STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
HUMOSCO INC., d/b/a HUMANA ) HOSPITAL SOUTH BROWARD, et al., )
)
Petitioner, )
)
vs. ) CASE NOS. 84-0235
) 85-3940
DEPARTMENT OF HEALTH AND )
REHABILITATIVE SERVICES, )
)
Respondent. )
)
RECOMMENDED ORDER
This matter was heard by William R. Dorsey, Jr., the Hearing Officer designated by the Division of Administrative Hearings in Fort Lauderdale, Florida, beginning on September 12, 1986, and in Tallahassee, Florida, on October 22 and December 1, 1986. A transcript of the Proceedings was filed and thereafter the parties submitted Proposed recommended orders. Rulings on proposed findings of fact are made in the Appendix to this Recommended Order.
For South Broward F. Phillip Blank, Esquire Hospital District: Tallahassee, Florida
and
Ursala Mancusi-Ungaro, Esquire Miami, Florida
For Department of Health and
Rehabilitative Douglas L. Mannheimer, Esquire Services: Tallahassee, Florida
For Humana South John H. French, Jr., Esquire Broward and Humana James C. Hauser, Esquire
of Florida, Inc.: Tallahassee, Florida
The following witnesses testified during the hearing:
For South Broward Hospital District: Frank V. Sacco, Frank M. Steffens, William Schnitt, Thomas J. Konrad, Ward M. Koutnik, Woodrin Grossman, Kevin Nolan, Wilson Atkinson, Lenora Wallace, Lois Dziedzic, and Lawrence Draizin.
For the Department of Health and Rehabilitative Services (HRS): Robert Sharpe.
For Humana South Broward Hospital (South Broward) and Humana Hospital Bennett (Bennett): Richard Baehr.
ISSUE
The issue is whether South Broward Hospital District's (District) application for a certificate of need to build and operate a satellite facility in southwest Broward County by transferring 100 beds and retiring 25 medical/surgical beds from its existing facility should be granted.
STIPULATION CONCERNING APPLICABLE STATUTES
A prehearing stipulation was filed in which the parties agree that criteria found in Sections 381.494(6)(c), Florida Statutes (1985), apply in determining whether the satellite facility should be built. Not all of these criteria are in dispute, however. By stipulation the criteria found in Section 381.494(6)(c)3., 6., 7., 11. and 13. 381.494(6)(d)3. and 5., Florida Statutes (1985), are inapplicable or are not in dispute. Section 381.494(6)(c)8., Florida Statutes (1985), is not in dispute as it relates to the availability of resources and capital or operating funds. The criteria set out in Section 381.494(6)(c)1., 2., 4., 5., 9., 10. and 12. apply and Humana contends the application of South Broward Hospital District does not meet them. Humana maintains that the application does not meet the criteria of Section 381.494(6)(d)1. 2. and 4., while the District maintains those are inapplicable because the District proposes no new services.
STIPULATED FACTS
The parties have also stipulated to the following facts:
The District's application was timely filed;
The petition for a formal hearing on the agency's intent to deny the certificate of need was timely filed;
The donated services expense, operating expenses and Hospital Cost Containment Board assessment found in the financial statements are reasonable;
The site preparation costs contained in Table 25 of District Exhibit H are reasonable, even in the event of any cost increase due to delays in commencement of the project;
The findings, opinion and data contained in District Exhibit 1 are reasonable;
The construction costs reflected in Table 25 of Exhibit H are reasonable, provided any increase in costs from delaying the opening of the satellite 17 months would not exceed 5 percent of the total construction cost; the construction figures include a contingency factor of 5 percent.
FINDINGS OF FACT
General
Procedural Background
Following the Department's expression of its intention to deny the application of the District to construct a new satellite hospital in southwest Broward County, the District requested a formal administrative hearing which became Case No. 84-0235.
On February 8, 1984, Humana Hospital Bennett moved to consolidate the District's case (DOAH Case No. 84-0235) with Cases No 84-0265 and 84-0266 (certificate of need applications to transfer beds from Humana South Broward to Humana Bennett) and Case No. 83-3944 (a certificate of need application to transfer beds from Humana South Broward to southwest Broward County). These three "Humana" cases were consolidated with South Broward Hospital District's application on February 23, 1984.
On February 24, 1984, Pembroke Pines General Hospital (Pembroke Pines) moved to intervene in Case No. 84-0235, the South Broward Hospital District application. The motion was granted on March 15, 1984, and final hearing was scheduled for June 20, 1984.
On April 11, 1984, Pembroke Pines moved for a continuance based, in part, on the need to consolidate Case Nos. 84-0235, 84-0265, 84-0266 and 83- 3944. The motion was granted on May 29, 1984.
On April 20, 1984, Humana South Broward moved to intervene in DOAH case No. 84-0235 (the South Broward Hospital District application) and the motion was granted. The final hearing was set for August 1, 1984, but was subsequently continued to October 15, 1984, and then to February 25, 1985.
Ultimately, the cases mentioned in the preceeding paragraphs were consolidated with an application for a certificate of need filed by Pembroke Pines to offer obstetrical services, which was Case No. 84-0610.
On July 23, 1986, Humana South Broward announced that it would not pursue the applications involved in Case No. 83-3944, its application to transfer beds from Humana South Broward to a southwest Broward County location.
In 1985, the South Broward Hospital District filed its application for a certificate of need to develop and operate a 100-bed satellite hospital in southwest Broward County by transferring 100 beds from the facility it operates in eastern Broward. The Department of Health and Rehabilitative Services Indicated its intent to deny that application. The district requested a hearing, and the case was assigned DOAH Case No. 85- 3940.
On April 11, 1986, South Broward Hospital District updated its two applications to permit the transfer of 100 beds from an existing facility to a satellite facility which would be composed of 92 medical/surgical beds and 8 intensive care beds.
Subsequently, South Broward Hospital District agreed to retirement off an additional 25 medical/surgical beds upon the opening of a satellite facility, which would remove those 25 licensed beds from its present facility in eastern Broward County and reduce the county's overall inventory of acute care beds. Department of Health and Rehabilitative Services agreed to support this application at the final hearing.
On September 9, 1986, after the hearing had begun, Pembroke Pines, South Broward Hospital District, and the Department of Health and Rehabilitative Services entered into a written agreement, part of which was that Pembroke Pines would withdraw its opposition to the District's application for approval of the satellite hospital. Humana South Broward and Humana Hospital Bennett were, thus, the only parties objecting to the application at final hearing.
The Parties
South Broward Hospital District (the District) was created in 1947 by the Florida Legislature in Chapter 24415, Laws of Florida, Special Acts of 1947, as an independent taxing authority. It assures access to health care services by the residents in its geographical area by constructing and operating health facilities serving the need for all types of health care within the District.
It provides services without regard to the ability of District residents to pay for them.
The District's geographic boundaries generally cover the southern 1/3 of Broward County and includes about 1/3 of the county population. The remaining portion of the county is served by a separate public entity, the North Broward Hospital District.
The District established Memorial Hospital of Hollywood (Memorial) in 1952 as a 100-bed hospital facility. Memorial has been expanded in 1957, 1962, 1967 and 1974.
Memorial is now a 737 bed full-service hospital accredited by the Joint Committee on Accreditation of Hospitals. It is the only provider in south Broward County of the following services:
cardiac surgery;
cardiac catheterization;
physical rehabilitation within a distinct comprehensive unit;
psychiatric services;
pediatric surgical programs;
pediatric intensive care;
full-service neonatology;
newborn intensive care/progressive care;
high risk obstetric maternity care;
residential substance abuse programs.
Some of these services are operated at a loss. Uncompensated care is
18.7 percent of the District's total operating budget. $14.8 million will be spent in the current year on services to indigents who use 6.7 percent of Memorial's patient days. Medicaid patients account for 6.3 percent of Memorial's patient days. Operating revenues and the District's power to levy and collect property taxes pay for the service to indigents. It is the most important provider of services to the indigent and medically underserved in South Broward County.
Memorial Hospital is located east of State Road 441 in a fully developed and matured area of Broward County.
Since 1976 the District has operated a 24-hour walk-in center in Pembroke Pines, in southwest Broward County, approximately 8 miles west of Memorial Hospital. It treats emergencies and provides routine unscheduled care.
In 1985, that center experienced over 24,000 patient visits. Of the twenty hospitals in Broward County, only three had more patient visits than the District's walk-in center.
The center also has a residential substance abuse treatment center of
14 beds, 12 of which are occupied on any given day.
In 1982, HRS granted the District a certificate of need far $1,000,000 authorizing the District to purchase the land upon which the proposed satellite hospital would be built, on Flamingo Road, between Johnson Street and Pines Boulevard.
Humana South Broward is a 282-bed acute care hospital located at 5100 West Hallandale Boulevard, Hollywood, Florida. It serves the southern portion of Broward County and is a wholly owned subsidiary of Humana.
Humana Hospital Bennett is a 204-bed acute care hospital located in West Broward County. It is a wholly owned subsidiary of Humana.
Factual Findings Concerning The Criteria Against which The Application Must Be Evaluated
General Applicability of Chapter 10-5, Florida Administrative Code
Under Rule 10-5.003, Florida Administrative Code, certificate of need applications are processed and reviewed under the provisions of Chapter 10-5. These rules implement the statutory criteria enacted a Section 381.494(6)(c) and (d), Florida Statutes (1985).
The project at issue involves the relocation reduction of licensed acute care beds The methodology for determining the need for new beds found in Rule 19-5.011(1)(m)6., Florida Administrative Code, is inapplicable, because no additional beds will be added to the inventory of the HRS service district. Central Florida Regional Hospital v. Daytona Beach General Hospital, 475 So.2d 974 (Fla. 1st DCA 1985). Similarly, the other standards found in the rule besides the need methodology also do not apply. Because no batching cycle is involved, no planning horizon is set involved.
The Department's Non-Rule Policy On Bed Transfer And Relocation.
The Department of Health and Rehabilitative Services has promulgated no rule governing the circumstances in which applications to transfer or relocate beds within a service district will be approved.
The Department's policy on the approval of such transfers and relocations has evolved over time.
An early, large hospital relocation decision by the Department involved the application of St. Luke's Hospital in Jacksonville, Certificate of Need #1487, which was granted in 1981. The Rule methodology for computing need for new beds had not been adopted then. The Department approved that ultimately unopposed application in order to improve geographic access to care for residents in a fast growing area, and due to life safety problems in the old facility.
Later, in 1982, Orlando Regional Medical Center applied for Certificate of Need #2868 to build a satellite facility by relocating 150 beds
to a fast growing area in southeast Orange County. This application also pre- dated the need methodology. The project was unopposed and was approved due to increased accessibility of medical services to a fast growing area and the hospital's plan to more efficiently use the vacated space at the existing facility.
Lee Memorial Hospital in Lee County received Certificate of Need #2851 in 1984, permitting the construction of a satellite facility and the renovation of an existing facility. That project was approved because:
The hospital needed to demolish obsolete buildings constructed in 1939. The construction of a satellite facility, which would be made up of 81 beds from the demolished main campus and 19 new beds, would have been no more costly than construction of a new facility on the current location.
Projected growth in the 65 and older population justified the additional beds according to the need methodology which had been adopted by rule.
Moving the existing and new beds to the satellite would decentralize the service district's concentration of beds in the City of Fort Myers.
The Department granted Beaches Hospital in Duval County Certificate of Need #352-6 in 1985 to transfer its 82 bed facility to a new location. That small public hospital provided vital medical services to Medicare and indigent patients. It would be forced to close in about 10 years if it did not relocate, due to deteriorating physical plant and inefficiencies in its physical layout. Beaches Hospital had been located in a decaying area. Physicians were locating away from the hospital's immediate area. Relocation was necessary for that public facility to remain financially viable.
In reviewing various State Agency Action Reports and Final Orders of the Department of Health and Rehabilitative Services concerning applications analogous to the one at issue here, the Department has looked at five factors in determining whether to approve applications for the relocation of beds:
whether the relocation is predicated upon the need for additional beds based on the need methodology of Rule 10-S.011(1)(m)., Florida Administrative Code, or the reduction of excess capacity within a district (or a subdistrict, if one has been established);
whether the proposed project improves geographic access to a sufficiently large segment of the population which is expected to experience serious problems in obtaining in-patient care;
whether the project improves availability of in-patient care to all residents of the community, especially Medicaid and indigent patients;
whether the relocation corrects life safety deficiencies that could not otherwise be resolved through less costly facility renovations, or replaces obsolete or deteriorating and inefficient public hospital facilities; and
whether the project will result in an increase in hospital costs and charges at a rate above the state average for hospitals of similar size, offering similar services.
The Department has formulated a draft policy with respect to standards for evaluating applications to transfer beds or convert facilities. This policy was first written on August 7, 1986, and is based on the agency's prior experience in health planning.
The Department's general policy for transfers and conversions is to try to "work off" any overbedding in a service district when approving transfers by requiring bed retirement as a condition to the approval of transfers.
This strategy is the Department's attempt to reduce the excess of licensed and approved medical/surgical beds. The Department does not believe it possesses statutory authority to de-license acute care beds or to retire acute care beds. Voluntary reduction of surplus beds in conjunction with applications to transfer beds or convert facilities provides one means for reduction of the number of beds in a service district.
When the Department reviews applications for transfers or conversions of beds, it seeks to assure there will be no adverse effect on a public facility which has traditionally provided services to indigents, providing access to medical services without regards to a patient's ability to pay. This insures low income groups access to health care facilities.
Another element of the Department's incipient policy is a review of the efficiency of the facility proposing the transfer, and examination of the applicant's historic cost per discharge, gross revenue per adjusted admission, and the general cost effect of the proposal, to assess whether the transfer or conversion would lead to higher patient charges.
The incipient policy is designed to promote price and non-price (service) competition among providers. Changing bed complements at facilities by transfer allows providers to compete for larger market shares, which fulfills the Department's statutory duty to promote competition among providers.
The Project's Consistency With The Department's Non-Rule Policy On Bed Transfer and Reallocation
The District's project will reduce the number of medical/surgical beds located in the service district (District X) by 25 beds. In the service district there are 5,770 medical/surgical beds, an excess of approximately 80 medical surgical beds as of the last calculation done by the Department. In the letter of denial attached in the State Agency Action Report, Humana exhibit N, there were 447 unused acute care beds available to the southwest Broward County population within reasonable access on a daily basis in 1984. The delicensure of 25 beds will only minimally advance the goal of reduction of excess capacity.
The proposed project does not improve geographic access to a sufficiently large segment of the population expected to experience serious problems in obtaining in-patient care. There is no persuasive evidence that any significant segment of the population in Broward County now has a serious problem in obtaining in-patient care. To the extent that a satellite facility in southwestern Broward County would bring an acute care hospital to that area, those living in that area would have enhanced or more convenient access, but that is a far cry from demonstrating that a population has a serious access problem. This project would not significantly improve the availability of in- patient care to Medicaid and indigent patients who are now served at the
District facility (Memorial Hospital) in east Broward. This situation might be different if there were subdistricting in Broward County, but none now exists. In fact, subdistricting has been considered by the Local Health Council, but rejected for lack of adequate data. Ad hoc subdistricting is inappropriate here.
There is no evidence of deterioration of the facilities of the District or the necessity to correct life safety deficiencies by building the satellite facility. This case is not like the Lee Memorial Hospital situation. Here, the District is in the process of a significant $50 million renovation of Memorial Hospital, including construction of an eight floor patient tower.
With respect to the effect on patient charges, the District has sufficient cash on hand to build the satellite. If the project is approved, it would have no effect on the charges to patients at the District's current hospital. It would, however, allow improvements in the use of space at the current hospital by relocating and retiring 125 beds from Memorial Hospital. Approximately 15,000 square feet of space will become available at the current facility. Data processing, management systems, engineering, billing and collection clerks are presently housed away from Memorial in 20,000 square feet of rented space. Consolidating these operations at the main campus would allow the District to save approximately $100,00 per year in lease payments.
Statutory Criteria For Evaluating
The Application Under Section 381.494(6)(c), Florida Statutes A. Consistency With The State Health Plan And the Local Health Plan Related To Occupancy Levels.
Section 381.494(1)(6)1., Florida Statutes.
The Florida State Health Plan and the Local Health Plan set as goals occupancy levels for surgical and acute care beds of 80 percent. State Plan, Goal 8, Objective 8.1; Local Plan, Goal 3, Objective 3.1.
The Local Health Plan recommends that there should be no new hospital construction until there is an average annual occupancy in the District equal to
80 percent. Local Plan, page 227.
Pembroke Pines General Hospital is the closest hospital to the proposed satellite, and now serves most of the area the satellite would serve. Pembroke Pines operates at below 50 percent occupancy for its medical/surgical beds. Excess or underutilized bed capacity contributes to higher health care costs. According to the Institute of Medicine, the cost of an empty bed is 50 percent of the cost of an occupied bed, made up largely of the overhead assigned to that empty bed. State Plan, page 70.
There had been a great growth in the number of acute care beds in Florida before the need methodology of the certificate of need program was developed. According to the Department of Health and Rehabilitative Services, there were 4,800 excess acute care beds in Florida as of July, 1986.
The State Health Plan sets the appropriate ratio of medical/surgical beds to the population as a ratio of 4.11 to 1,000. State Plan, Goal 6, Objective 6.1.
The overall medical/surgical bed ratio to population in District X is approximately 5.1 to 1,000, in excess of the State Health Plan goals. The Local Health Plan encourages the reduction of licensed beds to achieve a ratio of 4.5 medical/surgical beds to 1,000 population by 1988 and seeks to achieve an 85 percent occupancy rate by that time. Local Plan, Page 226. District X (Broward County) is significantly overbedded. The proposal from the District would reduce the total inventory of acute care beds by 25 beds. In return, it would cost the health care system in the District approximately $15,965,500 to build the satellite. Such a cost for a rather modest reduction of 25 beds is unwarranted.
Availability, Utilization, Geographic Accessibility And Economic Accessibility of Facilities in the District
Section 381.494(6)(c)2., Florida Statutes
The area that the District proposes to serve in the satellite facility includes census tracts 702-706, 1102, and 1103. These have a younger population and age distribution than Broward County as a whole.
This younger population has a lesser need for hospital services than older populations. District's exhibit, 1 table 2, shows that the elderly population in the satellite service area will decrease over time, so that by 1990 the elderly will comprise about 7 percent of that population. The elderly will be 23.7 percent of the total Broward County population in 1990.
The satellite facility does not propose pediatric services. The age group from 0-14 will achieve second highest population of growth in the service area, but the pediatric population will not benefit particularly from the proposed satellite, because licensed pediatric beds, pediatric and pediatric surgery will remain at the current facility.
The age cohort with the highest growth is that of ages 30-44. This group demands in-patient services at a smaller rate than the elderly and tend to use such services as obstetrics, nursery services, psychiatric services, substance abuse services, cardiac catheterization and cardiac surgery which will not be available in-house at the satellite.
The District does not propose to offer any service at the satellite not now available at existing hospitals in its service area. Other hospitals now serving the area which the satellite proposes to serve have additional capacity to serve population growth in western Broward. Pembroke Pines is the closest hospital to the proposed satellite, and now operates at below 50 percent occupancy for medical/surgical beds. There is sufficient unused capacity to accommodate projected demands in the HRS service District X. The majority of the population growth will be experienced in the area between Humana Bennett and Pembroke Pines Hospital. These facilities and other hospitals can meet projected demand from that population growth.
There is no geographic access problem for residents of the satellite service area in receiving in-patient hospital services at existing hospitals.
There is no significant indigent or medicaid populations in the west and southwestern areas of Broward County, which has a younger population and is a more recently developed part of the county. Typically older sections of the county have more medically indigent persons.
The current establishment of the satellite facility is not necessary to ensure the financial viability of South Broward Hospital District or to maintain its indigent care commitment. In the fiscal year 1985, the District made $19.2 million from hospital operations at Memorial and was the most profitable hospital in the State of Florida. In the fiscal year 1986, the District made $13 million from the operation of Memorial. The District is not in any financially dangerous situation and has unused additional taxing authority available to it. There is no evidence that the District will not remain financially viable through 1990.
Other Facilities and Services which
may serve as Alternatives to the Facilities and Services Proposed.
Section 381.494(6)(c)4., Florida Statutes.
The residents of the District requiring in-patient services will continue to do so. There are no less expensive alternatives to in-patient care which the District has failed to consider.
Probable Economies from Joint, Cooperative or Shared Services or Facilities.
Section 381.494(6)(c)5., Florida Statutes.
The uncompensated case load of the District is such that it is unlikely other hospitals would jointly operate a service or facility with the District. No such alternative has been proposed by Humana. If the satellite is built, the District will be able to use space vacated at the main campus for administrative operations now housed away from the Hospital in rented space.
The District would be able to handle many administrative matters, e.g. accounting, purchasing, risk management centrally if the satellite is built. The District would experience improved physical efficiency and save approximately $100,000 per year in rental payments.
Availability of Resources Including Health Manpower. Section 386.494(6)(c)8., Florida Statutes.
The District has the financial and human resources to operate the satellite. There is no evidence that approval of the project will have an adverse effect on training programs or divert human or financial resources from other needed health care. The satellite would be economically accessible to residents of the District, due to the statutory mandate that care be provided without regard to ability to pay.
Financial Feasibility.
Section 381.494(6)(c)9., Florida Statutes.
The project is financially feasible in the short and long terms. The District has the ability to fund the project in the short-term without borrowing. The total projected cost for the project is $15,965,50. This total cost is also reasonable.
For the first two years of projected operations, fiscal years 1990 and 1991, the facility would have an excess of revenue over expenses of $1,154,800 and $2,147,900, respectively. In the long-term, based on historical patient origin and marketshare data that is available, the project is financially feasible.
The breakeven point from a financial basis is achieved at a 44 percent occupancy rate, and on a cash flow basis, at a 35 percent occupancy rate. Even if the District only achieved a 16 percent share of the southwest Broward market by 1992, the facility would still be financially feasible. By servicing existing patients alone, the satellite would have an immediate 20-30 percent occupancy rate.
Needs of Health Maintenance Organizations. Section 381.494(6)(c)10., Florida Statutes.
The District is an efficient provider of health services and has attracted health maintenance organizations to contract with it due to its low costs. There is no evidence, however, that unless the satellite is approved, health maintenance organizations will not be able to obtain adequate services for their members at a reasonable price.
Probable Impact of the Proposed Satellite on the Cost of Health Services Proposed by the District.
Section 381.494(6)(c)12., Florida Statutes.
Because the project can be built with cash on hand, it will have no adverse effect on patient charges at Memorial Hospital.
Construction of the satellite would, however, draw patients from Humana Bennett and Humana South Broward, which now draw patients frown the area the satellite would service. The net financial loss to Humana Bennett in the first two years of satellite operation would be $1 million, and to Humana South Broward $1/2 million.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the subject matter and the parties. Section 120.57(1), Florida Statutes (1985). The South Broward Hospital District has the burden of proving it meets the statutory criteria and is entitled to a certificate of need. Boca Raton Artificial Kidney Center, Inc. v. Department of Health and Rehabilitative Services, 475 So.2d 260 (Fla. 1st DCA 1985). The applicable statutory criteria are found in Section 381.494(6)(c), Florida Statutes (1985). Not all those criteria are in dispute. Section 381.494(6)(c)3., 6., 7., 11., and 13. are not in dispute. Criteria in dispute are:
The need for the health care facilities and services being proposed in relation to the appli- cable district plan and state health plan adopted pursuant to Title XV of the Public Health Service Act.
The availability, quality of care, efficiency, appropriateness, accessibility, extent of utiliza-
tion, and adequacy of like and existing health care services in the service district of the applicant ...
The availability and adequacy of other health care facilities and services ... in the service district of the applicant, such as out-patient care and ambulatory or home care services, which may serve as alternatives for the health care facilities and services to be provided by the applicant ...
Probable economies and im- provements in services that may be derived from operation of joint, cooperative, or shared health care resources ...
The availability of resources, including health manpower, manage- ment personnel, ... for project accomplishment and operation; the effects the project will have on clinical needs of health pro- fessional training programs in the service district; the extent to which the services will be accessi- ble to schools for health professions in the service district for training purposes if such services are available in a limited number off facilities; the availa- bility of alternative uses of such resources for the provision of
other health services; and the extent to which the proposed services will be accessible to all residents of the service district
The immediate and long-term financial feasibility of the proposal.
Special needs and circum- stances of health maintenance organizations.
12. The probable impact of the proposed project on the cost of providing health services proposed by the applicant, upon considera- tion of factors including, but not limited to, the effects of competition on the supply of health services being proposed and the improvements or innovations in the financing and delivery of health services which foster competition and service to promote quality assurance and cost-effectiveness.
Also in dispute are the following portions of Section 381.494(6)(d), Florida Statutes (1985):
That less costly, more efficient, or more appropriate alternatives to such in-patient services are not available and the development of such alternatives has been studied and found not practicable.
That existing in-patient facilities providing in-patient services similar to those proposed are being used in an appropriate and efficient manner.
4. That patients will experience serious problems obtaining in- patient care of the type proposed, in the absence of the proposed new service.
The need methodology found in Rule 10-5.011(1)(m), Florida Administrative Code, would have provided other criteria to be met by applicant if this case involved new beds. South Broward Hospital District only seeks to transfer beds from its existing facility and will not add no new beds to the District, so the need methodology "has no applicability to this case". Central Florida Regional Hospital v. Daytona Beach General Hospital, 475 So.2d 974, 975 (Fla. 1st DCA 1985). Nonetheless, the applicant must still satisfy the statutory criteria set out above. The statutory consideration such as need, accessibility, and utilization must be satisfied even though the more precise standards of Rule 10-5.011(1)(m), Florida Administrative Code, which deal with the same subjects, will not be considered.
Subsection 381.494(6)(c)1., Florida Statutes (1985), requires that the proposal be consistent with the state health plan and the district health plan. Here the proposal is inconsistent with those plans. The existing hospitals have not met the 80 percent occupancy rate prescribed by the state and local plans. The expenditure in excess of $15,000,00 by the South Broward Hospital District to move the existing beds to western Broward and to retire 25 beds is not warranted.
Subsection 381.494(6)(c)2., Florida Statutes (1985), requires consideration of the availability, quality of care, accessibility, efficiency, extent of utilization, and adequacy of like and existing health care services in the service district. Normally, an applicant demonstrates that like and existing facilities are either inaccessible, over-utilized due to patient demand or do not provide the necessary array of services required by the public. In the alternative, an applicant might show that the existing services are also inadequate, unavailable, or inappropriate and that a new facility is warranted. Here, the existing facilities in Broward County are reasonably available and accessible to persons residing in southwestern Broward County. They are now under-utilized because they do not have the utilization rates which are the goals of the state and local health plans. The existing facilities do provide a full array-of services in a quality manner. Statutory criteria of subsection 381.494(6)(c)2. have not been met.
Subsection 381.494(6)(c)4. requires consideration of the availability and adequacy of other health care facilities and services in the service district such as out-patient care and ambulatory or home care services, which may serve as alternatives for the health care facilities and services to be provided by the applicant. There is no evidence that the in-patient services which the District proposes to provide should be provided in alternative settings such as out-patient care or home care services, so this factor is essentially neutral. The citizens of Broward County who require in-patient services from the South Broward Hospital District will continue to require them whether the satellite is built or not.
Subsection 381.494(6)(c)5., Florida Statutes (1985), requires consideration of probable economies and improvements in service that may be derived from the operation of joint, cooperative, or shared health care resources. Here there are no economies to be achieved through the cooperation of the District with other hospitals. Due to the mission of the District to provide services without regard to ability to pay, it is unlikely that any other hospitals would enter into a cooperative venture with the District. Its level of uncompensated care is too high to be attractive. There are significant economies that the satellite facility would derive, if built, because the South Broward Hospital District may administer both facilities from a single location and indeed may use space vacated by the retirement of 125 beds at the existing facility for administrative purposes rather than rent off campus space for those purposes as it does now. Those efficiencies are predicated on the assumption that the satellite will be built. Looking solely at the existing facility, however, it is not cost effective to build a $15,000,000 satellite facility in order to make available approximately 15,000 square feet of space to house at Memorial Hospital management functions which are now being housed in space rented by the District for approximately $100,000 a year. Thus, while significant economies can be achieved from joint operation if the satellite facility is built, these savings are not so great as to justify, in themselves, the construction of the satellite facility.
Subsection 381.494(6)(c)8., Florida Statutes (1985), requires consideration of several factors. The first are the availability of resources for project accomplishment and operation. From a financial point of view, the parties have stipulated that there are adequate funds for capital and operating expenditures. There is no credible evidence that the District lacks adequate health manpower or management personnel to staff the satellite. Neither is there any evidence that the satellite would have any effect on the clinical needs of health profession training programs in the service district. The District has not discussed what alternative uses might be made of the cash on hand which is sufficient to build the satellite for the purpose of determining whether those uses would be more beneficial than the construction of the satellite itself. There is insufficient evidence that in-patient services are not currently accessible to all residents of the service district without the satellite. It is tautological that they would be more geographically accessible to residents in southwestern Broward County if the satellite is constructed, but there is no accessibility problem without the construction of the satellite.
The District has proven that under subsection 381.494(6)(c)9 the project is financially feasible in the short and long terms.
There is inadequate evidence in the record of the needs and circumstances of health maintenance organizations, which are to be considered under subsection 381.494(6)(c)10., to weigh in the evaluation at all. While the District is an efficient provider of health care services which has a number of
contracts with health maintenance organizations, there is no showing that health maintenance organizations will not be able to obtain needed services if it must rely on the current facility which the District operates, and cannot draw upon beds or services located in southwestern Broward County at the satellite. The factor is thus neutral.
Under subsection 381.494(6)(c)12., the probable impact of the proposed project on the cost of providing health service proposed by the applicant will be zero insofar as having an effect on the charges for patient services made by the South Broward Hospital District to its patients. It can build the facility with cash and does not need to increase charges as the result of the satellite's construction. On the other hand, the construction of the satellite will impose on the health care system generally in District X the capital construction costs for the satellite facility. These beds already exist, however, at the District's current facility. The $15,000,000 cost arises from moving those beds. There has been no showing of need for additional beds in the District. The District is overbedded. It makes little sense to require the residents of the District to amortize an additional $15,000,00 capital cost for the purposes of moving beds from one location to another when the county is already overbedded. Moreover, the District proposes to draw patients in southwestern Broward to its facility and away from other providers in that area. Those other providers are not operating at occupancy level of 80 percent which is the goal of the state and local health plans. Building this facility will impede the goals of the state and local health plans, and cause the competing hospital to spread their fixed costs over a smaller patient base than they would otherwise have, rendering those hospitals less efficient. This would be tolerable if those hospitals were not providing adequate quality of care or were cost inefficient. That has not been proven by South Broward Hospital District, however. Therefore, there is no valid reason to provide to the District the advantage of locating in southwestern Broward County at the expense of market share to other existing providers. The criteria of subsection 381.494(6)(c)12. has not been met.
Because a capital expenditure is involved, Section 381.494(6)(d) applies. There are no less costly, more efficient or more appropriate alternatives to the in-patient services which the District proposes to provide, so the application meets the standard in Section 381.494(6)(d)1., Florida Statutes (1985).
The application does not meet Section 381.4-94(6)(d)2. in that existing in-patient facilities such as Pembroke Pines Hospital are operating at occupancy rates of below 80 percent and are therefore not being utilized in an efficient manner.
The District argues that patients will experience serious problems in obtaining in-patient care in the absence of the proposed new service, because the District will be left with a shrinking patient base in the eastern part of the county, the reputation of which is older and in greater need of services for which the District will not be compensated, and the District needs access to markets in the more affluent southwestern portion of the county to maintain its mission of providing services without regard to the ability to pay. Whether these problems will come to pass only the future will reveal. If those problems arise then will be soon enough to deal with them. The District's historic commitment to indigent care will provide the District with an important advantage in competing for beds in western Broward County if the county is subdistricted so that need in the western part of the county would be computed separately. similarly, if the county is not subdistricted and continues to grow
to the point where additional beds are needed under the rule methodology, the District will be in a good position to compete for those beds against other hospitals which do not provide the level of indigent care which the District provides. As matters stand now, however, the potential need for access to more affluent markets to maintain the District's indigent care load does not overbalance the lack of need for additional beds, or the expenditure of substantial sums of money to transfer already existing beds.
It is RECOMMENDED that the application of the South Broward Hospital District to build a satellite facility in southwest Broward County be denied
DONE AND ORDERED this 4th day of August, 1987, in Tallahassee, Florida.
WILLIAM R. DORSEY, JR.
Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32399-1550
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 4th day of August, 1987.
APPENDIX TO RECOMMENDED ORDER
Petitioner's proposed findings of fact are addressed as follows:
1. Covered | in | Finding | of | Fact | 1. |
2. Covered | in | Finding | of | Fact | 8. |
3. Covered | in | Finding | of | Fact | 9. |
4. Covered | in | Finding | of | Fact | 10. |
5. Covered | in | Finding | of | Fact | 12. |
6. Covered | in | Finding | of | Fact | 12. |
7. Covered | in | Finding | of | Fact | 12. |
8. Covered | in | Finding | of | Fact | 13. |
9. Covered | in | Finding | of | Fact | 14. |
Covered in Finding of Fact 15.
Rejected as cumulative.
Covered in Finding of Fact 15.
Covered in Finding of Fact 15.
Rejected as unnecessary.
Covered in Finding of Fact 15.
Covered in Finding of Fact 15.
Rejected as cumulative and unnecessary.
Covered in Finding of Fact 62.
Covered in Finding of Fact 16.
The evidence is not persuasive that western migration is leaving a concentration of patients without the ability to pay for medical services in the eastern portion of Broward. Indeed, there is no satisfactory north-south dividing line to make an east-west Broward comparison.
Covered in Finding of Fact 17.
Covered in Finding of Fact 18.
Covered in Finding of Fact 14.
Covered in Finding of Fact 20.
Covered in Finding of Fact 21.
Covered in Finding of Fact 22.
Covered in Finding of Fact 23
Covered in Finding of Fact 24.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as cumulative to findings of fact 12 and 15.
Covered in Finding of Fact 45.
Rejected as inapplicable to Broward County since beds are accessible to the entire population of the county.
Covered in Finding of Fact 46.
Rejected as unnecessary.
Rejected as unnecessary.
To the extent necessary covered in finding of fact 42.
Rejected for the reasons stated in 37 above.
Covered in Finding of Fact 44.
Rejected as unnecessary.
Covered in Finding of Fact 38.
Covered in Finding of Fact 47.
Rejected as an improper attempt to use U.S. 441 for ad hoc subdistricting.
See Finding of Fact 47.
See Finding of Fact 47.
Rejected because the cited portion of the Local Health Plan only states that a study may indicate that special consideration should be given to the western portion of the county.
Covered in Finding of Fact 47.
Covered in Finding of Fact 25.
Covered in Finding of Fact 26.
Covered in Finding of Fact 27.
Covered in Finding of Fact 28.
Rejected because the portion of Exhibit F related to Saxon General Hospital did not appear to support the findings proposed. See also the Final Order in Halifax Hospital Medical Center vs. Department of Health and Rehabilitative Services, 8 FALR 2038 (1986).
Covered in Finding of Fact 29.
Covered in Finding of Fact 30.
Covered in Finding of Fact 31.
Covered in Finding of Fact 32.
Rejected because there is no "maldistribution problem" in this case. Because Broward has no subdistricts.
Covered in Finding of Fact 33.
Covered in Finding of Fact 33.
Rejected as an unnecessary characterization.
Covered in Finding of Fact 34.
Rejected as unnecessary.
Covered in Finding of Fact 35.
Covered in Finding of Fact 36.
Covered in Finding of Fact 37.
Rejected because there is no need in west Broward for an additional facility.
72-75. Rejected as list persuasive and the evidence adopted in Findings of Fact 48-56.
Covered in Finding of Fact 49.
Rejected because there is no division point from which to compute a maldistribution; to attempt to do so is to engage in ad hoc subdistricting.
Covered in Finding of Fact 16 concerning location. The second sentence is rejected as unsupported insofar as it implies that those living in areas other than southwest Broward lack the ability to pay for medical services.
Rejected because there is no method by which to determine lessor or greater need in a district which is not subdistricted.
Rejected because the assumptions regarding payor mix are speculative
Rejected as speculative.
Covered in Finding of Fact 15.
Rejected as speculative.
Rejected because there is no need to follow the private pay patient population in the absence of a need for additional beds or expenditures to move existing beds.
Rejected for the reasons stated in Conclusions of Law
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Sentence one is covered in Finding of Fact 52 to the extent appropriate. Sentence two is rejected as unpersuasive.
Rejected because the evidence in support of the findings is not persuasive.
Rejected because, although true, the implicit inference that the contrary is true is not sustained by the evidence.
Covered in Finding of Fact 57.
97-98. Covered in Finding of Fact 57.
Rejected as unnecessary.
Rejected as unnecessary.
101-102. Rejected because no true efficiency is increased the increase in occupancy rate and efficiency is merely a paper gain.
104. Rejected as unnecessary because tertiary services will continue to be provided at the current facility.
105-111. Rejected as unnecessary, that Memorial is an efficient, low cost provider is true.
112-114. Rejected as unnecessary.
Rejected as unnecessary.
Rejected because it is not shown that the ongoing renovations at Pembroke Pines account for its occupancy rate being as low as 50 percent.
Rejected as unnecessary.
118-122. Rejected because notwithstanding those factors, Humana Bennett still has additional functional capacity.
Rejected as unnecessary.
Rejected as unnecessary.
125-126. While these factors may affect the occupancy rates at Humana South Broward they do not justify ignoring the occupancy goals set in the Local Health Plan that no new construction will take place until there is an average annual occupancy equal to 80 percent in the District.
Rejected as unnecessary.
Covered in Finding of Fact 57.
Rejected as unnecessary.
131-132. Covered in Finding of Fact 58. 133-134. Rejected as cumulative.
135-136. Covered in Finding of Fact 59.
137. Covered in Finding of Fact 60.
138-150. Rejected as cumulative to the finding that the project is financially feasible.
Covered in Finding of Fact 61.
Covered in Finding of Fact 61.
Covered in Finding of Fact 61.
154-158. Rejected as cumulative to the finding that the project is financially feasible.
Covered in Finding of Fact 61.
Rejected as unnecessary.
Rejected as unnecessary.
162-165. Rejected as unnecessary.
Covered in Finding of Fact 63.
Rejected as unnecessary.
Rejected because the impact on Humana South Broward will be approximately $1/2 million in the first two years of operation. See Finding of Fact 63.
169-172. Rejected as unpersuasive.
Rejected for the reasons stated in Finding of Fact 63.
Rejected as argument rather than a Finding of Fact. 175-181. Rejected as unnecessary.
182. Rejected because the construction of an entiresatellite hospital does appear to constitute "newhealth services to in-patients." The Final Order in Halifax Hospital Medical Center vs. Department of Health and Rehabilitative Services notwithstanding.
Humana's proposed findings of fact are addressed as follows:
Covered in Finding of Fact 15.
Covered in Finding of Fact 40.
Rejected as unnecessary.
Covered in Finding of Fact 8.
Rejected as unnecessary.
Covered in Findings of Fact 9 and 10.
Covered in Finding of Fact 52.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Covered in Finding of Fact 48.
Covered in Finding of Fact 49.
Covered in Finding of Fact 49.
Rejected as unnecessary.
Covered in Finding of Fact 49.
Covered in Finding of Fact 49.
Covered in Finding of Fact 50.
Rejected as unnecessary.
Covered in Finding of Fact 51.
Covered in Finding of Fact 51.
Covered in Finding of Fact 52.
Rejected as cumulative to Finding of Fact 52.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Covered in Finding of Fact 52.
Covered in Finding of Fact 52.
Covered in Finding of Fact 52.
Covered in Finding of Fact 53.
Rejected as cumulative to Finding of Fact 53.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected because quality of care is not an issue by stipulation of the parties.
Covered in Finding of Fact 54.
Covered in Finding of Fact 54
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
Covered in Finding of Fact 55.
Covered in Finding of Fact 55
Covered in Finding off Fact 55.
Covered in Finding of Fact 55.
Rejected as unnecessary.
Rejected as unnecessary.
49-85. Rejected because the criticism of the District's financial projections provided by Mr. Baehr was not persuasive, and the proof of the District on financial feasibility was persuasive. See Findings of Fact 59.
86-92. Rejected because the project can be built with cash and have no adverse impact on patient charges at Memorial Hospital or at the satellite.
Rejected as unnecessary.
Rejected as unnecessary.
Rejected as unnecessary.
96-103. Rejected as cumulative to the finding made in Finding of Fact 63.
Covered in Finding of Fact 63.
Rejected because the characterization of the impact of the loss of
$1/2 million on Humana South Broward as "tremendous" is not persuasive.
Covered in Finding of Fact 42.
Rejected as irrelevant because it would not be expected that a new satellite hospital would begin with an occupancy rate equal to 80 percent.
Rejected as unnecessary.
Covered in Finding of Fact 43.
110-111. Covered in Finding of Fact 62.
COPIES FURNISHED:
F. Phillip Blank, Esquire
241 East Virginia Street Tallahassee, Florida 32301
Ursala Mancusi-Ungaro, Esquire AmeriFirst Building
One S.E. Third Avenue Miami, Florida 33031
Douglas L. Mannheimer, Esquire Post Office Drawer 11300 Tallahassee, Florida 32302
John H. French, Jr., Esquire James C. Hauser, Esquire Post Office Box 1876
Tallahassee, Florida 32302-1876
Sam Power, Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, Florida 32399-0700
Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, Florida 32399-0700
John Miller, Acting General Counsel Department of Health and Rehabilitative Services
1323 Winewood Boulevard
Tallahassee, Florida 32399-0700
=================================================================
AGENCY FINAL ORDER
=================================================================
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
HUMOSCO, INC., d/b/a HUMANA HOSPITAL SOUTH BROWARD,
Petitioner,
CASE NO. 84-0235
vs. CON NO. 2834
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES,
Respondent.
/ SOUTH BROWARD HOSPITAL DISTRICT,
Petitioner, CASE NO. 85-3940 CON NO. 4019
vs.
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES,
Respondent,
and
NU-MED PEMBROKE, INC., d/b/a PEMBROKE PINES GENERAL HOSPITAL and HUMOSCO, INC. and HUMANA
OF FLORIDA, INC.,
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 that Recommended Order is attached hereto.
RULING ON -JOINT EXCEPTIONS FILED BY DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES (HRS) and SOUTH BROWARD
HOSPITAL DISTRICT (SBHD)
Exception number one (1) is denied. The substance of both proposed findings was dealt with at length in the Recommended Order. SBHD submit that
proposed Findings of Fact numbers thirty-five (35) and one hundred and three
(103) were not ruled on by the Hearing Officer. Proposed Finding of Fact number thirty-five (35) reiterates applicable portions of the State Health Plan (SHP). The Hearing Officer considered whether the SBHD application was consistent with the SHP and entered Findings of Fact numbers forty-two (42) through forty-seven
(47) which fully cover this issue. The Hearing Officer, in Finding of Fact number forty-six (46), quotes the same provision of the SHP as referred to in Proposed Finding number thirty-five (35). Proposed Finding of Fact number one hundred and three (103) states that the transfer and delicensure would enhance occupancy rates in the South Broward area. The Hearing Officer considered the effect of the proposed 25-bed delicensure and found in Finding of Fact number forty-seven (47):
District X (Broward County) is significantly overbedded. The proposal from the District would reduce the total inventory of acute care beds by 25 beds. In return, it would cost the health care system in the District approximately $15,965,500 to build the satellite. Such a cost for a rather modest reduction of 25 beds in unwarranted.
The joint Proposed Recommended Order made 182 Proposed Findings of Fact.
The failure of the Hearing Officer to explicitly rule on Proposed Findings numbers thirty-five (35) and one hundred and three (103) is a harmless error because the substance of the Proposed Findings was addressed at length. Health Care Management, Inc. vs. HRS, 479 So2d 193 (Fla. 1st DCA 1986).
HRS and SBHD except to the last sentence in Finding of Fact number twenty-four (24) on the basis that it is a Conclusion of Law. Exception number two (2) is granted as the challenged sentence is a Conclusion of Law. The planning horizon of Rule 10-5.011(1)(m)(6) is not applicable because this case involves the transfer and reduction of the inventory of acute care beds. Central Florida Regional Hospital vs. Daytona Beach General, 475 So2d 974 (Fla. 1st DCA 1985). The batching cycle rule is applicable as its purpose is not limited to computation of numeric need.
Exception number three (3) is denied. The Hearing Officer found no threat to the financial viability of SBHD. (Finding of Fact number fifty-five (55)).
Exception number four (4) is denied. Construction of the proposed satellite is not now justified. As pointed out by the Hearing Officer the SBHD's historic commitment to indigent care will be to its advantage in competing for beds in the future in Western Broward County.
Exception number five through eleven (11) are denied. Those exceptions challenge Finding of Fact number thirty-nine (39). The finding is supported by competent, substantial evidence. Such evidence is susceptible of ordinary methods of proof and falls under the realm of factual matters reserved to the Hearing Officer's determination. Baptist Hospital vs. HRS, 500 So2d 620 (Fla. 1st DCA 1986).
Exception number twelve (12) is denied. HRS and SBHD except to the second sentence of Finding of Fact number forty (40). The Hearing officer's finding that "there is no evidence of deterioration of the facilities of the District or the necessity to correct life safety deficiencies by building the
proposed satellite" is supported by competent, substantial evidence in the record. As such, this finding cannot be rejected. Heifetz vs. Department of Business Regulation, 475 So2d 1277 at 1281.
HRS and SBHD except to the last sentence of Finding of Fact number forty-seven (47) on the basis that it is a Conclusion of Law. Where there is excessive capital investment in the District, it was appropriate to comment on the wisdom of additional capital investment proposed by SBHD. Exception number thirteen (13) is denied.
The Hearing Officer's findings regarding the low occupancies at existing hospitals in the area of the proposed satellite are supported by competent, substantial evidence. The comment regarding projected demands is superfluous and is of no consequence to the decision reached in this case. HRS and SBHD's exception to sentence three (3) of the Finding of Fact number fifty- two (52) is without merit as it attempts to limit the department to consideration of only the occupancy levels of hospitals which are parties to this case. Sound health planning requires consideration of all relevant factors and proximate hospitals. Finding of Fact number fifty-two (52) is supported by competent, substantial evidence and thus, exceptions number fourteen (14) and fifteen (15) are denied.
The findings of paragraph fifty-five (55) require an evidentiary foundation. The findings are supported by competent, substantial evidence; thus, exception number sixteen (16) and seventeen (17) are denied.
The proposed additional Findings of Fact in exception number eighteen
(18) are inconsistent with the Hearing Officer's findings that there are no geographical or financial access problems in the District. It is highly questionable whether the department has the authority to make Findings of Fact which would modify or conflict with findings made by the Hearing Officer. Therefore, exception number eighteen (18) is denied. Inverness Convalescent Center et al. vs. HRS, Docket numbers BR-149 and BR-151, op. dated August 26, 1987 (Fla. 1st DCA); Friends of Children vs. HRS, 504 So2d 1345 (Fla. 1st DCA 1987); but see Humana vs. HRS et al., 492 So2d 388 (Fla. 4th DCA 1986).
Exceptions number nineteen (19) through forty-three (43) are denied. HRS declines to modify or add to the Conclusions of Law as requested by SBHD.
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 and incorporates by reference the conclusions of law set forth in the Recommended Order except where modified in the Rulings on Exceptions.
Based upon the foregoing, it is
ADJUDGED, that certificate of need applications numbered 2834 and 4019 by South Broward Hospital District to build a 100 bed satellite hospital in Southwest Broward County be denied.
DONE and ORDERED this 5th day of October, 1987, in Tallahassee, Florida.
Gregory L. Coler Secretary
Department of Health and Rehabilitative Services
by Assistant Secretary for Programs
COPIES FURNISHED:
William R. Dorsey, Jr. Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
F. Philip Blank, Esquire
241 East Virginia Street Tallahassee, Florida 32301
James C. Hauser, Esquire MESSER, VICKERS, CAPARFLLO,
FRENCH & MADSEN
Post Office Box 1876 Tallahassee, Florida 32302
John Rodriguez, Esquire 2727 Mahan Drive
Fort Knox Executive Building Tallahassee, Florida 32308
Ursala Mancusi-Ungaro, Esquire AmeriFirst Building
One South East Third Avenue Miami, Florida 33031
FALR
Post Office Box 385 Gainesville, Florida 32602
Nell Mitchem (PDDR)
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a copy of the foregoing was sent to the above-named people by U.S. Mail this 6th day of October, 1987.
R. S. Power, Agency Clerk Assistant General Counsel Department of Health and
Rehabilitative Services 1323 Winewood Boulevard Building One, Room 407
Tallahassee, Florida 32399-0700 904/488-2381
NOTICE OF RIGHT TO JUDICIAL REVIEW
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. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.
| Issue Date | Proceedings |
|---|---|
| Aug. 04, 1987 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Oct. 05, 1987 | Agency Final Order | |
| Aug. 04, 1987 | Recommended Order | Hospital request for Cert. of Need to build & operate a satellite facility denied due to hospital under utilized in an efficient manner. |
