STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

SAWGRASS CARE CENTER, INC., )

)

Petitioner, )

)

vs. ) CASE NO. 94-6256

)

AGENCY FOR HEALTH CARE ) ADMINISTRATION and LIFE CARE ) CENTERS OF AMERICA, INC., )

)

Respondents. )

)

RECOMMENDED ORDER

Pursuant to notice, the above matter was heard before the Division of Administrative Hearings by its assigned Hearing Officer, Donald R. Alexander, on August 28-31 and September 6, 1995, in Tallahassee, Florida.

APPEARANCES

For Petitioner: Robert D. Newell, Esquire

817 North Gadsden Street Tallahassee, Florida 32303-6313

For Respondent: Richard A. Patterson, Esquire (AHCA) 2727 Mahan Drive

Building 3, Suite 3400

Tallahassee, Florida 32308-5043

For Respondent: R. Bruce McKibben, Jr., Esquire (Life Care Post Office Drawer 810

(Centers) Tallahassee, Florida 32302-0810

STATEMENT OF THE ISSUE

The issue in this case is which of the two applications for a certificate of need filed by petitioner and co-respondent to construct a 80-bed nursing home facility in Duval County, Florida should be approved.

PRELIMINARY STATEMENT

This case began on September 16, 1994, when respondent, Agency for Health Care Administration, issued its notice of intent to grant an application by respondent, Life Care Centers of America, Inc., for a certificate of need to construct an 80-bed nursing facility in Duval County, Florida. Thereafter, petitioner, Sawgrass Care Center, Inc., which had filed a competing application, filed its request for a hearing to contest the decision. The petition was forwarded by the agency to the Division of Administrative Hearings on November 4, 1994, with a request that a Hearing Officer be assigned to conduct a hearing.

By notice of hearing dated December 5, 1994, a final hearing was scheduled for May 1-5 and 8-12, 1995, in Tallahassee, Florida. At the request of the parties, the hearing was continued to May 15-19 and 22-24, 1995, and then again to August 28-31 and September 6-8, 1995, at the same location. On November 15, 1994, the case was transferred from Hearing Officer Eleanor M. Hunter to the undersigned.

At final hearing, petitioner presented the testimony of J. David Hightower, Jr., a nursing home consultant and operator and accepted as an expert in nursing home administration and operation; Larry B. Carter, Sr., a contractor and accepted as an expert in construction costs, estimating and building; W. Eugene Nelson, a health care consultant and accepted as an expert in health care planning; Darryl H. Weiner, a financial consultant and accepted as an expert in health care finance; Robert Garland, an agency architect; and Jackie Garrett, a bank vice-president. Also, it offered petitioner's exhibits 1-5, 10-14, 15A, 15B, 18 and 19. All exhibits were received in evidence. Respondent, Agency for Health Care Administration (AHCA), presented the testimony of Alberta Granger, its health services and facilities consultant supervisor and accepted as an expert in health planning. Also, it offered respondent's exhibits 2 - 4 which were received in evidence. Respondent, Life Care Centers of America, Inc. (Life Care), presented the testimony of Clint Davis, its senior vice-president of operations-east and accepted as an expert in nursing home administration and operations; Brenda Sue Hutchings, its vice-president of clinical services and accepted as an expert in nursing home design and construction; Bo Russ, accepted as an expert in nursing home design and construction; Ricard A. Stern, its vice- president of development and accepted as an expert in nursing home development and financial feasibility; and Larry K. Richardson, its vice-president for planning and research. Also, it offered Life Care exhibits 1-3, 7, 13, 14, 19,

20 and 22. All exhibits were received in evidence.

The transcript of hearing (nine volumes) was filed on September 19, 1995. Proposed findings of fact and conclusions of law were filed by the parties on October 19, 1995. A ruling on each proposed finding is set forth in the Appendix attached to this Recommended Order.

FINDINGS OF FACT

Based on all of the evidence, the following findings of fact are determined:

1. Background

   
   

   1. This controversy involves two competing applications for a certificate of need (CON) to construct an 80-bed nursing home facility in northern Duval County. The applications were timely filed by petitioner, Sawgrass Care Center, Inc. (Sawgrass), and respondent, Life Care Centers of America, Inc. (Life Care). Regulatory jurisdiction for approval of CON applications lies with respondent, Agency for Health Care Administration (AHCA).

      
      

   2. The site of the proposed new facility will be AHCA subdistrict 1 of AHCA district IV, which comprises Nassau and northern Duval Counties. After reviewing the applications, on September 16, 1994, AHCA proposed to issue a CON to Life Care. That preliminary decision has been contested by Sawgrass on the ground Sawgrass, and not Life Care, is the better qualified applicant. The purpose of this recommended order is to determine which of the two competing applications should be approved. The parties agree that a fixed numeric need

      for eighty community nursing home beds exists so as to justify the approval of one of the applications.

      
      

2. Criteria

   
   

   1. The statutory review criteria for determining whether an application for a CON should be approved are found in Sections 408.035(1) and (2), Florida Statutes. In this respect, the parties have stipulated that paragraphs (e), (f), (g), (j), and (k) of subsection (1) and the entirety of subsection (2) are not applicable or not at issue. Remaining at issue are all or parts of paragraphs (a), (b), (c), (d), (h), (i), (l), (m), (n) and (o). These criteria will be discussed separately below.

      
      

      1. Section 408.035(1)(a). The need for the health care facilities, services and hospices being proposed in relation to the applicable district plan and state health plan, except in emergency circumstances which pose a threat to the public health.

         
         

   2. Each local health council has adopted a local health plan containing local health plan allocation factors. These factors represent the criteria which the local health council believes should be considered when CON applications are filed within its geographic area. There is also a state health plan which contains other factors to be considered when evaluating CON applications. Paragraph 408.035(1)(a) requires that the need for the proposals be considered "in relation to the applicable district plan and state health plan." This means that satisfaction of the local and state health plan factors is one criterion in the overall evaluation process. In this regard, the applicants have addressed these criteria in their applications.

      
      

   3. The parties have stipulated that factors 1, 3, 9, 10 and 11 of the state health plan have been satisfied by both applicants. They have further stipulated that both applicants have satisfied local health plan allocation factors 2-5, 7, 8, 12, 13 and 15.

      
      

   4. As to local allocation factor 1, which requires that applicants provide services "in a most economical manner in terms of capital and operational expenditures," the evidence shows that Sawgrass proposes lower overall construction cost, lower construction cost per square foot, lower total project cost and lower project cost per bed than does Life Care. In projecting these costs, Sawgrass used actual nursing home construction experiences in other states, adjusted for Florida using recognized cost manuals. While both applicants' projections are reasonable, Sawgrass' is more cost effective and thus it is best satisfies this factor.

      
      

   5. Local health plan allocation factor 10 generally requires that applicants have documentation to show that they have agreements with organizations and services "for the purpose of ensuring continuity of care." Sawgrass has such written agreements with three hospitals while Life Care submitted none. Accordingly, it is found that Sawgrass best satisfies this factor.

      
      

   6. As to local health plan allocation factor 12, which encourages applicants to contract with others to provide short term respite care, the record shows that both applicants satisfy this criterion.

      
      

   7. Local allocation factor 16 and state health plan allocation factor 8 are similar in nature and generally require that preference be given to an

      applicant with a record of providing high-quality or superior nursing home care. In this respect, the principal of Sawgrass, Health Management, Inc., has successfully managed nursing homes for some 25 years. None have ever been fined or had Class I deficiencies cited. Conversely, the nursing home in Florida which Life Care has operated for the most years, Life Care of Altamonte Springs, has had a conditional rating for most of the time since 1993, and still retained that rating at the time of hearing. Accordingly, it is found that Sawgrass best satisfies these two criteria.

      
      

   8. Local allocation factor 17 and state allocation factor 2 are substantially the same and require that preference be given to applicants who commit to maintaining a certain percentage of Medicaid patients. Because Sawgrass will accept as a condition on its CON to provide 87.5 percent of its total facility patient days annually to Medicaid patients, which exceeds the commitment of Life Care, it is entitled to preference in its application.

      
      

   9. Local allocation factor 18 requires that applicants document in their applications "a history of demonstrated willingness to accept local Medicaid residents requiring skilled rather than intermediate care." The more persuasive evidence supports a finding that because Sawgrass commits to serving 20 percent more Medicaid patients on an annualized basis than does Life Care, it has a greater likehood of securing more Medicaid skilled level residents than Life Care, and thus better satisfies this criterion.

      
      

   10. State allocation factor 4 requires that preference be given to an applicant "proposing to provide a continuum of services to community residents including, but not limited to, respite care and adult day care." The record shows that because Life Care proposes both respite and adult care as part of its continuum of care, while Sawgrass did not, it better satisfies this factor.

       
       

   11. As to state allocation factor 5, it provides that preference be given to applicants who propose "to construct facilities which provide maximum resident comfort and quality of care." Although both applicants provide resident comfort and quality of care in their proposed facilities, the evidence supports a finding that Sawgrass better satisfies this factor.

       
       

   12. State allocation factor 6 provides that preference be given to applicants "proposing to provide innovative therapeutic programs which have been proven effective in enhancing the residents' physical and mental functional level and emphasise restorative care." Although both applicants intend to provide the described innovative programs, only Sawgrass has described an intensive program of the type contemplated in the factor and agreed to have its CON conditioned on the delivery of those services. Therefore, it is found that Sawgrass better meets the requirements of the factor.

       
       

   13. State allocation factor 7 provides that preference be given to an applicant who proposes charges which do not exceed the highest Medicaid per deim rate in the subdistrict. Because Sawgrass' rates in years 1 and 2 are lower than those proposed by Life Care, and Life Care's rates are subject to manipulation after the CON is approved, it is found that Sawgrass should be given preference under this factor.

       
       

   14. State allocation factor 12 provides that preference be given to an applicant who proposes "lower administrative costs and higher resident care costs compared to the average nursing home in the district." Both applicants propose patient care expenses per patient day greater than the district average. However, Life Care's operational history belies its projection. In addition,

       its home office and management expenses are higher than the average for every subdistrict and district in which it operates or owns a nursing home in Florida. Given these shortcomings, it is found that Sawgrass better satisfies this criterion.

       
       

   15. In summary, after considering all the state and local factors, it is found that Sawgrass better meets, both qualitatively and quantitatively, the allocation factors and thus it better satisfies the requirements of paragraph 408.035(1)(a).

       
       

       1. Section 408.035(1)(b). The availability, quality of care, efficiency, appropriateness, accessibility, extent of utilization, inadequacy of like and existing health care services and hospices in the service district of the applicant.

          
          

   16. The evidence shows a large percentage of Medicaid funded residents in the subdistrict. Contrary to Life Care's assertion, there is insufficient evidence to establish that there is a need for health maintenance organization (HMO) and private pay beds in the subdistrict. Given this state of the record, it is found that Sawgrass will provide greater access to those persons most in need of care in the subdistrict, namely, Medicaid funded residents. Therefore, Sawgrass better satisfies this statutory criterion.

       
       

       1. Section 408.035(1)(c). The ability of the applicant to provide quality of care and the applicant's record of providing quality of care.

          
          

   17. As noted in finding of fact 9, local allocation factor 16 and state allocation factor 8 provide substantially the same criteria as are found in subsection 408.035(1)(c). Based on the findings previously made regarding those allocation factors, Sawgrass is deemed to be better able to provide, and has a better record of providing, "quality of care."

       
       

       1. Subsection 408.035(1)(d). The availability and adequacy of other health care facilities and services and hospices in the service district of the applicant, such as outpatient 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.

          
          

   18. Although the parties indicated that this criterion is still in dispute, there is a recognized need for eighty additional nursing home beds in north Duval County. Therefore, this criterion does not appear to apply to either proposed project.

       
       

       1. Subsection 408.035(1)(h). The availability of resources, including health manpower, management personnel, and funds for capital and operating expenditures, for project accomplishment and operation; the effects the project will have the clinical needs of health professional training programs in the service district; the extent to which the services will be accessible to schools for health professions in the service district for training purposes, if such services are available in a limited number of facilities; the availability 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 parties have stipulated that the only provision of this lengthy paragraph in dispute is "whether the applicants have funds available for capital and operating expenses."

   19. The evidence shows that both applicants have "funds available for capital and operating expenses" for their respective projects. Therefore, both applicants satisfy this criterion in equal measure.

       
       

       1. Subsection 408.035(1)(i) - The immediate and long-term financial feasibility of the proposal.

          
          

   20. The evidence supports a finding that both applicants have the ability to make their respective projects feasible in the immediate and long-term. Therefore, both applicants have satisfied this criterion in equal measure.

       
       

       1. Subsection 408.035(1)(l). The probable impact of the proposed project on the costs of providing health services proposed by the applicant, upon consideration 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.

          
          

   21. Because Sawgrass has a lower Medicare reimbursement rate in year one and year two than does Life Care, and Sawgrass proposes to provide a payor mix that is consistent with the needs of the area, Sawgrass will foster competition among existing and like facilities to provide a higher quality of care in a more cost effective manner.

       
       

       1. Subsection 408.035(1)(m). The costs and methods of the proposed construction, including the costs and methods of energy provision and the availability of alternative, less costly, or more effective methods of construction.

       
       

   22. Because Sawgrass has significantly lower construction costs per square foot, it is found that Sawgrass has the more cost effective methods and better satisfies this criterion.

       
       

       1. Subsection 408.035(1)(n). The applicant's past and proposed provision of health care services to Medicaid patients and the medically indigent

          
          

   23. The evidence shows that both applicants satisfy this statutory criterion in equal measure.

       
       

       1. Subsection 408.035(1)(o). The applicant's past and proposed provision of services which promote a continuum of care in multilevel health care system, which may include, but is not limited to, acute care, skilled nursing care, home health care, and adult congregate living facilities.

       
       

   24. Sawgrass is the only applicant that proposes providing a continuum of care in a multilevel health care system that includes skilled nursing beds and adult congregate living. In addition, Sawgrass has committed to the assisted living unit since it agreed to a condition on its CON as to the total square feet depicted on the schematics that depict the co-located ACLF and nursing home beds. Therefore, it is found that Sawgrass better satisfies this statutory criterion.

3. Summary and Overall Evaluation of Criteria

1. After making a balanced review of the foregoing statutory criteria, it is found that Sawgrass better satisfies the statutory criteria as a whole. Therefore, its application should be approved.

   
   

   CONCLUSIONS OF LAW

   
   

2. The Division of Administrative Hearings has jurisdiction over the subject matter and the parties hereto pursuant to Section 120.57(1), Florida Statutes.

   
   

3. Each applicant bears the burden of proving its entitlement to a certificate of need, based upon a balanced review of the criteria. Collier Medical Center, Inc. v. Dept. of Health and Rehabilitative Services, 462 So.2d 83, 84 (Fla. 1st DCA 1985).

   
   

4. By a preponderance of the evidence, petitioner has proved its entitlement to a certificate of need, based upon a balanced review of the criteria in Section 408.035, Florida Statutes. This being so, its application should be approved.

   
   

5. Finally, given the foregoing conclusion, petitioner's request for sanctions against Life Care because of its failure to produce certain financial records is deemed to be moot. Likewise, Sawgrass' motion to strike paragraph 60 of Life Care's proposed recommended order is rendered moot.

RECOMMENDATION

Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the Agency for Health Care Administration enter a final

order granting the application of Sawgrass Care Center, Inc. for a certificate of need to construct an eighty-bed nursing home facility in subdistrict 1 of district 4. The application of Life Care Centers of America, Inc. should be denied.

DONE AND ENTERED this 21st day of November, 1995, in Tallahassee, Florida.

DONALD R. ALEXANDER

Hearing Officer

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 21st day of November, 1995.

APPENDIX TO RECOMMENDED ORDER, CASE NO. 94-6256

Petitioner:

Petitioner's proposed findings have been accepted in substance, albeit in substantially shorter form.

Respondents:

1-20. Partially accepted in findings of fact 4-17. 21-34. Partially accepted in finding of fact 18.

35-42. Partially accepted in finding of fact 19.

43. Partially accepted in finding of fact 20. 44-46. Rejected as being unnecessary.

47-58. Partially accepted in finding of fact 21. 59-69. Partially accepted in finding of fact 22. 70-71. Rejected as being unnecessary.

72-74. Partially accepted in finding of fact 23. 75-85. Partially accepted in finding of fact 24. 86-90. Partially accepted in finding of fact 25.

91. Rejected as being unnecessary.

Note: Where a proposed finding has been partially accepted, the remainder has been rejected as being unnecessary for a resolution of the issues, irrelevant, not supported by the more credible, persuasive evidence, subordinate, or a conclusion of law.

COPIES FURNISHED:

Robert D. Newell, Esquire 817 North Gadsden Street

Tallahassee, Florida 32303-6313

Richard A. Patterson, Esquire Building 3, Suite 3400

2727 Mahan Drive

Tallahassee, Florida 32308-5043

R. Bruce McKibben, Jr., Esquire Post Office Drawer 810 Tallahassee, Florida 32302-0810

R. S. Power, Agency Clerk

Agency for Health Care Administration Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308-5403

Jerome W. Hoffman, Esquire General Counsel

Agency for Health Care Administration 2727 Mahan Drive

Tallahassee, Florida 32308-5043

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit to the agency written exceptions to this Recommended Order. All agencies allow each party at least ten days in which to submit written exceptions. Some agencies allow a larger period within which to submit written exceptions. You should contact the agency that will issue the Final Order in this case concerning agency rules on the deadline for filing exceptions to this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency that will issue the Final Order in this case.

================================================================= AGENCY FINAL ORDER

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

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

SAWGRASS CARE CENTER, INC.,

Petitioner,

CASE NO.: 94-6256

vs. CON NO.: 7734, 7736

RENDITION NO.:

STATE OF FLORIDA, AGENCY FOR AHCA-96-100-FOF-CON HEALTH CARE ADMINISTRATION and

LIFE CARE CENTERS OF AMERICA, INC.,

Respondents.

/

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 Agency for Health Care Administration (AHCA). The Recommended Order entered November 21, 1995, by Hearing Officer Donald Alexander is incorporated by reference.

RULING ON EXCEPTIONS FILED BY AHCA

Counsel excepts to the hearing officer's conclusion in paragraphs 10 and 18 that Sawgrass better satisfies the review criteria regarding service to Medicaid patients. The hearing officer based his conclusion on Sawgrass' proposed Medicaid service level of 87.5 percent and Life Care's proposed Medicaid service level of 68 percent. The agency presented testimony by its staff that the decision to give preference based on this criterion should include considerations beyond the proposed service level, such as the high level of migration of persons needing nursing home care from the subdistrict and the ability of a new facility to serve a broader range of patients. Whether to give a preference is a policy matter which is the responsibility of the agency. I concur with staff and conclude that Sawgrass is not entitled to the preference

given by the hearing officer. Killearn vs. Department of Community Affairs, 623 So2d 771, 776 (Fla. 1st DCA 1993)(findings infused with policy considerations). The exception is granted.

Counsel excepts to the conclusion in paragraph 11 that Sawgrass better satisfies the criterion regarding a documented "history of demonstrated willingness to accept local Medicaid residents requiring skilled rather than intermediate care." The conclusion is based not on a documented history, but on future intentions expressed in Sawgrass proposal. The exception is granted.

RULING ON EXCEPTIONS FILED BY LIFE CARE

Life Care maintains that there is an insufficient factual basis for the conclusion in paragraph 6 that Sawgrass better satisfies the local health council's consideration regarding an applicant's intention to provide services "in a most economical manner in terms of capital and operating expenditures." The hearing officer found that the approaches used by both applicants to predict costs are reasonable, but that Sawgrass should receive the preference because its costs are lower. I concur with the hearing officer. Life Care is asking the agency to reweigh the evidence which the agency has no authority to do at this level of review. The exception is denied. Heifetz vs. Department of Business Regulation, 475 So2d 1277,1281 (Fla. 1st DCA 1985).

Life Care challenges the factual basis for the finding in paragraphs 9 and

19 that Sawgrass should receive preference for its record of providing high quality care. Again, Life Care would have the agency reweigh the evidence. The exception is denied.

Life Care excepts to the hearing officer's findings related to the applicants' proposed Medicaid service levels Life Care also excepts to the findings relating to the applicants' histories of providing care to Medicaid and indigent residents. These exceptions reiterate the exceptions by counsel for the agency. The exceptions are granted.

Life Care excepts to the finding in paragraph 13 that Sawgrass proposal best satisfies the criterion regarding comfort and life style of the residents. Life Care maintains that the finding "ignores the facts in evidence." There is ample record support for the finding including the following design considerations of the Sawgrass proposal:

1. larger bedrooms,

2. combining 24 foot wide hallways with common areas to promote a non- institutional open space effect,

3. non-institutional elevation and exterior,

4. bay windows in patient rooms providing extra light and space for display of plants and other personal items,

5. a continuous loop inside the Alzheimer's unit for "wall walkers",

6. a closet for each resident, and

7. a shower in each patient room.

I concur with the hearing officer, the exception is denied.

Life Care's exception to the finding in paragraph 12 regarding the comparison of the administrative costs and patient care costs of the competing proposals reargues the weight of the evidence. The exception is denied.

Life Care maintains that the finding in paragraph 23 regarding the fostering of competition is not supported by the record. The hearing officer's inference that Sawgrass proposal will do more to foster competition is reasonable because Sawgrass' proposal is more consistent with the needs of the subdistrict. The exception is denied.

Life Care's exception to the finding in paragraph 24 regarding the comparison of the costs and methods of construction reargues the weight of the evidence and is denied. Likewise, the exception to the finding in paragraph 26 regarding the continuum of care proposed by the applicants is denied.

Life Care excepts to the hearing officer's conclusion that based on a consideration of all the review criteria Sawgrass' proposal should be approved. concur with the hearing officer. The exception is denied.

FINDINGS OF FACT

The agency hereby adopts and incorporates by reference the findings of fact set forth in the Recommended Order excepts as modified by the rulings on the exceptions.

CONCLUSIONS OF LAW

The agency hereby adopts and incorporates by reference the conclusions of law set forth in the Recommended Order.

Based upon the foregoing, it is

ADJUDGED, that the application of Sawgrass Care Center, Incorporated, for CON 7734 be APPROVED. The application of Life Care Centers of America; Inc. for CON 7736 is DENIED.

DONE and ORDERED this 5th day of February, 1996, in Tallahassee, Florida.

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

Douglas M. Cook, Director

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, 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.

COPIES FURNISHED:

Donald R. Alexander Hearing Officer

The DeSoto Building 1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

Richard Patterson, Esquire Senior Attorney, Agency for Health Care Administration 2727 Mahan Drive

Fort Knox 3, Suite 3431

Tallahassee, Florida 32308-5403

R. Bruce McKibben, Jr., Esquire HOLLAND & KNIGHT

Post Office Box 810

Tallahassee, Florida 32302-0810

Elizabeth Dudek (AHCA/CON) Alberta Granger (AHCA/CON) Elfie Stamm (AHCA/CON)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addresses by U.S. Mail this 6th day of February, 1996.

R. S. Power, Agency Clerk State of Florida, Agency for Health Care Administration 2727 Mahan Drive

Fort Knox 3, Suite 3431

Tallahassee, Florida 32308-5403

(904) 922-3808

Docket for Case No: 94-006256CON

Orders for Case No: 94-006256CON