STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DOCTOR'S OSTEOPATHIC HOSPITAL, ) INC., d/b/a GULF COAST HOSPITAL, )

)

Petitioner, )

)

vs. ) CASE NO. 83-2201

)

DEPARTMENT OF HEALTH AND )

REHABILITATIVE SERVICES, )

)

Respondent, )

and )

) LEE MEMORIAL HOSPITAL and NAPLES ) COMMUNITY HOSPITAL, )

)

Intervenors. )

)

RECOMMENDED ORDER

Pursuant to notice, an administrative hearing was held before Diane D. Tremor, Hearing Officer with the Division of Administrative Hearings, on June 26-28, 1984, in Fort Myers, Florida. The sole issue for determination in this proceeding is the number of acute care hospital beds which should be authorized in the Certificate of Need granted to the petitioner.

APPEARANCES

For Petitioner: Leonard A. Carson and

John D. C. Newton, II

253 East Virginia Street Tallahassee, Florida 32301

For Respondent HRS: Jay Adams

1323 Winewood Boulevard

Tallahassee, Florida 32301

For Lee Memorial: Ivan Wood

1221 Lamar, Suite 1400

Houston, Texas 77010

For Naples Community: Ken Hoffman

646 Lewis State Bank Building Tallahassee, Florida 32301

INTRODUCTION

This case is preceded by a lengthy history. In the Fall of 1978, Gulf Coast Hospital applied for a Certificate of Need to construct and operate a 116- bed osteopathic acute care hospital in Lee County, Florida. The application was

initially denied by the Department of Health and Rehabilitative Services (HRS) and Gulf Coast requested an administrative hearing. Subsequent to the hearing, a Recommended Order and a Final Order were entered denying the application.

Gulf Coast appealed the Final Order of denial, dated October 31, 1979, to the First District Court of Appeal. That Court reversed and remanded the matter to HRS with directions that it ". . . authorize such sized facility as the evidence already adduced or further evidence which may be adduced establishes." Gulf Coast Hospital, Inc. v. Department of Health and Rehabilitative Services, 424 So.2d 86 (Fla. 1st DCA, 1982).

In response to the Court's decision, HRS afforded Gulf Coast the opportunity to submit updated or supplemental information regarding the need for its 116-bed proposal. A revised application was filed, listing Doctor's Osteopathic Medical Center, d/b/a Gulf Coast Hospital, Inc. as the applicant.

HRS again denied the application and Gulf Coast sought both an administrative hearing and extraordinary relief from the First District Court of Appeal. The District Court denied the request for writ of mandamus, finding that the administrative hearing would allow HRS ". . the opportunity to support and, if necessary, to correct its position. . ." (Case No. AT-335, October 26, 1983).

The case thus proceeded before the Division of Administrative Hearings. After considering oral argument on the applicant's "Motion for Limitation of Final Hearing," the undersigned entered an Order dated February 17, 1984, holding that the sole issue for determination in this second administrative hearing is the appropriate number of acute care osteopathic beds allowable, but included within that issue is the issue of whether or not such beds are osteopathic beds. By a prehearing stipulation entered into prior to the intervention of Lee Memorial Hospital or Naples Community Hospital, the applicant and HRS stipulated that the petitioner's proposed facility will be an osteopathic facility as that term is used in Section 381.494(2), Florida Statutes. Thus, the sole issue for determination at the hearing is the number of beds to which the petitioner is entitled. The petitions to intervene filed by Lee Memorial and Naples Community having been granted subsequent to the filing of the pre-hearing stipulation entered into by the petitioner and HRS, the interveners were not permitted to expand the issue for determination in this proceeding.

The post-hearing Motion to Reopen Hearing filed by Lee Memorial was denied, as was its post-hearing Motion for Judicial Notice. Also, subsequent to the final hearing, the First District Court of Appeal, in yet another request by the applicant for extraordinary relief, has provided further guidance in determining the need for osteopathic beds. In Doctor's Osteopathic Medical Center, Inc. d/b/a Gulf Coast Hospital, Inc. v. Department of Health and Rehabilitative Services, So.2d, Case No. AZ-348, Op. filed August 7, 1984, the Court reiterated its prior mandate that a Certificate of Need be granted to Gulf Coast. The Court further ruled that the evidence on remand regarding the appropriate number of beds to be approved is not to include the number of beds intended to be issued to Manasota Osteopathic General Hospital in Sarasota County or to any other entity within the same district.

In support of its position of entitlement to a 120-bed facility, petitioner presented the testimony of Lloyd Dawson Gladding, D.O., accepted as an expert in the practice of osteopathy; Woodrin Grossman, accepted as an expert in auditing and accounting; Paul Parker and Thomas W. Schultz, both of whom were accepted as expert witnesses in the area of health planning; Jim Haas; and A. Joseph Picolla, James Taylor and Nicholas F. Centafont, all of whom are osteopathic

physicians practicing in Lee County, Florida. Petitioner's Exhibits 1-3, 5, 6, 11, 13, 15, 17, 18, 23, 27, 28, 34-36, 40 and 41 were received into evidence.

HRS presented the testimony of Eugene Nelson, who was accepted as an expert witness in health care planning. Its Exhibits 1 through 9 were received into evidence.

Petitioner and HRS stipulated to the standing of Lee Memorial hospital and Naples Community Hospital to intervene in this proceeding, and those parties did not present any witnesses at the hearing. They each introduced one exhibit.

Subsequent to the hearing, counsel for all parties except Naples Community Hospital submitted proposed findings of fact and proposed conclusions of law.

To the extent that the parties' proposed findings of fact are not incorporated in this Recommended Order, they are rejected as being not supported by competent substantial evidence adduced at the hearing, irrelevant or immaterial to the sole issue for determination in this proceeding or as constituting legal conclusions as opposed to factual findings.

FINDINGS OF FACT

Upon consideration of the oral and documentary evidence adduced at the hearing, the prehearing stipulation and stipulations of fact reached at the hearing, the following relevant facts are found:

1. Lee County, which contains the city of Ft. Myers, is the most populous county in HRS Service District VIII. There is a need in District VIII for 175 acute care hospital beds by the year 1988. A five-year horizon period is typically utilized when planning for the addition of new acute care hospital beds. At the time of the hearing, HRS had net yet projected the 1989 acute care bed need for District VIII.

   
   

2. According to the records of the Department of Professional Regulation, there are 58 licensed doctors of osteopathy located in District VIII, with 26 residing in Lee County, and 11 in the adjoining counties of Collier and Charlotte. The petitioner's proposed facility will be an osteopathic facility. For the purposes of this proceeding, there are no other osteopathic acute care hospitals in HRS Service District VIII.

   
   

3. Petitioner desires to construct and operate a 120-bed acute care osteopathic hospital in south Ft. Myers. The facility will be located no further than one mile south of Highway 865 (Summerlin Road), and will be bounded on the east by Highway 41, on the north by College Parkway and on the west by McGregor Boulevard. Eleven osteopathic physicians practicing in Lee County own stock in the proposed facility, and eight of these have their offices in close proximity to the proposed site.

   
   

4. It is anticipated that Gulf Coast Hospital will be a teaching hospital used by the Southeastern College of Osteopathic Medicine to train osteopathic interns and residents. Since all osteopathic physicians presently in Lee County are family practitioners, the proposed facility will not initially be suitable for training in the required areas of obstetrics, pediatrics or gynecology. It is anticipated that these areas of training will initially be provided in rotating internships with other osteopathic hospitals and that the proposed facility, when operating, will attract additional osteopathic physicians, including specialists, to the Lee County area.

5. HRS has not enacted a specific rule setting forth a methodology for determining acute care osteopathic hospital bed need. 1/

   
   

6. The need methodology chosen by petitioner to demonstrate osteopathic acute care bed need was to attempt to identify the current osteopathic patient population size, trend that number forward and then apply various bed-to- population ratios and use rates to that population. The various bed-to- population ratios applied to the population derived were the current and projected ratios in District VIII, the current and projected ratios for a combination of Charlotte, Collier and Lee Counties, and the current and projected ratios for Lee County alone. The ratios utilized range from 4.4 beds per thousand osteopathic patients to 5.0 beds per thousand osteopathic patients. The use rate based method employed by the petitioner relied upon actual hospital utilization by patients, and assumed that the osteopathic use rate would be the same as the allopathic use rate in he service area. The various bed-to- population ratios and use rate methodologies employed by the petitioner predicted a range of osteopathic bed need between 182 and 225 beds for Lee County alone, between 198 and 244 for Charlotte, Collier and Lee Counties combined and between 191 and 239 for District VIII as a whole. These projections were for 1984, 1988 and 1989. Utilization of a bed-to-population ratio as a methodology to determine need is one of the commonly accepted methods among health care planners. This methodology is particularly useful when more extensive data, such as actual numbers of physician admissions, patient utilization and average lengths of stay, is not known. This method's reliability is, of course, entirely dependent upon the reliability of the number used as the population figure. This would be true also of the use rate methodology.

   
   

7. To derive the osteopathic patient population size, petitioner engaged the firm of Price Waterhouse and Company to count active osteopathic patient files. An active patient was defined as a patient who had seen the osteopathic physician in the past three years. Generally, a patient below the age of 45 will visit a physician once every three to five years, a patient between 45 and

   55 will visit once every three years, a patient between 55 and 65 will visit once every two years, and a patient over 65 years of age will visit once a year. Thus, the three-year period was chosen as an accurate depiction of an active patient. Representatives from Price Waterhouse, on two separate occasions, went to the offices of various osteopathic physicians and performed an actual count of active patient charts, defined as being a medical record for any patient visiting the physician during the preceding three year period. No individual patient was counted more than once at the same office. In March of 1983, the offices of eight osteopathic physicians were visited and 33,108 total active charts were counted. In June of 1984, the active medical charts of fourteen osteopathic physicians were counted resulting in a figure of 41,186. Thirteen of the fourteen physicians had offices in Lee County, and one had an office in Naples. This latter count did not include one physician's files which had been counted in March of 1983 for a total of 3,432 active medical records.

   
   

8. The figure of 41,186 active charts was utilized by petitioner's health planning expert as the basis for making his need projections as discussed in paragraph (6) above. While the figure of 41,186 may be said to be conservative in that it counts the patients of only 13 of the 26 Lee County osteopathic physicians and only 14 of the 37 osteopathic physicians in the three-county area, this chart-counting method of depicting the osteopathic patient population has certain drawbacks. For example, among the patients who would be counted as active osteopathic patients would be former patients who have died, transients or seasonal visitors, persons under the primary or even joint care of an

   allopathic physician, persons who no longer wish to be treated by an osteopathic physician, persons who were seen by an osteopath solely because he was on call in a hospital emergency room or persons who have permanently moved out of the service area. While bed-to-population ratios are typically utilized to calculate future bed need, the counting of "active patient charts" to determine the population size is not a usual health planning tool.

   
   

9. The methodology employed by HRS in this proceeding to determine the number of osteopathic acute care beds needed was to analyze and utilize the actual experience in 1983 of other established osteopathic facilities in Florida. It was determined that all existing osteopathic hospitals are located in the seven counties of Broward, Dade, Duval, Hillsborough, Pinellas, Orange and Volusia. HRS extracted data from these existing facilities which reflected the number of admissions, the number of patient days, the average lengths of stay, the number of admission and patient days per osteopathic physician, and the admissions and patient days per 1,000 population. These figures were then lumped together by County, and then averaged or totalled to give an overall historical view of osteopathic utilization in Florida. The statewide use rates were then projected to the anticipated Lee County 1989 population and projected to 30 osteopathic physicians (a number derived by rounding the number 26 upward). This methodology resulted in an osteopathic bed-need range of from 52 to 79 bed In HRS's expert health planner's opinion, the correct measure of need is 60 beds.

   
   

10. The HRS proposed methodology also suffers from serious drawbacks. It is well established that health planning is to be performed on a community, as opposed to a statewide, need basis. The variances in the numbers compared and averaged among the seven counties in which osteopathic facilities are established exemplifies the need and requirements for planning which is specific to a particular community. For example, the number of osteopaths licensed in the seven counties ranged from 52 in Orange County to 219 in Broward County.

    The number of admissions per osteopath ranged from 51.5 in Broward County to

    103.6 in Orange County. The number of admissions per 1,000 population ranged from 5.3 in Hillsborough County to 22.3 in Pinellas County, and the number of patient days per 1,000 population ranged from 36.1 to 198.0 in the same counties. It is difficult to accept the assumption that Lee County osteopathic utilization will approximate the "state-wide" osteopathic utilization for one specific year when the statistical data itself is illustrative of wide divergencies among the seven counties with established osteopathic facilities. Obviously, a County's or service area's utilization will be dependent upon the size of the population, the age mix of the population and the number of physicians in the area. Additional shortcomings with HRS' methodology of analyzing a one-year period of historical data from existing osteopathic facilities are that the data utilized does not depict the number of allopathic physicians who admit patients to osteopathic facilities, the number of osteopathic physicians who admit patients to allopathic facilities, and the number of osteopathic physicians and/or patients residing in a county which does not have an osteopathic hospital but utilize the facilities of an existing osteopathic hospital.

    
    

    CONCLUSIONS OF LAW

    
    

11. The essential purposes and objectives of the Certificate of Need law and review process are to serve the health care needs of a community, while avoiding unnecessary duplications of existing health services, thus resulting in the goal of cost containment for health services. The need for an acute care osteopathic hospital is to be determined on the basis of the need for and

    availability of osteopathic services and facilities in the community, Section 381.494(2), Florida Statutes, and an applicant need not establish proof of discrimination by an existing hospital before a separate osteopathic hospital will be authorized. Section 395.011(6), Florida Statutes. The criteria of need, availability, quality of care, accessibility, extent of utilization and adequacy, as set forth in Sections 381.494(6)(c) and (d), Florida Statutes, are to be measured against the needs of osteopathic physicians and their patients for osteopathic facilities. Gulf Coast Hospital, Inc. v. Department of Health and Rehabilitative Services, 424 So.2d 86 (Fla. 1st DCA, 1982)

    
    

12. It having already been determined that the petitioner is entitled to a Certificate of Need for an osteopathic facility to be located in Lee County, the sole issue to be determined in this proceeding is the number of osteopathic beds required to meet the bed need of the Lee County community. There are no existing osteopathic facilities in Lee County and, for the purposes of this proceeding, in District VIII. Thus, there is no existing historical data which can form the beginning point to determine the potential utilization of an osteopathic facility in that community.

    
    

13. Two need methodologies were presented to the Hearing Officer in this proceeding. Both contain shortcomings, as discussed in the Findings of Fact above. Obviously, the prediction of future bed need in a community, whether it be osteopathic or allopathic, is not an exact science. Where there is no promulgated rule on the subject and where available site-specific data is lacking, the task becomes even more difficult.

    
    

14. HRS attempts to raise its proposed methodology to the status of "incipient policy" by arguing that it is the method (also called the "Wellington" method) approved by the Department in the case of Osteopathic Medical Hospitals, Inc.-Universal Health Services, Inc. v. Department of Health and Rehabilitative Services, 5 FALR 2294-A (December 26, 1983). That is somewhat of a mischaracterization. While the "Wellington" method adopted in that case did employ actual historic utilization figures when determining the need for a new osteopathic facility, that was because site-specific data was in existence due to the existence of an osteopathic acute care hospital in the same community. The "Wellington" method did not attempt to cross-apply data from one area of the State to another. To apply a methodology based upon an averaging of historical use rates statewide for a one year period to a single county would be to disregard the entire theme of the Certificate of Need law and practice of planning on a community basis. Thus, the methodology proposed by HRS in this proceeding must be rejected.

    
    

15. While the undersigned is reluctant to conclude, as a matter of law, that competent substantial evidence was adduced by the petitioner to adequately demonstrate an osteopathic bed need of the magnitude predicted by the petitioner's export witness, it is concluded that petitioner had demonstrated a need for the 120 beds requested. Use of a bed-to-population ratio to evaluate acute care bed need is an appropriate health planning technique. It is particularly useful when mere extensive data is not available, as is the situation here since an osteopathic hospital has never existed in either Lee County or the District. In order to determine the osteopathic patient population, the medical records of the "active" patients of osteopathic physicians were counted. This count was performed on two occasions. The first count involved the records of eight Lee County physicians and the second involved the records of fourteen physicians, all but one of whom was located in Lee County. While the count of 41,186 osteopathic patients may include persons who are no longer in the Lee County area or who are not truly "osteopathic"

    patients, these possibilities are balanced by the factors that the patient records of one-half the Lee County licensed osteopaths (one of whom had a patient count of 3,482) were not included and only one physician's records from the neighboring Collier County were counted. It seems reasonable to assume that at least a portion of the nine licensed osteopathic physicians in Collier County would utilize an osteopathic hospital in Ft. Myers, since the next nearest osteopathic facilities are presently located in either Pinellas County or the east coast of Florida. It is also reasonable to assume that the existence of an osteopathic hospital in Lee County will attract more osteopathic physicians to that area. Trending the present osteopathic population size forward to the year 19898, and utilizing an appropriate bed-to-population ratio, clearly results in a need for the 120 osteopathic acute care beds requested by the petitioner.

    
    

16. The First District Court of appeal having narrowed the issue in this proceeding to the appropriate size of the facility to be constructed by the petitioner, other issues raised by the intervenor, Lee Memorial Hospital, are specifically rejected.

RECOMMENDED ORDER

Based upon the findings of fact and conclusions of law recited herein, it is RECOMMENDED that petitioner be granted a Certificate of Need to construct and operate an osteopathic facility consisting of 120 acute care beds in Lee County, Florida.

Respectfully submitted and entered this 4th day of December, 1984, in Tallahassee, Florida.

DIANE D. TREMOR, 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 4th day of December, 1984.

ENDNOTE

1/ While a rule had been proposed at the time of the hearing, that rule was then and is now the subject of a pending rule-challenge proceeding. The methodology proposed in the challenged rule was not offered as being appropriate by any of the health planning experts who testified in this proceeding.

COPIES FURNISHED:

Leonard A. Carson and John D. C. Newton, II

253 East Virginia Street Tallahassee, Florida 32301

Jay Adams Department of HRS 1323 Winewood Blvd.

Tallahassee, Florida 32301

Ivan Wood

1221 Lamar, Suite 1400

Houston, Texas 77010

Ken Hoffman

646 Lewis State Bank Building Tallahassee, Florida 32301

David Pingree Secretary Department of HRS 1323 Winewood Blvd.

Tallahassee, Florida 32301

=================================================================

AGENCY FINAL ORDER

=================================================================

STATE OF FLORIDA

DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES

DOCTOR'S OSTEOPATHIC HOSPITAL, INC., d/b/a GULF COAST HOSPITAL,

Petitioner,

vs. CASE NO. 83-2201

DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES,

Respondent.

and

LEE MEMORIAL HOSPITAL and NAPLES COMMUNITY HOSPITAL,

Intervenor.

/

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 (hereinafter referred to as "DOAH") in the above-captioned case has submitted a Recommended Order to the Department of Health and Rehabilitative Services (hereinafter referred to as "HRS"). A copy of that Recommended Order is attached hereto as Exhibit A.

Intervenor, Lee Memorial Hospital, (hereinafter referred to as "Lee Memorial") filed Exceptions to the Recommended Order. A copy is attached hereto as Exhibit B. Petitioner, Doctors' Osteopathic Medical Center, Inc., d/b/a Gulf Coast Hospital, Inc., (hereinafter referred to as "Gulf Coast Hospital") filed Suggestions To the Agency Supporting the Recommended Order in the Nature of Exceptions. A copy is attached hereto as Exhibit C. Respondent, Department of Health and Rehabilitative Services (hereinafter referred to as "HRS") filed Exceptions to the Recommended Order. A copy is attached hereto as Exhibit D. Petitioner, Gulf Coast Hospital, filed a Motion To Strike Exceptions of Respondent HRS. A copy is attached hereto as Exhibit E. Petitioner, Gulf Coast Hospital, also filed a Memorandum in Support of Motion To Strike. A copy is attached hereto as Exhibit F. Intervenor, Lee Memorial, file a Notice of Filing. A copy is attached hereto as Exhibit C.

RULING ON MOTION

Rule 28-5.205, Fla. Admin. Code, authorizes motions to strike in opposition to a petition. Fla. R. Civ. P. 1.140(f) permits a party to move to strike redundant, immaterial, impertinent or scandalous matter from any pleading at any time. Fla. R. Civ. P. 1.150(a) permits a party to move to strike any pleading or part thereof which he deems to be a sham. Fla. R. Civ. P. 1.100(a) lists all pleadings and affirmatively states "no other pleading shall be allowed." Exceptions are not listed as pleadings. The Florida Rules of Civil Procedure may or may not be applicable in this instance. In any event, it is clear that the rules authorizing a motion to strike authorize the motion only to strike either a petition or a pleading. Exceptions to a Recommended Order is not a pleading or a petition, therefore, the Motion of Petitioner to Strike Exceptions to the Recommended Order filed by DHRS is not authorized and is DENIED.

RULING ON EXCEPTIONS

1. S120.57(1)(b)(g) states:

"The agency in its final order may reject or modify the conclusions of law and interpretation of administrative rules in the recommended order, but may not reject or modify the findings of fact unless the agency first determines from a review of the complete record, and states with particularity in the order, that the findings of fact were not based upon competent substantial evidence or that the proceedings on which the findings were based did not comply with essential requirements of law."

Petitioner's Suggestions to the Agency Supporting the Recommended Order in the Nature of Exceptions does not allege that the findings of fact are not based upon competent substantial evidence or that the proceeding did not comply with the essential requirements of law. The Hearing Officer addressed the findings of fact proposed by Petitioner. Petitioner suggests that the findings of fact in the Recommended Order be modified because "the Recommended Order would even more accurately reflect the evidence and the law if certain of petitioner's proposed findings of fact. . .had been made and a few findings and conclusions had not been made. There is no authority to modify findings of fact based on the suggested standard. The question is not whether the record contains

competent substantial evidence to support Petitioner's view, but whether competent substantial evidence supports the findings made by the Hearing Officer. Collier Medical Center, Inc. vs. State of Florida, DHRS, et al., 7 FALR 618. Therefore, Petitioner's suggestions in the nature of exceptions 1, 2, 3, 4, and 5, and the first sentence of HRS's exception 2 are denied.

1. DHRS has articulated its non-rule policy in the record. The Hearing Officer has adopted specific findings relating thereto. The rational basis for the policy, which is set forth, is neither arbitrary nor capricious. "[T]he applicant. . . carries the `ultimate burden of persuasion' of entitlement through all proceedings. . . Florida Dept. of Transp. v. J.W.C. Co., Inc., Fla. App.; 396 So.2d 778(1981). S381.494(2), Fla. Stat., mandates the need for osteopathic facilities be determined "on the need for and availability of osteopathic services and facilities in the community." It does not dictate how the need will be determined, however, and Petitioner has failed to carry its burden of persuasion of entitlement to 120 beds. The findings do demonstrate, however, entitlement to 60 beds. For these reasons, Lee Memorial's exceptions 1 and 2 and HRS's exceptions 1, 3, 4, and 2 as it relates to conclusions of law are granted. Petitioner's exception 6 is denied for the same reason.

   
   

2. Although Lee Memorial's argument that an "osteopathic wing" on Fort Myers Community Hospital be ordered because it will result in probable economies and improvements in service as a result of the operation of cooperative health care resources is attractive, it is probably beyond the scope of authority mandated by the Court in Gulf Coast Hospital, Inc. v. DHRS, 424 So.2d 86 (Fla. 1st DCA 1982), and is therefore denied.

FINDINGS OF FACT

The Department hereby adopts and incorporates by reference the findings of fact set forth in the Recommended Order.

CONCLUSIONS OF LAW

The Department hereby adopts paragraphs 1, 2, and 3 of the conclusions of law set forth in the Recommended Order.

DHRS extrapolated reliable statewide evidence adjusted to District 8 and Lee County to reach an osteopathic bed need for that area. Although the method employed by HRS may not be the only method to determine need, it is a reliable method of carrying out its legislative mandate, and Petitioner has failed to carry its ultimate burden of persuasion to entitlement of more than a 60-bed facility.

It is ADJUDGED that Doctor's Osteopathic Hospital, Inc., d/b/a Gulf Coast Hospital, be granted a Certificate of Need for a 60-bed osteopathic acute care hospital in Lee County, Florida.

DONE and ORDERED this 20th day of March 1985, in Tallahassee, Florida.

DAVID H. PINGREE

Secretary

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO 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 APPEAL 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.

Docket for Case No: 83-002201

Orders for Case No: 83-002201