kendall and West Kendall Baptist applications are approved, Kendall will have to generate volume at the expense of existing providers other than Baptist if it is to meet its projected utilizations. Mount Sinai theorizes that a portion of Kendall's volume at Tamiami Hospital will be achieved at Mount Sinai's expense, at a time that Mount Sinai can ill afford to lose business.
Mount Sinai did not challenge the West Kendall Baptist application because 85% of its patient volume is projected by the application to come from re-direction of patients that would have been served otherwise by Baptist hospitals. The potential of its volume of service to be affected by the approval of West Kendall Baptist's application, in Mount Sinai's view, is much less than the potential in the case of the Tamiami Hospital.
Competitors?
Kendall has never considered Mount Sinai to be a competitor. Prior to this case, Mount Sinai had never challenged a CON application of Kendall nor had Kendall ever challenged one filed by Mount Sinai.
Until recently, Mount Sinai has not regarded Kendall as much of a competitor either. In the Official Statement for two separate bond offerings, one in the amount of $25,000,000, and another in the amount of $70,340,000, both dated May 23, 2001, Mount Sinai devoted a section to a discussion of "Demographics and Competition."
The following appears in the "Demographics and Competition" section under a subheading entitled "Competing Hospitals":
The Medical Center considers its principal, although not exclusive, competition to be Aventura Hospital and Medical Center, Cedars Medical Center, Mercy Hospital, Jackson Memorial Medical Center (operated by Miami- Dade County) and Parkway Regional Medical Center. Other important competitors within certain segments of the Medical Center's market are Baptist Hospital of Miami, Palmetto General Hospital, and Memorial Hospital of Hollywood.
Kendall Ex. 5, at A-23. Kendall is not mentioned as a competitor.
Physical lay-out of hospitals in Miami-Dade County and driving distance between the proposed site for the Tamiami Hospital and Mount Sinai support Kendall's claim that it and Mount Sinai are not engaged in serious competition.
There are 16 hospitals within a 20-mile radius of the proposed site at Southwest 120th Street and Southwest 127th
Avenue. Neither Mount Sinai nor Miami Heart Institute is among the 16.
The driving distance from the proposed site at 120th Street and 137th Avenue is 23.9 miles to Mount Sinai and 24.4 to Miami Heart. It takes approximately 45 minutes to drive from Kendall to Mount Sinai if the traffic is not congested; otherwise it takes much longer. There are six hospitals along the most straight-forward drive (or in very close proximity to it) from the proposed site of Kendall's satellite hospital, Tamiami Hospital, to Mount Sinai: South Miami Hospital, Larkin Community Hospital, Health South Doctor's Hospital, Coral Gables Hospital, Mercy Hospital, Jackson Memorial Hospital, and South Shore Hospital. Another three lie between the proposed site and Mount Sinai and are within a few miles of the most direct drive between the two: Westchester General Hospital, Pan American Hospital, and South Shore Hospital.
Overlap between medical staffs also indicates that Kendall and Mount Sinai are not competitors. There is insignificant overlap between the medical staffs of Kendall and Mount Sinai.
The parties agree that medical staff overlap between existing providers is a criterion used to determine adverse impact to non-approved or non-applicant providers caused by expansion of beds or programs at the approved provider or, as in
this case, the establishment of a satellite hospital. See Tr. 426.
There are 16 physicians on staff at Kendall who, during calendar year 2002, were the attending physicians for discharges that occurred at Mount Sinai or Miami Heart. Of the 16, 15 had discharges at Mount Sinai. (The physician with ID FLME0053375 had discharges at Miami Heart but none at Mount Sinai, see Kendall Ex. 4, p. 23.) At Miami Heart, 12 of the 16 had discharges. (The physicians with IDs FLME 005564, FLME 0055703, FLME 0054181 and FLME 0045129 had discharges at Mount Sinai but none at Miami Heart, id.)
Of the 12 staff members with discharges at Miami Heart, they had 450 discharges or 5.9% of the total number of discharges (7,610) at the facility for the year.
At Mount Sinai, the overlap in terms of percentage of discharges, was even less. Of the 15 staff members who had discharges at Mount Sinai, they accounted for 282 discharges or 1.7% of the 16,381 total discharges for the year at Mount Sinai.
The degree of overlap between Kendall physicians and Mount Sinai or Miami Heart physicians can only be characterized as insignificant, an indicator that the Mount Sinai will not be substantially affected by the approval of Kendall's CON.
The Primary Service Area
Based on the experience of South Miami, it is reasonable for Kendall to estimate that approximately 90% of the admissions to the proposed Tamiami Hospital will come from a primary service area (the "PSA") encompassing seven zip codes: 33177, 33183, 33185, 33186, 33187, 33193, and 33196. These seven zip codes plus zip code 33175, a zip code not included in the PSA, comprise the West Kendall Area. Zip code 33175, the single zip code in West Kendall not included in the PSA, is the site of Kendall Regional Medical Center.
None of the zip codes in the PSA Kendall has designated in its application are part of Mount Sinai's service area. The following appears in Mount Sinai's Official Statements referred to in the "Demographics and Competition" section above under the sub-heading "Service Area":
For planning purposes, the Medical Center defines its primary service area as the communities of Miami Beach, Surfside, and Bal Harbour, and its secondary service area as the communities of North Miami, North Miami Beach, Sunny Isles and Aventura. Both the primary and secondary service areas lie within Miami-Dade County. Mount Sinai's tertiary service area includes mainland Miami-Dade County communities such as Miami Springs, Hialeah, Hialeah Gardens and West Miami, as well as the Broward County community of Hallandale.
Kendall Ex. 5, page A-20. There is no reference to Kendall or the West Kendall Area as part of Mount Sinai's service areas.
Population Growth
West Kendall is one of the few areas in Miami Dade County where there is still room for growth. Its population growth has been and is reasonably expected to continue to be robust. The 2003 population for the area is 261,150. The projected rate of growth for the area from 2003-2008 is 12.1%, with the actual population anticipated to grow by an additional 31,482.
Mount Sinai provides an insignificant level of service in the proposed Tamiami Hospital's PSA.
If one holds the use rate constant, when population growth in the service area is considered, the impact of Tamiami Hospital on Mount Sinai is negligible. In the year 2010, factoring in population growth, Mount Sinai will realize an increase of 102 patient days with approval, construction and operation of Tamiami Hospital.
The same is true for Miami Heart Institute. There will not be a substantial impact on Miami Heart. By 2010, as in the case of Mount Sinai, population growth will offset any losses incurred by Miami Heart due to the establishment of Tamiami Hospital.
Patients from the PSA
Patients who leave the Tamiami PSA to seek hospital services at Mount Sinai or Miami Heart are typically elective
patients referred by physicians rather than emergency room admissions or HMO referrals. These patients by-pass more proximate hospitals because of Mount Sinai's array of advanced medical and tertiary services favored by physicians or unavailable at existing facilities serving the PSA.
In calendar year 2002, Mount Sinai drew from the PSA
174 patients, slightly more than 1% of the total volume of patients at Mount Sinai for the year (16,366). The 174 patients include those who received open heart surgery and other specialized services that will not be offered at Tamiami Hospital.
Of the 7,610 patients seen at Miami Heart in calendar year 2002, 91 were discharges from the PSA, less than 1.2% of the total.
If Tamiami Hospital is approved, patients treated for open heart surgery and other specialty services at Mount Sinai and Miami Heart are not likely to be diverted to Kendall.
Cultural and Demographic Differences
Although the ethnic make-up of its patient population has become more Hispanic in recent years, Mount Sinai is not considered a Hispanic hospital. In contrast, more than 91% of the patients from the PSA discharged from Kendall are identified as white Hispanic. It is appropriate to consider Kendall as a Hispanic hospital, moreover, because it is in an area of Miami-
Dade County that has a high concentration of Hispanic residents, a bilingual culture and administrative and clinical staffs that are largely Hispanic.
For the 12 months ending June 30, 2002, Kendall's patients originating within the PSA that were Medicare patients were a number significantly higher than HMO/PPO patients. Just the opposite was true for Mount Sinai and Miami Heart patients over the same time period. This finding supports the finding that Mount Sinai/Miami Heart patients coming from the PSA constitute a younger, more mobile group than the patients from the PSA treated at Kendall. In all likelihood, this younger, mobile group will continue to seek services at Mount Sinai and Miami Heart for the reasons that they have sought them out in the first place. The establishment of Tamiami Hospital is not likely to affect this dynamic.
Recruitment of Staff
The extent to which nursing staff at Kendall reside in the same zip codes as nursing staff at Mount Sinai is minimal.
The zip code area from which Mount Sinai derives 51% of its registered nurses contributed only 9.9% of Kendall's RN work force. The area from which Mount Sinai drew 75.2% of its registered nurses contributed only 12% to Kendall's RNs.
It is not likely that Kendall would recruit administrative staff from Mount Sinai.
A statewide shortage of nurses has been in effect for some time. Miami Dade County, however, is not experiencing the shortage to the same extent as other parts of the state. One reason is that Miami-Dade Community College and Broward County Community College rank one and two among community colleges nationally in the number of nursing graduates.
To the extent the shortage is having an impact on Miami Dade County, there are methods for dealing with it. Systems adopted by All About Staffing, a subsidiary of Hospital Corporation of America and a provider of clinical staffing services to Kendall, present a promising future for the availability of nurses.
Kendall and Mount Sinai, moreover, attract different nurses in terms of culture and expectations. Nurses who work at Kendall are not generally interested in working at Mount Sinai. Nurses who work at Mount Sinai are not generally interested in working at Kendall.
Approval of Kendall's application is not likely to have an impact on Mount Sinai's ability to recruit and retain nurses.
AHCA's Position
The Agency referred Mount Sinai's petition, taking it "at its word when it alleged that it would be 'substantially affected' if the Agency were to grant the CON application . . .
that Mount Sinai challenges." AHCA's Brief and Proposed Recommended Order on Mount Sinai's Lack of Standing, p. 2.
At this stage of the proceeding, the Agency sees itself as sufficiently informed to support dismissal of the petition for lack of Mount Sinai's standing.
At hearing, Jeffrey N. Gregg, Chief of AHCA's Bureau of Health Facility Regulation testified in support of dismissal for lack of Mount Sinai's standing. The facts supporting the Agency's position are summarized in 1 through 6 of the Agency's Proposed Recommended Order.
CONCLUSIONS OF LAW
Jurisdiction
The Division of Administrative Hearings has jurisdiction over the parties and the subject matter in this case. §§ 120.569, 120.57(1), and 408.039(5), Fla. Stat.
Agrico Chemical Co. v. Department of Environmental Regulation, 406 So. 2d 478 (Fla. 2d DCA 1981) sets out a two- part test for standing in administrative proceedings in Florida: a party must show (1) that it will suffer injury in fact of sufficient immediacy and (2) that the injury is of the type or nature the proceeding is designed to protect.
The Agrico test applies to standing of an existing health care facility to initiate an administrative proceeding under Section 408.039(5)(c), Florida Statutes, the provision in
CON law that governs standing. Memorial Healthcare Group, Inc., d/b/a Memorial Hospital Jacksonville v. State of Florida, Agency
for Health Care Administration et al., 25 FALR 2712, 2719 (AHCA 2003).
Mount Sinai has the burden of proof in establishing its standing in this proceeding. See Balino v. Department of
Health and Rehabilitative Services, 348 So. 2d 349 (Fla. 1st DCA 1977).
In light of all the evidence, Mount Sinai has failed to show that it will suffer injury in fact of sufficient immediacy to support its petition in this case.
There will not be any new service at the new satellite hospital either by type or addition of beds that affects Mount Sinai. Nor is there any threat of any adverse impact either of significance or with sufficient immediacy that supports Mount Sinai's petition. Its petition should be dismissed.
Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Health Care Administration dismiss the petition of Mount Sinai Medical Center of Florida, Inc., in DOAH Case No. 03-2954, for lack of standing.
DONE AND ENTERED this 12th of March, 2004, in Tallahassee, Leon County, Florida.
S
DAVID M. MALONEY
Administrative Law Judge
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
(850) 488-9675 SUNCOM 278-9675
Fax Filing (850) 921-6847 www.doah.state.fl.us
Filed with the Clerk of the Division of Administrative Hearings this 12th day of March, 2004.
COPIES FURNISHED:
Stephen A. Ecenia, Esquire
Rutledge, Ecenia, Purnell & Hoffman, P.A.
215 South Monroe Street, Suite 420 Post Office Box 551
Tallahassee, Florida 32302-0551
Robert A. Weiss, Esquire Karen A. Putnal, Esquire
Parker, Hudson, Rainer & Dobbs, LLP The Perkins House, Suite 200
118 North Gadsden Street Tallahassee, Florida 32301
Geoffrey D. Smith, Esquire Susan C. Hauser, Esquire Blank, Meenan & Smith, P.A.
204 South Monroe Street Post Office Box 11068
Tallahassee, Florida 32302-3068
Tom R. Moore, Esquire
Agency for Health Care Administration 2727 Mahan Drive, Mail Station 3
Tallahassee, Florida 32308
Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Station 3
Tallahassee, Florida 32308
Valda Clark Christian, General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Station 3
Tallahassee, Florida 32308
Rhonda M. Medows, M.D., Secretary Agency for Health Care Administration 2727 Mahan Drive, Mail Station 3
Tallahassee, Florida 32308
NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
All parties have the right to submit written exceptions within
15 days from the date of this Recommended Order of Dismissal. Any exceptions to this Recommended Order of Dismissal should be filed with the agency that will issue the Final Order in this case.
| Issue Date | Document | Summary |
|---|---|---|
| Apr. 26, 2004 | Agency Final Order | |
| Mar. 12, 2004 | Recommended Order | Petitioner failed to show that it would suffer an injury in fact that supported its standing to initiate the proceeding. Recommended that case be dismissed. |
