Petitioner: WELLINGTON REGIONAL MEDICAL CENTER, INC., D/B/A WELLINGTON REGIONAL MEDICAL CENTER
Respondent: AGENCY FOR HEALTH CARE ADMINISTRATION AND BETHESDA HEALTHCARE SYSTEM, INC., D/B/A WEST BOYNTON COMMUNITY HOSPITAL
Judges: DAVID M. MALONEY
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Jun. 28, 2005
Status: Closed
Recommended Order on Thursday, April 5, 2007.
Latest Update: Apr. 23, 2009
Summary: Bethesda Healthcare Systems, Inc., filed Certificate of Need Application No. 9838 with the Agency for Health Care Administration. The application seeks authority to establish an 80-bed acute care satellite hospital in the West Boynton area of south Palm Beach County. The issue in this case is whether the Agency should approve the application.Bethesda Healthcare demonstrated the need for an 80-bed satellite hospital in the West Boynton area on the basis of enhanced access to emergency services fo
Summary: Bethesda Healthcare Systems, Inc., filed Certificate of Need Application No. 9838 with the Agency for Health Care Administration. The application seeks authority to establish an 80-bed acute care satellite hospital in the West Boynton area of south Palm Beach County. The issue in this case is whether the Agency should approve the application.Bethesda Healthcare demonstrated the need for an 80-bed satellite hospital in the West Boynton area on the basis of enhanced access to emergency services for the elderly.
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STATE OF FLORIDA agente
AGENCY FOR HEALTH CARE ADMINISTRATION ata, CLERK
RENDITION NO.: AHCA-@1- 4 @4 -FOF-CON O01 AUG ~
; UG 9 A q ! 0
CON NO. 9838
WELLINGTON REGIONAL MEDICAL Qo
CENTER, INC. d/b/a WELLINGTON a
REGIONAL MEDICAL CENTER, Boe OOS
Pee : wo ras cs
Petitioner, DOAH CASE NO. 05-2352CONO@G, Ye
AHCA NO. 2005005383 Boe ey
eee
vs. oy Zs ZB
a
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
and BETHESDA HEALTHCARE
SYSTEM, INC d/b/a WEST BOYNTON
COMMUNITY HOSPITAL,
Respondents.
JFK MEDICAL CENTER LIMITED
PARTNERSHIP d/b/a JFK MEDICAL
CENTER,
Petitioner, DOAH CASE NO. 05-2594CON
AHCA NO. 2005006121
VS.
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
and BETHESDA HEALTHCARE
SYSTEM, INC d/b/a WEST BOYNTON
COMMUNITY HOSPITAL,
Respondents.
TENET HEALTHSYSTEM HOSPITALS,
INC. d/b/a DELRAY MEDICAL CENTER,
Petitioner,
vs.
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
and BETHESDA HEALTHCARE
SYSTEM, INC d/b/a WEST BOYNTON
COMMUNITY HOSPITAL,
Respondents.
Ora,
7AUG 9 by.
DOAH CASE NO. 05-2753CON Djyjo,. 08
ye
AHCA NO. 2005006297 4M )5i/88' Ge
HEAR AI Ve
FINAL ORDER
This case was referred to the Division of Administrative Hearings (DOAH) where the
assigned Administrative Law Judge (ALJ), David M. Maloney, conducted a formal
administrative hearing. At issue in this proceeding is whether the Agency for Health Care
Administration (Agency) should grant the Certificate of Need (CON) application of Bethesda
Healthcare System, Inc. (“Bethesda”) to establish a new 80-bed acute care satellite hospital in the
West Boynton area of Palm Beach County, Acute Care Subdistrict 9-5. The Recommended
Order dated April 5, 2007 is incorporated herein by reference, except where noted infra.
RULINGS ON EXCEPTIONS
Wellington Regional Medical Center, Inc. (“Wellington”), JFK Medical Center Limited
Partnership (“JFK”), and Delray Medical Center, Inc. (“Delray”) all filed exceptions to which
Bethesda filed a response.
Wellington’s Exceptions
In Exception 1, Wellington took exception to the findings of fact in Paragraphs 100 and
101 of the Recommended Order, arguing that the findings were contrary to the governing CON
statutory rule criteria. However, Wellington made no showing that the findings of fact in
Paragraphs 100 and 101 of the Recommended Order were not based on competent, substantial
evidence. The Agency can only reject or modify findings of fact in a recommended order if
those findings are not based on competent, substantial evidence. See § 120.57(1)(J, Fla. Stat.;
Heifetz v. Department of Bus. Regulation, 475 So.2d 1277, 1281 (Fla. 1985) (holding that an
agency “may not reject the hearing officer’s finding [of fact] unless there is no competent,
substantial evidence from which the finding could reasonably be inferred”). Wellington’s
argument is irrelevant because the findings of fact in Paragraphs 100 and 101 of the
Recommended Order were based on competent, substantial evidence. See Exhibit B-28A. Thus,
the Agency cannot reject or modify them, Therefore Exception | is denied.
In Exception 2, Wellington took exception to the findings of fact in Paragraph 104 of the
Recommended Order, arguing that there was no competent, substantial evidence to support the
statement that it is no longer possible to predict acute care bed need in a subdistrict. However,
contrary to Wellington’s argument, the findings of fact in Paragraph 104 of the Recommended
Order were based on competent, substantial evidence. See Transcript, Volume 26, Pages 3418-
3430; and Transcript, Volume 28, Pages 3607-3608, Thus, the Agency is prohibited from
rejecting or modifying them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 2 is
denied.
In Exception 3, Wellington took exception to the findings of fact in Paragraph 107 of the
Recommended Order, to the extent that the findings implied that it was legally impermissible for
the Agency to define the need for an applicant’s proposed project. However, what a finding of
fact may or may not imply is irrelevant. The findings of fact in Paragraph 107 of the
Recommended Order were based on competent, substantial evidence. See Transcript, Volume
26, Pages 3421-3423. Thus, they cannot be disturbed by the Agency. See § 120.57(1)(), Fla.
Stat.; Heifetz. Therefore, Exception 3 is denied.
In Exception 4, Wellington took exception to the findings of fact in Paragraph 110 of the
Recommended Order, arguing that they were not supported by competent, substantial evidence.
However, contrary to Wellington’s argument, the findings of fact in Paragraph 110 of the
Recommended Order were based on competent, substantial evidence. See Transcript, Volume
27, Pages 3450-3451. Thus, the Agency cannot reject or modify them. See § 120.57(1)(), Fla.
Stat.; Heifetz. Therefore, Exception 4 is denied.
In Exception 5, Wellington took exception to the findings of fact in Paragraph 111 of the
Recommended Order, arguing that the statement that “convenience is considered a part of
access” did not identify a definition of “convenience” established or utilized by the Agency nor
did it offer any guidelines for its measurement. Wellington further argued that the findings
perpetuated an incipient and irrational Agency policy that essentially says that all CON
applications are really based on “special circumstances.” Regardless of Wellington’s arguments,
the findings of fact in Paragraph 111 of the Recommended Order were based on competent,
substantial evidence. See Transcript, Volume 26, Pages 3428-3430. Thus, they cannot be
disturbed by the Agency. See § 120.57(1)(J), Fla. Stat.; Heifetz. Therefore, Exception 5 is
denied.
In Exception 6, Wellington took exception to the finding of fact in Paragraph 112 of the
Recommended Order, wherein the ALJ stated that “the need for hospital services for the growing
population in West Boynton becomes more significant with the passing of time,” arguing that the
finding implied that the need for such services was not presently being met, or could not be met
in the future, by existing hospitals. However, Wellington’s argument is irrelevant. The findings
of fact in Paragraph 112 of the Recommended Order were based on competent, substantial
evidence (See Transcript, Volume 27, Pages 3515-3516 and 3547; and Exhibit JFK-139 at Pages
145-146), and thus cannot be rejected or modified by the Agency. See § 120.57(1)(/), Fla. Stat.;
Heifetz. Therefore, Exception 6 is denied.
In Exception 7, Wellington took exception to the finding of fact in Paragraph 118 of the
Recommended Order, wherein the ALJ stated that bed inventory in the subdistrict was not a
relevant concern, arguing that the statement was contrary to Section 408.035, Florida Statutes.
Regardless of Wellington’s argument, the findings of fact in Paragraph 118 of the Recommended
Order were based on competent, substantial evidence. See Transcript, Volume 26, Pages 3418-
3430; Transcript, Volume 28, Pages 3607-3608; and Exhibit B-28A. Thus, the Agency cannot
disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 7 is denied.
In Exception 8, Wellington took exception to the findings of fact in Paragraph 141 of the
Recommended Order, arguing that emphasis on projected population growth in the proposed
hospital’s primary service area (PSA) and home zip code was irrelevant because CON review
and related health care planning must be done on a district and subdistrict basis, not on a PSA or
zip code basis. Regardless of Wellington’s argument, the findings of fact in Paragraph 141 of
the Recommended Order were based on competent, substantial evidence (See Transcript,
Volume 14, Pages 1759-1764; Transcript, Volume 42, Pages 5550-5555; and Exhibits B-17 and
B-17-2), and thus cannot be rejected or modified by the Agency. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 8 is denied.
In Exception 9, Wellington took exception to the ALJ’s statement in Paragraph 146 of the
Recommended Order that there is no hospital located within the four zip code PSA selected by
Bethesda, arguing that it was irrelevant. Wellington also took exception to the statement in
Paragraph 146 of the Recommended Order that there are few areas in Florida with a population
in excess of 60,000 people that do not have a hospital as being irrelevant also. Lastly,
Wellington took exception to the last sentence in Paragraph 146 of the Recommended Order,
arguing that it seemed to ignore the existence of at least four existing hospitals which presently .
provide hospital services to the residents of the proposed new hospital’s PSA. Regardless of
Wellington’s issues with Paragraph 146 of the Recommended Order, the findings of fact
contained therein were based on competent, substantial evidence. See, e.g., Transcript, Volume
14, Pages 1727 and 1739-1741; and Exhibits B-17 and W-2. Thus, the Agency is prohibited
from rejecting or modifying them. See § 120.57(1)(J), Fla. Stat.; Heifetz. Therefore, Exception
9 is denied.
In Exception 10, Wellington took exception to the findings of fact in Paragraph 149 of
the Recommended Order, arguing that a comparison of the projected population in the proposed
new hospital’s PSA in 2011 to the projected population in Wellington’s home zip code in 2011
was irrelevant. However, Wellington’s argument is itself irrelevant. The findings of fact in
Paragraph 149 of the Recommended Order were based on competent, substantial evidence. See
Transcript, Volume 39, Pages 5129-5131; Transcript, Volume 42, Page 5556; Transcript,
Volume 43, Pages 5690-5691; and Exhibits B-17 and D-12. Thus, the Agency cannot disturb
them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 10 is denied.
In Exception 11, Wellington took exception to the statements in Paragraph 150 of the
Recommended Order that Claritas population data does not take into account updated housing
starts information or seasonal residents in an area. Wellington argued that the statement, while
technically accurate, was incomplete in that it ignored evidence presented that Claritas
population projection methodologies included use of deliverable mail addresses in census tracts,
Equifax information and data collected from state and local governments. However,
Wellington’s argument is irrelevant. The findings of fact in Paragraph 150 of the Recommended
Order were based on competent, substantial evidence. See, ¢.g., Transcript, Volume 14, Page
1743; Transcript, Volume 21, Pages 2726-2727; and Transcript, Volume 43, Pages 5715-5717.
Thus, the Agency is prohibited from rejecting or modifying them. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 11 is denied.
In Exception 12, Wellington took exception to the statement in Paragraph 159 of the
Recommended Order that “[m]any more projects have been approved by the County” as being so
vague as to provide no basis for a finding of ultimate fact or a conclusion of law. Wellington’s
argument is irrelevant. The findings of fact in Paragraph 159 of the Recommended Order were
based on competent, substantial evidence. See, ¢.g., Transcript, Volume 12, Pages 1513-1519;
and Exhibits B-30B and B-32. Thus, the Agency cannot reject or modify them. See §
120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 12 is denied.
In Exception 13, Wellington took exception to the findings of fact in Paragraph 163 of
the Recommended Order, arguing that the ALJ’s acceptance of several. witnesses’
characterization of recent growth as “explosive” and “phenomenal” was so vague that it could
not support a conclusion of ultimate fact or law. Wellington’s argument is not a valid exception.
The findings of fact in Paragraph 163 of the Recommended Order were based on competent,
substantial evidence. See, ¢.g., Transcript, Volume 1, Page 97; Transcript, Volume 3, Pages
291-292; and Exhibit B-54. Thus, the Agency cannot disturb them. See § 120.57(1)(J), Fla.
Stat.; Heifetz. Therefore, Exception 13 is denied.
In Exception 14, Wellington took exception to the findings of fact in Paragraph 211 of
the Recommended Order, arguing that, because there was no competent, substantial evidence of
a future diminution in access to certain hospital services, there was no competent, substantial
evidence that a new hospital was needed in order to avoid future diminution in access to certain
hospital services. However, contrary to Wellington’s assertions, the findings of fact in Paragraph
211 of the Recommended Order were based on competent, substantial evidence. See Exhibit
JFK-139. Thus, the Agency is prohibited from rejecting or modifying them. See § 120.57(1)(),
Fla. Stat.; Heifetz. Therefore, Exception 14 is denied.
In Exception 15, Wellington took exception to the findings of fact in Paragraphs 214-215
of the Recommended Order, arguing that they were not findings of fact but merely recitations of
Bethesda’s arguments and rationales for its proposed project. Wellington’s exception is not
valid. The findings of fact in Paragraphs 214-215 of the Recommended Order were based on
competent, substantial evidence. See, e.g., Transcript, Volume 27, Pages 3444-3445; and
Exhibits B-1F and JFK-139. Thus, the Agency cannot reject or modify them. See §
120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 15 is denied.
In Exception 16, Wellington took exception to the ALJ's statement in Paragraph 222 of
the Recommended Order that emergency department (ED) and emergency room (ER)
overcrowding was a serious issue in the subdistrict and in the County, and, as a result, the special
needs of the elderly were not being served. According to Wellington, the finding goes to
convenience, not access, and ignored other evidence. However, Wellington’s arguments are
irrelevant. The findings of fact in Paragraph 222 of the Recommended Order were based on
competent, substantial evidence. See Exhibit B-28A; and ruling on Delray’s Exception 25 infra.
Thus, the Agency cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore,
Exception 16 is denied.
In Exception 17, Wellington took exception to the findings of fact in Paragraphs 224 and
225 of the Recommended Order, arguing that there was no competent, substantial evidence that
the statements that relate to Florida in general were applicable to Palm Beach County or
Subdistrict 9-5, However, contrary to Wellington’s argument, the findings of fact in Paragraphs
224 and 225 of the Recommended Order were based on competent, substantial evidence. See
Exhibit B-15-2. Thus, the Agency is prohibited from rejecting or modifying them. See §
120.57(1)(D), Fla. Stat.; Heifetz. Therefore, Exception 17 is denied.
In Exception 18, Wellington took exception to the finding of fact in Paragraph 226 of the
Recommended Order, arguing that the finding was misleading and irrelevant. However,
regardless of Wellington’s argument, the finding of fact in Paragraph 226 of the Recommended
Order was based on competent, substantial evidence (See Transcript, Volume 57, Page 7694),
and thus cannot be disturbed by the Agency. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore,
Exception 18 is denied.
In Exception 19, Wellington took exception to the statement in Paragraph 228 of the
Recommended Order that there have been excessively long average lengths of emergency
department patient stays at Wellington, arguing that it was incomplete and misleading.
Regardless of Wellington’s argument, the findings of fact in Paragraph 228 of the Recommended
Order were based on competent, substantial evidence. See Transcript, Volume 14, Pages 1779-
1782, 1784-1787, 1789-1790, 1795-1796 and 1820; Transcript, Volume 23, Pages 2978-2980;
Transcript, Volume 32, Pages 4277 and 4279; Transcript, Volume 24, Pages 3194-3195;
Transcript, Volume 37, Pages 4897-4903; and Exhibits B-17, B-71H, B-73-2, and W-18. Thus,
the Agency is prohibited from rejecting or modifying them. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 19 is denied.
In Exception 20, Wellington took exception to the findings of fact in Paragraphs 229-235,
arguing that they were irrelevant because there was no competent, substantial evidence that the
construction of a new satellite hospital in West Boynton would have any material impact on ED
wait times, ED holds, instances of patients leaving without being seen, or instances of patients
leaving against medical advice at Bethesda’s ED or any other existing hospital in the subdistrict.
However, Wellington’s exception is not valid because the findings of fact in Paragraphs 229-235
of the Recommended Order were based on competent, substantial evidence. See Transcript,
Volume 2, Pages, 149-151 and 212; Transcript, Volume 10, Pages 1249-1250, 1262-1263, 1266,
1287 and 1296-1297; Transcript, Volume 14, Pages 1779-1782 and 1784-1787; and Exhibit B-
17. Thus, the Agency cannot reject or modify them. See § 120.57(1)(), Fla. Stat.; Heifetz.
Therefore, Exception 20 is denied.
In Exception 21, Wellington took exception to the statement in Paragraph 247 of the
Recommended Order that Wellington had, in the last two years, experienced a substantial
increase in the number of ED stays of more than 6 hours, arguing that the statement was
incomplete and misleading. However, Wellington’s argument is irrelevant. The findings of fact
in Paragraph 247 of the Recommended Order were based on competent, substantial evidence.
See Transcript, Volume 23, Pages 2978-2980; and Exhibit W-18. Thus, the Agency cannot
disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 21 is denied.
In Exception 22, Wellington took exception to the statement in Paragraph 249 of the
Recommended Order that existing, expanded EDs have not been able to meet the needs of the
subdistrict, particularly the elderly’s need for adequate access to hospital services in EDs.
Wellington did not argue that the findings of fact in Paragraph 249 of the Recommended Order
were not based on competent, substantial evidence. Indeed, they were based on competent,
substantial evidence. See Transcript, Volume 2, Pages 149-151 and 212; Transcript, Volume 10,
Pages 1249-1250 and 1262-1263; Transcript, Volume 14, Pages 1769-1770; and Exhibits B-15-
2, B-17 and B-28A. Thus, the Agency is unable to reject or modify them. See § 120.57(1)(),
Fla. Stat.; Heifetz. Therefore, Exception 22 is denied.
In Exception 23, Wellington took exception to the findings of fact in Paragraphs 254-255
of the Recommended Order because they suggested that elderly patients from the West Boynton
area with serious or life-threatening medical conditions had suffered adverse outcomes as a result
of delays in receiving medical care at existing EDs. Regardless of what Wellington argued the
findings may or may not suggest, they were based on competent, substantial evidence (See
Transcript, Volume 2, Pages 149-151 and 212; Transcript, Volume 14, Pages 1769-1770; and
Exhibits B-1C and B-17) and thus cannot be disturbed by the Agency. See § 120.57(1)(), Fla.
Stat.; Heifetz. Therefore, Exception 23 is denied.
In Exception 24, Wellington took exception to the use of the term “significant number” in
Paragraph 256 of the Recommended Order to describe the number of elderly patients in the West
Boynton area who would enjoy enhanced access to emergency services and better quality of care.
if the proposed hospital is built. According to Wellington, because the term provided no
quantification and was not applied to any standard established by the Agency, it could not be
used to provide a basis for a finding of ultimate fact or conclusion of law. However,
Wellington’s arguments are irrelevant because the findings of fact in Paragraph 256 of the
Recommended Order were based on competent, substantial evidence (See Transcript, Volume 2,
11
Pages 149-151 and 212-213; and Transcript, Volume 4, Pages 409-410 and 450-451), and thus
cannot be overturned by the Agency. See § 120.57(1)(J, Fla. Stat.; Heifetz. Therefore,
Exception 24 is denied.
In Exception 25, Wellington took exception to the statement in Paragraph 277 of the
Recommended Order that many Hispanic migrants reside in the western areas of the county,
arguing that there was no competent, substantial evidence to support the finding. However,
contrary to Wellington’s argument, the findings of fact in Paragraph 277 of the Recommended
Order were based on competent, substantial evidence. See Transcript, Volume 2, Pages 166-167.
Thus, the Agency is prohibited from rejecting or modifying them. See § 120.57(1)(J, Fla. Stat.;
Heifetz. Therefore, Exception 25 is denied.
In Exception 26, Wellington took exception to the statement in Paragraph 283 of the
Recommended Order that patients of Caridad Clinic have to travel “significant distances” to
access an existing hospital, as well as the finding that Hispanic patients may have to travel. a
significant distance from wherever they reside in the county to an existing hospital if they do not
go to the Clinic first. Wellington argued that these findings were not based on competent,
substantial evidence. However, contrary to Wellington’s argument, the findings of fact in
Paragraph 283 of the Recommended Order were based on competent, substantial evidence. See
Transcript, Volume 1, Page 107; and Transcript, Volume 2, Pages 148-151. Thus, the Agency
cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 26 is denied.
In Exception 27, Wellington took exception to the characterization in Paragraph 284 of
the Recommended Order of the proposed satellite hospital as being “much closer to the Caridad
Clinic” than presently existing hospitals, arguing that it was not based on competent, substantial
evidence. However, contrary to Wellington’s assertion, the findings of fact in Paragraph 284 of
the Recommended Order were based competent, substantial evidence. See Transcript, Volume
1, pages 102-109; Transcript, Volume 2, Page 148; Transcript, Volume 14, Page 1847;
Transcript, Volume 23, Pages 3027-3028; and Exhibits B-1C and B-1F. Thus, the Agency is not
permitted to reject or modify them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception
27 is denied.
In Exception 28, Wellington took exception to the statement in Paragraph 296 of the
Recommended Order that patients seeking treatment in emergencies “generally prefer to be
within 30 minutes driving time of a hospital,” arguing that the statement was not a statutory or
tule criterion by which to measure access or need and thus irrelevant. However, regardless of
Wellington’s argument, the findings of fact in Paragraph 296 of the Recommended Order were
based on competent, substantial evidence (See Exhibits B-1D and B-60), and thus cannot be
rejected or modified by the Agency. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore,
Exception 28 is denied.
In Exception 29, Wellington took exception to the findings of fact in Paragraph 303 of
the Recommended Order, arguing that there was no competent, substantial evidence that the
purported geriatric program or the staffing at the new hospital would consist of any services or
staffing not already offered by and available at existing hospitals in the subdistrict. However,
contrary to Wellington’s assertions, the findings of fact in Paragraph 303 of the Recommended
Order were based on competent, substantial evidence. See Transcript, Volume 1, Page 116; and
Transcript, Volume 5, Page 645. Thus, the Agency cannot disturb them. See § 120.57(1)(), Fla.
Stat.; Heifetz. Therefore, Exception 29 is denied.
In Exception 30, Wellington took exception to the statement in Paragraph 308 of the
Recommended Order that numerous studies report that age-related driving problems begin as
early as 60 years old, arguing that it was incomplete and irrelevant because it ignored competent,
substantial evidence showing that the literature indicates that there are no pronounced driving
difficulties in the 65 to 80 age group that would affect their access to hospital services, and that
Florida only requires retesting for a driver’s license at age 80. Wellington also argued that the
findings ignored the evidence that the medically related transportation difficulties of the truly
elderly do not relate to the one or two trips to a hospital that they might make in a year, but relate
more to accessing primary care at a location other than a hospital on a more regular basis.
However, Wellington’s arguments are not a valid exception to the findings of fact in Paragraph
308 of the Recommended Order. Regardless of whether the findings may or may not be
incomplete or irrelevant, they were based on competent, substantial evidence (See Transcript,
Volume 53, Pages 7257-7268; and Exhibit JFK-121), and thus cannot be overturned by the
Agency. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 30 is denied.
In Exception 31, Wellington took exception to the relevance of the findings of fact in
Paragraph 313 of the Recommended Order, arguing that the findings were incomplete and
ignored other relevant evidence. Regardless of Wellington’s arguments, the findings of fact in
Paragraph 313 of the Recommended Order were based on competent, substantial evidence (See
Transcript, Volume 21, Pages 2683-2685; and Exhibits B-62 and W-2), and thus cannot be
rejected or. modified by the Agency. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore,
Exception 31 is denied.
In Exception 32, Wellington took exception to the statement in Paragraph 315 of the
Recommended Order that road improvements in the West Boynton area had been relatively few,
arguing that it was unsupported by competent, substantial evidence. However, contrary to
Wellington’s argument, the findings of fact in Paragraph 315 of the Recommended Order were
based on competent, substantial evidence. See Transcript, Volume 19, Pages 2479-2480; and
Exhibit B-45A, Thus, the Agency cannot disturb them. See § 120.57(1)(J), Fla. Stat.; Heifetz.
Therefore, Exception 32 is denied.
In Exception 33, Wellington took exception to the characterization in Paragraph 316 of
the Recommended Order of existing hospitals in the subdistrict as “outlying hospitals,” arguing
that it implied that the existing hospitals were located in inaccessible, remote, rural areas.
However, whatever Wellington believed the findings of fact in Paragraph 316 of the
Recommended Order imply is irrelevant. The findings of fact in Paragraph 316 of the
Recommended Order were based on competent, substantial evidence (See Transcript, Volume
19, Pages 2479-2480; and Exhibit B-45A), and thus cannot be overtumed by the Agency. See §
120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 33 is denied.
In Exception 34, Wellington took exception to the findings of fact in Paragraph 325 of
the Recommended Order, arguing that there was no competent, substantial evidence that traffic
congestion or drive times to existing hospitals in the subdistrict ever had an adverse effect on any
West Boynton resident seeking emergency services. Wellington also argued that the findings
ignored evidence presented at hearing that there were significant road improvements planned in
Palm Beach County. Regardless of Wellington’s arguments, the findings of fact in Paragraph
325 of the Recommended Order were based on competent, substantial evidence. See Transcript,
Volume 2, Pages 202-203; Transcript, Volume 10, Pages 1250-1251; Transcript, Volume 16,
Page 1974; and Exhibits B-71H and W-30. Thus, the Agency cannot reject or modify them. See
§ 120.57( 1)(), Fla. Stat.; Heifetz. Therefore, Exception 34 is denied.
In Exception 35, Wellington took exception to the findings of fact in Paragraph 327 as
being incomplete and misleading, and therefore irrelevant. However, because the findings of
15
fact in Paragraph 327 of the Recommended Order were based on competent, substantial evidence
(See Transcript, Volume 3, Pages 282-286, 292-298 and 338; and Exhibits B-8A, B-8F and B-
8G), the Agency cannot disturb them. See § 120.57(1)(J, Fla. Stat.; Heifetz. Therefore,
Exception 35 is denied.
In Exception 36, Wellington took exception to the findings of fact in Paragraph 329 of
the Recommended Order, arguing that the findings ignored competent, substantial and
uncontroverted evidence that the Palm Beach County Fire and Rescue Department anticipated
that the planned construction of new stations in the western part of the county would
significantly reduce transport times to existing hospitals. However, whatever evidence
Wellington believed a finding of fact might have ignored is irrelevant. Because the findings of
fact in Paragraph 329 of the Recommended Order were based on competent, substantial evidence
(See Transcript, Volume 43, Page 5735; and Exhibit D-12) they cannot be rejected or modified
by the Agency. See § 120.57(1)(J), Fla. Stat.; Heifetz. Therefore, Exception 36 is denied.
In Exception 37, Wellington took exception to the statement in Paragraph 330 of the
Recommended Order that the availability of on-call physician specialists did not affect turnover
times, arguing that the statement was not supported by competent, substantial evidence.
However, contrary to Wellington’s argument, the findings of fact in Paragraph 330 of the
Recommended Order were based on competent, substantial evidence. See Transcript, Volume 3,
Pages 301-302. Thus, the Agency is prohibited from rejecting or modifying them. See §
120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 37 is denied.
In Exception 38, Wellington took exception to the relevance of Paragraph 333 of the
Recommended Order, arguing that it ignored other competent, substantial evidence and failed to
identify any standard established by statute, rule or agency policy against which the 30 minute
16
cumulative response, travel and turnover time referenced in the paragraph should be measured.
However, Wellington’s arguments are irrelevant because the findings of fact in Paragraph 333 of
the Recommended Order were based on competent, substantial evidence. See Transcript,
Volume 3, Page 314; Transcript, Volume 56, Pages 7568-7575; and Exhibit B-163. Thus, the
Agency cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz, Therefore, Exception 38 is
denied.
In Exception 39, Wellington took exception to the findings of fact in Paragraph 338 of
the Recommended Order, arguing that the findings implied that traffic conditions worsened
between April 2005 and March 2006 when, in fact, they did not materially change. However,
whatever Wellington believed a finding of fact might imply is not relevant. Because the findings
of fact in Paragraph 338 of the Recommended Order were based on competent, substantial
evidence (See Transcript, Volume 19, Pages 2382-2383, 2393-2400, 2402-2403, 2409-2410,
2412-2414, 2427-2428, 2478-2480 and 2487-2494; Transcript, Volume 26, Pages 3381-3382;
and Exhibit B-45A) they cannot be overtumed by the Agency. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 39 is denied.
In Exception 40, Wellington took exception to the findings of fact in Paragraph 353 of
the Recommended Order, arguing that they were irrelevant because a 30-40 minute drive time
standard was established in Wellington Regional Medical Center, Inc. d/b/a Wellington Regional
Medical Center v. AHCA et.al (Bethesda I), 27 FALR 1446 (AHCA 2005). Wellington also
argued that there was no competent substantial evidence to show that travel times to existing
hospitals would exceed 40 minutes in 2010. Regardless of Wellington’s arguments, the findings
of fact in Paragraph 353 of the Recommended Order were based on competent, substantial
evidence. See Transcript, Volume 19, Pages 2413-2414, 2478 and 2487-2494; Transcript,
Volume 26, Pages 3349-3351 and 3381-3388; and Exhibits B-45A and B-45A.J. Thus, the
Agency is prohibited from rejecting or modifying them. See § 120.57(1)(J, Fla. Stat.; Heifetz.
Therefore, Exception 40 is denied.
In Exception 41, Wellington took exception to the findings of fact in Paragraph 355 of
the Recommended Order, arguing that they were not findings of fact but rather a recitation of the
Agency’s position. Whatever Wellington might call them, the findings of fact in Paragraph 355
of the Recommended Order were based on competent, substantial evidence (See Transcript,
Volume 27, Pages 3450-3451, 3511-3514, 3515-3516, 3525-3526, 3539-3540, 3541-3543 and
3547-3549; and Transcript, Volume 28, Pages 3585-3586), and thus cannot be disturbed by the
Agency. See § 120.57(1)(J, Fla. Stat.; Heifetz. Therefore, Exception 41 is denied.
In Exception 42, Wellington took exception to the findings of fact in Paragraph 356 of
the Recommended Order as being irrelevant. However, whether Wellington believes a finding
of fact was irrelevant is of no relevance. Because the findings of fact in Paragraph 356 of the
Recommended Order were based on competent, substantial evidence (See Transcript, Volume
28, Pages 3585-3592; Transcript, Volume 30, Pages 3931 and 3941; and Exhibits B-74E, B-95,
B-133, B-149 and JFK-139 at Pages 44-46), the Agency cannot reject or modify them. See §
120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 42 is denied.
In Exception 43, Wellington took exception to the findings of fact in Paragraph 369 of
the Recommended Order, arguing that there was no competent, substantial evidence to establish
that any elderly patients in the West Boynton area had experienced increasing difficulties
traveling to existing hospitals to access hospital and emergency services. Wellington also took
exception to the characterization of existing hospitals as “distant existing hospitals.”
Wellington’s exceptions have no merit. The findings of fact in Paragraph 369 of the
Recommended Order were based on competent, substantial evidence. See Transcript, Volume 4,
Pages 474-481; and Exhibits B-26B and B-26-1. Thus, the Agency is prohibited from rejecting
or modifying them. See § 120.57(1)(J), Fla. Stat.; Heifetz. Therefore, Exception 43 is denied.
In Exception 44, Wellington took exception to the findings of fact in Paragraph 403
because the ALJ did not reject Bethesda’s application after finding that Wellington’s expansion
of its current facility was a more cost effective response to community growth in the West
Boynton area. However, Wellington’s argument is irrelevant because the findings of fact in
Paragraph 403 of the Recommended Order were based on competent, substantial evidence. See
Transcript, Volume 22, Pages 2788-2789 and 2795-2812. Thus, the Agency cannot alter them.
See § 120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 44 is denied.
In Exception 45, Wellington took exception to the findings of fact in Paragraphs 415-417
of the Recommended Order, arguing that there was no competent, substantial evidence to
support Bethesda’s “illogical argument” that, by converting its current 67 semi-private rooms,
the bottleneck from its ED to impatient beds would be eliminated. Wellington further argued
that there was no evidence to support the statement that the average length of stay in any ED in
the subdistrict would be reduced in any meaningful way if the proposed hospital is built.
However, contrary to Wellington’s arguments, the findings of fact in Paragraphs 415-417 of the
Recommended Order were based on competent, substantial evidence. See Transcript, Volume 6,
Page 693; Transcript, Volume 9, Pages 1146 and 1153; Transcript, Volume 10, Pages 1310-
1316; and Exhibit B-7A. Thus, the Agency cannot disturb them. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 45 is denied.
In Exception 46, Wellington took exception to the finding of fact in Paragraph 419 of the
Recommended Order, arguing that there was no competent, substantial evidence that growth in
each existing hospital’s service area would offset the impact of establishing a new hospital in an
area from which each hospital currently drew patients. However, contrary to Wellington’s
assertions, the finding of fact in Paragraph 419 of the Recommended Order was based on
competent, substantial evidence. See Transcript, Volume 56, Pages 7630-7640; and Exhibit B-
163, Thus, the Agency cannot reject or modify it. See § 120.57(1)(), Fla. Stat.; Heifetz.
Therefore, Exception 46 is denied.
In Exception 47, Wellington took exception to the findings of fact in Paragraphs 427-430,
arguing that there was no competent, substantial evidence to support the findings of fact in those
paragraphs. However, contrary to Wellington’s argument; the findings of fact in Paragraphs
427-430 of the Recommended Order were based on competent, substantial evidence. See
Transcript, Volume 16, Pages 2019-2037; Transcript, Volume 43, Page 5698; and Exhibits B-
18A, B-18F, B-18G, B-18H, B-28A, B-67H, W-2 and W-29. Thus, they cannot be disturbed by
the Agency. See § 120.57(1)(/), Fla. Stat.; Heifetz. Therefore, Exception 47 is denied.
In Exception 48, Wellington took exception to the findings of fact in Paragraph 432 of
the Recommended Order, arguing that the findings were not based on competent, substantial
evidence. However, contrary to Wellington’s assertion, the findings of fact in Paragraph 432 of
the Recommended Order were based on competent, substantial evidence. See Transcript,
Volume 22, Pages 2842-2844; and Exhibit B-67-6. Thus, the Agency cannot reject or modify
them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 48 is denied.
In Exception 49, Wellington took exception to the findings of fact in Paragraph 433 of
the Recommended Order, arguing that the findings were not based on competent, substantial
evidence. However, contrary to Wellington’s argument, the findings of fact in Paragraph 433 of
the Recommended Order were based on competent, substantial evidence. See Transcript,
20
Volume 22, Pages 2800-2801 and 2847-2850; and Exhibit B-67-6. Thus, the Agency is
prohibited from rejecting or modifying them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore,
Exception 49 is denied.
In Exception 50, Wellington took exception to the findings of fact in Paragraph 444 of
the Recommended Order, arguing that the findings incorrectly implied that the standard for
determining whether the adverse impact of a proposed new hospital on an existing hospital was
acceptable was whether the proposed new hospital would put the continued existence of the
existing hospital in peril. However, what Wellington believed a finding of fact might imply is
irrelevant. Since the findings of fact in Paragraph 444 of the Recommended Order were based
on competent, substantial evidence (See Transcript, Volume 51, Pages 7005-7010), the Agency
cannot reject or modify them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 50 is
denied.
In Exception 51, Wellington took exception to the findings of fact in Paragraph 464 of
the Recommended Order, arguing that there was no competent, substantial evidence to support
the apparent attempt to characterize the healthcare needs of the elderly in the West Boynton area
as being no different that the healthcare needs of the non-elderly, such that a community hospital
that did not offer tertiary and more complete hospital services was perfectly adequate to meet
their needs. Regardless of Wellington’s argument concerning what the findings might attempt to
characterize, the findings themselves were based on competent, substantial evidence. See, ¢.g.,
Transcript, Volume 9, Pages 1112-1113; Transcript, Volume 23, Page 2983-2985 and 2990-
2991; Transcript, Volume 24, Page 3247; and Exhibits B-1F, B-132, JFK-131, JFK-135, JFK-
137, W-31. Thus, the Agency is not permitted to alter them. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 51 is denied.
21
In Exception 52, Wellington took exception to the fact that, in the findings of fact in
Paragraphs 466 and 472 of the Recommended Order, the ALJ, while admitting that the proposed
hospital would not have the ability to provide quality of care to patients who presented in
emergent need of tertiary services and that the proposed hospital may be a “trap” for such
patients, did not explain why these issues were not reasons for denying Bethesda’s CON
application. However, Wellington’s argument is irrelevant. The findings of fact in Paragraphs
466 and 472 of the Recommended Order were based on competent, substantial evidence. See
Transcript, Volume 32, Pages 4289-4290; and Transcript, Volume 52, Pages 7118-7119. Thus,
they cannot be rejected or modified by the Agency. See § 120.57(1)(/), Fla. Stat.; Heifetz.
Therefore, Exception 52 is denied.
In Exception 53, Wellington took exception to the findings of fact in Paragraph 473 of
the Recommended Order, arguing that there was no competent, substantial evidence to support
the findings. However, contrary to Wellington’s assertion, the findings of fact in Paragraph 473
of the Recommended Order were based on competent, substantial evidence. See, e.g.,
Transcript, Volume 2, Pages 148-151 and 230; and Transcript, Volume 4, Pages 448-451. Thus,
the Agency cannot disturb them. See § 120.57(1)(J, Fla. Stat.; Heifetz. Therefore, Exception 53
is denied.
In Exception 54, Wellington took exception to the findings of fact in Paragraph 501 of
the Recommended Order, arguing that JFK did not argue in favor of establishing specialty
hospitals in Florida. However, regardless of Wellington’s issues with the findings of fact in
Paragraph 501 of the Recommended Order, they were based on competent, substantial evidence.
See Transcript, Volume 54, Page 7311. Thus, the Agency is prohibited from rejecting or
modifying them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 54 is denied.
22
In Exception 55, Wellington took exception to the findings of fact in Paragraphs 522 and
523 of the Recommended Order, arguing that they ignored competent, substantial evidence
indicating that the recruitment of specialty doctors in Palm Beach County had been and
continued to be a major problem. However, whatever evidence Wellington believes a finding of
fact may have ignored is irrelevant. With the exception of the second sentence of Paragraph 523
(which a review of the record revealed the absence of Dr. Lakow’s testimony on that issue), the
findings of fact in Paragraphs 522 and 523 of the Recommended Order were based on
competent, substantial evidence. See Transcript, Volume 1, Pages 81-82; Transcript, Volume 9,
Pages 1094-1101; Transcript, Volume 29, Pages 3709-3710; Transcript, Volume 37, Pages 4901-
4902 and 4951-4954; and Exhibits B-28F, B-68B and W-30. Thus, the Agency cannot alter
them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 55 is granted only to the
extent that the second sentence of Paragraph 523 is stricken.
In Exception 56, Wellington took exception to the findings of fact in Paragraph 535 of
the Recommended Order, arguing that the findings were not based on competent, substantial
evidence. However, contrary to Wellington’s argument, the findings of fact in Paragraph 535 of
the Recommended Order were based on competent, substantial evidence. See Transcript,
Volume 22, Pages 2784-2789, 2842 and 2869; Transcript, Volume 24, Pages 3140, 3188 and
3234; Transcript, Volume 36, Pages 4736 and 4759; and Transcript, Volume 37, Pages 4853 and
4927. Thus, the Agency cannot reject or modify them. See § 120.57(1)(), Fla. Stat.; Heifetz.
Therefore, Exception 56 is denied.
In Exception 57, Wellington took exception to the findings of fact in Paragraph 564 of
the Recommended Order, arguing that they were incomplete and therefore inaccurate and
irrelevant. Regardless of Wellington’s argument, the findings of fact in Paragraph 564 of the
23
Recommended Order were based on competent, substantial evidence. See Transcript, Volume
24, Pages 3072-3073. Thus, the Agency is prohibited from rejecting or modifying them. See §
120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception.57 is denied.
In Exception 58, Wellington took exception to the findings of fact in Paragraphs 573-576
of the Recommended Order, to the extent that the ALJ failed to explain why these findings did
not support an ultimate recommended finding denying Bethesda’s CON application, However,
Wellington’s argument is irrelevant. Since the findings of fact in Paragraphs 573-576 of the
Recommended Order were based on competent, substantial evidence (See, e.g., Transcript,
Volume 15, Pages 1879-1880; Transcript, Volume 27, Pages 3479-3480; and Exhibits B-1F and
B-28A), the Agency cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore,
Exception 58 is denied.
In Exception 59, Wellington took exception to the findings of fact in Paragraph 587 of
the Recommended Order, arguing that it ignored the fact that the existing hospitals in the
subdistrict were geographically accessible from the West Boynton area. However, Wellington’s
argument is irrelevant because the findings of fact in Paragraph 587 of the Recommended Order
were based on competent, substantial evidence. See Transcript, Volume 1, Pages 117-118;
Transcript, Volume 7, Pages 910-911; and Transcript, Volume 15, Pages 1879-1880. Thus, the
Agency cannot reject or modify them. See § 120.57(1)(/), Fla. Stat.; Heifetz. Therefore,
Exception 59 is denied.
In Exception 60, Wellington took exception to the findings of fact in Paragraph 593 of
the Recommended Order, arguing that there was no competent, substantial evidence to support
an assumption that the existing hospitals could increase quality of care or reduce their prices in
order to overcome the advantage Bethesda would enjoy by virtue of the location of the proposed
24
hospital. Wellington also argued that there was no competent, substantial evidence showing any
lack of, or deficiency in, quality of care at any of the existing hospitals. However, contrary to
Wellington’s arguments, the findings of fact in Paragraph 593 of the Recommended Order were
based on competent, substantial evidence. See Transcript, Volume 27, Pages 3479-3480;
Transcript, Volume 43, Page 5786; Transcript, Volume 53, Pages 7277-7279; and Exhibit B-1F.
Thus, the Agency is prohibited from rejecting or modifying them. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 60 is denied.
In Exception 61, Wellington took exception to the findings of fact in Paragraphs 602-609
of the Recommended Order, arguing that the findings were incomplete and therefore irrelevant
because they ignored other evidence. However, Wellington’s argument is irrelevant because the
findings of fact were based on competent, substantial evidence. See Transcript, Volume 1, Pages
83-84; Transcript, Volume 11, Pages 1402-1408; Transcript, Volume 14, Pages 1820-1822;
Transcript, Volume 23, Pages 3053 and 3055; Transcript, Volume 30, Page 3920; Transcript,
Volume 43, Pages 5721-5722; and Exhibits B-2H, B-2], B-2N, B-20, B-2P, B-17, JFK-139 and
W-2. Thus, the Agency cannot disturb them. See § 120.57(1)(J, Fla. Stat.; Heifetz. Therefore,
Exception 61 is denied.
In Exception 62, Wellington argued that there was no competent, substantial evidence in
this case to show that: (1) existing hospitals in the subdistrict were not geographically,
demographically and programmatically accessible to the residents of the West Boynton area; (2)
existing hospitals did not provide high quality acute care; (3) existing hospitals would not
construct sufficient inpatient and ED capacity to absorb the increased utilization created by
anticipated future population growth in the subdistrict; (4) emergency treatment was being, or
would be delayed or denied to residents of the subdistrict; or (5) existing hospitals would lack
25
ED capacity in the foreseeable future. However, Wellington’s exception did not clearly identify
the disputed portion of the recommended order by page number or paragraph, did not identify the
legal basis for the exception and did not include appropriate and specific citations to the record.
While Section 120.57(1)(k), Florida Statutes (2006), requires that the Agency’s “final order shall
include an explicit ruling on each exception”, the Agency “need not rule on an exception that
does not clearly identify the disputed portion of the recommended order by page number or
paragraph, that does not identify the legal basis for the exception, or that does not include
appropriate and specific citations to the record.” Thus, the Agency declines to rule on Exception
62.
JFK’s Exceptions
In Exception 1, JFK took exception to the findings of fact in Paragraphs 89, 92, 94-104,
107-109, 111 and 217 of the Recommended Order, and the conclusions of law in Paragraphs
631-633, 636, 637, 639, 640, 641, 645, 646, 648 and 654 of the Recommended Order, arguing
that the ALJ erred in finding and concluding that the legal framework in which Bethesda’s CON
application is to be considered had substantially changed since Bethesda J. The findings of fact
in Paragraphs 89, 92, 94-104, 111 and 217 of the Recommended Order were based on
competent, substantial evidence. See ruling on Delray’s Exceptions 4-10 and 15 infra; and
Transcript, Volume 27, Pages 3482-3483. Thus, the Agency cannot reject or modify them. See
§ 120.57(1)(D, Fla. Stat.; Heifetz. Further, JFK’s argument concerning the conclusions of law in
Paragraphs 631-633, 636, 637, 639, 640, 641, 645, 646, 648 and 654 of the Recommended Order
concern a legal issue that may be outside of the Agency substantive jurisdiction. See ruling on
Delray’s Exception 3 infra. Nevertheless, even if the Agency does have substantive jurisdiction
26
over the conclusions of law in these paragraphs, it could not substitute conclusions of law as or
more reasonable than those of the ALJ. Therefore, Exception 1 is denied.
In Exception 2, JFK took exception to the findings of fact and conclusions of law in the
Recommended Order wherein the ALJ stated that the Agency currently has not travel time
standard with respect to acute care services, including, but not limited to, Paragraph 110. In
regards to Paragraph 110 of the Recommended Order, the findings of fact in that paragraph were
based on competent, substantial evidence (See ruling on Delray’s Exception 14 infra), and thus
cannot be disturbed by the Agency. See § 120.57(1)(), Fla. Stat.; Heifetz. What JFK, Delray
and Wellington all argued is that the travel time standards stated within the findings of fact of
previous CON recommended orders.constituted existing Agency policy and precedent because
they were adopted by the Agency in final orders. However, such is not the case. Agencies often
have no choice but to adopt findings of fact because they were based on competent, substantial
evidence and thus could not be rejected or modified by the agency. See § 120.57(1)(), Fla. Stat.;
Heifetz. The competent, substantial evidence in one case may not be the same in another case, as
was the situation in the case at bar. Jeffrey Gregg clearly and unequivocally testified that the
Agency does not have a travel time standard. Such a standard does not exist in rule or statute.
What the ALJ found in Bethesda I as a reasonable travel time standard is not applicable in this
matter. Therefore, Exception 2 is denied.
In Exception 3, JFK took exception to the findings of fact in Paragraph 111 of the
Recommended Order to the extent that the ALJ’s statements were intended as a finding that
CON applicants for satellite hospitals were not required to satisfy statutory and rule review
criteria, but could make up their own concepts and definitions of need. However, whatever JFK
believed a finding might have intended is irrelevant. The findings of fact in Paragraph 111 of the
27
Recommended Order were based on competent, substantial evidence. See Transcript, Volume
26, Pages 3428-3430. Thus, the Agency is prohibited from rejecting or modifying them. See §
120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 3 is denied.
In Exception 4, JFK took exception to the findings of fact in Paragraphs 118 and 119 of
the Recommended Order, and the conclusions of law in Paragraph 645 of the Recommended
Order, arguing that the ALJ misapprehended the relevance and weight to be accorded to bed
inventories and misapplied the law by confusing the criteria issues of “access” and “need.” The
findings of fact in Paragraphs 118 and 119 of the Recommended Order were based on
competent, substantial evidence. See Transcript, Volume 26, Pages 3420 and 3429-3430;
Transcript, Volume 27, Page 3486; Transcript, Volume 39, Page 5132; and Exhibits B-28A and
JFK-139 at Pages 21-22. Thus, the Agency cannot alter them. See § 120.57(1)(/), Fla. Stat.;
Heifetz. The conclusions of law in Paragraph 645 were based on the findings of fact in
Paragraphs 118 and 119 of the Recommended Order, and the Agency finds that, while it does
have substantive jurisdiction over the conclusions of law in Paragraph 645 of the Recommended
Order, it could not substitute conclusions of law as or more reasonable than those of the ALJ.
Therefore, Exception 4 is denied.
In Exception 5, JFK took exception to Paragraph 106 of the Recommended Order, The
Agency grants the exception and modifies Paragraph 106 as set forth in the ruling on Delray’s
Exception 11 infra.
In Exception 6, JFK took exception to the fact that the ALJ erroneously ignored, and
failed to make specific findings on, substantial issues and evidence presented by JFK and other
parties regarding the adverse impacts on the ability of local hospitals to recruit, retain and
maintain adequate clinical staffing if Bethesda’s application was approved. However, JFK’s
28
exception did not clearly identify the disputed portion of the recommended order by page
number or paragraph. While Section 120.57(1)(k), Florida Statutes (2006), requires that the
Agency’s “final order shall include an explicit ruling on each exception”, the Agency “need not
rule on an exception that does not clearly identify the disputed portion of the recommended order
by page number or paragraph, that does not identify the legal basis for the exception, or that does
not include appropriate and specific citations to the record.” Thus, the Agency declines to rule
on Exception 6,
In Exception 7, JFK took exception to the ALJ’s ultimate conclusions that Bethesda’s
CON application should be approved. However, JFK’s exception did not clearly identify the
disputed portion of the recommended order by page number or paragraph. Therefore, the
Agency declines to rule on Exception 7, See § 120.57(1)(k), Fla. Stat.
Delray’s Exceptions
In Exception 1, Delray took exception to the fact that the case ever proceeded to a formal
hearing. However, Delray’s exception did not clearly identify the disputed portion of the
recommended order by page number or paragraph. Thus, the Agency declines to rule on it. See
§ 120.57(1)(k), Fla. Stat.
In Exception 2, Delray took exception to Paragraph 85 of the Recommended Order, and,
in particular, to the last sentence of Paragraph 85, arguing that the Agency’s preliminary decision
was not entitled to any presumption of correctness, that the findings were based solely on the .
State Agency Action Report (SAAR), and that the finding improperly placed the burden of proof
on the Wellington, JFK and Delray. Regardless of Delray’s arguments, the findings of fact in
Paragraph 85 of the Recommended Order were based on competent, substantial evidence, See
29
Bethesda’s Exhibit B-1F. Thus, the Agency cannot reject or modify them. See § 120.57(1)(),
Fla. Stat.; Heifetz. Therefore, Exception 2 is denied.
In Exception 3, Delray took exception to Paragraph 88 of the Recommended Order,
arguing that the ALJ failed to resolve the significant issue of how Bethesda’s application was
handled by the Agency in this case, and that the ALJ ignored record testimony that the Agency
made no effort to differentiate Bethesda’s current application from its previous one that was
denied. Delray also argued that the ALJ incorrectly interpreted the doctrine of administrative
finality. Paragraph 88 of the Recommended Order is a mixed finding of fact and conclusion of
law that deals with a legal issue that may be outside the Agency’s substantive jurisdiction.!
Nevertheless, the Agency does not need to address the issue because Paragraph 88 is simply a
restatement of the ALJ’s previous decision on the issue that he made when he rendered an Order
on March 24, 2006 that denied Delray’s Motion for a Summary Recommended Order Denying
CON Application. Therefore, Exception 3 is denied.
In Exception 4, Delray took exception to the findings of fact in Paragraph 89 of the
Recommended Order, arguing that the findings of fact were not supported by the record.
Paragraph 89 of the Recommended Order is also a mixture of findings of fact and conclusions of
law regarding an issue that may be outside the scope of the Agency’s jurisdiction (See the ruling
on Delray’s Exception 3 supra). Nevertheless, the Agency need not address that matter because,
contrary to Delray’s assertions, the findings of fact in Paragraph 89 of the Recommended Order
were based on competent, substantial evidence. See’ Exhibit B-28A, Bethesda I final order,
which was officially recognized by the ALJ. Thus, the Agency cannot reject or modify them.
See § 120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 4 is denied.
} See, ¢.g., Decp Lagoon Boat Club, Ltd. v. Sheridan, 784 So.2d 1140, 1142 (Fla. 2d DCA 2001) (stating an agency does not
have substantive jurisdiction to decide whether the doctrine of collateral estoppel applies to a particular case).
30
In Exception 5, Delray took exception to the findings of fact in Paragraph 94 of the
Recommended Order, arguing that the rule changes have not substantially or materially changed
the “legal framework” in which Bethesda’s application is to be considered. Paragraph 94 of the
Recommended Order is also mixture of findings of fact and conclusions of law. The findings of
fact in Paragraph 94 of the Recommended Order were based on competent, substantial evidence.
See Transcript, Volume 26, Pages 3419-3420; Transcript, Volume 27, Pages 3607-3608, and
Exhibit B-28A. Thus, the Agency is prohibited from rejecting or modifying them. See §
120.57(1)(), Fla. Stat.; Heifetz. The conclusions of law concern an issue that may be outside the
Agency’s substantive jurisdiction. See the ruling on Delray’s Exception 3 supra. ‘Nevertheless,
the conclusions of law were based on findings of fact, which in tum were based on competent,
substantial evidence. Thus, even if the Agency had substantive jurisdiction over the conclusions
of law in Paragraph 94 of the Recommended Order, it could not substitute conclusions of law as
or more reasonable than those of the ALJ. Therefore, Exception 5 is denied.
In Exception 6, Delray took exception to the findings of fact in Paragraph 96 of the
Recommended Order, arguing again that the rule changes have not substantially or materially
changed the “legal framework” in which Bethesda’s application is to be considered. Regardless
of Delray’s arguments, the findings of fact in Paragraph 96 of the Recommended Order were
based on competent, substantial evidence, namely the final order in Bethesda I. Thus, the
Agency cannot reject or modify them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore,
Exception 6 is denied.
In Exception 7, Delray took exception to the findings of fact in Paragraphs 100 and 101
of the Recommended Order, arguing that the findings were not an accurate statement of Agency
policy and precedent with respect to. the interpretation of Section 408.035(5), Florida Statutes,
31
and reflected a misinterpretation and misapplication of the law. However, regardless of Delray’s
arguments, the findings of fact in Paragraph 100 and 101 of the Recommended Order were based
on competent, substantial evidence. See Exhibit B-28A. Further, the ALJ findings of fact in the
last two sentences of Paragraph 101 of the Recommended Order were reasonable inferences
based on competent, substantial evidence. Thus, the Agency cannot reject or modify them. See
§ 120.57(1)(J, Fla. Stat.; Heifetz. Therefore, Exception 7 is denied.
In Exception 8, Delray took exception to the findings of fact in Paragraph 102 of the
Recommended Order, arguing that the findings were not supported by law or the record. The
findings of fact in Paragraph 102 of the Recommended Order were based on competent,
substantial evidence. See Transcript, Volume 26, Pages 3418-3430. Thus, the Agency cannot
reject or modify them. See § 120.57(1)(/), Fla. Stat.; Heifetz. Therefore, Exception 8 is denied.
In Exception 9,. Delray took exception to the findings of fact in Paragraph 103 of the ;
Recommended Order, arguing that any findings that the “legal framework” in which Bethesda’s
application is to be considered has changed such that administrative finality and res judicata are
inapplicable were not supported by law or the record. Regardless of Delray’s arguments, the
findings of fact in Paragraphs 103 of the Recommended Order were based on competent,
substantial evidence. See Transcript, Volume 26, Pages 3418-3430; and Exhibit B-28A. Thus,
the Agency is prohibited from rejecting or modifying them. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 9 is denied.
In Exception 10, Delray took exception to the findings of fact in Paragraph 104 of the
Recommended Order, based on the arguments set forth in Exceptions 4, 5 and 6. Regardless of
Delray’s arguments, the findings of fact in Paragraph 104 of the Recommended Order were
based on competent, substantial evidence. See Transcript, Volume 26, Pages 3418-3430; and
32
Transcript, Volume 28, Pages 3607-3608. Thus, the Agency is prohibited from rejecting or
modifying them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 10 is denied.
In Exception 11, Delray took exception to the findings of fact in Paragraph 106 of the
Recommended Order, arguing that the findings were not supported by the record. A review of
the record shows that, while the first sentence of Paragraph 106 was based on competent,
substantial evidence (See Transcript, Volume 28, Page 3591), the second sentence of the
paragraph was not based on competent substantial evidence. Therefore, Delray’s Exception 11 is
partially granted to the extent that the second sentence of Paragraph 106 will be modified to
state:
After a year of study, the advisory group ultimately made no
recommendations to AHCA about how it should go about
considering applications for new hospitals.
In Exception 12, Delray took exception to the findings of fact in Paragraph 107 of the
Recommended Order, first arguing that any findings that the “legal framework” in which
Bethesda’s application is to be considered has changed such that administrative finality and res
judicata are inapplicable were not supported by law or.the record. Second, Delray argued that
the considerations and issues advanced by Bethesda to show “need” have not substantially
changed since Bethesda I. Finally, Delray argued that the ALJ failed to consider that fact that
Bethesda’s evidence of “need” did not provide any significant detail at the zip code level,
subdistrict, or district level. However, regardless of Delray’s arguments, the findings of fact in
Paragraph 107 of the Recommended Order were based on competent, substantial evidence. See
Transcript, Volume 26, Pages 3421-3423. Thus, the Agency cannot reject or modify them. See
§ 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 12 is denied.
33
In Exception 13, Delray took exception to the findings of fact in Paragraph 108 of the
Recommended Order based upon the reasoning set forth in Exceptions 4, 5 and 6. Regardless of
Delray’s arguments, the findings of fact in Paragraph 108 of the Recommended Order were
based on competent, substantial evidence. See, e.g., Transcript, Volume 26, Page 3423. Thus,
the Agency cannot disturb them. See § 120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 13
is denied.
In Exception 14, Delray took exception to the findings of fact in Paragraph 110 of the
Recommended Order, arguing that the findings were contrary to the Agency’s policy and
precedent of applying a 30 minute or more travel time standard. However, the “precedent” cited
to by Delray were “not normal” circumstances cases that are inapplicable to this matter. Delray
also argued that such a standard was applied in Bethesda I, yet not applied in this matter.
However, Delray’s argument is inaccurate. Based upon the ruling on Wellington’s Exception 4
and JFK’s Exception 2 supra, Exception 14 is denied.
In Exception 15, Delray took exception to the findings of fact in Paragraph 111 of the
Recommended Order based upon the reasoning set forth in Exceptions 4, 5 and 6. Moreover,
Delray argued that the findings of fact in Paragraph 111 of the Recommended Order were a
misstatement and misapplication of the law to the extent that they found that Bethesda was not
required to prove need for its CON application to be approved in this case. The findings of fact
in Paragraph 111 of the Recommended Order were based on competent, substantial evidence
(See Transcript, Volume 26, Pages 3428-3430) and thus cannot be disturbed by the Agency. See
§ 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 15 is denied.
In Exception 16, Delray took exception to the findings of fact in Paragraph 112 of the
Recommended Order, arguing that the firidings were not supported by the record and that the
34
ALJ failed to consider significant issues that were raised in this regard. Additionally, Delray
argued that the passage of time is does not constitute a substantial change in circumstances so as
to defeat the doctrines of administrative finality, res judicata, collateral estoppel and stare decisis.
Further, Delray argued that it is not and has not ever been law that population growth
automatically or necessarily gives rise to “need,” and to the extent that the findings in Paragraph
112 of the Recommended Order find or imply otherwise, they are simply wrong under the law
and not supported by the record. Finally, Delray contended that for population to constitute a
substantial change in material circumstances it would necessarily have to cause or create some
circumstance that was not an issue in Bethesda I and Delray claimed that Bethesda had not
proved this to be the case. However, despite Delray’s arguments, the findings of fact in
Paragraph 112 of the Recommended Order were based on competent, substantial evidence (See
Transcript, Volume 27, Pages 3515-3516 and 3547, and Exhibit JFK-139 at Pages 145-146), and
thus the Agency cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore,
Exception 16 is denied.
In Exception 17, Delray took exception to the findings of fact in Paragraphs 113-115 of
the Recommended Order, first arguing that the findings were nothing more than “findings of
what the Agency found” and not entitled to any presumption of correctness in this de novo
proceeding. Delray further argued that the references to the Agency’s focus on “the future” and
“planning for the future” were improper to the extent that they were based on a future beyond a
5-year planning horizon. In making this argument, Delray cited to its March 17, 2006 Motion in
Limine that was denied by the ALJ. Delray is, in essence, asking the Agency to review the
ALJ’s ruling on an evidentiary issue, which it cannot do. See Barfield v. Dep’t of Health, 805
So.2d 1008 (Fla. lst DCA 2002). Moreover, the findings of fact in Paragraphs 113-115 of the
35
Recommended Order were based on competent, substantial evidence (See Exhibit B-1F; and
Exhibit JFK-139 at Pages 45-46, 75-77 and 150-152) and thus cannot be disturbed by the
Agency. See § 120.57(1)(J, Fla. Stat., Heifetz. Therefore, Exception 17 is denied.
In Exception 18, Delray took exception to the findings of fact in Paragraph 119 of the
Recommended Order, arguing that the findings were a complete mischaracterization of the issue
in this case and reflect a misunderstanding or misapplication of the law. The findings of fact in
Paragraph 119 of the Recommended Order were based on competent, substantial evidence (See
Transcript, Volume 26, Pages 3420 and 3429-3430; Transcript, Volume 27, Page 3486;
Transcript, Volume 39, Page 5132; and Exhibit JFK-139 at Pages 21-22) and thus cannot be
disturbed by the Agency. See § 120.57(1)(J), Fla. Stat.; Heifetz. : Therefore, Exception 18 is
denied.
In Exception 19, Delray took exception to the findings of fact in all but the first sentence
of Paragraph 140 of the Recommended Order, arguing that the findings were not supported by
law or by the record. Delray, is, in essence, asking the Agency to re-weigh the record evidence
in order to make findings that are more favorable to Delray’s position, which the Agency cannot
do. See Barfield. Additionally, regardless of Delray’s arguments, the findings of fact in
Paragraph 140 of the Recommended Order were based on competent, substantial evidence. See
Transcript, Volume 14, Pages 1759-1764; and Exhibit B-17. Thus, the Agency cannot disturb
them. See § 120.57(1)(J), Fla. Stat.; Heifetz. Therefore, Exception 19 is denied.
In Exception 20, Delray took exception to the findings of fact in Paragraphs 141-209 of
the Recommended Order, arguing that none of the findings in these paragraphs constituted a
substantial change in material circumstances such that administrative finality and res judicata
would not apply. Delray is again asking the Agency to review the ALJ’s ruling on an issue that
36
may be outside the scope of the Agency substantive jurisdiction. See the ruling on Delray’s
Exception 3 supra. Additionally, regardless of Delray’s arguments, the findings of fact in
Paragraphs 141-209 of the Recommended Order were based on competent, substantial evidence
(See, ¢.g., Transcript, Volume 4, Pages 482-484 and 486; Transcript, Volume 12, Pages 1491-
1601; Transcript, Volume 13, Pages 1615 and 1621-1708; Transcript, Volume 14, Pages 1743-
1745 and 1760-1765; and Exhibits B-17, B-26C, B-30A-I, B-32, B-33, B-34, B-54, B- 83, and
JFK-134) and thus cannot be rejected or modified by the Agency. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 20 is denied.
In Exception 21, Delray took exception to the findings of fact in Paragraph 145 of the
Recommended Order, to the extent that the paragraph contained findings that go far beyond the
applicable five-year planning horizon. However, since the findings of fact in Paragraph 145 of
the Recommended Order were based on competent, substantial evidence (See Transcript,
Volume 14, Pages 1761-1764; and Exhibit B-17) the Agency cannot disturb them. See §
120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 21 is denied.
In Exception 22, Delray took exception to the findings of fact in Paragraph 147 of the
Recommended Order, arguing also that the findings in the paragraph go far beyond the
applicable five-year planning horizon. Additionally, Delray argued that, even with projections
extended far beyond the planning horizon, there was no change in the fact that the projected rate
of growth for the West Boynton area exceeded the projected rate of growth for Palm Beach
County, District 9 and the State of Florida. Regardless of Delray’s argument, the findings of fact
in Paragraph 147 of the Recommended Order were based on competent, substantial evidence.
See Transcript, Volume 14, Pages 1743-1745 and 1762-1763; and Exhibit B-17. Thus, the
Agency cannot disturb them. See § 120.57(1)(/, Fla. Stat.; Heifetz. Therefore, Exception 22 is
denied.
In Exception 23, Delray took exception to the findings of fact in Paragraphs 151-197 of
the Recommended Order and the findings of fact in the last sentence of Paragraph 202 of the
Recommended Order, arguing that Mr. Kilday’s testimony did not constitute a substantial change
in material circumstances such that administrative finality and res judicata would not apply.
The findings of fact in Paragraphs 151-197 of the Recommended Order and the last sentence of
Paragraph 202 of the Recommended Order were based on competent, substantial evidence. See,
e¢.g., Transcript, Volume 4, Pages 482-484 and 486; Transcript, Volume 12, Pages 1491-1601;
Transcript, Volume 13, Pages 1615 and 1621-1708; Transcript, Volume 14, Pages 1743-1745
and 1760-1765; and Exhibits B-17, B-26C, B-30A-I, B-32, B-33, B-34, B-54, B- 83, and JFK-
134. Because of this, the Agency is prohibited from disturbing them. See § 120.57(1)()), Fla.
Stat.; Heifetz. Therefore, Exception 23 is denied.
In Exception 24, Delray took exception to the findings of fact in Paragraph 200 of the
Recommended Order, arguing that the findings of fact did not constitute a substantial change in
material circumstances. Regardless of Delray’s arguments, the findings of fact in Paragraph 200
of the Recommended Order were based on competent, substantial evidence. See Transcript,
Volume 42, Pages 5608-5610; and Exhibits B-28A, Bethesda I, 27 FALR at 1473; B-148A and
B-148D. Thus, the Agency cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz.
Therefore, Exception 24 is denied.
In Exception 25, Delray took exception to the findings of fact in Paragraphs 222-262 of
the Recommended Order, arguing that the issues discussed in these paragraphs did not constitute
a substantial change in material circumstances such that the doctrines of administrative finality
38
and res judicata would not apply. However, regardless of Delray’s arguments, the findings of
fact in Paragraphs 222-262 of the Recommended Order were based on competent, substantial
evidence. See Transcript, Volume 1, Page 115; Transcript, Volume 2, Pages, 149-151 and 212;
Transcript, Volume 4, Pages 488-492; Transcript, Volume 9, Page 1148; Transcript, Volume 10,
Pages 1249-1250, 1262-1263, 1266, 1287 and 1296-1297; Transcript, Volume 14, Pages 1779-
1782, 1784-1787, 1789-1790, 1795-1796 and 1820; Transcript, Volume 23, Pages 2978-2980;
Transcript, Volume 24, Pages 3194-3195; Transcript, Volume 32, Pages 4277 and 4279;
Transcript, Volume 37, Pages 4897-4903; Transcript, Volume 57, Page 7694; and Exhibits B-
1C, B-1D, B-1F, B-15-2, B-17, B-26-2, B-48, B-51, B-54, B-55, B-56, B-57, B-58, B-63, B-64,
B-71D, B-71H, B-73G, B-73H, B-73L, B-73-2, and W-18. Thus, the Agency is prohibited from
rejecting or modifying them. See § 120.57(1)(J, Fla. Stat.; Heifetz. Therefore, Exception 25 is
denied.
In Exception 26, Delray took exception to the findings of fact in Paragraph 222 of the
Recommended Order, arguing that the ALJ’s finding that there was evidence to support
Bethesda’s claim that the special needs of the elderly were not being adequately served due to
emergency department overcrowding was not supported by the record. Delray, is again, in
essence, asking the Agency to re-weigh the evidence in order to make findings more favorable to
Delray’s position, which the Agency cannot do. See Heifetz. The ALJ’s finding was based on
competent, substantial evidence. See ruling on Exception 25 supra. Thus, the Agency cannot
disturb it. See § 120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 26 is denied.
In Exception 27, Delray took exception to the findings of fact in Paragraph 230 of the
Recommended Order, arguing that “holds” are clearly not a new or changed issue since Bethesda
1. Based upon the ruling on Exception 25 supra, Exception 27 is also denied,
39
In Exception 28, Delray took exception to the findings of fact in Paragraph 234 of the
Recommended Order, arguing that the record does not support the finding that “ED holds, and
resulting back-up and crowding in the BMH ED, has an adverse effect on the quality of care
provided to ED patients.” Delray is again, in essence, asking the Agency to re-weigh the
evidence presented in this matter in order to make findings that are more favorable to Delray’s
position. However, the Agency is not allowed to engage in such action. See Heifetz. The
findings of fact in Paragraph 234 of the Recommended Order were based on competent,
substantial evidence. See Transcript, Volume 2, Pages 150-151 and 212; and Transcript,
Volume 10, Pages 1266 and 1287. Thus, the Agency is prohibited from rejecting or modifying
them. See § 120.57(1)(J, Fla. Stat.; Heifetz. Therefore, Exception 28 is denied.
In Exception 29, Delray took exception to the findings of fact in Paragraphs 248 and 249
of the Recommended Order, arguing that the findings were not a new or changed issue since
Bethesda J, were not supported by the record, and failed to consider significant issues raised and
evidence presented that were contrary to the findings. However, regardless of Delray’s
arguments, the findings of fact in Paragraphs 248 and 249 of the Recommended Order were
based on competent, substantial evidence. See ruling on Exception 25 supra. Thus, the Agency
cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 29 is denied.
In Exception 30, Delray took exception to the findings of fact in Paragraphs 251-253 of
the Recommended Order, arguing that findings were not a new or changed issue since Bethesda
I, that the letters and testimony referenced in the findings were full of hearsay and speculation,
and that the ALJ made findings contrary to the record. Delray is again asking the Agency to re-
weigh the evidence in order to make findings that are more favorable to Delray’s position, which
the Agency cannot do. See Heifetz. Delray is also asking the Agency to review an evidentiary
40
ruling, which the Agency cannot do. See Barfield. The findings of fact in Paragraphs 251-253
' of the Recommended Order were based on competent, substantial evidence. See ruling on
Exception 25 supra. Thus, the Agency is prohibited from rejecting or modifying them. See §
120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 30 is denied.
In Exception 31, Delray took exception to the findings of fact in Paragraph 256 of the
Recommended Order, arguing that the testimony of a community witness is not a substantial
change in material circumstances. Delray also argued that the record did not support a finding
that the new Bethesda Hospital emergency department would improve the quality of care for
anyone. Lastly, Delray argued that the ALJ’s finding that elderly patients in the West Boynton
area “will enjoy enhanced access” was based on an incorrect interpretation and application of the
statutory criteria in Section 408.035(5), Florida Statutes. The findings of fact in Paragraph 256
of the Recommended Order were based on competent, substantial evidence. See Transcript,
Volume 2, Pages 149-151 and 212-213; and Transcript, Volume 4, Pages 409-410 and 450-451.
Thus, the Agency is prohibited from rejecting or modifying them. See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 31 is denied.
In Exception 32, Delray took exception to the findings of fact in the last two sentences of
Paragraph 261 of the Recommended Order, arguing that they were not supported by law or the
record and that they reflected the application of an improper legal standard. Regardless of
Delray’s arguments, the findings of fact in Paragraph 261 of the Recommended Order were
based on competent, substantial evidence. See Transcript, Volume 2, Pages 212-213; Transcript,
Volume 14, Pages 1741 and 1766-1771; and Transcript, Volume 17, Pages 2143-2145. Thus,
the Agency cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 32
is denied.
41
In Exception 33, Delray took exception to the findings of fact in Paragraphs 268-289 of
the Recommended Order, arguing that the “special needs of Spanish-speaking migrants” was
clearly not a substantial change in material circumstances such that the application of
administrative finality could be avoided. Regardless of Delray’s arguments, the findings of fact
in Paragraphs 268-289 of the Recommended Order were based on competent, substantial
evidence. See Transcript, Volume 1, Pages 102-109; Transcript, Volume 2, Pages 144-148, 161-
162 and 166-168; Transcript, Volume 14, Page 1847; Transcript, Volume 27, Pages 3444-3447,
and Exhibits B-1F, B-17 and B-43E. Thus, the Agency is prohibited from rejecting or
modifying them. See § 120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 33 is denied.
In Exception 34, Delray took exception to the findings of fact in Paragraphs 268 and 269
of the Recommended Order, arguing that they are nothing more than findings of what the
Agency found in its preliminary review of Bethesda’s CON application. - The findings of fact in
Paragraphs 268 and 269 of the Recommended Order were based on competent, substantial
evidence. See Exhibit B-1F. Thus, the Agency cannot reject or modify them. See §
120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 34 is denied.
In Exception 35, Delray took exception to the findings of fact in Paragraph 279 of the
Recommended Order, arguing that they were not supported by the record. Based upon the ruling
in Exception 33 supra, Exception 35 is also denied.
In Exception 36, Delray took exception to the findings of fact in Paragraph 284 of the
Recommended Order, arguing that they too were not supported by the record. Based on the
ruling on Exception 33 supra, Exception 36 is also denied.
In Exception 37, Delray took exception to the findings of fact in Paragraphs 290-309 of
the Recommended Order, arguing that the subject matter of the findings, the “special needs of
42
the elderly,” was not a new circumstance and had not changed at all since Bethesda I. However,
regardless of Delray’s argument, the findings of fact in Paragraphs 290-309 of the
Recommended Order were based on competent, substantial evidence. See Transcript, Volume 1,
Page 116; Transcript, Volume 4, Pages 450-452; Transcript, Volume 5, Page 645; Transcript,
Volume 6, Pages 732-733; Transcript, Volume 12, Page 1493; Transcript, Volume 14, Pages
1767-1768 and 1841-1844; Transcript, Volume 15, Pages 1858-1859; Transcript, Volume 19,
Pages 2413-2414; Transcript, Volume 20, Page 2597; Transcript, Volume 21, Pages 2725 and
2746; Transcript, Volume 27, Page 3445; Transcript, Volume 32, Page 4317; Transcript, Volume
42, Pages 5570-5571; Transcript, Volume 43, Pages 5674, 5685 and 5727-5728; Transcript,
Volume 53, Pages 7257-7264; and Exhibits B-1C, B-1D, B-15J, B-15K, B-150, B-15P, B-17, B-
26-1, B-45A, B-60 and W-30. Thus, the Agency is prohibited from rejecting or modifying them.
See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 37 is denied.
In Exception 38, Delray took exception to the findings of fact in Paragraphs 326-335 of
the Recommended Order, arguing that, in making the findings, the ALJ completely failed to
consider significant issues and evidence with regard to the alleged EMS problems discussed in
these findings. Again, Delray is, in essence, asking the Agency to re-weigh the evidence in order
to make findings that are more favorable to Delray’s position, which the Agency cannot do. See
Heifetz. Furthermore, the Agency cannot disturb the findings of fact in Paragraphs 326-335 of
the Recommended Order because they were based on competent, substantial evidence (See, ¢.g.,
Transcript, Volume 3, Pages 282-289, 292-309, 314, 317-319 and 338; Transcript, Volume 56,
Pages 7568-7575; and Exhibits B-8A, B-8E, B-8F and B-8G). See § 120.57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 38 is denied.
43
In Exception 39, Delray took exception to the finding of fact in Paragraph 326 of the
Recommended Order, arguing that the finding was not supported by the record. Contrary to
Delray’s argument, the finding of fact in Paragraph 326 of the Recommended Order was a
reasonable inference based on competent, substantial evidence. See Transcript, Volume 3, Pages
321-325; and Exhibit B-8A. Thus, the Agency is prohibited from rejecting or modifying it. See
§ 120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 39 is denied.
In Exception 40, Delray took exception to the findings of fact in Paragraph 334 of the
Recommended Order, arguing that the findings were not supported by the record. Contrary to
Delray’s argument, the findings of fact in Paragraph 334 of the Recommended Order were based
on competent, substantial evidence. See ruling on Exception 38 supra. Thus, the Agency cannot
disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 40 is denied.
In Exceptions 41 and 42, Delray took exception to the findings of fact in Paragraph 336-
353 of the Recommended Order, arguing that the findings did not constitute a substantial change
in material circumstances since Bethesda I, and that the ALJ failed to consider significant issues
and evidence relating thereto. Regardless of Delray’s argument, the findings of fact in Paragraph
336-353 of the Recommended Order were based on competent, substantial evidence. See
Transcript, Volume 13, Page 1705; Transcript, Volume 19, Pages 2382-2383, 2393-2400, 2402-
2403, 2409-2410, 2412-2414, 2420-2422, 2427-2428, 2478-2480 and 2487-2494; Transcript,
Volume 25, Pages 3274-3278, 3286 and 3288-3289; Transcript, Volume 26, Pages 3318, 3336,
3347, 3377-3379, 3381-3382 and 3386-3388; Transcript, Volume 46, Pages 6167-6168, 6173
and 6196; Transcript, Volume 58, Pages 7791, 7795 ‘and 7800-7815; and Exhibits B-1C, B-30H,
B-45A, B-45F, B-45H, B-45A.1, B-51, B-54, B-63 and JFK-137. Thus, the Agency cannot
44
reject or modify them. See § 120.57(1)()), Fla. Stat.; Heifetz. Therefore, Exceptions 41 and 42
are denied. .
In Exception 43, Delray took exception to the findings of fact in Paragraphs 354-356 of
the Recommended Order, arguing that the Agency had an established “policy and precedent”
with regard to a travel time standard to acute care hospitals, that there was no “statutory
mandate” that the Agency “plan ahead and not wait until drive times to acute care services
exceed 30-40 minutes,” and that the ALJ made findings based on projections into the future well
beyond the planning horizon. First, contrary to Delray’s argument, the Agency’s adoption of
findings of fact in a recommended order does not necessarily constitute Agency policy and
precedent. Agencies, in general, are often forced to adopt findings of fact that they do not agree
with because those findings of fact are based on competent, substantial evidence and thus cannot
be rejected or modified by an agency. Second, both of Delray’s arguments are irrelevant. The
findings of fact in Paragraphs 354-356 of the Recommended Order were based on competent,
substantial evidence. See Transcript, Volume 27, Pages 3512-3514, 3515, 3525-3526 and 3547-
3548; Transcript, Volume 28, Pages 3585-3592; Transcript, Volume 30, Pages 3931 and 3941;
and Exhibits B-74E, B-95, B-133, B-149 and JFK-139 at Pages 44-46. Thus, the Agency cannot
disturb them. See § 120.57(1)(/, Fla. Stat.; Heifetz. Therefore, Exception 43 is denied.
In Exception 44, Delray took exception to the findings of fact in Paragraphs 359-366 of
the Recommended Order, arguing that the findings did not constitute a substantial change in
material circumstances. Regardless of Delray’s argument, the findings of fact in Paragraphs
359-366 of the Recommended Order were based on competent, substantial evidence. See
Transcript, Volume 1, Pages 99-101; Transcript, Volume 8, Pages 1033-1034; Transcript,
Volume 14, Pages 1735-1736; Transcript, Volume 22, Pages 2883-2885; Transcript, Volume 23,
45
Pages 2968-2970; Transcript, Volume 24, Pages 3183-3186; Transcript, Volume 35, Pages 3692-
3698; Transcript, Volume 31, Pages 4057-4059; Transcript, Volume 37, Pages 4913-4914; and
Exhibits B-1D, B-1F, B-50, B-51, B-59, B-71B, JFK-137, W-29 and W-31. Thus, the Agency
cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 44 is denied.
In Exception 45, Delray took exception to the findings of fact in Paragraphs 367-374 of
the Recommended Order, arguing that the findings did not constitute a substantial change in
material circumstances since Bethesda I, and that the ALJ failed to consider the significant fact
that COWBRA solicited the letters of support from its members and only asked for information
about negative experiences due to waits in hospital ERs. Regardless of Delray’s arguments, the
findings of fact in Paragraphs 367-374 of the Recommended Order were based on competent,
substantial evidence. See Transcript, Volume 1, Pages 115-116; Transcript, Volume 3, Pages
279-391; Transcript, Volume 4, Pages 474-481; Transcript, Volume 10, Pages 1207 and 1213-
1214; Transcript, Volume 12, Pages 1488-1489; Transcript, Volume 54, Page 7310; and Exhibits
B-1D, B-8A, B-26B, B-26-1, B-47A and B-65. Thus, the Agency is prohibited from rejecting or
modifying them. See § 120.57(1)(J), Fla. Stat.; Heifetz. Therefore, Exception 45 is denied.
In Exception 46, Delray took exception to the findings of fact in Paragraph 372 of the
Recommended Order, arguing that the findings were contrary to the record and did not constitute
a substantial change in material circumstances since Bethesda_J. Regardless of Delray’s
arguments, the findings of fact in Paragraph 372 of the Recommended Order were based on
competent, substantial evidence. See Transcript, Volume 3, Pages 279-391; and Exhibits B-8A
and B-65. Thus, the Agency cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz.
Therefore, Exception 46 is denied.
46
In Exception 47, Delray took exception to the findings of fact in Paragraphs 375-379 and
413-417 of the Recommended Order, arguing that the findings did not constitute a substantial
change in material circumstances since Bethesda I, and that the ALJ failed to consider significant
issues and evidence relating to Bethesda’s arguments about private rooms. Regardless of
Delray’s arguments, the findings of fact in Paragraphs 375-379 and 413-417 of the
Recommended Order were based on competent, substantial evidence. See Transcript, Volume 1,
Pages 109-112; Transcript, Volume 2, Pages 270-272; Transcript, Volume 6, Page 693;
Transcript, Volume 8, Pages 1029-1030; Transcript, Volume 9, Pages 1146 and 1153;
Transcript, Volume 10, Pages 1310-1316; Transcript, Volume 14, Pages 1737-1738; Transcript,
Volume 22, Pages 2800-2802; Transcript, Volume 24, Page 3187; Transcript, Volume 36, Page
4760; Transcript, Volume 37, Page 4869; and Exhibits B-1C, B-7A, B-28E, B-59 and B-62.
Thus, the Agency is prohibited from rejecting or modifying them. See § 120.57(1)(J, Fla. Stat.;
Heifetz. Therefore, Exception 47 is denied.
In Exception 48, Delray took exception to the findings of fact in Paragraphs 384-388 of
the Recommended Order, arguing that the findings did not constitute a substantial change in
material circumstances since Bethesda I. Regardless of Delray’s argument, the findings of fact
in Paragraph 384-388 of the Recommended Order were based on competent, substantial
evidence. See Transcript, Volume 1, Pages 112-113; Transcript, Volume 14, Pages 1775-1777,
Transcript, Volume 20, Page 2564; Transcript, Volume 21, Pages 2709 and 2710-2716;
Transcript, Volume 24, Page 3189; Transcript, Volume 27, Pages 3474-3475; Transcript,
Volume 37, Pages 4858-4861; Transcript, Volume 43, Pages 5678-5683; and Exhibit B-17.
Thus, the Agency cannot reject or modify them. See § 120.57(1)(), Fla. Stat.; Heifetz.
Therefore, Exception 48 is denied.
47
In Exception 49, Delray took exception to the findings of fact in Paragraphs 415-417 of
the Recommended Order, arguing that the findings were not supported by the record. Contrary
to Delray’s argument, the findings of fact in Paragraphs 415-417 of the Recommended Order
were based on competent, substantial evidence. See ruling on Exception 47 supra. Thus, the
Agency cannot disturb them. See § 120.57(1)(D, Fla. Stat.; Heifetz. Therefore, Exception 49 is
denied.
In Exception 50, Delray took exception to the findings of fact in Paragraphs 418-445 of
the Recommended Order, arguing that the ALJ, in making these findings, did not properly
account for the fact that in addition to the significant adverse impact that the new hospital would
have on existing providers, the new hospital was being proposed at a time when the overall
healthcare system and market in Palm Beach County was in a state of flux. Regardless of
Delray’s argument, the findings of fact in Paragraphs 418-445 of the Recommended Order were
based on competent, substantial evidence. See Transcript, Volume 16, Pages 2019-2037;
Transcript, Volume 21, Pages 2676 and 2721-2724; Transcript, Volume 22, Pages 2800-2801,
2842-2844, 2847-2850 and 2900-2901; Transcript, Volume 24, Pages 3140, 3177-3180 and
3213-3214; Transcript, Volume 35, Pages 4672-4674; Transcript, Volume 37, Page 4924;
Transcript, Volume 43, Pages 5698 and 5705-5707; Transcript, Volume 45, Page 6113;
Transcript, Volume 47, Pages 6377-6383; Transcript, Volume 48, Pages 6443-6478; Transcript,
Volume 49, Pages 6583-6585; Transcript, Volume 51, Pages 7005-7010 and 7020-7021;
Transcript, Volume 56, Pages 7616-7625 and 7630-7639; Exhibits B-16D, B-18A, B-18C, B-
18D, B-18E, B-18F, B-18G, B-18H, B-20A, B-20H, B-28A, B-67H, B-67-5, B-67-6, B-71N, B-
72B, B-75N; B-132, B-163, D-12, JFK-12B, W-2 and W-29; and Manatee Memorial Hospital,
LP et.al v. Agency for Health Care Administration (North Port HMA), 28 FALR 1697, 1733
48
(AHCA 2006). Thus, the Agency cannot disturb them. See § 120.57(1)(), Fla. Stat.; Heifetz.
Therefore, Exception 50 is denied.
In Exception 51, Delray took exception to the findings of fact in Paragraphs 446-501 of
the Recommended Order, arguing that the findings did not constitute a substantial change in
material circumstances since Bethesda I, and that, in making the findings, the ALJ ignored the
fact that Bethesda had still not met with its medical staff to discuss how it planned to implement
a common medical staff and ER call schedule between its current facility and the proposed
satellite hospital. Regardless of Delray’s arguments, the findings of fact in Paragraphs 446-501
of the Recommended Order were based on competent, substantial evidence. See Transcript,
Volume 1, Pages 77-78, 93 and 114; Transcript, Volume 2, Page 205-208, 241 and 269;
Transcript, Volume 3, Pages 315-316; Transcript, Volume 4, Pages 398-411, 422-423, 426-427,
429-431, 436-444, 448-454, 458-459, 462, 463-467 and 469; Transcript, Volume 9, Pages 1100-
1106 and 1177; Transcript, Volume 10, Pages 1247-1248 and 1280; Transcript, Volume 24,
Pages 3164, 3199-3204 and 3244-3245; Transcript, Volume 29, Pages 3674-3677 and 3713-
3719; Transcript, Volume 31, Pages 4088-4089; Transcript, Volume 32, Pages 4196-4197, 4221-
4226 and 4289-4290; Transcript, Volume 38, Pages 5032-5037; Transcript, Volume 39, Page
5191; Transcript, Volume 54, Pages 7310-7311; and Exhibits B-1C, B-28A, JFK-129, JFK-130,
JFK-132 and JFK-137. Thus, the Agency cannot disturb them. See § 120,57(1)(), Fla. Stat.;
Heifetz. Therefore, Exception 51 is denied.
In Exception 52, Delray took exception to the finding of fact in Paragraph 484 of the
Recommended Order, arguing that the finding was not supported by the record. Contrary to
Delray’s argument, the finding of fact in Paragraph 484 of the Recommended Order was based
on competent, substantial evidence. See Transcript, Volume 32, Page 4197. Thus, the Agency is
prohibited from rejecting or modifying it. See § 120.57(1)(D, Fla. Stat.; Heifetz. Therefore,
Exception 52 is denied.
In Exception 53, Delray took exception to the findings of fact in Paragraph 530 of the
Recommended Order, arguing that the findings were not supported by the record. Contrary to
Delray’s argument, the findings of fact in Paragraphs 530 of the Recommended Order were
based on competent, substantial evidence. See Transcript, Volume 9, Pages 1172-1173;
Transcript, Volume 35, Pages 4581-4582; and Exhibit B-22A. Thus, the Agency cannot disturb
them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 53 is denied.
In Exception 54, Delray took exception to the findings of fact in Paragraph 565 of the
Recommended Order, arguing that the findings were based on projections beyond the applicable
planning horizon. Regardless of Delray’s argument, the findings of fact in Paragraph 565 of the
Recommended Order were based on competent, substantial evidence. See Transcript, Volume
15, Pages 1867-1869 and 1876-1877; and Exhibit B-17. Thus, the Agency cannot reject or
modify them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 54 is denied.
In Exception 55, Delray took exception to the findings of fact in Paragraphs 576-593 of
the Recommended Order, arguing that the findings were not supported by the record. Contrary
to Delray’s argument, the findings of fact in Paragraphs 576-593 of the Recommended Order
were based on competent, substantial evidence. See Transcript, Volume 1, Pages 117-118,
Transcript, Volume 7, Pages 910-911; Transcript, Volume 15, Pages 1878-1880; Transcript,
Volume 18, Pages 2349-2350; Transcript, Volume 24, Page 3173; Transcript, Volume 27, Pages
3479-3480; Transcript, Volume 37, Pages 4919-4923; Transcript, Volume 40, Pages 5300-5302;
Transcript, Volume 43, Pages 5783 and 5786; Transcript, Volume 53, Pages 7273-7274 and
7277-7279, Transcript, Volume 54, Pages 7305-7306; and Exhibits B-1C, B-1F, B-28A, B-62,
50
B-73P, B-75F and D-12. Thus, the Agency cannot disturb them. See § 120.57(1)(J), Fla. Stat.;
Heifetz. Therefore, Exception 55 is denied.
In Exception 56, Delray took exception to the findings of fact in Paragraphs 594-596 of
the Recommended Order, arguing that the findings revealed an improper and erroneous
interpretation of the statutory criterion in Section 408.035(8), Florida Statutes and that the ALJ
ignored other relevant evidence. Delray is again, in essence, asking the Agency to re-weigh the
evidence in order to make findings that are more favorable to Delray’s position, which the
Agency cannot do. See Heifetz. Furthermore, regardless of Delray’s arguments, the findings of
fact in Paragraphs 594-596 of the Recommended Order were based on competent, substantial
evidence. See Joint Pre-hearing Stipulation. Thus, the Agency cannot disturb them. See §
120.57(1)(J), Fla. Stat.; Heifetz. Therefore, Exception 56 is denied.
In Exception 57, Delray took exception to the findings of fact in Paragraphs 598-615 of
the Recommended Order, arguing that the findings did not constitute a substantial change in
material circumstances since Bethesda I. Regardless of Delray’s argument, the findings of fact
in Paragraphs 598-615 of the Recommended Order were based on competent, substantial
evidence. See Transcript, Volume 1, Pages 76-77 and 83-84; Transcript, Volume 7, Pages 933-
936; Transcript, Volume 11, Pages 1402-1408 and 1412-1414; Transcript, Volume 14, Pages
1820-1822; Transcript, Volume 22, Page 2896; Transcript, Volume 23, Pages 3053 and 3055;
Transcript, Volume 27, Pages 3448-3449 and 3480; Transcript, Volume 30, Page 3920;
Transcript, Volume 44, Pages 5934-5935; Transcript, Volume 47, Pages 6342-6344; Transcript,
Volume 48, Page 6484; Transcript, Volume 50, Pages 6841-6842; Transcript, Volume 51, Pages
7032-7037; and Exhibits B-1C, B-1F, B-2H, B-2I, B-2N, B-20, B-2P, B-17, B-201, B-50, B-
51
67G, B-67H, JFK-12A, JFK-139 and W-2. Thus, the Agency is prohibited from rejecting or
modifying them. See § 120.57(1)(), Fla. Stat.; Heifetz. Therefore, Exception 57 is denied.
In Exceptions 58-65, Delray took exception to the conclusions of law in Paragraphs 628-
640 of the Recommended Order, arguing that the ALJ incorrectly ruled on the issues of
administrative finality and res judicata that were raised in this matter. While there is some
question whether the Agency has substantive jurisdiction over the issues addressed in Paragraphs
628-640 of the Recommended Order (See ruling on Delray’s Exception 3 supra), the Agency
does not need to address that question. Like the case of Wuesthoff Memorial Hospital, Inc. v.
AHCA, 06-0571 (DOAH January 26, 2007) (AHCA April 11, 2007), the conclusions of law in
Paragraphs’ 628-640 of the Recommended Order were based on factual findings that
demonstrated the doctrines of administrative finality and res judicata should not apply in this
case, including the fact that the legislature had abolished CON review for beds added to existing
hospitals since Bethesda’s first CON application, the repeal of the acute care bed need
methodology since Bethesda’s first CON application, tremendous population growth in the West
Boynton area since Bethesda’s first CON application, increasing delays in accessing hospital
emergency services, and the issue of ED overcrowding since Bethesda’s first CON application.
These factual findings were, in turn, based on competent, substantial evidence. See, €.2.,
Paragraphs 95-103 of the Recommended Order and the rulings on Wellington’s Exception 1,
JFK’s Exception 1 and Delray’s Exceptions 6-9 supra; Paragraphs 141-209 and the rulings on
Wellington’s Exceptions 8-13 and Delray’s Exceptions 20-24 supra; Paragraphs 325-358 and the
rulings on Wellington’s Exceptions 34-42 and Delray’s Exceptions 38-43 supra; and Paragraphs
218-267 of the Recommended Order and the rulings on Wellington’s Exceptions 16-24 and
Delray’s Exceptions 25-32 supra. Therefore, Exceptions 58-65 are denied.
52
In Exception 66, Delray took exception to the conclusions of law in Paragraph 641 of the
Recommended Order, arguing that the ALJ did not apply a standard consistent with law and that
the conclusions were not supported by the record. However, the conclusions of law in Paragraph
641 of the Recommended Order were based on the findings of fact, which, in turn, were based on
competent, substantial evidence. See the rulings on Wellington’s Exceptions 1-61, JFK’s
Exceptions 1-5 and Delray’s Exceptions 1-57 supra. The Agency finds that, while it does have
substantive jurisdiction over the conclusions of law in Paragraph 641 of the Recommended
Order, it could not substitute conclusions of law as or more reasonable than those of the ALJ.
Therefore, Exception 66 is denied.
in Exception 67, Delray took exception to the conclusions of law in Paragraph 643 of the
Recommended Order, arguing that they were not supported by the record and contrary to the
legal authorities regarding administrative finality and res judicata. The conclusions of law in
Paragraph 643 of the Recommended Order were based on the findings of fact in Paragraph 568-
593 of the Recommended Order, which, in turn, were based on competent, substantial evidence.
See the rulings on Wellington’s Exceptions 58-60 and Delray’s Exception 55 supra. Thus, the
Agency finds that, while it does have substantive jurisdiction over the conclusions of law in
Paragraph 643 of the Recommended Order, it could not substitute conclusions of law as or more
reasonable than those of the ALJ. Therefore, Exception 67 is denied.
In Exception 68, Delray took exception to the conclusions of law in Paragraph 645 of the
Recommended Order on the grounds that the ALJ completely failed to consider the lower cost
alternative of an off-site ED, and that the statement that “[bJed inventory in the Subdistrict is no
longer relevant” was a misstatement that reflected a misconstruction and misapplication of the
statutory criteria. The conclusions of law in Paragraph 645 of the Recommended Order were
53
based on the findings of fact in Paragraphs 118-119, 263-267, 389-397 and 594-596 of the
Recommended Order, which, in turn, were based on competent, substantial evidence. See, e.g.,
the rulings on Wellington’s Exception 7, JFK’s Exception 4 and Delray’s Exceptions 18 and 56
supra. Thus, the Agency finds that, while it does have substantive jurisdiction over the
conclusions of law in Paragraph 645 of the Recommended Order, it could not substitute
conclusions of law as or more reasonable than those of the ALJ. Therefore, Exception 68 is
denied.
In Exception 69, Delray took exception to the conclusions of law in Paragraph 646 of the
Recommended, arguing that they were not supported by the record and reflected an erroneous
interpretation and application of the law. The conclusions of law in Paragraph 646 of the
Recommended Order were based on the findings of fact in Paragraphs 218-267 and 325-358 of
the Recommended Order, which, in turn, were based on competent, substantial evidence. See,
¢.g., the rulings on Wellington’s Exceptions 16-24 and 34-42, and Delray’s Exceptions 25-32
and 38-43 supra. Thus, the Agency finds that, while it does have substantive jurisdiction over
the conclusions of law in Paragraph 646 of the Recommended Order, it could not substitute
conclusions of law as or more reasonable than those of the ALJ. Therefore, Exception 69 is
denied.
In Exception 70, Delray took exception to the conclusions of law in Paragraph 648 of the
Recommended Order, based on its argument in Exception 69. Based upon the ruling on
Exception 69, Exception 70 is also denied.
In Exception 71, Delray took exception to the conclusion of law in Paragraph 649 of the
Recommended Order on the grounds that it was not supported by the record. The conclusions of
law in Paragraph 646 of the Recommended Order were based on the findings of fact in
Paragraphs 123-445 of the Recommended Order, which, in turn, were based on competent,
substantial evidence. See, e.g., the rulings on Wellington’s Exceptions 8-50, JFK’s Exception |
and Delray’s Exceptions 19-50 supra. Thus, the Agency finds that, while it does have
substantive jurisdiction over the conclusions of law in Paragraph 649 of the Recommended
Order, it could not substitute conclusions of law as or more reasonable than those of the ALJ.
Therefore, Exception 71 is denied. °
In Exception 72, Delray took exception to the conclusions of law in Paragraph 654 of the
Recommended Order, arguing that they were contrary to the record and the law applicable to this
case. Based on the rulings on Delray’s Exceptions 1-71, Exception 72 is also denied.
FINDINGS OF FACT
The Agency hereby adopts the findings of fact set forth in the Recommended Order,
except where noted infra.
CONCLUSIONS OF LAW
The Agency adopts the conclusions of law set forth in the Recommended Order.
ORDER
Based upon the foregoing, Bethesda’s CON application no. 9838 is granted.
DONE and ORDERED this {* day of Avg vst —_, 2007, in Tallahassee, Florida.
ANDREW€; OBI. M.D., SECRETARY
AGENCY FOR HEALTH CARE ADMINISTRATION
55
NOTICE OF RIGHT TO JUDICIAL REVIEW
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 THE 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.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has
been furnished by U.S. Mail, or by the method indicated, to the persons named below on this
PF day of Ala gust , 2007.
RICHARD J. SHOOP, Agency
Agency for Health Care Administration
2727 Mahan Drive, MS#3
Tallahassee, Florida 32308-5403
(850) 922-5873
COPIES FURNISHED TO:
David M. Maloney
Administrative Law Judge
Division of Administrative Hearings
The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
C. Gary Williams, Esquire
Ausley & McMullen
Post Office Box 391
Tallahassee, Florida 32302
56
Stephen A. Ecenia, Esquire
Rutledge, Ecenia, Purnell & Hoffman, P.A.
Post Office Box 551 :
Tallahassee, Florida 32302-0551
John H. Parker, Jr., Esquire
Parker, Hudson, Rainer & Dobbs
1500 Marquis Two Tower
285 Peachtree Center Avenue, Northeast
Atlanta, Georgia 30303
Karen A. Putnal, Esquire
Parker, Hudson, Rainer & Dobbs, LLP
118 North Gadsden Street, Suite 200
Tallahassee, Florida 32301
Robert D. Newell, Jr., Esquire
Newell, Terry & Douglas, P.A.
817 North Gadsden Street
Tallahassee, Florida 32303-6313
Michael O. Mathis, Esquire
Assistant General Counsel
Agency for Health Care Administration
2727 Mahan Drive, MS #3
Tallahassee, Florida 32308
Elizabeth Dudek
Health Quality Assurance
Jan Mills
Facilities Intake Unit
57
Docket for Case No: 05-002352CON
Issue Date |
Proceedings |
Apr. 23, 2009 |
BY ORDER OF THE COURT: Appellant`s motion and amended motion for rehearing is denied.
|
Jul. 07, 2008 |
BY ORDER OF THE COURT: Appellant`s (Delray Medical Center, Inc., d/b/a Delray Medical Center) unopposed motion filed July 1, 2008, for extension ot Time is granted filed.
|
Jul. 07, 2008 |
BY ORDER OF THE COURT: Appelant`s unopposed motion filed June 30, 2008, for extension of time is granted filed.
|
Jun. 23, 2008 |
BY ORDER OF THE COURT: AHCA`s motion for extension of time is granted.
|
Jun. 09, 2008 |
BY ORDER OF THE COURT: Appellees` joint motion for extension of time is granted as to AHCA.
|
Jun. 09, 2008 |
BY ORDER OF THE COURT: Joint unopposed motion for extension of time is granted as to AHCA.
|
Jun. 06, 2008 |
BY ORDER OF THE COURT: Appellee`s motion for extension of time is granted.
|
Jun. 02, 2008 |
BY ORDER OF THE COURT: Appellee`s motion for extension of time is granted.
|
Apr. 18, 2008 |
BY ORDER OF THE COURT: Appellee`s motion for extension of time is granted.
|
Apr. 14, 2008 |
BY ORDER OF THE COURT: Appellee`s motion for extension of time is granted (05-2753CON).
|
Apr. 02, 2008 |
BY ORDER OF THE COURT: Motion for expanded brief by Delray Medical Center and motion for expanded brief by JFK Medical Center is granted (4D07-3527).
|
Apr. 02, 2008 |
BY ORDER OF THE COURT: Motion for expanded brief by Delray Medical Center and motion for expanded brief by JFK Medical Center is granted (4D07-3528).
|
Mar. 31, 2008 |
BY ORDER OF THE COURT: Motion for expanded brief by Delray Medical Center and motion for expanded brief by JFK Medical Center is granted (4D07-3789).
|
Mar. 06, 2008 |
BY ORDER OF THE COURT: Appellants` motion to clarify is granted.
|
Mar. 05, 2008 |
BY ORDER OF THE COURT: Appellant`s joint motion to clarify and establish time for service of initial briefs is granted.
|
Dec. 14, 2007 |
BY ORDER OF THE COURT: appellant`s motions filed December 3, 2007, and agreed amended motion filed December 7, 2007, for consolidation are granted filed.
|
Dec. 12, 2007 |
BY ORDER OF THE COURT: motion to supplement the record is denied without prejudice.
|
Nov. 19, 2007 |
BY ORDER OF THE COURT: Appellee`s motion for extension of time is granted.
|
Nov. 13, 2007 |
BY ORDER OF THE COURT: Appellee`s motion filed November 5, 2007, for extension of time is granted.
|
Nov. 01, 2007 |
BY ORDER OF THE COURT: Appellee`s motion for extension of time is granted.
|
Oct. 12, 2007 |
BY ORDER OF THE COURT: notice of appearance and substitution of counsel, Justin M. Senior is hereby substituted for Michael Mathis filed.
|
Oct. 12, 2007 |
BY ORDER OF THE COURT: notice of appearance and substitution of counsel, Justin M. Senior is hereby substituted for Michael Mathis filed.
|
Sep. 14, 2007 |
Acknowledgment of New Case, DCA Case No. 4D07-3489 filed.
|
Sep. 14, 2007 |
Acknowledgment of New Case, DCA Case No. 4D07-3527 filed.
|
Sep. 14, 2007 |
Acknowledgment of New Case, DCA Case No. 4D07-3528 filed.
|
Aug. 09, 2007 |
Final Order filed.
|
Aug. 09, 2007 |
JFK Medical Center`s Exceptions to Recommended Order filed.
|
Apr. 05, 2007 |
Recommended Order cover letter identifying the hearing record referred to the Agency.
|
Apr. 05, 2007 |
Recommended Order (hearing held April 3-7, 10-14, 17-20, 25-28 and May 1-5, 8-13, and 15, 2006). CASE CLOSED.
|
Jan. 30, 2007 |
Notice of Supplemental Authority filed.
|
Jan. 08, 2007 |
Notice of Supplemental Authority filed.
|
Dec. 15, 2006 |
Notice of Supplemental Authority filed.
|
Nov. 27, 2006 |
Letter to Judge Maloney from K. Putnal regarding exhibits omitted from the admitted exhibit list of Bethesda`s Proposed Recommended Order filed.
|
Sep. 12, 2006 |
Proposed Recommended Order of Bethesda Healthcare System, Inc. filed.
|
Sep. 12, 2006 |
Wellington Regional Medical Center, Inc.`s Proposed Recommended Order filed.
|
Sep. 12, 2006 |
Columbia/JFK Medical Center Limited Partnership d/b/a JFK Medical Center`s Proposed Recommended Order filed.
|
Sep. 12, 2006 |
Proposed Recommended Order by Delray Medical Center filed.
|
Sep. 12, 2006 |
AHCA`s Statement of Position Regarding a Geographic Access Policy for Acute Care Services filed.
|
Sep. 12, 2006 |
Bethesda`s Reply to Delray`s Response to Bethesda`s Memorandum of Law as to AHCA`s Lack of a Drive Time Access Policy for Acute Care Hospital Services filed.
|
Sep. 12, 2006 |
Notice of Appearance (filed by K. Putnal).
|
Sep. 11, 2006 |
Respondent, State of Florida, Agency for Health Care Administration`s Proposed Recommended Order filed.
|
Aug. 21, 2006 |
Order Granting Extension of Time (proposed recommended orders to be filed by September 12, 2006).
|
Aug. 17, 2006 |
Unopposed Motion for Extension of Time to File Proposed Recommended Orders filed.
|
Jul. 20, 2006 |
Order (any objection not expressly ruled upon above is overruled).
|
Jul. 13, 2006 |
Delray`s Response in Opposition to Bethesda`s Memorandum of Law as to AHCA`s Lack of a Drive Time Access Policy for Acute Care Hospital Services filed.
|
Jun. 30, 2006 |
Bethesda`s Responses to Petitioners` Objections to Depositions filed.
|
Jun. 30, 2006 |
Delray`s Response to Bethesda`s Post-hearing Objections to Depositions Offered into Evidence filed.
|
Jun. 23, 2006 |
Wellington`s Objections filed.
|
Jun. 23, 2006 |
JFK Medical Center Limited Partnership d/b/a JFK Medical Center`s Notice of Objections to Depositions filed.
|
Jun. 23, 2006 |
Combined Witness and Exhibit Indexes filed.
|
Jun. 23, 2006 |
Delray`s Objections to Deposition Testimony Offered into Evidence filed.
|
Jun. 23, 2006 |
Bethesda`s Post-hearing Objections to Depositions Offered into Evidence filed.
|
Jun. 19, 2006 |
Transcript (Volumes 1-58) filed. |
Jun. 08, 2006 |
Joint Status Report on Agreement of Parties Regarding Post-hearing Submissions filed.
|
May 31, 2006 |
Letter to Judge Maloney from J. Menton filed.
|
May 02, 2006 |
Bethesda`s Memorandum of Law as to AHCA`s Lack of a Drive Time Access Policy for Acute Care Hospital Services filed.
|
May 01, 2006 |
CASE STATUS: Hearing Held. |
May 01, 2006 |
Bethesda`s Motion in Limine to Exclude any Testimony or Exhibits Relating to Pinecrest Rehabilitation Hospital filed.
|
Apr. 28, 2006 |
Bethesda`s Memorandum of Law in Support of its Objections to Evidence of Mapquest Distance and Drive Time Estimates filed.
|
Apr. 20, 2006 |
Bethesda`s Motion to Quash Subpoena of Kieran Kilday filed.
|
Apr. 17, 2006 |
Bethesda`s Reply to JFK`s and Delray`s Responses in Opposition to Motion in Limine as to Adverse Impact filed.
|
Apr. 14, 2006 |
Notice of Substitution of Counsel and Request for Service (filed by M. Mathis).
|
Apr. 11, 2006 |
Order (Delray`s Motion in Limine denied).
|
Apr. 10, 2006 |
JFK Medical Center Limited Partnership d/b/a JFK Medical Center`s Response to Bethesda`s Motion in Limine to Exclude Evidence of Anticipated Adverse Impact from New OHS Programs in the District filed.
|
Apr. 10, 2006 |
Delray Medical Center`s Amended Joinder in JFK`s Response to Bethesda`s Motion in Limine to Exclude Evidence of Anticipated Adverse Impact from New OHS Programs in the District filed.
|
Apr. 05, 2006 |
AHCA`s Statement of Position with Respect to the "Planning Horizon" Issue (and in Response to Delrays Motion in Limine) filed.
|
Apr. 04, 2006 |
Amended Notice of Hearing (hearing set for April 3 through 7, 10 through 14, 17 through 20, 25 through 28 and May 1 through 5, 2006; 9:00 a.m.; Tallahassee, FL; amended as to additional dates for hearing).
|
Apr. 03, 2006 |
CASE STATUS: Hearing Partially Held; will recommence on May 1, 2006. |
Apr. 03, 2006 |
JFK`s Motion for Extension of Time to Respond to Bethesda`s Motion in Limine to Exclude Evidence of Anticipated Adverse Impact from New OHS Programs in the District filed.
|
Apr. 03, 2006 |
Order (denying JFK and Kendall Healthcare Group`s motion to quash).
|
Mar. 31, 2006 |
Amended Exhibit List of Bethesda Healthcare System, Inc. d/b/a West Boynton Community Hospital filed.
|
Mar. 31, 2006 |
Reply to Bethesda`s Response to Delray`s Motion in Limine filed.
|
Mar. 31, 2006 |
Delray Medical Center`s Trial Brief filed.
|
Mar. 30, 2006 |
Joint Pre-hearing Stipulation filed.
|
Mar. 29, 2006 |
AHCA`s Response and Objections to Delray`s Second Request for Admissions filed.
|
Mar. 27, 2006 |
Delray Medical Center`s Response to Bethesda Healthcare System, Inc.`s Second Request for Production of Documents filed.
|
Mar. 27, 2006 |
Bethesda`s Motion in Limine to Exclude Evidence of Anticipated Adverse Impact from New OHS Programs in the District filed.
|
Mar. 24, 2006 |
Bethesda`s Motion in Limine to Exclude JFK`s New and Untimely Analyses and Related Exhibits of Ron Luke and any Related Testimony filed.
|
Mar. 24, 2006 |
Bethesda`s Response to Delray`s Motion in Limine filed.
|
Mar. 24, 2006 |
Order (Motion for Summary Recommended Order Denying CON Application is denied).
|
Mar. 24, 2006 |
Bethesda`s Responses and Objections to Delray`s Second Request for Admissions filed.
|
Mar. 23, 2006 |
Bethesda`s Notice of Filing; Appendices C and D filed (not available for viewing).
|
Mar. 23, 2006 |
Bethesda`s Response to Delray`s Reply filed.
|
Mar. 22, 2006 |
JFK`s Joinder in Delray`s Motion for Summary Recommended Order filed.
|
Mar. 22, 2006 |
Notice of Taking Deposition Duces Tecum filed.
|
Mar. 22, 2006 |
Delray`s Reply to Bethesda`s Response to Delray`s Motion for Summary Recommended Order filed.
|
Mar. 20, 2006 |
Appendix to Bethesda`s Response to Delray`s Motion for Summary Recommended Order filed (not available for viewing).
|
Mar. 20, 2006 |
Bethesda`s Response to Delray`s Motion for Summary Recommended Order filed.
|
Mar. 20, 2006 |
Bethesda`s Notice of Filing Depositions and Deposition Exhibits in Support of Response to Delray`s Motion for Summary Recommended Order filed (condensed depositions and exhibits not available for viewing).
|
Mar. 17, 2006 |
Delray Medical Center`s Motion in Limine filed.
|
Mar. 15, 2006 |
Notice of Taking Deposition filed.
|
Mar. 10, 2006 |
Bethesda`s Response to HCA JFK`s and Kendall`s Motion to Quash Subpoena Duces Tecum for Travel Time Study filed.
|
Mar. 10, 2006 |
Order (Bethesda`s Motion for Extension of Time to Respond is granted to the extent that the time for filing a response is extended from March 14, 2006, until the close of business on Monday, March 20, 2006; Delray is granted leave to file a reply to the response, provided it is filed prior to the close of business at DOAH on Wednesday, March 22, 2006).
|
Mar. 09, 2006 |
Motion for Extension of Time to Respond to Motion for Summary Recommended Order filed.
|
Mar. 09, 2006 |
JFK`s Notice of Status Conference filed.
|
Mar. 07, 2006 |
Delray Medical Center`s Notice of Filing Exhibits to Motion for Summary Recommended Order Denying CON Application filed (not available for viewing).
|
Mar. 07, 2006 |
Deposition of Michael C. Carroll (Volumes I - V) filed.
|
Mar. 07, 2006 |
Delray Medical Center`s Notice of Filing Depositions of Michael C. Carroll filed.
|
Mar. 07, 2006 |
Deposition of Robert Hill (Volumes I - III) filed.
|
Mar. 07, 2006 |
Delray Medical Center`s Notice of Filing Depositions of Robert Hill filed.
|
Mar. 06, 2006 |
Motion for Summary Recommended Order Denying CON Application filed.
|
Mar. 01, 2006 |
JFK Medical Center`s and Kendall Healthcare Group, Ltd.`s Motion to Quash Subpoena Duces Tecum filed.
|
Mar. 01, 2006 |
Order (Motion for Prtective Order is denied).
|
Feb. 28, 2006 |
Withdrawal of Motion for Protective Order to Reschedule Deposition of Jill Gregory filed.
|
Feb. 27, 2006 |
Bethesda`s Motion for Protective Order to Reschedule Deposition of Jill Gregory Unilaterally Scheduled March 1, 2006 filed.
|
Feb. 24, 2006 |
Notice of Taking Deposition filed.
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Feb. 24, 2006 |
Bethesda`s Response in Opposition to Delray Medical Center`s Motion for Protective Order filed.
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Feb. 23, 2006 |
Motion to Abate filed.
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Feb. 23, 2006 |
Bethesda`s Second Request for Production of Documents to Delray Medical Center filed.
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Feb. 23, 2006 |
Delray`s Objections and Motion for Protective Order Regarding Bethesda`s Notice of Taking Deposition Duces Tecum of William Jeffery Davis filed.
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Feb. 22, 2006 |
Delray Medical Center`s Second Request for Admissions to Agency for Health Care Administration filed.
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Feb. 22, 2006 |
Delray Medical Center`s Second Request for Admissions to Bethesda Healthcare System, Inc. filed.
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Feb. 21, 2006 |
Motion for Protective Order filed.
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Feb. 16, 2006 |
Notice of Taking Deposition filed.
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Feb. 07, 2006 |
Bethesda`s First Amended Notice of Taking Deposition Duces Tecum of Gina Melby filed.
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Feb. 07, 2006 |
Bethesda`s First Amended Notice of Taking Deposition Duces Tecum of Thomas Davidson filed.
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Feb. 07, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Eric Kramer, M.D. filed.
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Feb. 07, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of John Levin, D.P.M. filed.
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Feb. 07, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Santiago Hernandez, M.D. filed.
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Feb. 07, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Malcolm Dorman, M.D. filed.
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Feb. 07, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Michael Patterson filed.
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Feb. 07, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of James Jaffe, M.D. filed.
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Feb. 07, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Steven Dutcher, D.O. filed.
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Feb. 07, 2006 |
Bethesda`s Amended Notice of Taking Deposition Duces Tecum of Michael Lakow, M.D. filed.
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Feb. 07, 2006 |
Bethesda`s Amended Notice of Taking Deposition Duces Tecum of P. William Ludwig, M.D. filed.
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Feb. 01, 2006 |
Notice of Taking Telephonic Deposition Duces Tecum filed.
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Jan. 31, 2006 |
Bethesda`s Notice of Taking Rule 1.310(b)(6) Deposition Duces Tecum of JFK Medical Center Limited Partnership filed.
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Jan. 31, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Eva Ricketts filed.
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Jan. 31, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Mitchell Feldman filed.
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Jan. 31, 2006 |
Bethesda`s Notice of Taking Rule 1.310(b)(6) Deposition Duces Tecum of Delray Medical Center, Inc. filed.
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Jan. 31, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Robert J. Greene filed.
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Jan. 31, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Patricia Greenberg filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Madelyn Christopher filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Alan Pillersdorf, M.D. filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Kenneth Scheppke, M.D. filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of James Goldenberg, M.D. filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Charles Posternack, M.D. filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Gerardo Aguirre, M.D. filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Samuel Lederman, M.D. filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Skip Marsh filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Trudy Bromley filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Mark Goldstein, M.D. filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of P. William Ludwig, M.D. filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Michael Lakow, M.D. filed.
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Jan. 30, 2006 |
Bethesda`s First Supplement to its Notice of Taking Deposition Duces Tecum of Gina Melby filed.
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Jan. 30, 2006 |
Bethesda`s First Supplement to its Notice of Taking Rule 1.310(b)(6) Deposition Duces Tecum of JFK Medical Center Limited Partnership filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Thomas Davidson filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Kevin Dilallo filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Rule 1.310(b)(6) Deposition Duces Tecum of Wellington Regional Medical Center, Inc. filed.
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Jan. 30, 2006 |
Bethesda`s First Supplement to its Notice of Taking Deposition Duces Tecum of Thomas Davidson filed.
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Jan. 30, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of David Soria, M.D. filed.
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Jan. 23, 2006 |
Bethesda`s Amended Notice of Taking Deposition Duces Tecum of David Sachs, M.D. filed.
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Jan. 23, 2006 |
Bethesda`s Amended Notice of Taking Deposition Duces Tecum of Robert J. Greene filed.
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Jan. 23, 2006 |
Bethesda`s Amended Notice of Taking Deposition Duces Tecum of Patricia Greenberg filed.
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Jan. 23, 2006 |
Bethesda`s Amended Notice of Taking Deposition Duces Tecum of Lloyd Zucker, M.D. filed.
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Jan. 23, 2006 |
Bethesda`s Amended Notice of Taking Rule 1.310(b)(6) Deposition Duces Tecum of Delray Medicial Center, Inc. filed.
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Jan. 23, 2006 |
Bethesda`s Amended Notice of Taking Deposition Duces Tecum of Mitchell Feldman filed.
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Jan. 20, 2006 |
Bethesda`s Notice of Taking Rule 1.310(b)(6) Deposition Duces Tecum of Delray Medical Center, Inc. filed.
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Jan. 20, 2006 |
Delray`s Objections and Motion for Protective Order Regarding Bethesda`s Notice of Taking Deposition Duces Tecum of Delray Medical Center, Inc. filed.
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Jan. 20, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Mitchell Feldman filed.
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Jan. 20, 2006 |
Delray`s Objections and Motion for Protective Order Regarding Bethesda`s Notice of Taking Deposition Duces Tecum of Mitchell Feldman filed.
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Jan. 20, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Lloyd Zucker, M.D. filed.
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Jan. 20, 2006 |
Delray`s Objections and Motion for Protective Order Regarding Bethesda`s Notice of Taking Deposition Duces Tecum of Lloyd Zucker, M.D. filed.
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Jan. 20, 2006 |
Bethesda`s Notice of Taking Deposition Duces Tecum of David Sachs, M.D. filed.
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Jan. 20, 2006 |
Delray`s Objections and Motion for Protective Order Regarding Bethesda`s Notice of Taking Deposition Duces Tecum of David Sachs, M.D. filed.
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Jan. 18, 2006 |
Notice of Taking Deposition Duces Tecum filed.
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Jan. 11, 2006 |
Motion for Protective Order filed.
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Dec. 19, 2005 |
Delray Medical Center`s Motion to Compel filed.
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Dec. 14, 2005 |
Notice of Taking Corporate Deposition Duces Tecum filed.
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Dec. 05, 2005 |
Notice of Taking Deposition Duces Tecum filed.
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Dec. 05, 2005 |
Bethesda`s Notice of Taking Rule 1.310(b)(6) Deposition Duces Tecum of Tenet Florida, Inc. filed.
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Nov. 23, 2005 |
Bethesda`s Motion to Compel JFK to Answer Interrogatories and Produce Documents filed.
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Nov. 07, 2005 |
Amended Notice of Taking Deposition Duces Tecum filed.
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Nov. 02, 2005 |
Notice of Unavailability filed.
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Nov. 02, 2005 |
Notice of Hearing (hearing set for April 3 through 7, 10 through 14, 17 through 20 and 25 through 28, 2006; 9:00 a.m.; Tallahassee, FL).
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Nov. 01, 2005 |
Supplemental Response to Order Canceling Hearing filed.
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Oct. 28, 2005 |
JFK`s Scheduling Response filed.
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Oct. 28, 2005 |
Bethesda`s Response to Order Canceling Hearing filed.
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Oct. 28, 2005 |
Delray`s Response to Order Canceling Hearing filed.
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Oct. 28, 2005 |
WRMC`s Response to Request for Hearing Dates filed.
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Oct. 26, 2005 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Alan Miller filed.
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Oct. 26, 2005 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Steve Filton filed.
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Oct. 26, 2005 |
Subpoena Duces Tecum filed.
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Oct. 26, 2005 |
Order Cancelling Hearing (parties to advise status by October 28, 2005).
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Oct. 21, 2005 |
Order (Delray`s Motion for Continuance denied without prejudice, WRMC`s Motio in Limine denied, WRMC`s Alternative Motion for Continuance denied without prejudice, JFK`s Motion in Limine denied without prejudice).
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Oct. 19, 2005 |
Delray`s Response to Bethesda`s Motion to Compel Delray to Answer Interrogatories and Produce Documents filed.
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Oct. 19, 2005 |
Notice of Taking Deposition Duces Tecum filed.
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Oct. 19, 2005 |
Notice of Telephonic Hearing filed.
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Oct. 17, 2005 |
Bethesda`s Response in Opposition to Motions to Continue filed.
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Oct. 17, 2005 |
JFK`s Joinder in Motion to Continue and Motion in Limine filed.
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Oct. 14, 2005 |
Supplement to Motion in Limine and in the Alternative Motion for Continuance filed.
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Oct. 13, 2005 |
Bethesda`s Notice of Service of Answers and Objections to Wellington`s Second Set of Interrogatories filed.
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Oct. 13, 2005 |
Notice of Taking Deposition Duces Tecum filed.
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Oct. 13, 2005 |
Notice of Service of Bethesda`s Answers and Objections to JFK Medical Center`s First Set of Interrogatories filed.
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Oct. 13, 2005 |
Bethesda`s Notice of Service of Responses and Objections to Wellington`s First Set of Interrogatories filed.
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Oct. 13, 2005 |
Bethesda`s Notice of Service of Responses and Objections to Delray`s Second Set of Interrogatories filed.
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Oct. 13, 2005 |
Bethesda`s Notice of Service of Responses and Objections to Delray`s First Set of Interrogatories filed.
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Oct. 12, 2005 |
Bethesda`s Motion to Compel Delray to Answer Interrogatories and Produce Documents filed.
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Oct. 12, 2005 |
Bethesda`s Motion to Compel Wellington to Answer Interrogatories and Produce Documents filed.
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Oct. 12, 2005 |
Motion in Limine and in the Alternative Motion for Continuance filed.
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Oct. 12, 2005 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Steve Filton filed.
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Oct. 12, 2005 |
Bethesda`s Notice of Taking Deposition Duces Tecum of Alan Miller filed.
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Oct. 11, 2005 |
Motion to Continue and Request for Status Conference filed.
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Sep. 26, 2005 |
AHCA`s Response to Delray`s First Request for Admissions filed.
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Sep. 20, 2005 |
Wellington`s Response and Objections to Bethesda`s First Request for Production of Documents filed.
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Sep. 20, 2005 |
Wellington`s Notice of Service of Answers and Objections to Bethesda`s First Set of Interrogatories filed.
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Sep. 15, 2005 |
Delray Medical Center`s Response to Bethesda Healthcare System, Inc.`s First Request for Production of Documents filed.
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Sep. 15, 2005 |
Delray Medical Center`s Notice of Service of Answers to Bethesda`s First Interrogatories filed.
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Sep. 15, 2005 |
Notice of Appearance as Co-counsel filed.
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Sep. 15, 2005 |
Notice of Taking Depositions Duces Tecum filed.
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Sep. 15, 2005 |
Wellington Regional Medical Center Inc.`s Second Request for Production of Documents to Bethesda Healthcare System, Inc. filed.
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Sep. 13, 2005 |
Notice of Taking Deposition Duces Tecum (J. Gregg) filed.
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Sep. 13, 2005 |
Notice of Service of Wellington Regional Medical Center`s Second Set of Interrogatories to Bethesda Healthcare System, Inc. filed.
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Sep. 12, 2005 |
JFK Medical Center Limited Partnership, d/b/a JFK Medical Center`s response to Bethesda`s First Request for Production of Documents filed.
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Sep. 12, 2005 |
Notice of Service of JFK Medical Center Limited Partnership, d/b/a/ JFK Medical Center`s Answers and Objections to Bethesda`s First Set of Interrogatories filed.
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Sep. 09, 2005 |
Notice of Service of JFK Medical Center Limited Partnership, d/b/a/ JFK Medical Center`s First Set of Interrogatories to Bethesda Health System, Inc. filed.
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Sep. 09, 2005 |
JFK Medical Center`s First Request for Production of Documents to Bethesda Health care System, Inc. filed.
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Aug. 26, 2005 |
Wellington Regional Medical Center, Inc.`s First Request for Production of Documents to Bethesda Healthcare System, Inc. filed.
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Aug. 26, 2005 |
Notice of Service of Wellington Regional Medical Center`s First Set of Interrogatories to Bethesda Healthcare System, Inc. filed.
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Aug. 26, 2005 |
Delray Medical Center`s Notice of Service of It`s Second Interrogatories to Bethesda Healthcare System, Inc. filed.
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Aug. 26, 2005 |
Delray Medical Center`s Motion to Exceed Number of Interrogatories filed.
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Aug. 26, 2005 |
Delray Medical Center`s Notice of Service of It`s First Interrogatories to Bethesda Healthcare System, Inc. filed.
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Aug. 26, 2005 |
Delray Medical Center`s First Request for Production of Documents to Bethesda Healthcare System, Inc. filed.
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Aug. 26, 2005 |
Delray Medical Center`s First Request for Admissions to Bethesda Healthcare System, Inc. filed.
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Aug. 26, 2005 |
Delray Medical Center`s First Request for Admissions to Agency for Health Care Administration filed.
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Aug. 03, 2005 |
Order Granting Consolidation (consolidated cases are: 05-2352CON, 05-2594CON, and 05-2753CON).
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Aug. 03, 2005 |
Order of Pre-hearing Instructions.
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Aug. 03, 2005 |
Notice of Hearing (hearing set for November 29 through December 2, 5 through 9, 12 through 16 and 19 through 23, 2005; 9:00 a.m.; Tallahassee, FL).
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Jul. 29, 2005 |
Joint Response to Initial Orders and Unopposed Joint Motion to Consolidate filed.
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Jul. 18, 2005 |
Notice of Appearance (filed by J. Parker Jr. and R. Weiss).
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Jul. 12, 2005 |
Order (WRMC`s Motion to Enlarge Time to Respond to Initial Order granted, parties shall have up to and including July 29, 2005, for which to file their response to the Initial Order).
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Jul. 11, 2005 |
WRMC`s Motion to Enlarge Time to Respond to Initial Order filed.
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Jul. 01, 2005 |
Initial Order.
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Jun. 28, 2005 |
Wellington Regional Medical Center, Inc.`s Petition for Formal Administrative Hearings filed.
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Jun. 28, 2005 |
Notice (of Agency referral) filed.
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Orders for Case No: 05-002352CON
Issue Date |
Document |
Summary |
Aug. 08, 2007 |
Agency Final Order
|
|
Apr. 05, 2007 |
Recommended Order
|
Bethesda Healthcare demonstrated the need for an 80-bed satellite hospital in the West Boynton area on the basis of enhanced access to emergency services for the elderly.
|