The Issue Whether depreciation of buildings or other property purchased with federal grants in prior years was an allowable expense, requiring reimbursement by petitioner under its contract with the District II-B Mental Health Board and/or its predecessor for community mental health and related services? Whether disallowing such depreciation was a break with prior practice and, if so, whether an agency can lawfully make such a change without rulemaking?
Findings Of Fact For the fiscal year ended June 30, 1977, respondent reported depreciation of $18,540 for purposes of state reimbursement on account of building or equipment constructed or purchased with federal grants before July 1, 1976. The amount of depreciation is not in dispute between the parties. Petitioner, Department of Health and Rehabilitative Services (HRS), contracted with District Mental Health Board Number IV on June 30, 1976, Respondent's 1/ Exhibit No. A-1, and with the successor District Mental Health Board Number II-B on January 1, 1977, Respondent's Exhibit No. A-2, for community mental health and related services in Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor and Wakulla Counties for the fiscal year July 1, 1976, through June 30, 1977. The District Mental Health Board, both as originally constituted and as renamed and reconstituted (The Board), in turn subcontracted with respondent to provide the community mental health and related services called for in its contracts with petitioner. Subsequently, The Board assigned to respondent its interest in the contracts with petitioner relative to fiscal year 1976-1977. Both contracts, Respondent's Exhibit Nos. A-1 and A-2, provide that the parties mutually agree, inter alia: That both parties have read and will comply with the following: 45 CFR Part 228 (as amended) Title XX Regulations HRSM 55-1, Title XX Eligibility Determination Manual This language appears in Part III of each contract under the heading "Federal and State Laws, Standards and Directive." The parties stipulated that 45 CFR Part 74 is incorporated by reference in 45 CFR 228.9 and, therefore, in the contracts in issue. In Part II of each contract in a section styled "Participation in Title XX Funding Program," The Board agrees: To participate in the Department's data reporting systems as required by the Department and Federal rules and regulations for the Title XX funding program in order to receive any funding under the terms of this agreement. Also, to comply with Rules, Regulations and Guidelines, and Instruction established by 45 CFR Part 228 and the Department of Health and Rehabilitative Services for one Title XX funding program. (See Attachment #1) Neither Respondent's Exhibit No. A-1 nor Respondent's Exhibit No. A-2 had any attachments. All disbursements called for by the contracts are "subject to funds being made available by the Florida Legislature or other sources." At the time each of these contracts was entered into and until at least as late as April of 1977, petitioner had consistently, in auditing programs, allowed depreciation on buildings built or property acquired with federal, county or donated moneys so long as they were built or acquired before the contract year began. (Expenditures of such moneys were not reimbursed in the year made, however.) This practice did not change with promulgation and use of the first version of the form now known as HRS-MH Form 1025, "Title XX Quarterly Services Summary," Respondent's Exhibit No. G-2. Under the heading "Unit Cost," Respondent's Exhibit No. G-2 and its predecessors have had, at all pertinent times, three columns labeled "Total," "State" and "Title XX," respectively. On the basis of these "Quarterly Services Summaries," HRS draws down Title XX funds. In the spring of 1981, HRS disallowed depreciation like that at issue here, claimed by respondent for fiscal year ended June 30, 1976, Petitioner's Exhibit No. 1, but this did not lower respondent's actual reimbursement; and no administrative hearing was requested or objection noted. From January 1, 1975, until December 31, 1976, Rule 10E-4.07(3)(s), Florida Administrative Code, was in full force and effect and provided: 4300 Rental of Buildings Reimbursable: Rental of buildings or office space for facility or board up to the maximum of the state office rental rate schedule published annually by the Department of General Services. See Exhibit 6. Donated Space-Cost absorbed by others. Those facilities or boards with space furnished free may claim as reimbursable an allowance for rent not to exceed the state office rental rate schedule published annually by the Department of General Services. See Exhibit 6. Non-reimbursable: If a facility or board owns a building or equipment and rents it to another facility or board, the rent or the depreciation may be claimed as a reimbursable expense, but not both. Respondent's Exhibit C. In preparing the foregoing findings of fact, the hearing officer has had the benefit of respondent's recommended findings of fact and conclusions of law. The proposed findings have been largely adopted, in substance. To the extent they have not been, they have been deemed immaterial, cumulative or unsupported by the weight of the evidence.
Recommendation Upon consideration of the foregoing, it is RECOMMENDED: That petitioner take steps to recover from respondent eighteen thousand five hundred forty dollars ($18,540.00). DONE and ENTERED this 3rd day of June, 1983, in Tallahassee, Florida. ROBERT T. BENTON II Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 3rd day of June, 1983.
The Issue The issue is whether petitioner's request for an exemption from disqualification from employment in a position of special trust should be granted.
Findings Of Fact Based upon all of the evidence, the following findings of fact are determined: This case involves a request by petitioner, Alvin V. Walker, for an exemption from disqualification from employment in a position of special trust. If the request is approved, petitioner intends to work in the psychiatric wing of a local hospital with persons suffering from mental illness. Respondent, Department of Health and Rehabilitative Services, is the state agency charged with the responsibility of approving or denying such requests. Petitioner is now barred from doing such work because of a disqualifying offense which occurred on August 8, 1990. On that date, petitioner was arrested for the offense of "prostitution," a misdemeanor under Chapter 796, Florida Statutes. The circumstances surrounding the incident were not discussed at final hearing. However, the Florida Department of Law Enforcement report stipulated into evidence indicates that on April 30, 1991, adjudication of guilt was withheld by the Duval County Court, and the arrest was sealed. Although the denial of petitioner's request was based solely on his 1990 arrest, at hearing petitioner candidly acknowledged that in 1992 he was invited into the automobile of an undercover police officer in Duval County and was asked what type of sexual things he liked to do. After answering the question, he was given a citation for an undisclosed offense and later pled nolo contendere to the charge. For this, he received one month's probation. Since that time, his record is unblemished. Shortly after the 1992 incident, petitioner began counseling sessions with a mental health counselor. He has continued his therapy since that time. The counselor described petitioner as a "very decent" person with "high morals," and someone who has shown improvement in terms of stability since he began his counseling sessions. From June 1993 until May 1995, petitioner was employed as a rehabilitation counselor with Renaissance Center, Inc. (Renaissance), a residential treatment facility for adults eighteen years of age and older with chronic mental illnesses. In June 1995, Renaissance was acquired by Mental Health Resources and petitioner continued doing the same type of work for the successor firm. He left there in January 1996 for employment with the St. Johns River Hospital as a mental health assistant in the facility's psychiatric unit. In April 1996, however, a background screening disclosed his 1990 arrest, and he was forced to resign pending the outcome of this proceeding. If petitioner's request is approved, the facility will rehire him. Petitioner's former employer at Renaissance established that petitioner was a very conscientious, responsible, and reliable employee who poses no threat to his clients. The employer considered petitioner to be of "good moral character." For the last four or five years, petitioner has been actively involved in the "Outreach" ministry of his church. That program involves providing spiritual support, services and counseling to prisoners in the Duval County Jail each Sunday with follow-up sessions during the week. Members of his church attested to his good moral character. Based on the testimony of witnesses Britt, Toto, Cross and DeWees, as corroborated by petitioner's own testimony, it is found that petitioner has presented sufficient evidence of rehabilitation since his 1990 arrest, he is of "good character," and he poses no threat to the safety or well-being of his clients. The request for an exemption should accordingly be approved.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the Department of Health and Rehabilitative Services enter a final order granting petitioner's request for an exemption from disqualification for employment in a position of special trust. DONE AND ENTERED this 10th day of September, 1996, in Tallahassee, Florida. DONALD R. ALEXANDER, Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675, SunCom 278-9675 Filed with the Clerk of the Division of Administrative Hearings this 10th day of September, 1996. COPIES FURNISHED: Gregory D. Venz, Agency Clerk Department of Health and Rehabilitative Services 1317 Winewood Boulevard, Room 200-X Tallahassee, Florida 32399-0700 Richard E. Doran, Esquire Department of Health and Rehabilitative Services 1317 Winewood Boulevard, Room 204 Tallahassee, Florida 32399-0700 Pauline M. Ingraham-Drayton, Esquire 200 West Forsyth Street, Suite 80 Jacksonville, Florida 32202 Roger L. D. Williams, Esquire Post Office Box 2417 Jacksonville, Florida 32231-0083
Findings Of Fact Based on the evidence offered at the formal hearing in this case, the following facts are found: The Petitioner, Elizabeth R. Hillegas, took the Mental Health Counselor licensure examination administered on April 21, 1989. The Petitioner's examination was given a failing grade. The Petitioner needs to receive credit for correct answers on at least two more questions in order to be entitled to a passing grade. The Petitioner's answers to questions 8, 17, and 33 on the subject examination were incorrect. 2/ All three of the challenged questions, namely questions 8, 17, and 33, inquire as to matters which are part of the basic training in the field of Mental Health Counseling or matters which are crucial to competent practice in the field of Mental Health Counseling. The challenged questions ask about matters which should be known by a competent Mental Health Counselor. Therefore, the challenged questions are within the appropriate subject matter domain for a licensure examination for the profession of Mental Health Counselor. 3/
Recommendation For all of the foregoing reasons, it is RECOMMENDED that the Board of Mental Health Counselors issue a final order in this case dismissing the Petition and assigning to the Petitioner a failing grade on the April 21, 1989, Mental Health Counselor licensure examination. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 25th day of May 1990. MICHAEL M. PARRISH 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 25th day of May 1990.
The Issue By agreement of the parties, the issues to be resolved herein are as follows: Whether or not Alachua County denied Petitioner promotion to the position of Drug Counselor II because of her race (black) over her white counterpart. Whether Alachua County denied Petitioner promotion to the position of Victim Advocate Director and revised the position qualifications to preclude Petitioner because of her race (black). If either of these issues were resolved in Petitioner's favor, Alachua County would be guilty of an unfair employment practice pursuant to the Florida Human Rights Act of 1977, as amended [Section 760.10 et seq. F.S.].
Findings Of Fact Petitioner is a black female. She was 41 years of age at the time of formal hearing. Between April 20, 1984 and approximately April 30, 1989, Petitioner was employed by Metamorphosis. Metamorphosis is an organization that was part of the Alachua County Department of Corrections. The Alachua County Department of Corrections was subsequently renamed the Department of Criminal Justice. Petitioner initially was hired as a Drug Counselor I. Metamorphosis' primary goal is to provide long-term, multi-disciplinary treatment and rehabilitation for chronic substance abusers. It accepts only adults with an on-going history of substance abuse with any drug, other than alcohol, as the primary addictive agent. The program's main goal is to help such people become socially functional again. Petitioner initially testified that she had applied for the position of Drug Counselor II on six separate occasions, but testified in detail to only five. Petitioner never received the position of Drug Counselor II. Petitioner professed that she first applied for the Drug Counselor II position in October 1984, approximately six months after she began employment as a Drug Counselor I. However, Petitioner's Alachua County personnel file, which is required to be kept intact for 75 years, does not contain any application by Petitioner for the position of Drug Counselor II in 1984. Petitioner first stated that she was interviewed for the Drug Counselor II position in 1984 by James Whitaker, a white, and Ed Royal, a black. Petitioner later testified that Jim Whitaker and Scott Simmons, a black, interviewed her in 1984. Mr. Simmons did not testify. Mr. Royal did not testify. Mr. Whitaker did not confirm interviewing Petitioner for the Drug Counselor II position in 1984, but he stated that he had participated with Ed Royal in the hiring interview for Petitioner when she was initially hired as a Drug Counselor I from outside the program approximately April 20, 1984. The Drug Counselor II position was filled in 1984 by James Santangelo, a white, who was hired from outside the program to begin work in 1985. Historically, the Drug Counselor II positions within Metamorphosis were the senior therapist positions which required background in community clinical therapy. Petitioner's qualifications for Drug Counselor II as of 1984 were as follows: She received of Bachelor of Science Degree in Criminal Justice from Florida Memorial College in Miami with a minor in Urban Services. She had acted as Vice-president of the Board of Directors for Sexual Abuse Resources Center and was also a public speaker for the Commission on "status of women family violence". At the time Petitioner allegedly applied for the position of Drug Counselor II in 1984, she had been a Drug Counselor I for approximately six months. As Drug Counselor I, Petitioner had counseled individually and in groups, facilitated therapeutic and pre-vocational groups, supervised clients in employment training, vocation, and mock job interviews. She assisted in the intake process and coordinated and provided recreational activities for the clients. She distributed medication to the residents, handled negative attitudes of residents, monitored urinalysis testing, wrote letters to probation officers and judges, kept records, and maintained files for residents, and other work-related duties. Petitioner completed intake interviews, qualified individuals for acceptance or denial into the Metamorphosis Program, supervised and conducted structured groups, trained Drug Counselor Aides for the night shift, signed-off on clients' psycho/social evaluations, and assisted newly hired Drug Counselor II's. James Santangelo, who received the Drug Counselor II position in 1984, had qualifications as follows: Prior to coming to Metamorphosis, he worked for five years in a forensic mental hospital, the North Florida Evaluation and Treatment Center (NFETC). Four of those five years he was a therapist supervisor in a psychiatric unit. He ran therapy groups, scheduled concerns with the staff, held individual sessions with clients, taught adjunctive therapies to the clients, such as stress management, anger management, and drug abuse techniques. Prior to that, he was a school teacher. Santangelo received a Bachelor of Arts with honors from the College of Education at the University of Florida, majoring in psychology. Santangelo also served as an outreach worker for the Alachua County School Board from January through June 1978. In this position he was the first person to contact families whose children were having problems with truancy or whose children were suspected of being victims of child abuse or neglect. He also had an employment history of extensive special skills. Mr. Santangelos's qualifications for the Drug Counselor II position were superior to Petitioner's in 1984, if, indeed, she applied in that year. Petitioner professed that the second time she applied for the Drug Counselor II position was in 1986, when she had approximately two years experience as a Drug Counselor I within the Metamorphosis program. Again, neither Petitioner nor Respondent (by way of Petitioner's personnel file) had any copy of such an application. Petitioner testified that she was interviewed for the position of Drug Counselor II in 1986 by either Jim Whitaker and James Santangelo or by Jim Whitaker and Ed Royal. Neither Whitaker nor Santangelo confirmed that an interview of Petitioner for Drug Counselor II occurred in that year. Ed Royal did not testify, but it was shown that Ed Royal, a black, actually made the appointment of Tootie Richey, a white female, to the Drug Counselor II position which was open in 1986. Ms. Richey was hired from outside the program. Petitioner had "heard" Ms. Ritchey was a licensed clinical social worker but actually had no way of comparing her own qualifications with Ritchey's. Sometime in 1986, the State of Florida had established a means by which persons working with addiction rehabilitation could become "Certified Addiction Professionals" (CAPs) if they had a college degree, or "Certified Addiction Associate Professionals" (CAAPs) if they did not have a college degree. Mr. Whitaker became a CAAP in 1986 and Santangelo became a CAP in 1987. Petitioner never received such certification. In 1987, Metamorphosis was somewhat restructured so that Drug Counselor II positions became supervisory positions in the program. There were then two Drug Counselor II positions. One Drug Counselor II would supervise the Drug Counselor I's and the other Drug Counselor II would supervise the Drug Counselor Aides. Petitioner's first documented application is dated February 2, 1988. She was applying at that time for a position as an Evaluation Rehabilitation Case Worker I, not Drug Counselor II. Petitioner was referred for that position as a qualified candidate, but Edward Woodbury, also black, was selected for that position. In her testimony, Petitioner professed to have applied for Drug Counselor II, Rehabilitative Case Worker, and Program Coordinator by way of "Applicant Update Sheets" filed on June 27, 1988, October 4, 1988 and November 29, 1988. The greater weight of the credible evidence shows that Petitioner's June 27, 1988 application (P-1) was for promotion to be Program Coordinator of the Metamorphosis Program. This document, filled out at that time entirely by Petitioner, asserts that she had previously applied for Rehabilitation Case Worker and Drug Counselor II, but does not state when she applied. At that time, Jim Whitaker, a white, was the Program Coordinator. During the 1987 reorganization, the Program Coordinator position had been changed from clinical duties to administrative duties which Whitaker did not want to do and did not feel capable of handling. Whitaker therefore requested a "downward promotion" from Program Coordinator to some clinical position. Since there was no vacant clinical position (either as Drug Counselor II or otherwise) in the program, the Alachua County Personnel Director, Colleen Hayes, suggested that the position of Program Coordinator be posted as needing to be filled but that the job posting be made only within the Metamorphosis program itself so that only Metamorphosis staff would be allowed to apply. Ms. Hayes further suggested that when the promotional decision was made, Whitaker should be allowed to go into the lower position vacated by whatever Metamorphosis staff member was promoted into the Program Coordinator position currently held by Whitaker. It was understood that Whitaker would suffer no decrease in pay in the lower position of Drug Counselor II. Ms. Hayes' suggestion was followed, and ultimately, James Santangelo, then a Drug Counselor II, was selected to replace Whitaker as Program Coordinator. Whitaker exercised his option to take Santangelo's vacated Drug Counselor II position. Contrary to Petitioner's testimony, Santangelo's Drug Counselor II position was never advertised nor open to competitive interviewing at that time, and therefore there was no Drug Counselor II position vacant for which Petitioner could have applied. However, Mr. Whitaker's qualifications for the Drug Counselor II position were clearly superior to Petitioner's, anyway. At the time of Whitaker's "downward promotion," Whitaker's qualifications (for Drug Counselor II) included 15 years of experience on the Metamorphosis staff, beginning on October 14, 1974, as an entry level Drug Counselor I on night shift for one and a half years. He had served on the day shift for one year and then been promoted to Drug Counselor II where he had served until 1976. He had life experience as a drug abuser, including 13 months of Metamorphosis residential care for drug abuse, which was and is considered very valuable in a drug addiction counselor. He also had, over time, worked every shift, every level of group with every client from clients #86 to #1100 sequentially, and with every staff person in Metamorphosis to that date. Whitaker also had been Program Coordinator from 1978 to 1988. At the time of Whitaker's "downward promotion," Santangelo's qualifications for Program Coordinator included all of those set out supra in Finding of Fact 11, plus approximately two years as a Drug Counselor II. By the time of Whitaker's "downward promotion", both Whitaker and Santangelo had been state certified through examination. (See Finding of Fact 15). At the time of Whitaker's "downward promotion", Petitioner had the same qualifications set out supra in Finding of Fact 10, plus an additional two years as a Drug Counselor I. She was not state certified as an addiction professional. By comparison, James Santangelo's qualifications for the Metamorphosis Program Coordinator position were clearly superior to those of Petitioner. Also, the record reflects no persuasive evidence that Respondent's downward transfer process, which on this occasion accommodated Mr. Whitaker, was contrary to, or unique within, the standard operating procedure of the Respondent's personnel department. There likewise is no persuasive evidence that the downward transfer process required the promotion of a Drug Counselor II (Santangelo) over a Drug Counselor I (Petitioner) into the Metamorphosis Program Coordinator position, so as to be "rigged" to prohibit Petitioner, as a minority employee, from being promoted. The greater weight of the credible evidence shows that Petitioner next applied for a Drug Counselor II position on October 4, 1988 (P-2). That document, made out solely by Petitioner, asserts she previously applied for Drug Counselor II and Program Coordinator without stating any dates. Lennard Perry, a black, who was seeking a downward transfer from Evaluation and Rehabilitation Case Worker I was ultimately hired for the Drug Counselor II position, but he was hired on a competitive basis. Petitioner's November 29, 1988 "Applicant Update Sheet" (P-3), again made out solely by herself, asserts she had previously applied for the Drug Counselor II position in September 1988. There is no documentary evidence of any kind of September 1988 application by Petitioner. Petitioner herself testified that the Drug Counselor II position was unfunded after her first 1988 application and then stated it was unfunded after her third 1988 application. This confusion may account for her saying at one point that she had applied for Drug Counselor II six times. However, Respondent's witnesses were credible and persuasive that the Drug Counselor II position was phased out after Petitioner last applied due to lack of funding and further reorganization. In making the foregoing findings of fact, the undersigned has rejected the testimony of Petitioner and Warren A. McCluney that a white man named Alan Pappas ever filled the Drug Counselor II position after any of Petitioner's 1988 applications. Their unsupported testimony on this issue is not probative that Alan Pappas was ever employed full-time and paid by Metamorphosis, even though Mr. McCluney stated that he saw Mr. Pappas receive a paycheck at the same time Mr. McCluney himself did. Mr. McCluney did not specify that the check Pappas allegedly received was a Metamorphosis or county check. He also testified that Mr. Pappas was only present at Metamorphosis for nine months during 1987, and that period bears no relationship to Petitioner's not being promoted in 1988. Other witnesses clearly testified that Mr. Pappas never worked for Metamorphosis in any capacity at any time. There is no evidence or pleading of record to support Petitioner's allegations that she filed any formal discrimination claim before 1988. The position of Victim Advocate Director was advertised by posting of the job description from February 13 to February 17, 1989. Petitioner applied for the position on February 16, 1989. Respondent received so few applicants in response to the February 1989 Victim Advocate Director job posting that the Respondent's Personnel Director feared the hiring procedure would be compromised. No one was hired for the Victim Advocate Director at that time. The dearth of applicants was believed to be the direct result of the low number of Victim Advocate Programs statewide so that, in turn, few people could meet the job position requirement of a minimum of one year's supervisory experience in a Victim Advocacy Program. It was ultimately decided to rewrite the minimum qualifications and re-advertise. At no time material did Petitioner have one year's supervisory experience in a Victim Advocacy Program. The only pertinent revision of the minimum position qualifications was that one year of supervisory experience in any related area was acceptable the second time the Victim Advocate Director position was advertised. The second time the Victim Advocate Director position was advertised, an applicant's supervisory experience did not have to be specifically in a Victim Advocate program. The job position revision was reviewed by Ida Rawls-Robinson, the Director of the Alachua County Equal Opportunity Office prior to publishing it. Ms. Rawls-Robinson, a black, approved the amended requirements because the amendment broadened the base of the pool of qualified people, thus inferentially making the position more accessible to minorities. Before the second job-posting, Petitioner received a letter dated April 14, 1989 from Personnel Director, Colleen Hayes, advising Petitioner that the job criteria for the position of Victim Advocate Director had been revised. In Colleen Hayes' April 14, 1989 letter, Petitioner was asked to complete the enclosed application update sheet if she felt she was still qualified after the revision of the minimum qualifications, but she did not do so. Instead, Petitioner forwarded a memorandum to Colleen Hayes to the effect that since her original application was less than six months old, Petitioner would not submit an application update in response to the revised job description, although she remained interested in the position. The second job-posting with the broadened minimum qualifications was posted from April 17 to April 29, 1989. Petitioner was not referred for the position of Victim Advocate Director because she did not have the minimum one year supervisory experience in the revised category either. The requirements had always required one year of supervisory experience in any event. The position of Victim Advocate Director was never actually filled by Respondent. It was ultimately moved to, and funded by, the State Attorney's Office.
Recommendation Upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Florida Human Relations Commission enters a final order dismissing the petition for relief filed herein. DONE and ENTERED this 24th day of July, 1992, at Tallahassee, Florida. ELLA JANE P. DAVIS, 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 24th day of July, 1992. APPENDIX TO RECOMMENDED ORDER The following constitute specific rulings pursuant to Section 120.59(2) F.S. upon the parties' respective proposed findings of fact (PFOF): Petitioner's PFOF: 1 Covered under preliminary matters 2-5, 7-8, 17-18, 20-21 23-26, 29-39 Accepted 6, 9, 15-16, 19, 27-28 Accepted in substance but modified to more accurately reflect the record as a whole, to eliminate hearsay, and to describe and resolve the issues as raised by Petitioner. 22 Rejected as stated. Petitioner initially testified to this. Later, she professed that the budget cuts occurred after the third application. The RO reflects all reconciled, competent, credible evidence. Respondent's PFOF: Respondent waived filing posthearing proposals. COPIES FURNISHED: Bruce W. Smith, Esquire Post Office Box 450 Gainesville, Florida 32602 Mary Marshall, Esquire Alachua County Attorney's Office Post Office Box 2877 Gainesville, Florida 32602-2877 Margaret A. Jones, Clerk Commission on Human Relations 325 John Knox Road Building F Suite 240 Tallahassee, Florida 32303-4113 Dana Baird, General Counsel Commission on Human Relations 325 John Knox Road Building F Suite 240 Tallahassee, Florida 32303-4113
The Issue The issue presented herein is whether or not a CON to construct a 60-bed short-term psychiatric hospital in District XI should be issued to Florida Medical Center (FMC).
Findings Of Fact FMC seeks a CON for a 60-bed free-standing psychiatric facility to be located in the Key Largo area of Monroe County in HRS District XI. FMC intends to provide 6.25 percent of its patient days at no charge to indigent patients. It further intends to provide another 6.25 percent of its patient days to HRS' clients and Baker Act patients at 50 percent of its projected charge, or $200 per day. (FMC Exhibit 2, Table 7). FMC proposes to build this facility at a cost of $6,060,000. Dr. Richard Matthews, Ph.D., has been executive director of the Guidance Clinic of the Upper Keys since 1973 and is a clinical psychologist. He is responsible for the overall administration and supervision of mental health, alcohol, drug abuse and out-patient services provided under contract with HRS. Dr. Matthews was qualified as an expert in clinical psychology and the mental health delivery health system in Monroe County. (FMC Exhibit 13). There are three guidance clinics in Monroe County, one each for the upper, lower and middle Keys. HRS contracts through each of these clinics to provide mental health care for its clients. There are no community mental health centers in Monroe County and the clinics are the sole means of delivering mental health care on behalf of HRS' clients within the county. Currently, the guidance clinic of the upper Keys places its in- patients in Harbor View Hospital in Dade County at a cost of $236 per day. Neither Harbor View nor any other hospital provides free days to any of the guidance clinics for in-patient psychiatric care. (FMC Exhibit 13, P. 9) Jackson Memorial Hospital does not accept indigent or charity psychiatric patients from Monroe County. There have been occasions where patients without resources have been unable to be hospitalized although hospitalization was indicated. The middle Keys has a crisis hospitalization unit with a limited number of beds. Patients needing hospitalization longer than three days must be transferred to Harbor View or some other facility in the District. The 15 beds at Depoo Hospital in Key West are not readily accessible to residents of the upper Keys. Residents needing psychiatric services usually go to hospitals in Dade County. Coral Reef Hospital, the nearest psychiatric facility to Petitioner's proposed facility, has in the past refused to negotiate a discounted rate with the guidance clinic. Dr. Matthews, on one occasion, sent a patient to Coral Reef who was refused treatment. Currently, no psychiatrist practices in Key Largo because there are no psychiatric beds to which a psychiatrist could admit patients. The discounted rate of $200 per day quoted by FMC is some $36 per day less than the guidance clinic currently pays to providers for referrals of its patients for psychiatric care. Additionally, the 6.25 percent of free care that Petitioner proposes is greater than the free care which the guidance clinic currently receives from any facility since no facility presently gives any free care to the clinic. The guidance clinic supports Petitioner's CON application and will contract with Petitioner who provides services for in-patients. Grant Center is a long-term 140-bed psychiatric hospital specializing in the treatment of children and adolescents. It is the nearest facility to Petitioner's proposed facility. Grant Center has agreed to refer adult patients to Petitioner. Grant Center treats 2-3 adults a month who need psychiatric care. (FMC Exhibit 14). There is one hospital providing psychiatric care in Dade County which was surveyed by the Health Care Finance Administration (HCFA) in March, 1988. Currently, a third party insurance carrier no longer utilizes Grant Center because of price. If a facility has prices which carriers consider too expensive, utilization will go down. (FMC Exhibit 14, P. 7). Grant Center currently contracts with HRS to provide its clients care at a rate of approximately $350 per day, a rate one half of Grant Center's normal rate. Jackson Memorial is the only Dade County hospital which will treat an indigent psychiatric patient. Grant Center intends to assist Petitioner with staffing or programmatic needs. It has 80-100 professional staff, most of whom live in close proximity to Key Largo. Robert L. Newman, C.P.A., is the chief financial officer at FMC. He testified, by deposition, as an expert in hospital accounting and finance. Newman analyzed the Hospital Cost Containment Board (HCCB) reports for each hospital in District XI which provides psychiatric care. There is no free standing psychiatric hospital in the District which reports any indigent or uncompensated care. Among area acute care hospitals which have psychiatric units, Miami Jackson rendered 38.89 percent indigent care, Miami Children's rendered 6.5 percent indigent care, and no other facility reported that it rendered more than 1.75 percent indigent care. (FMC see Exhibit 11, disposition exhibit 1). Jackson provides no free care to Monroe County residents and Miami Children's care is limited to treating children while Petitioner is seeking adult beds. Jayne Coraggio testified (by deposition) as an expert in psychiatric staffing and hiring. She is currently Petitioner's director of behavioral sciences. The ideal patient to staff ratio is 4 to 5 patients per day per professional staff member. During the evening shift, the ideal patient ratio per professional staff member is 7 to 8 patients. (FMC Exhibit 12, PP. 6-7). Petitioner's facility is adequately staffed based on the above ratios. FMC is considered overstaffed in the psychiatric unit by some of the other area hospitals since they do not staff as heavily as does Petitioner. Lower staffing ratios can affect quality of care since patients and their families would not receive as much therapy. Family therapy is important because the family needs to know about changes in the patient in order to make corrective adjustments. The family that is required to travel in excess of 45 minutes or more one way is less likely to be involved in family therapy. Islara Souto was the HRS primary reviewer who prepared the state agency action report (SAAR) for Petitioner's CON application. (FMC Exhibit 15). District 11 has subdivided into five subdistricts for psychiatric beds. Florida is deinstitutionalizing patients from its mental hospitals. To the extent that private psychiatric hospitals do not accept nonpaying patients, their existence will not solve the problem of caring for such patients. Souto acknowledged that the local health councils conversion policy discriminates against subdistrict 5 because there are so few acute care beds in the subdistrict. In fact, the conversion policy actually exacerbates the maldistribution of beds in the district. (FMC 15, page 26). The psychiatric facility nearest the proposed site (Coral Reef), had an occupancy of 90.3 percent. Souto utilized a document entitled Florida Primary Health Care Need Indicators, February 1, 1986, and determined that Monroe County has not been designated as a health manpower shortage area, nor a medically underserved area. This information is relied upon by health planners to determine the availability of health manpower in an area. This report refers both to physicians and R.N.'s. The average adult per diem for free-standing hospitals in District 11 range from $430 at Charter to just over $500 at Harbor View. Although districts have established subdistricts for psychiatric beds, no psychiatric bed subdistrict in any district has been promulgated by HRS as a rule. The access standard that is relevant to this proceeding is a 45-minute travel standard contained in Rule 10-5.011(1)(o)5.G. That standard states: G. Access Standard. Short-term inpatient hospital psychiatric services should be available within a maximum travel time of 45 minutes under average travel conditions for at least 90 percent of this service area's population. Here, the standard refers to the service area which is determined to be an area different than a service district. Applying the travel time standard on a service area basis makes the most sense since the subdistrict is established by the local health council and not the applicant. Analyzing this access standard on a sub-district level, 90% of the sub-districts population is not within 45 minutes of any facility anywhere in sub-district V since the sub-district is more than two hours long by ordinary travel and the population is split two-thirds in lower Dade County and one-third in Monroe County, the bulk of which is in Key West. (FMC Exhibit 17). Therefore, a facility located on either end of this sub-district is not readily accessible by the applicable travel standards to citizens at the other end of the sub-district. This access standard must however be measured and considered with the needs for psychiatric services of the kind Petitioner is proposing to provide. Petitioner has not presented any access surveys or assessments of the caliber relied upon by the Department in the past. Petitioner's facility which would be located in the Key Largo area will no doubt provide better geographic accessibility to residents of District XI who live in the Key Largo area. HRS has in the past used a sub-district analysis to determine geographic accessibility for psychiatric beds even though it has not promulgated a rule for sub-districts for psychiatric beds. See, for example, Psychiatric Hospital of Florida vs. Department of Health and Rehabilitative Services and Pasco Psychiatric Center, DOAH Case No. 85-0780. Likewise, the Department has approved the conversion of acute-care beds to psychiatric beds even though it found that there was a surplus of psychiatric beds in the district. (Petitioner's Exhibit 7). The Department has in the past used a geographic access analysis to approve psychiatric beds in District XI and has used the sub- district analysis or a time travel analysis in its review of Cedars, Coral Reef, Depoo (for psychiatric beds) and the Glenbiegh case (for long term substance abuse). The bed need calculations for the January, 1992 planning horizon shows a surplus of 180 short-term in-patient psychiatric beds. (HRS Exhibit 2). The occupancy level for short-term psychiatric beds in the district is below 70%. (HRS Exhibit 2, pages 11-12). Additionally, the occupancy standards of the local and state health plan, of which the department is required to review CON applications, have not been met in this instance. (HRS Exhibit 2, Pages 6-7). Petitioner has not submitted any documentation to HRS regarding special circumstances need. Petitioner's proposal at final hearing for a staff referral agreement with another local hospital was not contained in the CON application filed with HRS. (FMC Exhibit 14, pages 11-12). Although Petitioner has alluded to some unspecified access problem for residents in the Florida Keys, Petitioner has not documented a real access problem and certainly not a demonstration of inaccessibility under the rule access standard. (Florida Administrative Code Rule 10-5.011(1)(o)5.g.)(HRS Exhibit 2, pages 14-15). Although the proposed project would increase availability and access for underserved groups in the district, the percentage of total patient days for "indigents" is not substantial and certainly not to the point to warrant deviation from the usual access criteria. 2/
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, IT IS RECOMMENDED THAT: Petitioner's application for a Certificate of Need to build a 60-bed free- standing psychiatric hospital in District XI be DENIED. DONE and ENTERED this 28th day of February, 1989 in Tallahassee, Florida. JAMES E. BRADWELL 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 28th day of January, 1989.
The Issue The issue for determination is whether Petitioner's Medicaid provider number should be cancelled.
Findings Of Fact I.M.P.A.C.T. Institute, Inc. (Petitioner) provides primarily counseling services to residents of Broward County and the surrounding areas. The majority of the residents who receive Petitioner's services are low income, have language barriers and have little education. Petitioner provides a valuable and important service to the community that it serves. At all times material hereto, Petitioner was licensed by the Department of Health and Rehabilitative Services in accordance with Chapter 397, Florida Statutes. Petitioner was issued its regular license on December 29, 1994. At all times material hereto, Petitioner was enrolled as a community mental health provider in the Florida Medicaid program pursuant to Subsection 409.906(8), Florida Statutes. Petitioner has been enrolled in the Medicaid program for approximately three years. At all times material hereto, Petitioner has been issued a Medicaid provider number which has been continuously renewed. Petitioner is currently receiving Medicaid reimbursement for community mental health services pursuant to Subsection 409.906(8), Florida Statutes. On June 10, 1994, Petitioner executed a Medicaid Provider Agreement (Agreement). The Agreement provides in pertinent part: The provider and the Department [Depart- ment of Health and Rehabilitative Services] agree to abide by the Florida Administrative Code, Florida Statutes, policies, procedures, manuals of the Florida Medicaid Program and Federal laws and regulations. The agreement may be terminated upon thirty days written notice by either party. The Department may terminate this agreement in accordance with Chapter 120, F.S. Respondent has a handbook which describes, among other things, the community mental health services program and provider participation requirements. Effective December 1995, the handbook provides in pertinent part: Community mental health services are governed . . . through the authority of Chapter 409.906(8), Florida Statutes. * * * To be eligible to be enrolled in Medicaid, a provider must have a current contract pursuant to the provisions of Chapter 394, Florida Statutes, for the provision of community mental health services; and, if applicable, a regular (i.e., not provisional or interim) license as an alcohol prevention and treatment or drug abuse treatment and prevention program from the district Depart- ment of Health and Rehabilitative Services (HRS), Alcohol, Drug Abuse and Mental Health (ADM) program office. Petitioner does not have a contract with the Department of Health and Rehabilitative Services, Alcohol, Drug Abuse and Mental Health (ADM) program office. Petitioner has been attempting to obtain a contract with the Health and Rehabilitative Services ADM program office but has been unable to do so because the Health and Rehabilitative Services ADM office has had no money to fund such a contract. Respondent is cancelling Petitioner's Medicaid provider number because Petitioner does not have a contract with the Health and Rehabilitative Services ADM program office.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Health Care Administration enter a final order terminating I.M.P.A.C.T. Institute, Inc.'s Medicaid provider contract and cancelling its Medicaid provider number. DONE AND ENTERED on this 8th day of October, 1996, in Tallahassee, Leon County, Florida. ERROL H. POWELL Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 SUNCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 8th day of October, 1996. APPENDIX The following rulings are made on the parties' proposed findings of fact: Petitioner Partially accepted in finding of fact 1. Partially accepted in finding of fact 1. Partially accepted in finding of fact 4. Rejected as being argument, or a conclusion of law. Rejected as being argument, or a conclusion of law. Rejected as being argument, or a conclusion of law. Partially accepted in findings of fact 5, 8, and 9. Rejected as being subordinate, irrelevant, or unnecessary. Respondent Partially accepted in finding of fact 2. Partially accepted in finding of fact 3. Partially accepted in finding of fact 6. Partially accepted in finding of fact 5. Partially accepted in finding of fact 7. Partially accepted in finding of fact 8. NOTE: Where a proposed finding has been partially accepted, the remainder has been rejected as being subordinate, irrelevant, unnecessary, cumulative, not supported by the evidence, argument, or a conclusion of law. COPIES FURNISHED: Jason H. Clark, Esquire Post Office Box 17486 West Palm Beach, Florida 33416 Roger R. Maas, Esquire Agency for Health Care Administration 2727 Mahan Drive, Ft. Knox No. 3 Tallahassee, Florida 32308-5403 Sam Power, Agency Clerk Agency for Health Care Administration Fort Knox Building 3, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308-5403 Jerome W. Hoffman, General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308-5403
The Issue At issue in this proceeding is whether petitioner's request to modify its certificate of need from a 60-bed child/adolescent psychiatric hospital to a 45- bed child/adolescent and 15-bed adult psychiatric facility should be approved.
Findings Of Fact Case status In February 1993, petitioner, Martin H.M.A., Inc., d/b/a SandyPines Hospital (SandyPines), filed an application with the respondent, Agency for Health Care Administration (AHCA), for a modification of its certificate of need (CON) from a 60-bed child/adolescent psychiatric hospital to a 45-bed child/adolescent and 15-bed adult psychiatric hospital. Upon review, AHCA concluded that SandyPines' request could not be accommodated under the modification provisions of Rule 59C-1.019, Florida Administrative Code, and required certificate of need review. Accordingly, AHCA proposed to deny SandyPines' request, and these formal proceedings to review, de novo, the agency's decision were commenced at SandyPines' request. The applicant SandyPines is the holder of certificate of need number 4004 which authorized it to construct a 60-bed child/adolescent psychiatric facility. That facility was constructed and is currently in operation in Tequesta, Martin County, Florida. SandyPines is now, and has been since it commenced operations in January 1990, licensed as a Class III Special Psychiatric Hospital with 60 psychiatric child/adolescent beds. It has never provided adult inpatient psychiatric services and, until approximately October 18, 1993, had never provided any adult outpatient psychiatric services. The adult outpatient psychiatric services currently provided by SandyPines are not subject to CON review. SandyPines's fiscal problems When SandyPines opened in January 1990, no managed care organizations existed in its local market; however, with each passing year managed care has become more prevalent such that currently 45-50 percent of SandyPines admissions are covered by some form of managed care. This has significantly adversely affected SandyPines' revenues such that it lost approximately $600,000 last fiscal year and, absent increased occupancy levels, its continued viability is, at best, questionable. Indeed, if SandyPines continues to operate as currently configured, it projects a loss for the fiscal year ending September 30, 1994, of $1,099,777. Occupancy levels are low, however, for District IX as a whole, due in large measure to the demands for managed care. For the six-month period ending June 1993, the average occupancy rate for child/adolescent psychiatric beds was 35 percent and for adult psychiatric beds 65 percent. To address its faltering business, SandyPines has, as heretofore noted, begun to provide adult psychiatric services on an outpatient basis; however, unless it can combine inpatient adult psychiatric services with the program it is doubtful that its adult program will prove successful. In this regard, SandyPines offered proof, which is credited, that patients and their physicians are looking for what has been termed "one-stop shopping." The patient does not want to go to one facility for outpatient care and another facility for inpatient care, and the referring physicians would rather send all of their patients to one facility that offers a full spectrum of services. Therefore, from a marketing perspective, the addition of adult inpatient psychiatric services at SandyPines would have a positive effect. Whether modification of SandyPines' CON to allow inpatient adult psychiatric services will increase the hospital's daily census and utilization sufficiently to assure its viability is, at best, fairly debatable. To analyze the impact of redesignating 15 child/adolescent beds to 15 adult psychiatric beds, SandyPines made an assumption of an average daily census of 10.5 patients on the 15-bed adult psychiatric unit. Based on such assumption, SandyPines calculated a net income from that unit, for the fiscal year ending September 30, 1994, assuming it opened April 1, 1994, of $589,664, and a net loss for the facility as a whole of $510,113, as opposed to a net loss of $1,099,777 without the adult unit. Based on the same assumptions, SandyPines calculated a net income for the fiscal year ending September 30, 1985, for the adult unit at $1,111,008, and a net income for the facility as a whole with an adult unit at $44,980. As heretofore noted, SandyPines' ability to achieve an average daily census of 10.5 patients is, at best, fairly debatable. To SandyPines' credit, it has an active advertising and marketing department comprised of six people and its director of marketing and business development. This marketing group is constantly striving to develop relationships with referral sources and to develop programs to meet market needs and demands. There was, however, no proof of record to demonstrate any existent commitments in the community or any objective data to support the conclusion that SandyPines could reasonably expect to attain an average daily census of 10.5 patients. Moreover, four of SandyPines' potential competitors for adult psychiatric patients exhibited more than a 78 percent occupancy rate for the first six months of 1993, which may be reflective of among other attributes, a strong existent referral pattern, and the overall District average was only 65 percent, which reflects significant unused capacity. On balance, the proof is not compelling that SandyPines could achieve the occupancy levels it projected. Whether SandyPines achieved its projected occupancy levels for adult services or some lesser level would not, however, significantly adversely impact existing providers. Moreover, the redesignation of beds and the necessary modification of the facility to meet required legal standards of separation of adult and child/adolescent units would require no more than $50,000-$80,000; a capital expenditure well below that which would require CON review. Is modification appropriate Pertinent to this case, Rule 59C-1.109, Florida Administrative Code, provides: A modification is defined as an alteration to an issued, valid certificate of need or to the condition or conditions on the face of a certificate of need for which a license has been issued, where such an alteration does not result in a project subject to review as specified in . . . subsection 408.036(1) . . ., Florida Statutes. Subsection 408.036(1), Florida Statutes, provides in pertinent part: . . . all health-care-related projects, as described in paragraphs (a)-(n), are subject to review and must file an application for a certificate of need with the department. The department is exclusively responsible for determining whether a health-care-related project is subject to review under [ss.408.031-408.045]. * * * (e) Any change in licensed bed capacity. * * * (h) The establishment of inpatient institutional health services by a health care facility, or a substantial change in such services . . . * * * (1) A change in the number of psychiatric . . . beds. Finally, pursuant to the Legislature mandate of Section 408.034(3), Florida Statutes, to "establish, by rule, uniform need methodologies for health services and health facilities," AHCA has promulgated Rule 59C-1.040, Florida Administrative Code, which establishes discrete methodologies for calculating the need for the establishment of inpatient adult psychiatric services and inpatient child/adolescent psychiatric services, and provides for the identification of the number of hospital inpatient psychiatric beds for adults and children/adolescents by facility. As heretofore noted, SandyPines' license designates it as a "Class III Special Psychiatric hospital with 60 Psychiatric Child/Adolescent beds," and the inventory established pursuant to Rule 59C- 1.040(11), Florida Administrative Code, has identified SandyPines' beds as child/adolescent. Resolution of the parties' dispute as to whether SandyPines' proposed conversion of beds from child/adolescent to adult is subject to CON review under Section 408.036(1)(e), (h) and (l), Florida Statutes, and therefore not susceptible to modification under Rule 59C-1.109(1), resolves itself to an interpretation of Section 408.306(1), Florida statutes, and the provisions of Chapter 59C-1, Florida Administrative Code. SandyPines contends that hospital inpatient psychiatric services, as used in Chapter 408, Florida Statutes, and Chapter 59C-1, Florida Administrative Code, is a generic term for the treatment of psychiatric disorders and that its proposal to treat adults, as opposed to children/adolescents, is not a change in health services. Accordingly, SandyPines concludes that the proposed conversion does not constitute "[a] change in licensed bed capacity," "the establishment of inpatient institutional health services by a health care facility, or a substantial change in such services," or " change in the number of psychiatric beds," such that CON review would be required under Section 408.306(e), (h) and (l), Florida Statutes. Contrasted with SandyPines' position, AHCA interprets the foregoing provisions of law, when read in para materia, and with particular reference to Rule 59C-1.040, Florida Administrative Code, as establishing two discrete types of inpatient psychiatric services, to wit: child/adolescent and adult. The separate CON review criteria established by Rule 59C-1.040, Florida Administrative Code, for child/adolescent and adult inpatient psychiatric services is consistent with AHCA's interpretation. Indeed, the rule, among other things, establishes separate bed need methodologies, fixed need pools, bed inventories, utilization thresholds, and minimum unit sizes for child/adolescent and adult services. Granting SandyPines' request would run counter to these CON review criteria by, among other things, altering the District IX inventory of child/adolescent and adult psychiatric beds, as well as awarding adult psychiatric beds when there is no need under the established methodology. Finally, consistent with the provisions of Section 395.003(4), Florida Statutes, the agency has issued SandyPines a license "which specifies the service categories and the number of hospital beds in each bed category [60 psychiatric child/adolescent beds] for which [the] license [was issued]." Granting SandyPines' request would constitute a change in its "licensed bed capacity." Considering the foregoing provisions of law, it is concluded that the interpretation advanced by SandyPines is strained, and the interpretation advanced by AHCA is reasonable. Accordingly, it is found that SandyPines' proposed conversion of 15 child/adolescent psychiatric beds to 15 adult psychiatric beds is subject to CON review because such conversion constitutes "[a] change in licensed bed capacity," "the establishment of inpatient institutional health services by a health care facility, or a substantial change in such services," or "a change in the number of psychiatric beds." Section 408.036(e), (h) and (l), Florida Statutes
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that a final order be rendered denying SandyPines' request to modify its certificate of need from a 60-bed child/adolescent psychiatric hospital to a 45-bed child/adolescent and 15-bed adult psychiatric facility. DONE AND ORDERED in Tallahassee, Leon County, Florida, this 14th day of March 1994. WILLIAM J. KENDRICK 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 14th day of March 1994.
