Findings Of Fact Upon consideration of the oral and documentary evidence presented the following facts are found: Petitioners each made application for a certificate of need under the provisions of Sections 381.493 through 381.497, Florida Statutes, 1975, which applications were submitted to the Bureau of Community Medical Facilities and accepted as complete by the bureau. Each application seeks a certificate of need for a third generation computerized axial tomography scanner (whole body unit) hereinafter referred to as a CAT scanner. There is presently in Jacksonville a head scanner installed at St. Vincent Hospital in November, 1975, and a whole body scanner at St. Luke's Hospital which has been in full operation since January, 1976. All three Petitioners are located in Jacksonville, Florida. The applications were processed by the appropriate Health Systems Agency. After due consideration the Health Systems Agency recommended that each of the three applications be granted. At the request of the Bureau of Community Medical Facilities, Department of Health and Rehabilitative Services, the State Hospital Advisory Council reviewed the applications and upheld the Health Systems Agency's determination that the three applications should be granted certificates of need. After consideration of the applications, the Health Systems Agency's recommendation the State Hospital Advisory Council's recommendation, Mr. Art Forehand, Administrator, Office of Community Medical Facilities, Respondent herein, notified each of the three Petitioners that their applications were not favorably considered. Mr. Forehand's notification set forth three reasons for the unfavorable consideration. Those were (1) lack of demonstrated need for the requested scanner, (2) failure of each application to demonstrate positive action toward containment of cost for services rendered to the public, and (3) lack of demonstrated unavailability, unaccessability, and inadequacy of like services within the Jacksonville area. At the time of his decision Mr. Forehand had no material or information available to him which was not available to the Health Systems Agency or the State Hospital Advisory Council at the time of their decision. At the time the three applications were denied Mr. Forehand felt that there did exist a need for one additional scanner in the Jacksonville area but he did not feel that he should bear the burden of deciding which one of the three applications should be granted and therefore all three were denied. Except for those matters set forth in Mr. Forehand's denial and noted above, none of the parties to this proceeding disputed that the criteria for determining need found in Section 101-1.03(c), F.A.C., were met. A study of computerized axial tomography with suggested criteria for review of certificate of need applications was conducted by the staff of the Health Systems Agency of Northeast Florida relative to the Duval County area. This study was published in April of 1976 and its findings appear to have been accepted by the Health Systems Agency. As one of its suggested criteria for determining need it found that a hospital or applicant should have a potential case load of at least 1,000 CAT scans per year. The study went on to project a potential case load for the three Petitioners herein. That projection for Baptist Memorial Hospital shows a a potential case load of 2,512 scans per year. The study noted that Baptist Memorial projected 1,300 scans for the first year during start up operations and 2,080 scans during the second and third years of their forecast. The study found that Riverside Hospital has a potential case load of 1,196 scans per year compared to their own projections of 1,432 scans per year. The study finally found that the University Hospital has a potential case load of 1,558 scans per year compared to their projection of 2,904. Testimony on behalf of the Respondent shows that in the opinion of Respondent full use of a CAT scanner is 10 scans per day on a 20-day work month working five days a week. As shown by unrebutted testimony the existing scanner at St. Luke's Hospital in Jacksonville is presently averaging 10 scans per day, five-days a week. Further, according to the evidence presented by Respondent, the existing scanner at St. Vincent is being utilized to at least 85 percent of its capacity. Respondent took the position at the hearing that when existing scanners are being used to 85 percent or more of their capacity a need exists for more equipment. Thus, it appears that using the criteria of utilization adhered to by Respondent, the existing CAT scanners in Jacksonville are being utilized to the extent that there is a need for additional scanners. University Hospital has 310 licensed beds and is the community hospital in Duval County with the responsibility of serving the indigent on an emergency and short term basis. It is the trauma center of the city and has the most active emergency room. It is also the major teaching hospital in Duval County. Respondent agrees that it has the greatest need of any hospital in Duval County for a CAT scanner. The University Hospital has approximately 300 visits per month to its emergency room. In the four months prior to the date of final hearing the hospital did 586 skull x-rays due to trauma. In the case of acute trauma patients frequently may not be moved from one hospital to another for the purpose of a CAT scan nor, in some cases, should other dangerous invasive techniques be used for diagnosis. Baptist Hospital has 567 licensed beds and is a major oncology center or cancer center and does a large amount of surgical cancer work in additional to radiation therapy. With the possible exception of University Hospital, Baptist Hospital is the largest pediatric hospital in the area. According to the testimony of the administrator of the hospital it would take 14 to 18 months after receipt of a certificate of need to have a CAT scanner in service. Riverside Hospital has 183 licensed beds. The hospital has been a specialty hospital since its establishment in 1908 and serves the Riverside Clinic. The hospital has approximately 200 specialized physicians, all board certified, on-staff. Riverside is a unique hospital because of its degree of specialty and its relationship to Riverside Clinic. Riverside Hospital does 100 percent of the Riverside Clinic's radiology work. Riverside Hospital has been known as an established diagnostic center. Witnesses for Riverside Hospital testified that if they were not able to have a CAT scanner their reputation and ability to provide first class service would be seriously diminished. CAT scanners represent a significant development in diagnostic medicine. They reduce the need for many dangerous, painful and costly injections of dye, air and radioactive isotopes required by some of the more traditional diagnostic procedures. The three most common tests displaced by CAT scanners are pneumoencephalography, angiography and radioactive isotope scanning. The first two of the foregoing are particularly expensive procedures and require hospitalization. At present, patients at the three Petitioner hospitals have to be transported to another facility in order to use a scanner. The transfer of an inpatient to another hospital for a scan may effectively consume the better part of a patient's day and may require an extra day of hospitalization. The cost of transportation, increased hospital stay and ancillary matters increase the actual cost to the Patient. Patients suffering from severe trauma or otherwise in a critical state, may not be transported out of a hospital to a scanner. All three of the Petitioners have an active neurological and neurosurgical staff and qualified radiologists. The unrebutted testimony indicates that, although CAT scanners are a new development whose potential has not yet been fully explored and whose development may not yet be final, they nevertheless have become an essential diagnostic tool of regular use.
Findings Of Fact The Change of Ownership In March 1993, Galen filed an application for a CON to add a ten-bed Level II Neonatal Intensive Care Unit (NICU) at its hospital known as Westside Regional Medical Center, located in Broward County in District X. This application, CON No. 7248, was initially denied by the Agency. Galen filed a Petition for Formal Administrative Hearing on August 12, 1993, challenging that denial and seeking approval of its application. In the same batching cycle, Memorial filed an application for a ten bed Level II NICU, Con No. 7249, which the Agency also preliminarily denied. On August 13, 1993, Memorial filed its petition for formal administrative hearing. The cases were consolidated for hearing by Order entered September 3, 1993. Two existing providers of Level II NICU services in the District sought and were granted leave to intervene: NBHD and Plantation. On January 7, 1994, NBHD filed a Motion for Summary Recommended Order. The basis for summary relief was that subsequent to the filing of its application for the Westside facility, Galen had sold or transferred that facility to Columbia and that Columbia had become the new license holder for the facility. Galen responded in opposition that no material facts set forth in the application for the CON to establish the Level II NICU at Westside had changed as a result of the transfer to Columbia. Furthermore, Galen contends that its application must be permitted to undergo the de novo comparative review process. The Galen application was deemed complete, preliminarily reviewed and initially denied. The basis of the initial denial was unrelated to any change in ownership. Galen timely sought de novo comparative review by invoking the administrative hearing process on August 12, 1993. The application has not been withdrawn. On November 5, 1993, Galen entered into a purchase and sale agreement with Columbia. Under the terms of that agreement, Columbia undertook legal responsibility for all liabilities and contractual obligations related to the Westside facility. As required by law, Columbia filed a change of ownership application (CHOW) with the Agency which ultimately issued a new license to Columbia for the operation of the Westside facility. The Agency's CHOW file establishes that the Agency received and reviewed the following documents, among others, related to Columbia: A list of the officers and directors of Columbia; Columbia's articles of incorporation; the certificate of incorporation of Columbia issued by the State of Florida; Columbia's audited financial statements; affidavits asserting that Columbia would accept all outstanding liabilities due and payable to the State of Florida, including but not limited to any outstanding liabilities to the Medicaid Program; assertions that Columbia would correct deficiencies, if any, on the facilities most recent license survey; and assertions that Columbia would comply in all respects with applicable provisions under Chapter 766, Florida Statutes (regarding the Florida Patient's Compensation Fund). The deposition of Mr. James A. Cruickshank, chief Operating Officer for Westside Regional Medical Center, was admitted into evidence by NBHD. Mr. Cruickshank testified that he had been employed at Westside since 1987. He is directly responsible for the operations of the facility, and held that position and those duties both before and after the transfer of assets to Columbia. He participated in the preparation of the CON application and is familiar with its contents. Mr. Cruickshank testified that, as Chief Operating Officer, he was familiar with the following matters, none of which had changed, or were expected to vary from the representations made in the CON application, as a result of the transfer of assets to Columbia: Administration - no change; Admission and discharge policies - no change; Operational Management - no change; Personnel - no change; Staffing - no change; Medical staff - no change; Medical committees - no change; Financial personnel - no change; Charges of fees - no change; Financial policies or procedures - no change; Budgeting process - no change; Financial commitments - no change; Projected costs - no change; Financial feasibility - no change; Data or underlying assumptions - no change; Admissions or discharge data - no change; Average length of stay data - no change; Scope of services - no change; Level of proposed services for NICU unit, including: Nursing, Specialty Nursing, Surgical, Emergency, Respiratory therapy, X-Ray; Obstetrics; Ultrasound; Clinical laboratory; Nutritional; Anesthesia; or social services - no change from those represented in the CON application. Quality of care - no change; Standards and qualifications for medical staff - no change; Ratios for medical specialists - no change; Nursing staff qualifications, specialists or ratios - no change; Patient stations, equipment or physical plant and layout - no change; Licensed bed capacity - no change; Accessibility of services - no change; AA. Extent to which proposed NICU unit will address patient need in district - no change; BB. Extent to which the medically under served individuals in the district use or will use the Westside facility - no change; CC. Ability of the facility to meet any federal regulations requiring uncompensated care, community service or access by minority and handicapped service to federally assisted programs - no change; DD. Utilization data - no change; EE. Recruitment - no change; Mr. Cruickshank's testimony in this regard is accepted. Mr. Cruickshank testified that the financial feasibility and stability of this proposal is strengthened by the Columbia acquisition: Westside is the only facility owned by Columbia; the only capital projects or expenditures for which Columbia would be responsible would thus be significantly less than the $27,755,000 listed on Schedule 2 of the CON application; and the source of funds for the proposed NICU is from operating expenses. Mr. Cruickshank's testimony in this regard is also accepted. Mr. Cruickshank, testified that Galen's board no longer has operational responsibility for or exercises any control over Westside Regional Medical Center. /2 Galen is no longer financially committed to the proposed project. Galen's letter of intent was accompanied by a resolution of its board. Galen's CON Application No. 7248 included a listing of Galen of Florida, Inc.'s board. Columbia and Galen do not share any of the same board members. Mr. Cruickshank testified that Galen's CON application only provided Galen's audited financial statements, and did not contain Columbia's audited financial statements. No audited financial statements for Columbia have been provided to AHCA in relation to CON application 7248. Statutory and Regulatory Criteria Rule 59C-1.008, Florida Administrative Code (the Rule), provides an outline for what is required of a CON applicant to have an application accepted and reviewed by AHCA. The Rule implements the statutory criteria in Section 408.037, Florida Statutes, which specifies the CON "Application Content" requirements. Section 408.037, Florida Statutes, provides, in part, that an application for a CON shall contain: A statement of the financial resources needed by and available to the applicant to accomplish the proposed project. This statement shall include: A complete listing of all capital projects . . . pending, approved, or underway in any state at the time of the application . . .[and] shall include the applicant's actual or proposed financial commitment to those projects and an assessment of their impact on the applicant's ability to provide the proposed project . . . (c) A detailed financial projection . . . [which] shall include a detailed evaluation of the impact of the proposed project on the cost of other services provided by the applicant . . . An audited financial statement of the applicant . . . includ[ing] . . . a balance sheet and a profit-and-loss statement of the two previous fiscal year's operation . . . A certified copy of a resolution by the board of directors of the applicant , or other governing authority if not a corporation, authorizing the filing of the application; authorizing the applicant to incur the expenditures necessary to accomplish the proposed project; certifying that if issued a certificate, the applicant shall accomplish the proposed project within the time allowed by law and at or below the costs contained in the application; and certifying that the applicant shall license and operate the facility. [Emphasis added.] Section 408.037, Florida Statutes. Elizabeth Dudek, Chief of CON and Budget Review for Respondent AHCA, testified that an applicant's failure to comply with the statutory requirements concerning submission of the letter of intent and board resolution would result in the rejection of the application. Pursuant to the above statutory criteria, if an applicant fails to submit audited financial statements, AHCA would deem the application incomplete, and the application would be withdrawn from consideration. The Rule also incorporates the letter of intent and board resolution provisions found in Section 408.039(2), Florida Statutes. This statute provides: . . . a letter of intent shall be filed by the applicant . . . [which] describe[s] the proposal with specificity, including proposed capital expenditures, number of beds sought . . . [and the] identy of the applicant, including the names of those with controlling interest in the applicant. The letter of intent shall contain a certified copy of a resolution by the board of directors of the applicant . . . authorizing the filing of the application described in the letter of intent; authorizing the applicant to incur the expenditures necessary to accomplish the proposed project; certifying that if issued a certificate, the applicant shall accomplish the proposed project within the time allowed by law and at or below the costs contained in the application; and certifying that the applicant shall license and operate the facility. [Emphasis added.] Section 408.039(2)(a-c), Florida Statutes. Ms. Dudek testified that, pursuant to this statute, the licenseholder for Westside Regional Medical Center is required to be the applicant for a CON. At the time Galen submitted the letter of intent, Galen was the licenseholder for Westside Regional Medical Center. Columbia has not filed a letter of intent or board resolution for CON Application No. 7248. In the case of an existing licensed facility, the "applicant" referred to in the statute and the Rule must attest that they will license and operate the facility, and thus is required to be the facility's licenseholder. If AHCA issued a CON to the applicant, Galen, for the proposed project, Galen would not be able to meet the requirement that it license and operate the project because Galen no longer holds the license for Westside Regional Medical Center. Rule 59C-1.008(1)(n), Florida Administrative Code, provides: The applicant for a project shall not change from the time a letter of intent is filed, or from the time an application if filed in the case of an expedited review project, through the time of the actual issuance of a Certificate of Need. Properly executed corporate mergers or changes in the corporate name are not a change in the applicant. /3 Nothing in the statute specifically mandates that the licenseholder cannot change or that such change compels involuntary withdrawal of the application from comparative review. Ms. Dudek testified that when she received notice that AHCA had issued a new license which changed the ownership of Westside Regional Medical Center of Columbia, she determined that, pursuant to Rule 59C-1.008, the CON application filed by Galen was no longer an application that could be reviewed because the entity submitting the application was no longer the licenseholder. Ms. Dudek explained that in circumstances where the licenseholder sells the facility to another corporation who then becomes the new licenseholder, as is the case here, the rule requires that AHCA reject the CON application because it would not contain a letter of intent, board resolution, audited financial statements, capital project listing and proforma's for the acquiring entity. Galen did not offer testimony to show that the change in the applicant had occurred as a corporate name change or as a corporate merger. Ms. Dudek testified that subsequent to the omissions period, applicants are not permitted to amend the application, and AHCA is prohibited by rule from considering subsequent events in the application review process. Rule 59C-1.010(2)(b), Florida Administrative Code, provides in pertinent part: Subsequent to an application being deemed complete by the agency, no further application information or amendment will be accepted by the agency. Ms. Dudek testified that the purpose for this prohibition is to set forth parameters in terms of what information will be reviewed for a particular period of time, so that each applicant knows what the agency considers, and that it is considering the same information for all applicants as of the date each is deemed complete. Without amending or supplementing the application, there is no outlet for Columbia to produce, or for the agency to consider, information concerning the new licenseholder. Amending and supplementing the application is prohibited by Rule 59C-1.010, Florida Administrative Code, as discussed in finding of fact #31. Ms. Dudek testified that when an existing facility submits a CON application, the "applicant" is required by Agency rule to be the current licenseholder. Rule 59C-1.008(1)(m), Florida Administrative Code, provides in pertinent part: An applicant for a project subject to Certificate of Need review which affects an existing licensed health care facility . . . must be the license holder. . . . If agency records indicate information different from that presented in the letter of intent with respect to the identification of the holder of the license and the licensure status, then the agency records create a rebuttable presumption as to the correctness of those records and therefore the application will be rejected. Ms. Dudek testified that agency records show that Columbia currently holds the license for Westside Regional Medical Center. Mr. Cruickshank confirmed that Columbia, and not Galen, is the current licenseholder for Westside Regional Medical Center.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a summary final order be entered dismissing the Petition for Formal Administrative Hearing filed by Galen of Florida, Inc., d/b/a Westside Regional Medical Centers in this case. DONE and ORDERED this 11th day of May 1994, in Tallahassee, Florida. JAMES W. YORK, Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 904/488-9675 FILED with the Clerk of the Division of Administrative Hearings this 11th day of May 1994.
The Issue The issue is whether South Broward Hospital District's (District) application for a certificate of need to build and operate a satellite facility in southwest Broward County by transferring 100 beds and retiring 25 medical/surgical beds from its existing facility should be granted. STIPULATION CONCERNING APPLICABLE STATUTES A prehearing stipulation was filed in which the parties agree that criteria found in Sections 381.494(6)(c), Florida Statutes (1985), apply in determining whether the satellite facility should be built. Not all of these criteria are in dispute, however. By stipulation the criteria found in Section 381.494(6)(c)3., 6., 7., 11. and 13. 381.494(6)(d)3. and 5., Florida Statutes (1985), are inapplicable or are not in dispute. Section 381.494(6)(c)8., Florida Statutes (1985), is not in dispute as it relates to the availability of resources and capital or operating funds. The criteria set out in Section 381.494(6)(c)1., 2., 4., 5., 9., 10. and 12. apply and Humana contends the application of South Broward Hospital District does not meet them. Humana maintains that the application does not meet the criteria of Section 381.494(6)(d)1. 2. and 4., while the District maintains those are inapplicable because the District proposes no new services. STIPULATED FACTS The parties have also stipulated to the following facts: The District's application was timely filed; The petition for a formal hearing on the agency's intent to deny the certificate of need was timely filed; The donated services expense, operating expenses and Hospital Cost Containment Board assessment found in the financial statements are reasonable; The site preparation costs contained in Table 25 of District Exhibit H are reasonable, even in the event of any cost increase due to delays in commencement of the project; The findings, opinion and data contained in District Exhibit 1 are reasonable; The construction costs reflected in Table 25 of Exhibit H are reasonable, provided any increase in costs from delaying the opening of the satellite 17 months would not exceed 5 percent of the total construction cost; the construction figures include a contingency factor of 5 percent.
Findings Of Fact General Procedural Background Following the Department's expression of its intention to deny the application of the District to construct a new satellite hospital in southwest Broward County, the District requested a formal administrative hearing which became Case No. 84-0235. On February 8, 1984, Humana Hospital Bennett moved to consolidate the District's case (DOAH Case No. 84-0235) with Cases No 84-0265 and 84-0266 (certificate of need applications to transfer beds from Humana South Broward to Humana Bennett) and Case No. 83-3944 (a certificate of need application to transfer beds from Humana South Broward to southwest Broward County). These three "Humana" cases were consolidated with South Broward Hospital District's application on February 23, 1984. On February 24, 1984, Pembroke Pines General Hospital (Pembroke Pines) moved to intervene in Case No. 84-0235, the South Broward Hospital District application. The motion was granted on March 15, 1984, and final hearing was scheduled for June 20, 1984. On April 11, 1984, Pembroke Pines moved for a continuance based, in part, on the need to consolidate Case Nos. 84-0235, 84-0265, 84-0266 and 83- 3944. The motion was granted on May 29, 1984. On April 20, 1984, Humana South Broward moved to intervene in DOAH case No. 84-0235 (the South Broward Hospital District application) and the motion was granted. The final hearing was set for August 1, 1984, but was subsequently continued to October 15, 1984, and then to February 25, 1985. Ultimately, the cases mentioned in the preceeding paragraphs were consolidated with an application for a certificate of need filed by Pembroke Pines to offer obstetrical services, which was Case No. 84-0610. On July 23, 1986, Humana South Broward announced that it would not pursue the applications involved in Case No. 83-3944, its application to transfer beds from Humana South Broward to a southwest Broward County location. In 1985, the South Broward Hospital District filed its application for a certificate of need to develop and operate a 100-bed satellite hospital in southwest Broward County by transferring 100 beds from the facility it operates in eastern Broward. The Department of Health and Rehabilitative Services Indicated its intent to deny that application. The district requested a hearing, and the case was assigned DOAH Case No. 85- 3940. On April 11, 1986, South Broward Hospital District updated its two applications to permit the transfer of 100 beds from an existing facility to a satellite facility which would be composed of 92 medical/surgical beds and 8 intensive care beds. Subsequently, South Broward Hospital District agreed to retirement off an additional 25 medical/surgical beds upon the opening of a satellite facility, which would remove those 25 licensed beds from its present facility in eastern Broward County and reduce the county's overall inventory of acute care beds. Department of Health and Rehabilitative Services agreed to support this application at the final hearing. On September 9, 1986, after the hearing had begun, Pembroke Pines, South Broward Hospital District, and the Department of Health and Rehabilitative Services entered into a written agreement, part of which was that Pembroke Pines would withdraw its opposition to the District's application for approval of the satellite hospital. Humana South Broward and Humana Hospital Bennett were, thus, the only parties objecting to the application at final hearing. The Parties South Broward Hospital District (the District) was created in 1947 by the Florida Legislature in Chapter 24415, Laws of Florida, Special Acts of 1947, as an independent taxing authority. It assures access to health care services by the residents in its geographical area by constructing and operating health facilities serving the need for all types of health care within the District. It provides services without regard to the ability of District residents to pay for them. The District's geographic boundaries generally cover the southern 1/3 of Broward County and includes about 1/3 of the county population. The remaining portion of the county is served by a separate public entity, the North Broward Hospital District. The District established Memorial Hospital of Hollywood (Memorial) in 1952 as a 100-bed hospital facility. Memorial has been expanded in 1957, 1962, 1967 and 1974. Memorial is now a 737 bed full-service hospital accredited by the Joint Committee on Accreditation of Hospitals. It is the only provider in south Broward County of the following services: cardiac surgery; cardiac catheterization; physical rehabilitation within a distinct comprehensive unit; psychiatric services; pediatric surgical programs; pediatric intensive care; full-service neonatology; newborn intensive care/progressive care; high risk obstetric maternity care; residential substance abuse programs. Some of these services are operated at a loss. Uncompensated care is 18.7 percent of the District's total operating budget. $14.8 million will be spent in the current year on services to indigents who use 6.7 percent of Memorial's patient days. Medicaid patients account for 6.3 percent of Memorial's patient days. Operating revenues and the District's power to levy and collect property taxes pay for the service to indigents. It is the most important provider of services to the indigent and medically underserved in South Broward County. Memorial Hospital is located east of State Road 441 in a fully developed and matured area of Broward County. Since 1976 the District has operated a 24-hour walk-in center in Pembroke Pines, in southwest Broward County, approximately 8 miles west of Memorial Hospital. It treats emergencies and provides routine unscheduled care. In 1985, that center experienced over 24,000 patient visits. Of the twenty hospitals in Broward County, only three had more patient visits than the District's walk-in center. The center also has a residential substance abuse treatment center of 14 beds, 12 of which are occupied on any given day. In 1982, HRS granted the District a certificate of need far $1,000,000 authorizing the District to purchase the land upon which the proposed satellite hospital would be built, on Flamingo Road, between Johnson Street and Pines Boulevard. Humana South Broward is a 282-bed acute care hospital located at 5100 West Hallandale Boulevard, Hollywood, Florida. It serves the southern portion of Broward County and is a wholly owned subsidiary of Humana. Humana Hospital Bennett is a 204-bed acute care hospital located in West Broward County. It is a wholly owned subsidiary of Humana. Factual Findings Concerning The Criteria Against which The Application Must Be Evaluated General Applicability of Chapter 10-5, Florida Administrative Code Under Rule 10-5.003, Florida Administrative Code, certificate of need applications are processed and reviewed under the provisions of Chapter 10-5. These rules implement the statutory criteria enacted a Section 381.494(6)(c) and (d), Florida Statutes (1985). The project at issue involves the relocation reduction of licensed acute care beds The methodology for determining the need for new beds found in Rule 19-5.011(1)(m)6., Florida Administrative Code, is inapplicable, because no additional beds will be added to the inventory of the HRS service district. Central Florida Regional Hospital v. Daytona Beach General Hospital, 475 So.2d 974 (Fla. 1st DCA 1985). Similarly, the other standards found in the rule besides the need methodology also do not apply. Because no batching cycle is involved, no planning horizon is set involved. The Department's Non-Rule Policy On Bed Transfer And Relocation. The Department of Health and Rehabilitative Services has promulgated no rule governing the circumstances in which applications to transfer or relocate beds within a service district will be approved. The Department's policy on the approval of such transfers and relocations has evolved over time. An early, large hospital relocation decision by the Department involved the application of St. Luke's Hospital in Jacksonville, Certificate of Need #1487, which was granted in 1981. The Rule methodology for computing need for new beds had not been adopted then. The Department approved that ultimately unopposed application in order to improve geographic access to care for residents in a fast growing area, and due to life safety problems in the old facility. Later, in 1982, Orlando Regional Medical Center applied for Certificate of Need #2868 to build a satellite facility by relocating 150 beds to a fast growing area in southeast Orange County. This application also pre- dated the need methodology. The project was unopposed and was approved due to increased accessibility of medical services to a fast growing area and the hospital's plan to more efficiently use the vacated space at the existing facility. Lee Memorial Hospital in Lee County received Certificate of Need #2851 in 1984, permitting the construction of a satellite facility and the renovation of an existing facility. That project was approved because: The hospital needed to demolish obsolete buildings constructed in 1939. The construction of a satellite facility, which would be made up of 81 beds from the demolished main campus and 19 new beds, would have been no more costly than construction of a new facility on the current location. Projected growth in the 65 and older population justified the additional beds according to the need methodology which had been adopted by rule. Moving the existing and new beds to the satellite would decentralize the service district's concentration of beds in the City of Fort Myers. The Department granted Beaches Hospital in Duval County Certificate of Need #352-6 in 1985 to transfer its 82 bed facility to a new location. That small public hospital provided vital medical services to Medicare and indigent patients. It would be forced to close in about 10 years if it did not relocate, due to deteriorating physical plant and inefficiencies in its physical layout. Beaches Hospital had been located in a decaying area. Physicians were locating away from the hospital's immediate area. Relocation was necessary for that public facility to remain financially viable. In reviewing various State Agency Action Reports and Final Orders of the Department of Health and Rehabilitative Services concerning applications analogous to the one at issue here, the Department has looked at five factors in determining whether to approve applications for the relocation of beds: whether the relocation is predicated upon the need for additional beds based on the need methodology of Rule 10-S.011(1)(m)., Florida Administrative Code, or the reduction of excess capacity within a district (or a subdistrict, if one has been established); whether the proposed project improves geographic access to a sufficiently large segment of the population which is expected to experience serious problems in obtaining in-patient care; whether the project improves availability of in-patient care to all residents of the community, especially Medicaid and indigent patients; whether the relocation corrects life safety deficiencies that could not otherwise be resolved through less costly facility renovations, or replaces obsolete or deteriorating and inefficient public hospital facilities; and whether the project will result in an increase in hospital costs and charges at a rate above the state average for hospitals of similar size, offering similar services. The Department has formulated a draft policy with respect to standards for evaluating applications to transfer beds or convert facilities. This policy was first written on August 7, 1986, and is based on the agency's prior experience in health planning. The Department's general policy for transfers and conversions is to try to "work off" any overbedding in a service district when approving transfers by requiring bed retirement as a condition to the approval of transfers. This strategy is the Department's attempt to reduce the excess of licensed and approved medical/surgical beds. The Department does not believe it possesses statutory authority to de-license acute care beds or to retire acute care beds. Voluntary reduction of surplus beds in conjunction with applications to transfer beds or convert facilities provides one means for reduction of the number of beds in a service district. When the Department reviews applications for transfers or conversions of beds, it seeks to assure there will be no adverse effect on a public facility which has traditionally provided services to indigents, providing access to medical services without regards to a patient's ability to pay. This insures low income groups access to health care facilities. Another element of the Department's incipient policy is a review of the efficiency of the facility proposing the transfer, and examination of the applicant's historic cost per discharge, gross revenue per adjusted admission, and the general cost effect of the proposal, to assess whether the transfer or conversion would lead to higher patient charges. The incipient policy is designed to promote price and non-price (service) competition among providers. Changing bed complements at facilities by transfer allows providers to compete for larger market shares, which fulfills the Department's statutory duty to promote competition among providers. The Project's Consistency With The Department's Non-Rule Policy On Bed Transfer and Reallocation The District's project will reduce the number of medical/surgical beds located in the service district (District X) by 25 beds. In the service district there are 5,770 medical/surgical beds, an excess of approximately 80 medical surgical beds as of the last calculation done by the Department. In the letter of denial attached in the State Agency Action Report, Humana exhibit N, there were 447 unused acute care beds available to the southwest Broward County population within reasonable access on a daily basis in 1984. The delicensure of 25 beds will only minimally advance the goal of reduction of excess capacity. The proposed project does not improve geographic access to a sufficiently large segment of the population expected to experience serious problems in obtaining in-patient care. There is no persuasive evidence that any significant segment of the population in Broward County now has a serious problem in obtaining in-patient care. To the extent that a satellite facility in southwestern Broward County would bring an acute care hospital to that area, those living in that area would have enhanced or more convenient access, but that is a far cry from demonstrating that a population has a serious access problem. This project would not significantly improve the availability of in- patient care to Medicaid and indigent patients who are now served at the District facility (Memorial Hospital) in east Broward. This situation might be different if there were subdistricting in Broward County, but none now exists. In fact, subdistricting has been considered by the Local Health Council, but rejected for lack of adequate data. Ad hoc subdistricting is inappropriate here. There is no evidence of deterioration of the facilities of the District or the necessity to correct life safety deficiencies by building the satellite facility. This case is not like the Lee Memorial Hospital situation. Here, the District is in the process of a significant $50 million renovation of Memorial Hospital, including construction of an eight floor patient tower. With respect to the effect on patient charges, the District has sufficient cash on hand to build the satellite. If the project is approved, it would have no effect on the charges to patients at the District's current hospital. It would, however, allow improvements in the use of space at the current hospital by relocating and retiring 125 beds from Memorial Hospital. Approximately 15,000 square feet of space will become available at the current facility. Data processing, management systems, engineering, billing and collection clerks are presently housed away from Memorial in 20,000 square feet of rented space. Consolidating these operations at the main campus would allow the District to save approximately $100,00 per year in lease payments. Statutory Criteria For Evaluating The Application Under Section 381.494(6)(c), Florida Statutes A. Consistency With The State Health Plan And the Local Health Plan Related To Occupancy Levels. Section 381.494(1)(6)1., Florida Statutes. The Florida State Health Plan and the Local Health Plan set as goals occupancy levels for surgical and acute care beds of 80 percent. State Plan, Goal 8, Objective 8.1; Local Plan, Goal 3, Objective 3.1. The Local Health Plan recommends that there should be no new hospital construction until there is an average annual occupancy in the District equal to 80 percent. Local Plan, page 227. Pembroke Pines General Hospital is the closest hospital to the proposed satellite, and now serves most of the area the satellite would serve. Pembroke Pines operates at below 50 percent occupancy for its medical/surgical beds. Excess or underutilized bed capacity contributes to higher health care costs. According to the Institute of Medicine, the cost of an empty bed is 50 percent of the cost of an occupied bed, made up largely of the overhead assigned to that empty bed. State Plan, page 70. There had been a great growth in the number of acute care beds in Florida before the need methodology of the certificate of need program was developed. According to the Department of Health and Rehabilitative Services, there were 4,800 excess acute care beds in Florida as of July, 1986. The State Health Plan sets the appropriate ratio of medical/surgical beds to the population as a ratio of 4.11 to 1,000. State Plan, Goal 6, Objective 6.1. The overall medical/surgical bed ratio to population in District X is approximately 5.1 to 1,000, in excess of the State Health Plan goals. The Local Health Plan encourages the reduction of licensed beds to achieve a ratio of 4.5 medical/surgical beds to 1,000 population by 1988 and seeks to achieve an 85 percent occupancy rate by that time. Local Plan, Page 226. District X (Broward County) is significantly overbedded. The proposal from the District would reduce the total inventory of acute care beds by 25 beds. In return, it would cost the health care system in the District approximately $15,965,500 to build the satellite. Such a cost for a rather modest reduction of 25 beds is unwarranted. Availability, Utilization, Geographic Accessibility And Economic Accessibility of Facilities in the District Section 381.494(6)(c)2., Florida Statutes The area that the District proposes to serve in the satellite facility includes census tracts 702-706, 1102, and 1103. These have a younger population and age distribution than Broward County as a whole. This younger population has a lesser need for hospital services than older populations. District's exhibit, 1 table 2, shows that the elderly population in the satellite service area will decrease over time, so that by 1990 the elderly will comprise about 7 percent of that population. The elderly will be 23.7 percent of the total Broward County population in 1990. The satellite facility does not propose pediatric services. The age group from 0-14 will achieve second highest population of growth in the service area, but the pediatric population will not benefit particularly from the proposed satellite, because licensed pediatric beds, pediatric and pediatric surgery will remain at the current facility. The age cohort with the highest growth is that of ages 30-44. This group demands in-patient services at a smaller rate than the elderly and tend to use such services as obstetrics, nursery services, psychiatric services, substance abuse services, cardiac catheterization and cardiac surgery which will not be available in-house at the satellite. The District does not propose to offer any service at the satellite not now available at existing hospitals in its service area. Other hospitals now serving the area which the satellite proposes to serve have additional capacity to serve population growth in western Broward. Pembroke Pines is the closest hospital to the proposed satellite, and now operates at below 50 percent occupancy for medical/surgical beds. There is sufficient unused capacity to accommodate projected demands in the HRS service District X. The majority of the population growth will be experienced in the area between Humana Bennett and Pembroke Pines Hospital. These facilities and other hospitals can meet projected demand from that population growth. There is no geographic access problem for residents of the satellite service area in receiving in-patient hospital services at existing hospitals. There is no significant indigent or medicaid populations in the west and southwestern areas of Broward County, which has a younger population and is a more recently developed part of the county. Typically older sections of the county have more medically indigent persons. The current establishment of the satellite facility is not necessary to ensure the financial viability of South Broward Hospital District or to maintain its indigent care commitment. In the fiscal year 1985, the District made $19.2 million from hospital operations at Memorial and was the most profitable hospital in the State of Florida. In the fiscal year 1986, the District made $13 million from the operation of Memorial. The District is not in any financially dangerous situation and has unused additional taxing authority available to it. There is no evidence that the District will not remain financially viable through 1990. Other Facilities and Services which may serve as Alternatives to the Facilities and Services Proposed. Section 381.494(6)(c)4., Florida Statutes. The residents of the District requiring in-patient services will continue to do so. There are no less expensive alternatives to in-patient care which the District has failed to consider. Probable Economies from Joint, Cooperative or Shared Services or Facilities. Section 381.494(6)(c)5., Florida Statutes. The uncompensated case load of the District is such that it is unlikely other hospitals would jointly operate a service or facility with the District. No such alternative has been proposed by Humana. If the satellite is built, the District will be able to use space vacated at the main campus for administrative operations now housed away from the Hospital in rented space. The District would be able to handle many administrative matters, e.g. accounting, purchasing, risk management centrally if the satellite is built. The District would experience improved physical efficiency and save approximately $100,000 per year in rental payments. Availability of Resources Including Health Manpower. Section 386.494(6)(c)8., Florida Statutes. The District has the financial and human resources to operate the satellite. There is no evidence that approval of the project will have an adverse effect on training programs or divert human or financial resources from other needed health care. The satellite would be economically accessible to residents of the District, due to the statutory mandate that care be provided without regard to ability to pay. Financial Feasibility. Section 381.494(6)(c)9., Florida Statutes. The project is financially feasible in the short and long terms. The District has the ability to fund the project in the short-term without borrowing. The total projected cost for the project is $15,965,50. This total cost is also reasonable. For the first two years of projected operations, fiscal years 1990 and 1991, the facility would have an excess of revenue over expenses of $1,154,800 and $2,147,900, respectively. In the long-term, based on historical patient origin and marketshare data that is available, the project is financially feasible. The breakeven point from a financial basis is achieved at a 44 percent occupancy rate, and on a cash flow basis, at a 35 percent occupancy rate. Even if the District only achieved a 16 percent share of the southwest Broward market by 1992, the facility would still be financially feasible. By servicing existing patients alone, the satellite would have an immediate 20-30 percent occupancy rate. Needs of Health Maintenance Organizations. Section 381.494(6)(c)10., Florida Statutes. The District is an efficient provider of health services and has attracted health maintenance organizations to contract with it due to its low costs. There is no evidence, however, that unless the satellite is approved, health maintenance organizations will not be able to obtain adequate services for their members at a reasonable price. Probable Impact of the Proposed Satellite on the Cost of Health Services Proposed by the District. Section 381.494(6)(c)12., Florida Statutes. Because the project can be built with cash on hand, it will have no adverse effect on patient charges at Memorial Hospital. Construction of the satellite would, however, draw patients from Humana Bennett and Humana South Broward, which now draw patients frown the area the satellite would service. The net financial loss to Humana Bennett in the first two years of satellite operation would be $1 million, and to Humana South Broward $1/2 million.
Recommendation It is RECOMMENDED that the application of the South Broward Hospital District to build a satellite facility in southwest Broward County be denied DONE AND ORDERED this 4th day of August, 1987, in Tallahassee, Florida. WILLIAM R. DORSEY, JR. Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 4th day of August, 1987. APPENDIX TO RECOMMENDED ORDER Petitioner's proposed findings of fact are addressed as follows: 1. Covered in Finding of Fact 1. 2. Covered in Finding of Fact 8. 3. Covered in Finding of Fact 9. 4. Covered in Finding of Fact 10. 5. Covered in Finding of Fact 12. 6. Covered in Finding of Fact 12. 7. Covered in Finding of Fact 12. 8. Covered in Finding of Fact 13. 9. Covered in Finding of Fact 14. Covered in Finding of Fact 15. Rejected as cumulative. Covered in Finding of Fact 15. Covered in Finding of Fact 15. Rejected as unnecessary. Covered in Finding of Fact 15. Covered in Finding of Fact 15. Rejected as cumulative and unnecessary. Covered in Finding of Fact 62. Covered in Finding of Fact 16. The evidence is not persuasive that western migration is leaving a concentration of patients without the ability to pay for medical services in the eastern portion of Broward. Indeed, there is no satisfactory north-south dividing line to make an east-west Broward comparison. Covered in Finding of Fact 17. Covered in Finding of Fact 18. Covered in Finding of Fact 14. Covered in Finding of Fact 20. Covered in Finding of Fact 21. Covered in Finding of Fact 22. Covered in Finding of Fact 23 Covered in Finding of Fact 24. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected as cumulative to findings of fact 12 and 15. Covered in Finding of Fact 45. Rejected as inapplicable to Broward County since beds are accessible to the entire population of the county. Covered in Finding of Fact 46. Rejected as unnecessary. Rejected as unnecessary. To the extent necessary covered in finding of fact 42. Rejected for the reasons stated in 37 above. Covered in Finding of Fact 44. Rejected as unnecessary. Covered in Finding of Fact 38. Covered in Finding of Fact 47. Rejected as an improper attempt to use U.S. 441 for ad hoc subdistricting. See Finding of Fact 47. See Finding of Fact 47. Rejected because the cited portion of the Local Health Plan only states that a study may indicate that special consideration should be given to the western portion of the county. Covered in Finding of Fact 47. Covered in Finding of Fact 25. Covered in Finding of Fact 26. Covered in Finding of Fact 27. Covered in Finding of Fact 28. Rejected because the portion of Exhibit F related to Saxon General Hospital did not appear to support the findings proposed. See also the Final Order in Halifax Hospital Medical Center vs. Department of Health and Rehabilitative Services, 8 FALR 2038 (1986). Covered in Finding of Fact 29. Covered in Finding of Fact 30. Covered in Finding of Fact 31. Covered in Finding of Fact 32. Rejected because there is no "maldistribution problem" in this case. Because Broward has no subdistricts. Covered in Finding of Fact 33. Covered in Finding of Fact 33. Rejected as an unnecessary characterization. Covered in Finding of Fact 34. Rejected as unnecessary. Covered in Finding of Fact 35. Covered in Finding of Fact 36. Covered in Finding of Fact 37. Rejected because there is no need in west Broward for an additional facility. 72-75. Rejected as list persuasive and the evidence adopted in Findings of Fact 48-56. Covered in Finding of Fact 49. Rejected because there is no division point from which to compute a maldistribution; to attempt to do so is to engage in ad hoc subdistricting. Covered in Finding of Fact 16 concerning location. The second sentence is rejected as unsupported insofar as it implies that those living in areas other than southwest Broward lack the ability to pay for medical services. Rejected because there is no method by which to determine lessor or greater need in a district which is not subdistricted. Rejected because the assumptions regarding payor mix are speculative Rejected as speculative. Covered in Finding of Fact 15. Rejected as speculative. Rejected because there is no need to follow the private pay patient population in the absence of a need for additional beds or expenditures to move existing beds. Rejected for the reasons stated in Conclusions of Law Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Sentence one is covered in Finding of Fact 52 to the extent appropriate. Sentence two is rejected as unpersuasive. Rejected because the evidence in support of the findings is not persuasive. Rejected because, although true, the implicit inference that the contrary is true is not sustained by the evidence. Covered in Finding of Fact 57. 97-98. Covered in Finding of Fact 57. Rejected as unnecessary. Rejected as unnecessary. 101-102. Rejected because no true efficiency is increased the increase in occupancy rate and efficiency is merely a paper gain. 104. Rejected as unnecessary because tertiary services will continue to be provided at the current facility. 105-111. Rejected as unnecessary, that Memorial is an efficient, low cost provider is true. 112-114. Rejected as unnecessary. Rejected as unnecessary. Rejected because it is not shown that the ongoing renovations at Pembroke Pines account for its occupancy rate being as low as 50 percent. Rejected as unnecessary. 118-122. Rejected because notwithstanding those factors, Humana Bennett still has additional functional capacity. Rejected as unnecessary. Rejected as unnecessary. 125-126. While these factors may affect the occupancy rates at Humana South Broward they do not justify ignoring the occupancy goals set in the Local Health Plan that no new construction will take place until there is an average annual occupancy equal to 80 percent in the District. Rejected as unnecessary. Covered in Finding of Fact 57. Rejected as unnecessary. 131-132. Covered in Finding of Fact 58. 133-134. Rejected as cumulative. 135-136. Covered in Finding of Fact 59. 137. Covered in Finding of Fact 60. 138-150. Rejected as cumulative to the finding that the project is financially feasible. Covered in Finding of Fact 61. Covered in Finding of Fact 61. Covered in Finding of Fact 61. 154-158. Rejected as cumulative to the finding that the project is financially feasible. Covered in Finding of Fact 61. Rejected as unnecessary. Rejected as unnecessary. 162-165. Rejected as unnecessary. Covered in Finding of Fact 63. Rejected as unnecessary. Rejected because the impact on Humana South Broward will be approximately $1/2 million in the first two years of operation. See Finding of Fact 63. 169-172. Rejected as unpersuasive. Rejected for the reasons stated in Finding of Fact 63. Rejected as argument rather than a Finding of Fact. 175-181. Rejected as unnecessary. 182. Rejected because the construction of an entiresatellite hospital does appear to constitute "newhealth services to in-patients." The Final Order in Halifax Hospital Medical Center vs. Department of Health and Rehabilitative Services notwithstanding. Humana's proposed findings of fact are addressed as follows: Covered in Finding of Fact 15. Covered in Finding of Fact 40. Rejected as unnecessary. Covered in Finding of Fact 8. Rejected as unnecessary. Covered in Findings of Fact 9 and 10. Covered in Finding of Fact 52. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Covered in Finding of Fact 48. Covered in Finding of Fact 49. Covered in Finding of Fact 49. Rejected as unnecessary. Covered in Finding of Fact 49. Covered in Finding of Fact 49. Covered in Finding of Fact 50. Rejected as unnecessary. Covered in Finding of Fact 51. Covered in Finding of Fact 51. Covered in Finding of Fact 52. Rejected as cumulative to Finding of Fact 52. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Covered in Finding of Fact 52. Covered in Finding of Fact 52. Covered in Finding of Fact 52. Covered in Finding of Fact 53. Rejected as cumulative to Finding of Fact 53. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected because quality of care is not an issue by stipulation of the parties. Covered in Finding of Fact 54. Covered in Finding of Fact 54 Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. Covered in Finding of Fact 55. Covered in Finding of Fact 55 Covered in Finding off Fact 55. Covered in Finding of Fact 55. Rejected as unnecessary. Rejected as unnecessary. 49-85. Rejected because the criticism of the District's financial projections provided by Mr. Baehr was not persuasive, and the proof of the District on financial feasibility was persuasive. See Findings of Fact 59. 86-92. Rejected because the project can be built with cash and have no adverse impact on patient charges at Memorial Hospital or at the satellite. Rejected as unnecessary. Rejected as unnecessary. Rejected as unnecessary. 96-103. Rejected as cumulative to the finding made in Finding of Fact 63. Covered in Finding of Fact 63. Rejected because the characterization of the impact of the loss of $1/2 million on Humana South Broward as "tremendous" is not persuasive. Covered in Finding of Fact 42. Rejected as irrelevant because it would not be expected that a new satellite hospital would begin with an occupancy rate equal to 80 percent. Rejected as unnecessary. Covered in Finding of Fact 43. 110-111. Covered in Finding of Fact 62. COPIES FURNISHED: F. Phillip Blank, Esquire 241 East Virginia Street Tallahassee, Florida 32301 Ursala Mancusi-Ungaro, Esquire AmeriFirst Building One S.E. Third Avenue Miami, Florida 33031 Douglas L. Mannheimer, Esquire Post Office Drawer 11300 Tallahassee, Florida 32302 John H. French, Jr., Esquire James C. Hauser, Esquire Post Office Box 1876 Tallahassee, Florida 32302-1876 Sam Power, Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 John Miller, Acting General Counsel Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 =================================================================
Conclusions Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency has jurisdiction over the above-named Respondent pursuant to Chapter 408, Part IJ, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Administrative Complaint and Election of Rights form to the Respondent. (Ex. 1) The Election of Rights form advised of the right to an administrative hearing. 3. The parties have since entered into the attached Settlement Agreement. (Ex. 2) Based upon the foregoing, it is ORDERED: 1. The Settlement Agreement is adopted and incorporated by reference into this Final Order. The parties shall comply with the terms of the Settlement Agreement. 2. The Respondent shall pay the Agency $2,500,00. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. If full payment has not been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the “Agency for Health Care Administration” and containing the AHCA ten-digit case number should be sent to: Office of Finance and Accounting Revenue Management Unit Agency for Health Care Administration 2727 Mahan Drive, MS 14 Tallahassee, Florida 32308 3. Conditional licensure status is imposed on the Respondent beginning on March 3, 2011 and ending on April 1, 2011. Filed November 29, 2011 11:03 AM Division of Administrative Hearings ORDERED at Tallahassee, Florida, on this 25 day of WN. Berber , 2011. Agency for Health Care Administration
Other Judicial Opinions A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of 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 CERTIFY that a true and correct copy of this Final Order was served on the below-named persons by the method designated on this Ze tay of Lake Ae fa , 2011. SS : = lerk Richard Shoop, Age Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Jan Mills Finance & Accounting Facilities Intake Unit Revenue Management Unit (Electronic Mail) (Electronic Mail) Mary Daley Jacobs Anna Small Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Attorney for the Respondent LaVie Care Centers 10210 Highland Manor Drive, Suite 250 Tampa, Florida 33610 (U.S. Mail) Claude B. Arrington Administrative Law Judge Division of Administrative Hearings (Electronic Mail)
Conclusions THIS CAUSE comes before the AGENCY FOR HEALTH CARE ADMINISTRATION (the "Agency") concerning Certificate of Need ("CON") Application No. 10048, which was filed by SHANDS TEACH HOSPITAL AND CLINICS, INC. d/b/a SHANDS REHAB HOSPITAL (hereinafter "Shands"), LEESBURG REGIONAL MEDICAL CENTER, INC. (hereinafter "Leesburg") and Filed May 7, 2010 2:01 PM Division of Administrative Hearings. HEALTHSOUTH REHABILITAITON HOSPITAL OF OCALA, LLC ("hereinafter "HealthSouth" in the First Batching Cycle of 2009 request a CON to establish a comprehensive medical rehabilitation hospital. The Agency preliminarily approved HealthSouth Rehabilitation Hospital of Ocala, LLC application for CON 10048, thus denying the applications of Shands and Leesburg Cycle of 2009. Thereafter, Shands and Leesburg timely filed Petitions for Formal Administrative Hearing with respect to the preliminary approval of HEALTHSOUTH'S application, which the Agency Clerk forwarded to the Division of Administrative Hearings ("DOAH"). On March 16, 2010, HealthSouth filed a Notice of Voluntary Dismissal withdrawing its CON application. The Notice of Voluntary Dismissal is attached hereto as Exhibit A. On March 17, 2010, DOAH issued an Order Closing Files as a result of the voluntary dismissal. It is therefore ORDERED and ADJUDGED: The voluntary dismissal by HealthSouth and the withdrawal of its CON application are hereby acknowledged and accepted. The above-styled cases are hereby closed. DONE and ORDERED this ay of _ in Tallahassee, Florida. ,Q ,,Y ---' 2010, THOMAS W. ARNOLD, Secretary
Other Judicial Opinions A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY ALONG WITH THE FILING FEE 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 THE 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. or interoffice mail to the persons named below on this '7:1$-- day of 2, :2_ -.!-.:: ;::::--===:::: RICHARD J. SHOOP, Ag.....-T.--."--" lerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 (850) 412-36.3«:? COPIES FURNISHED TO: Charles A. Stampelos Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Mark A. Emanuele, Esquire Deborah S. Platz, Esquire Panza, Maurer & Maynard, P.A. Bank of America Building, Third Floor 3600 North Federal Highway Fort Lauderdale, Florida 33308-6225 Counsel for HealthSouth Rehabilitation Hospital of Ocala, LLC Paul H. Amundsen, Esquire Susan L. St. John, Esquire Julia E. Smith, Esquire Amundsen & Smith, P.A. 502 East Park Avenue Post Office Drawer 1759 Tallahassee, Florida 32302 Counsel for Leesburg Regional Medical Center F. Philip Blank, Esquire Blank & Meenan, P.A. 204 South Monroe Street Tallahassee, Florida 32301 Counsel for Shands Teaching Hospital and Clinics, Inc. d/b/a Shands Rehab Hospital Richard Joseph Saliba, Esquire Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, Building 3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) Janice Mills Facilities Intake Agency for Health Care Administration 2727 Mahan Drive, Building 3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail)
Conclusions THIS CAUSE came before the State of Florida, Agency for Health Care Administration (“the Agency") for the issuance of a final order. 1. On March 10, 2014, Greystone Hospice of District 7B, LLC, (“Greystone”) requested a formal administrative hearing to contest the preliminary denial of Certificate of Need (“CON”) Application No. 10209, which it submitted to establish a hospice program in the Agency Health Planning Service District 7, Hospice Service Area 7B, and to contest the preliminary approval of Halifax Hospice, Inc.’s (“Halifax”) CON Application No. 10210, to Filed May 15, 2014 4:20 PM Division of Administrative Hearings establish a hospice program in Hospice Service Area 7B. 2. The matter was referred to the Division of Administrative Hearings (CDOAH”) where it was assigned Case No. 14-1368CON. 3. On April 1, 2014, Halifax requested a formal administrative hearing challenging the co-batched applications and supporting the Agency’s preliminary approval of Halifax’s CON Application No. 10210, to establish a hospice program in Service Area 7B, and to support the Agency’s preliminary denial of the co-batched application filed by Greystone. 4. The request was referred to DOAH where it was assigned Case No. 14-1472CON. 5. On April 2, 2014, DOAH issued an Order of Consolidation. 6. On April 18, 2014, Greystone filed a Notice of Voluntary Dismissal. It is therefore ORDERED: 7. The denial of Greystone’s CON Application No. 10209 is upheld. 8. The approval of Halifax’s CON Application No. 10210 is upheld subject to the conditions noted in the State Agency Action Report. ORDERED in Taliahassee, Florida, on this ee day of [hae , 2014. ab hb Ductere Elizabeth Dudek, Secretary Agency for Hegfth Care Administration
Other Judicial Opinions A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of 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. Page 2 of 3 CERTIFICATE OF SERVICE I CERTIFY that a true and correct copy of this Final Order was served on the below- —~—” named persons by the method designated on this [Pine Les , 2014. Richard J. Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 (850) 412-3630 W. David Watkins Administrative Law Judge Division of Administrative Hearings (Electronic Mail) Lorraine M. Novak, Esquire Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Stephen A. Ecenia, Esquire Rutledge, Ecenia and Purnell, P.A. Post Office Box 551 Tallahassee, Florida 32302-0551 Steve@reuphlaw.com (Electronic Mail) Seann M. Frazier, Esquire Parker, Hudson, Rainer and Dobbs, LLP 215 South Monroe Street, Suite 750 Tallahassee, Florida 32301 Sfrazier@phrd.com (Electronic Mail) R. David Prescott, Esquire Rutledge, Ecenia and Purnell, P.A. Jonathan L. Rue, Esquire Parker, Hudson, Rainer and Dobbs, LLP Post Office Box 551 285 Peachtree Center Avenue, Suite 1500 Tallahassee, Florida 32302-0551 Atlanta, Georgia 30303 David@reuphlaw.com jrue@phrd.com (Electronic Mail) (Electronic Mail) | Gabriel F.V. Warren, Esquire James McLemore, Supervisor Rutledge, Ecenia and Purnell, P.A. Certificate of Need Unit Post Office Box 551 Agency for Health Care Administration Tallahassee, Florida 32302-0551 (Electronic Mail) Gabriel@reuphlaw.com (Electronic Mail) Page 3 of 3
