Judges: ARNOLD H. POLLOCK
Agency: Agency for Health Care Administration
Latest Update: Apr. 21, 1986
Summary: Agency reliance on unproven policy rather than rule method criteria, was not valid basis for denial of Certificate of Need to operate home health agency.
85-1415.PDFSTATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
PERSONNEL POOL OF ORANGE )
COUNTY, INC., )
)
Petitioner, )
)
vs. ) Case No. 85-1415
)
DEPARTMENT OF HEALTH AND ) REHABILITATIVE SERVICES and ) HOSPICE OF CENTRAL FLORIDA, INC., )
)
Respondent. )
) WINTER PARK MEMORIAL HOSPITAL ) ASSOCIATION, INC., d/b/a HOME ) HEALTH CARE OF WINTER PARK, )
)
Petitioner, )
)
vs. ) Case No. 85-1508
)
DEPARTMENT OF HEALTH AND ) REHABILITATION SERVICES and ) HOSPICE OF CENTRAL FLORIDA, INC., )
)
Respondent. )
) WINTER PARK MEMORIAL HOSPITAL ) ASSOCIATION INC., d/b/a HOME ) HEALTH CARE OF WINTER PARK, )
)
Petitioner, )
)
vs. ) Case No. 85-1969
)
DEPARTMENT OF HEALTH AND ) REHABILITATIVE SERVICES and ) HOSPICE OF CENTRAL FLORIDA, INC., )
)
Respondent. )
)
RECOMMENDED ORDER
Consistent with an Order of Hearing Officer Ella Jane P. Davis, dated November 20, 1985, a hearing in this case was held before Arnold H. Pollock, a Hearing Officer with the Division of Administrative Hearings, in Orlando, Florida, on January 14-16, 1986. To be determined at the hearing was which of the applicants, if any, should be issued a Certificate of Need to conduct home health care agency services in Orange and Seminole Counties, Florida.
APPEARANCES
For Personnel Pool Thomas D. Watry, Esquire of Orange County: 1200 Carnegie Building
133 Carnegie Way Atlanta, Georgia 30303
For Winter Park Sydney H. McKenzie III, Esquire Memorial Hospital: Martin J. Edenfield, Esquire
2700 Blair Stone Road, Suite C Post Office Box 6507 Tallahassee, Florida 32314
For Hospice of James M. Barclay, Esquire Central Florida: Jay Adams, Esquire
Suite 200
215 West Virginia Street Tallahassee, Florida 32301
For Department of Harden King, Esquire Health and Assistant General Counsel Rehabilitative Department of Health and Services: Rehabilitative Services
1323 Winewood Boulevard
Tallahassee, Florida 32301 BACKGROUND INFORMATION
On March 15, 1985, Personnel Pool of Orange County, Inc.,(Personnel pool) filed a Petition for Formal Administrative Proceeding contesting the Department of Health and Rehabilitative Services' (DHRS) intent to deny its application for a Certificate of Need (CON) to conduct a home health agency in Orange County, Florida. On May 15, 1985, Hospice of Central Florida, Inc., (Hospice), whose application for a CON to provide similar services had been approved, moved to intervene in that case.
This motion to intervene was granted by Hearing Officer Davis on June 18, 1985. In the same order, the case was consolidated for comparative hearing with DOAH Case No. 85-1508 involving Winter
Park Memorial Hospital, Inc 's (Winter Park) contest of the denial of its CON application, in which Hospice was also an intervenor. On June 11, 1985, Winter Park petitioned to intervene in Personnel Pool's case and thereafter, on July 10, 1985, that motion was granted.
On July 24, 1985, Hospice moved to consolidate Winter Park's contest of the grant of a CON to Hospice (Case No. 85-1969) with the above cases, which motion was granted. The cases were originally scheduled to be heard on December 3-5, 1985, but on November 1, 1985, Hospice- requested a continuance which was granted by Hearing Officer Davis on November 8, 1985. That same day, Hospice also moved for a stay or continuance and for a consolidation of these cases with several others in the hands of other hearing officer and realignment of these cases. On November 20, 1985, Hearing Officer Davis entered an Order and Notice in this case which denied the last mentioned Motion for Consolidation and Realignment as to these cases, but reassigned them to the undersigned, setting the date for hearing as January 14-16, 1986, in Orlando, Florida. The hearing was thereafter held as scheduled.
At the hearing, Hospice presented the testimony of Jane R. Weber, Executive Director of Hospice Mary M. Manrique, Nursing Coordinator for Hospice; and Thomas F. Porter, a private health care consultant. Hospice also introduced Hospice Exhibits A through F.
Winter Park presented the testimony of Van Talbert, Director of Planning for that hospital Michael P. Rosen, Administrator of ABC Home Health Services and Director of Planning for Methodist Hospital in Jacksonville Joan Knight, Director of Patient Services at Winter Park John S. Fleming, M.D., a staff physician at the hospital and Dr. Charles C. Grant, a family practitioner from Maitland Winter Park also introduced its Exhibits 1 through 4.
Personnel Pool presented the testimony of Dennis Glisson, Central Florida Regional Manager for Personnel Pool and Deborah Simmons Kolb, Vice-President of a management consulting firm in the health care area. Personnel Pool also introduced Exhibits 1 through 3.
DHRS introduced the testimony of Reid S. Jaffe, a health services consultant from the agency headquarters. It did not introduce any documentary evidence.
The three applicants have submitted post-hearing proposed findings of fact which have been thoroughly considered and evaluated in the preparation of this Recommended Order. Specific
rulings on each proposed finding of fact are contained in an appendix to this Recommended Order as appropriate. DHRS failed to submit any proposals.
FINDINGS OF FACT
Hospice is a non-profit, licensed home health organization currently certified by Medicare which offers home health care and has, in addition, contracts with some hospitals in the area to provide home continuation of care. Its current program calls for it to provide services of a physical, spiritual, and psychological nature to terminally ill patients and their families. It is currently located in Orange County, Florida, operating under a CON and providing the services described above which it proposes to continue for Orange and Seminole Counties. If the pending CON is approved, it will expand its service to those patients who are terminally ill but who have more than one year to live.
There are at least 15 members on Hospice's Board of Directors which includes a wide array of community-based individuals from business, finance, health, clergy, and other fields. There is an emphasis on divergence racially as well as ethnically and by interest.
Hospice utilizes 39 paid staff members of whom 25 are full time, and approximately 104 volunteers who are involved in direct patient care both in homes and in hospitals. These a individuals provide such functions as bereavement counseling, office support, and a speakers bureau. In the proposed home health agency, volunteers will be matched individually to patients according to the patient's need and will provide a break to the primary care giver, will run errands, offer friendship, and perform other functions of a similar nature.
During 1985, 7,366 hours of service were performed by Hospice volunteers, representing a paid cost of approximately 432,000. Hospice's current annual operating budget for expenses is $815,000. Sources of revenue generally include government pay, insurance, gifts, and a sliding scale fee. Total income for the year was approximately $1,100,000. All fees are negotiable.
During the past year, the patient census for Hospice has doubled. The services proposed will be provided in Orange and Seminole Counties. Hospice proposes to serve terminally ill patients with a prognosis of more than six months to live. It is anticipated that more children and AIDS patients will be treated, in addition to the elderly, and Hospice will work to provide palliative care.
Currently, patients who do not qualify for hospice care are those who: (a) have more than 6 months to live, (b) cannot admit that they have a problem, or (c) do not have a primary care giver. Conversely, current criteria for admission to patient status within the hospice program are that the patient: (a) have less than 6 months to live, (b) be referred by a physician, (c) live in Orange or Seminole Counties, and (d) have a primary care giver in the home. If Hospice's proposal for a home health agency is approved, the criteria will basically remain the same except that the patients to be served will be those of a terminal nature with more than 6 months to live. Service will be available 24 hours a day, 7 days a week.
Hospice currently provides between seven and twelve per cent of its care on an indigent basis. If the CON is approved, Hospice estimates that its indigent service will be, as a minimum, five per cent Medicaid and four per cent direct indigent care, which totals nine per cent.
Regulatory reviews of the Hospice program are currently accomplished by state, federal and hospital accrediting agencies. No change is anticipated in the event of approval of the new home health agency.
Referrals of patients now come from various members of the community. The patient's physician must agree to a referral and, in addition, to be a member of the treatment team while the patient is in the Hospice program. Hospice currently works closely with two hospitals in the Orlando area and has contractual arrangements with other sources such as various therapists, dieticians, and the like. In 1985, care was furnished to 428 patients and families. The current Hospice cannot serve all patients who are being referred to it, and between 12 and 15 otherwise qualifing and needing patients are turned away each month.
Hospice's Board of Directors has approved 525,000 for start-up costs for the new agency if it is approved. These funds are currently on hand and available. Staff education and research are currently provided and will be provided in the new agency, if approved.
The new agency would become a comprehensive home health agency if that would be necessary to insure approval of a CON. This is not, however, the desire of the Hospice Board. In the preferred concept, the primary thrust is still to be toward the terminally ill patient, but regardless of which avenue is followed, there is no doubt that Hospice will continue to receive and maintain its philanthropic support.
Hospice has prepared detailed plans to provide the type of hospice care it desires to provide for terminal patients and, if possible, will limit the service to those who are terminally ill, changing only the life expectancy criteria. However, planning for comprehensive care has not been accomplished in great detail. While Hospice is still oriented toward the terminally ill patient, the one year criteria is no longer so significant. The terminal nature of the illness, even if longer than one year, is the paramount consideration. Consequently, it is anticipated that AIDS victims, children, and others who are terminally ill, but who may be expected to live for longer than one year, would be eligible for treatment in the home health agency run by Hospice, if approved.
The service to be provided to terminally ill patients by Hospice includes skilled nursing care (chemotherapy, hydrotherapy, psychosocial activity, etc.) in the home as well as pastoral services through interdenominational clergy support. This is similar to what is currently offered but is somewhat more intense with the addition of technical nursing services in the home as described above.
Hospice's nurses currently visit three or four patient families per day. This should rise to four to five patient visits per day under the home health agency, if approved. Personnel feel they can hire to need under the new organization and will also rely to a great extent on volunteers. They intend to recruit more professional volunteers. Pastoral personnel are all volunteers.
Expert examination of all three applicants in relationship to the statutory criteria outlined in Section 381.494(6)(c), Florida Statutes, reveals that on the whole, all proposals are generally consistent with the local health plan. Hospice has written agreements with various hospitals in the area, which is a plus, and so does Winter Park. At the present time, Personnel Pool does not but gets referrals as an existing provider and is qualified to do so.
Both Hospice and Winter Park provide care to indigents. Review of the applications of all three parties reveals that all have indicated a willingness to provide all services called for in the health plan including indigent care.
With regard to the availability of care in the service district, Hospice is targeting its service to a specific population, the terminally ill with more than 6 months to live who, under the current hospice rule, they cannot now serve.
Regarding the ability of the applicants to provide the care, there is no information to indicate that any of the three applicants would be unable to provide the care called for.
As to the economies and improvements envisioned by joint service, Hospice (1) is an existing agency with experience in treating the patients it proposes to treat, (2) receives donations of funds, (3) has an existing facility, and (4) has an existing volunteer force.
Concerning the extent of availability of services to schools for training and the availability of service to all residents in the service district, Hospice provides in-service education and education to nursing students as well as education regarding terminally ill patients in the schools and universities. The others apparently do not. All three intend to provide care to indigents.
With regard to financial feasibility, in terms of the long term and the immediate, all applicants satisfy the requirements. As to potential patients, based on the most recent information available, there should be approximately 55,000 patient visits a year.
Winter Park Memorial Hospital Association, Inc., is a
301 bed private, not-for-profit acute care hospital offering a full complement of varied services. Hospital policy is to provide services to its patients without regard for ability to pay upon orders of a physician on staff. It is a fully regulated facility.
Winter Park has applied for a CON to establish a home health agency to provide services to Medicare patients. It would, if approved, provide post-hospital care, skilled and non skilled, for former hospital patients and others from outside the hospital. The location of its office would be somewhere on the hospital campus, and the facility would be operated by a sister organization. Proposed area of service would be Orange and Seminole Counties. The home health agency's policy toward indigent care would be the same as that stated above for the hospital.
Services to be rendered would include skilled nursing care, specialized programs such as cardiac rehabilitation, maternity services, diabetic education, metabolic support, medical social work, intravenous therapy, physical therapy, speech therapy, and occupational therapy.
Winter Park's home health agency staff initially would be made up of nursing personnel from the existing hospital. As
the program grew, however, additional personnel would be hired, and the agency would initiate a staff share program with the hospital, when possible, to reduce the staffing costs. Standards of care would be insured by the normal state accreditation, reviews, and regulations.
The hospital's application for a home health agency should be approved because: (1) It is a not-for-profit corporation and as a result, funds generated can be returned to the facility to support indigent care costs. (2) The costs of operation are low per the Hospital Cost Containment Board, due to efficiency efforts undertaken by the parent corporation, and this expertise would be carried over to the home health agency. (3) Medical staff would find the home health agency affiliated with the hospital to be very acceptable and would cooperate with the operation, resulting in increased medical participation, (4) Uniformity of control between the hospital and the home health agency would facilitate and expedite patient care throughout the system, and the use of the same personnel would assure higher quality control. (5) Staff education would be shared, resulting in increased economies, as accounting, purchasing, and administrative services would be shared. (6) A continuum of care for patients from the hospital to the home health agency would be enhanced.
Addressing the statutory criteria referenced above in the discussion of Hospice's application, all home health agencies must relate effectively to the district health plan in order to survive. Winter Park's relationship to the hospital gives it a special relationship which, of the other two, only Hospice has anything to compare with it. All applicants have committed themselves to provide indigent care. All will accept patients who are referred to them and no group is excluded by any of the three applicants. In substance, then, there is little variance between the three applicants in regard to indigent care.
Further, all three applicants contended that they would provide a full range of service. Personnel Pool and Winter Park both agree to provide service to whoever needs it. Hospice, however, deals primarily with terminal patients.
Concerning the ability of the applicants to provide quality care, all applicants are qualified. As to the economies to be gained by sharing resources, here, Winter Park has a hospital to share with and thereby has the greatest potential to achieve efficiency. Hospice will achieve this to a lesser degree both more than Personnel Pool.
With regard to the effects on competition, generally, competition in the home health agency area does not result in lowering costs. Some experts do not believe the use of
volunteers results in lowering the cost of providing skilled nursing care. Nonetheless, this does not seem to be a major consideration.
The operation envisioned for Winter Park is a 24 hour,
7 days a week one. The hospital affiliated agency would provide an alternative option to hospitalization, home care, or nursing homes. Decisions would be easier to make and would be better when made. Use of a home health agency affiliated with the hospital would promote better follow-up of patients. Time lags in receiving reports from the field would be shortened. This would result in a benefit to the patient from the standpoint of better information available on the patient's condition.
Personnel Pool of Orange County is a wholly owned subsidiary of Medical Personnel Pool, Inc., a home health staffing service with over 200 offices nationwide, of which 144 are Medicare certified. Of the 23 offices in Florida, 4 are Medicare certified. In District 7, there are three offices. The one in Volusia County is Medicare certified, but those in Melbourne and Orlando are not.
Personnel Pool provides registered and licensed practical nursing assistance, home health aides, companions, live-ins, and speech and respiratory therapists to patients in its service area. Both the Orlando and Melbourne offices have referral services in place of existing hospitals, nursing homes, the clergy, and previous and current patients. Their source of revenue is private pay, insurance, and third- party pay. The Personnel Pool offices in both Orlando and Melbourne do not -receive Medicare or Medicaid reimbursements.
Both of these offices continue to get frequent requests from referral sources for Medicare and Medicaid services, which they cannot provide. There is no difference between the clinical care service for Medicare or private pay patients. 34. In 1985, Personnel Pool provided 300,000 hours of service in District 7 across a broad range of services. Some are Medicare reimbursable and some are not. In the Orlando office. approximately forty per cent of the services are provided to patients in facilities and sixty per cent are provided to patients in the home. Out of the Melbourne, office, all is home care.
During the last two years, Personnel Pool has had an average of 350 people on its payroll at any given time. Forty per cent are licensed and sixty per cent are not. Professional personnel in the non-certified offices in District 7 (Orlando and
Melbourne) are paid by the hour. In the Volusia County office, which is Medicare certified, the professional people (nurses) are paid on a "per visit" basis. Personnel Pool finds that the "per visit" basis is a far more efficient method of employing personnel.
Personnel Pool participates with some health maintenance organizations (HMO's) in the Orlando and Daytona areas. These relationships are currently in jeopardy because of DHRS' ruling that HMO's should contract with Medicare certified home health agencies.
Personnel Pool does not discriminate for any reason and has a program for continuing education for headquarters and field staff as well as for professional and licensed/unlicensed personnel. Personnel Pool field offices get a substantial amount of support from corporate headquarters in the areas of education and training, finance, recruiting, and referral.
Personnel Pool's request for a CON was filed so that the agency could become a full service provider to the entire community, including those of need who are not now served. No expenditures would be necessary to start Medicare work. The offices are already in business and operating. All that would be needed would be the manuals.
Personnel Pool's application projects a patient/year volume of 11,000 visits, and Mr. Glisson is satisfied that this projection is accurate since Personnel Pool already turns away that many now because some offices are not Medicare certified. Its indigent care is totally uncompensated no reimbursement at all. It has committed to devote two per cent of its total patient load to Medicaid if its application is approved. For uncompensated visits, it intends to provide one uncompensated visit for every twenty Medicaid compensated visits, or five per cent. Seventy-eight per cent of the total patient volume will be Medicare compensated and five per cent of that, or 3.9 per cent of the whole, will be devoted to indigent & other cases where CON's have been issued.
Personnel Pool has already been approved for a CON for its Brevard County office. That decision is currently on appeal. The application here is for approval of the Orlando office. Because of the central location, Personnel Pool desires to service the whole district out of Orlando. If necessary, it, would do so from the Brevard Office but that would not be as efficient. Also, the Orlando area, because it is larger, has a greater patient base. There would be little difference in the physical plant and equipment wherever the main office was located.
An expert with extensive experience in the home health care field concluded that there is sufficient need in District 7 for all three applicants to be approved. Dr. Kolb's analysis related to the application of the proposed rule methodology to the demographic statistics and a critique of the result based on what she considers-to be erroneous data used by DHRS. In light of the fact that the proposed rule was determined to be invalid as a result of a Final Order, DOAH Case No. 85-1377R, entered by Hearing Officer Charles C. Adams on March 12, 1986, there is no rule methodology prescribed for assessing the need for home health agencies other than the statutory criteria.
Dr. Kolb strongly feels that the 1983 use data should be used to assess need in this case. She contends that the most recent rates should be used as a review of utilization rates back to 1979 reveals a clear upward trend in all three categories of the population being considered. These are (1) over 65 Medicare,
(2) under 65 disabled Medicare, and (3) under 65 non-Medicare. Utilizing the most current available utilization rate, it is possible to establish a total need within the district, and the local health council can allocate this need among the applicants.
Dr. Kolb's projection of a net home health agency need in 1988 for District 7 used a district specific rate utilization for that year. She concluded, based on a projection of 353,901 projected Medicare home health visits, four additional home health agencies will be needed in 1988. No evidence was produced by any party to contradict this conclusion and it is accepted as a fact. The parties have stipulated that the proper planning horizon for determining the need for additional home health agencies is two years.
In the State Agency Action Report submitted on the three applicants here, the preamble speaks to the issue of competition versus cost containment. In the instant case, a large percentage of patients are public paid (Medicare/Medicaid). Therefore, it is imperative to look at the projected costs as reimbursement levels from those programs are keyed to cost factors. It is also imperative to look at the issue of continuity of care and who is or might be served by a home health agency. DHRS took the position that Hospice was an appropriate recipient because a new agency under Hospice's auspices will allow continuity of care for-those patients who are currently in Hospice care but who will require the longer period of care that Hospice cannot now provide. In addition, terminally ill children who are not disabled will be able to receive treatment from the Hospice agency. DHRS also considered that another factor in Hospice's favor was its large number of volunteers who purportedly will reduce costs.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and the subject matter of this proceeding.
DHRS sought to analyze the three applicants under a proposed rule methodology that was, at the time of the hearing and at the time of application, subject to challenge by another home health agency. On March 12, 1986, as was stated above, the hearing officer in that case entered a Final Order (DOAH Case No. 85-1377R, Home Health Staffing and Services Association v. DHRS) in which the proposed rule, 10-5.11(14) was declared invalid.
Though the ruling in question had not been entered at the time of the hearing and therefore the rule in question was proposed methodology, the agency attempted to develop its policy in this case through the administrative hearing process, a procedure which is acceptable under certain circumstances. In such a case, however, the agency must establish the reasonableness of its policy by competent substantive evidence, McDonald v. Department of Banking and Finance, 346 So. 2d 569 (Fla. 1st DCA 1977).
It is clear that DHRS totally failed to establish its methodology policy in this case. The only testimony presented by the agency was that of Mr. Jaffe, its in-house health services consultant, who attempted to justify using prior years' utilization rates rather than the most appropriate and current ones. He was unable to do so, and by far the greatest weight of testimony by experts for all the applicants clearly indicates that the most appropriate utilization rate is that for 1983, in this case, rather than that- attempted to be applied by DHRS, 1982. The agency has, in fact, failed to sustain its burden of justifying a divergence from the most current utilization rate.
Once it is determined that the proposed rule methodology and the attempted administrative procedure developed methodology are inaccurate and insufficient, the only remaining relevant criteria exist in the statute under the provision of Section 381.494(6), Florida Statutes. Those criteria which are relevant to this proceeding have been fully discussed in the Findings of Fact above.
There is no doubt that all three of the applicants met the criteria set forth and stipulated as being relevant to this case. The only question was whether two or three additional agencies were required, and since an application of the most recent utilization figures reveals that all three can be
effectively and properly utilized, it is clear that all three should be issued Certificates of Need.
RECOMMENDATION
In light of the forgoing Findings of Fact and Conclusions of Law, therefore, it is
RECOMMENDED that Certificate of Need Number 3746 be issued to Winter Park Memorial Hospital Association, Inc. Certificate of Need Number 3474 be issued to Hospice of Central Florida, Inc. and Certificate of Need Number 3475 be issued to Personnel Pool of Orange County for operation of home health agencies in Orange and Seminole Counties, Florida.
RECOMMENDED this 21st day of April, 1986, at Tallahassee, Florida.
ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32399
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 21st day of April, 1986.
COPIES FURNISHED:
Thomas D. Watry, Esquire 1200 Carnegie Building
133 Carnegie Way Atlanta, Georgia 30303
Sydney H. McKenzie III, Esquire Martin J. Edenfield, Esquire 2700 Blair Stone Road, Suite C Post Office Box 6507
James M. Barclay, Esquire Jay Adams, Esquire
Suite 200
215 East Virginia Street Tallahassee, Florida 32301
Harden King, Esquire Assistant General Counsel Department of Health and Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, Florida 32301
William Page, Jr., Secretary Department of Health and Rehabilitative Services
1323 Winewood Boulevard
Tallahassee, Florida 32301
APPENDIX
The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this ease:
RULINGS ON PROPOSED FINDINGS OF FACT SUBMITTED BY HOSPICE OF CENTRAL FLORIDA, INC.
1-3. Accepted as background information
4. Accepted in Finding of Fact 41
5-6. Rejected as immaterial in light of ruling in DOAH Case No. 85-1377 .
Accepted in Finding of Fact 43
Subordinate to other Findings of Fact
Accepted in Finding of Fact 41
No such proposed Finding of Fact
Accepted in Finding of Fact 41
Rejected as immaterial in light of ruling in DOAH Case No. 85-1377.
Accepted in Finding of Fact 43
Accepted in Finding of Fact 43
15-19. Subordinate to Finding of Fact 43
Accepted in Finding of Finding of Fact 15
Accepted in Finding of Fact 15
22-26. Accepted in Findings of Fact 15-21
Adopted in Findings of Fact 15-21
Subordinate to Finding of Fact 41
RULINGS ON PROPOSED FINDINGS OF FACT SUBMITTED BY HOME HEALTH CARE OF WINTER PARK
1-3. Accepted as background information
Accepted
Accepted as background information 6-8. Accepted
Adopted in Finding of Fact 23
Accepted but subordinated to Finding of Fact 41 11-12. Adopted in Finding of Fact 23
13. Adopted in Findings of Fact 14 and 30 14-15. Adopted in Finding of Fact 27
No such numbered Finding of Fact
Subordinate to Finding of Fact 43
Accepted
Adopted in Finding of Fact 24
20-24. Adopted in Finding of Fact 26
25. Subordinate to Finding of Fact 41 26-39. Accepted
40-42. Subordinate to ultimate issue
43-78. Subordinate to Finding of Fact 43
79. Accepted and adopted in Finding of Fact 41
80-101. Adopted in Finding of Fact 42 or subordinate thereto
RULINGS ON PROPOSED FINDINGS OF FACT SUBMITTED BY PERSONNEL POOL OF ORANGE COUNTY, INC.
Accepted as background information
Subordinate to Findings of Fact 15-21
Adopted in Finding of Fact 31
Adopted in Finding of Fact 32
Accepted in Finding of Fact 31
Accepted in Finding of Fact 40
Accepted in Finding of Fact 32
Accepted in Finding of Fact 31 33
11. Accepted in Finding of Fact 34
12-13. Accepted in Finding of Fact 35
Accepted in Finding of Fact 36
Accepted in Finding of Fact 37
16-17. Subordinate to Findings of Fact 31-37 18-19. Accepted in Finding of Fact 40
20-23. Subordinate to Finding of Fact 43
24-26. Accepted in Finding s of Fact 38 and 39 27-29. Subordinate to Findings of Fact 31-37 30-42. Accepted as background
43-44. Subordinate to Finding of Fact 43
45-63. Rejected as immaterial in light of DOAH Case No. 85-1377R 64-77. Adopted in Findings of Fact 42-44
Docket for Case No: 85-001415
Orders for Case No: 85-001415
| Issue Date |
Document |
Summary |
|
Apr. 21, 1986 |
Recommended Order
|
Agency reliance on unproven policy rather than rule method criteria, was not valid basis for denial of Certificate of Need to operate home health agency.
|
