STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FAMILY CENTER HOME HEALTH CARE, ) INC., )

)

Petitioner, )

)

vs. ) CASE NO. 81-3262

) STATE OF FLORIDA, DEPARTMENT ) OF HEALTH AND REHABILITATIVE ) SERVICES, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, James E. Bradwell, held a public hearing in this case on May 24, 1982, in Palatka, Florida.

APPEARANCES

For Petitioner: Daniel D. Richardson, Esquire

1636 Atlantic Bank Building Jacksonville, Florida 32202

For Respondent: James M. Barclay, Esquire

Department of Health and Rehabilitative Services

Office of Health Planning and Development

1317 Winewood Boulevard

Tallahassee, Florida 32301

ISSUE

Whether or not the Petitioner is entitled to be issued a Certificate of Need to establish a home health agency to serve Putnam County, Florida.

FINDINGS OF FACT

1. Based upon my observation of the witnesses and their demeanor while testifying, the documentary evidence received, post-hearing memoranda and the entire record compiled herein, the following relevant facts are found.

   
   

2. Family Center Home Health Care, Inc. (Petitioner), filed an application seeking to establish a home health agency to serve Putnam County, Florida. Ms.

   Felice M. Knotts, R.N., M.S.N., is the person who completed the application for the issuance of a Certificate of Need on behalf of Petitioner. Ms. Knotts has been a registered nurse since approximately 1966, and is a Doctoral candidate for a degree in Health Services Administration. The application was referred to the North Central Florida Health Planning Council, Inc., pursuant to Sections 381.493-.499, Florida Statutes, for review and comments. The Health Systems Agency (HSA) staff, its project review committee and its Board of Directors each recommended denial to the Department of Health and Rehabilitative Services of a Certificate of Need with the Board recommending denial by a vote of 23 to 0.

   
   

3. Need for the proposed project is to be measured against standards found in the Local Health System's plan and Chapter 10-5, Florida Administrative Code, pursuant to Section 381.494, Florida Statutes (1979).

   
   

4. By letter dated October 27, 1981, Petitioner was advised by the Respondent that her proposal to establish a home health agency in Putnam County had been reviewed by the North Central Florida Health Planning Council, Inc., and was denied on the basis that the proposed project was inconsistent with the HSA's health system plan and Chapter 10-5.11 (14), Florida Administrative Code. In addition, the two (2) current home health agencies operating in Putnam County, even if combined, do not reach the average daily census maximum of three hundred (300) which is required for the establishment of another home health agency.

   
   

5. As stated, currently there are two (2) home health agencies licensed to serve Putnam County, Upjohn Health Services and Central Florida Home Health Services. During 1980, Upjohn served six (6) patients and Central Florida Home Health Services served one hundred sixty-two (162) patients. Upjohn found demand insufficient in Putnam County to establish a sub-unit. At the time that Petitioner's application was reviewed by the Department of Health and Rehabilitative Services, Upjohn had a case load of five (5) patients while Central Florida had a case load of ninety-five (95). During the hearing herein, representatives of each agency indicated that it had sufficient capacity to meet future demands.

   
   

6. Standard 1-1 in the Health System's plan requires that the need for new home health agencies be based on home health use rates, projected population and a minimum volume of 1,200 patients per year per agency. Based on current regional use rates of six (6) patients per 1,000 population and the projected population in 1985 of some 56,800 people in Putnam County, 341 Putnam County residents would need home health care during 1985. By use of this standard, the need could exist for less than one-third (1/3) of a single home health agency.

   
   

7. Petitioner sought to introduce into evidence a chart which would purportedly show the need as required pursuant to Chapter 10-5, Florida Administrative Code. The chart was based on Ms. Knotts' contact with numerous physicians who practice in the subject area and purportedly recorded their responses in a document designated as Petitioner's Composite Exhibit No. 3. Based on the fact that none of the physicians who purportedly relayed information to Petitioner was present to testify during the course of this hearing, information contained in petitioner's survey is hearsay. As such, that information is not, standing alone, reliable or sufficient to support a basis for which a finding of fact can be made. Chapter 120.58(1)(a), Florida Statutes.

   
   

8. Rule 10-5.11(14)(b), Florida Administrative Code, provides that a Certificate of Need for a proposed new home health agency shall not be issued

   until the daily census of each of the existing home health agencies or sub-units providing services within the health service area of the proposed new home health agency has reached an average of three hundred (300) patients for the immediate preceeding calendar quarter. That rule also allows for need to be shown for a proposed new home health agency by demonstrating mitigating and extenuating circumstances as follows:

   
   

   That the population of a proposed service area is being denied access to home health care services because existing agencies are unable to provide service for all persons in need of home health care or that approval of the new home health agency would foster cost contain ment for all providers in the health service area.

   
   

9. Based on the above, it is concluded that the two (2) currently licensed home health agencies in Putnam County have not obtained the average daily census of three hundred (300) patients. Likewise, there was no substantial competent evidence that the population of Putnam County is being denied home health services or that creation of Petitioner's home health agency would foster cost containment for all providers in the health service area. In this regard, officials from the existing two (2) currently licensed home health agencies testified to the extensive under-utilization of existing services which would likely have the effect of increasing charges because of the duplication of

   under-utilized services which cannot be demonstrated to be cost-effective. Based thereon, I shall recommend that the Petitioner's application to create a home health care agency be denied.

   
   

   CONCLUSIONS OF LAW

   
   

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

    
    

11. The parties were duly noticed pursuant to the notice provisions of Chapter 120, Florida Statutes.

    
    

12. The authority of the Respondent is derived from Chapter 381, Florida Statutes, and Rule Chapter 10-5, Florida Administrative Code.

    
    

13. Chapter 381.494(1), Florida Statutes (1979), provides in pertinent part that all health care facilities proposed to be offered (are) subject to review under this act 2/ and shall, accordingly, file application for a certificate of need. In examining need, the Legislature has announced its intent to stimulate the establishment and continuous reevaluation of community- oriented health goals by providers, consumers and public agencies; to assist in the rational examination of alternate methods of achieving those goals and to aid in their achievement through the most effective means possible within the limits of available resources. It was, therefore, imperative to plan the rendering of health services in order to meet and provide for community health needs in a responsible and effective manner. In such planning, the communities are assisted by a state health planning agency whose duty it is to coordinate the activities of all health planning agencies. The health planning agencies are invested with the roles of providing information, consulting, stimulating

and advising health care institutions and other health care providers and consumers. Chapter 381.493(2), Florida Statutes. With those goals in mind, the local health system agencies devise percent plans to carry out the above directives. Such standards are found in the Local Health System's plan and in Chapter 10-5, Florida Administrative Code, pursuant to Chapter 381.494, Florida Statutes (1979). Based on the above findings and conclusions which reflect that the Petitioner's proposed project is not consistent with the health system's plan or Rule 10-5.11(14), Florida Administrative Code, demand or need for this project has not been established. Evidence herein reveals that the combined census of the current home health agencies licensed and operating in Putnam County do not reach the three hundred (300) average daily census maximum required for additional home health agency licensure. Likewise, there was no substantial competent evidence which would warrant the granting of the subject application based on mitigating and extenuating circumstances applicable to the Petitioner's proposal pursuant to Rule 10-5.11(14)(b), Florida Administrative Code.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, it is hereby

RECOMMENDED:

That the Respondent, State of Florida, Department of Health and Rehabilitative Services, enter a final order denying Petitioner's application for the issuance of a Certificate of Need to establish a home health agency to serve Putnam County, Florida.

RECOMMENDED this 20th day of August, 1982, in Tallahassee, Florida.

JAMES E. BRADWELL, Hearing Officer Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32301

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 20th day of August, 1982.

ENDNOTES

1/ The hearing officially closed on June 28, 1982, the date on which the parties were afforded leave to file post-hearing memoranda supportive of their respective positions. The parties have submitted proposed memoranda which were con sidered by me in preparation of this Recommended Order. To the extent that the parties' proposed findings and conclu sions are not incorporated in this Recommended Order, they were deemed irrelevant, immaterial or not otherwise supported by record evidence.

2/ The Health Facilities and Health Services Planning Act. Chapter 381.493(1), Florida Statutes (1979).

COPIES FURNISHED:

Daniel D. Richardson, Esquire 1636 Atlantic Bank Building Jacksonville, Florida 32202

James M. Barclay, Esquire Department of HRS

Office of Health Planning and Development

1317 Winewood Boulevard

Tallahassee, Florida 32301

David Pingree, Secretary Department of Health and

Rehabilitative Services 1323 Winewood Boulevard

Tallahassee, Florida 32301

Docket for Case No: 81-003262

Orders for Case No: 81-003262