The Issue The issue is whether the correctional officer certification of Steven S. Wright should be revoked or otherwise penalized based on the acts alleged in the Administrative Complaint.
Findings Of Fact Steven S. Wright is a certified correctional officer, having been issued certificate number 43-88-502-05 on December 19, 1988. Mr. Wright was employed as a Correctional Officer I at Lake Correctional Institute in June 1989. On the morning of June 20, 1989, and on other occasions, Mr. Wright had discussed drugs with inmates. He did not encourage or support the use of drugs. He believed these discussions were a useful part of the rehabilitation process. Later on June 20, 1989, Inmate Clinton Gholson approached Mr. Wright in the Food Services area and placed a piece of paper in Mr. Wright's pocket. Mr. Wright was planning to be married in a short time. Gholson had indicated that he and some other inmates wanted to make a wedding present for Wright in Arts and Crafts. Because inmates are generally prohibited from giving gifts to correctional officers, Mr. Wright and Gholson had agreed to a paper work process which was to be followed if Gholson and the others wished to make the gift for Mr. Wright. Authorization was to be sought before Mr. Wright actually received the gift. Gholson was to give Mr. Wright a choice of gifts Gholson could make. Mr. Wright understood that Gholson was to give him a short written list from which to pick. While Mr. Wright was working on June 20, 1989, Gholson approached him from behind and slipped the piece of paper into Mr. Wright's back pocket. Gholson indicated it was the gift list and Mr. Wright was to circle the gift he wanted. Gholson said something like, "You do that and that's what we'll make." Mr. Wright did not look at the note then. He forgot about it and finished his work. When Mr. Wright got home that evening, he discovered the note in his pocket. When he opened it, instead of a gift list, he found $3.00 and a note asking Mr. Wright to smuggle drugs (a "twenty cent piece") into the prison and they would make $240.00 from it. Mr. Wright was scheduled off from work the next two days. He was afraid he would lose his job because of what Gholson had done. When Mr. Wright returned to work on June 23, 1989, he told Sergeant Alexander what had happened. She sent him to Major Collier to make a report. Wright made the report and submitted it. He had forgotten to bring the note and money that day, so he could not attach it to the report. When Mr. Wright returned home that night, the note and money were gone. It was never determined if his wife or his nephew or someone else had thrown it away. Once Gholson knew he had Mr. Wright in a bad position, he used it to his advantage. He began demanding money from Mr. Wright and stated at various times that he had given Mr. Wright $10.00 to buy drugs and that he had loaned Mr. Wright $10.00. Mr. Wright reported these incidents immediately. When Gholson wrote another note demanding $10.00, Mr. Wright immediately turned that note over to Major Collier. A hearsay statement from Gholson in the form of a taped interview was submitted into evidence. It is found that Gholson's statements are so unbelievable as to be unworthy of any credibility. Even if the statements were not hearsay, they would be too unbelievable to form the basis for a finding of fact. Mr. Wright was fired from his job at Lake Correctional Institute as a result of these incidents and Gholson's statements. While there are some insignificant inconsistencies among the various statements and reports given by Mr. Wright, I find that his testimony and account of these events is absolutely credible and worthy of belief. While it is not disputed that Mr. Wright left the correctional institute on June 20, 1989, with a note and $3.00 which Gholson slipped into his pocket, it is affirmatively found that Mr. Wright had unwittingly done so. Mr. Wright had no idea that Gholson had placed money into his pocket until he reached home later that night. Mr. Wright did not knowingly accept money from Gholson.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is recommended that the Criminal Justice Standards and Training Commission enter a Final Order dismissing all charges against Steven S. Wright. RECOMMENDED this 10th day of June, 1991, at Tallahassee, Florida. DIANE K. KIESLING, 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 10th day of June, 1991.
Conclusions Having reviewed the Amended Notice of Intent to Deny, the Amended Administrative Complaint, and 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 pursuant to Chapter 408, Part IJ, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Amended Notice of Intent to Deny, the Amended Administrative Complaint, the Administrative Complaint, and the Election of Rights forms (Composite Ex. 1). The Election of Rights forms 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: Filed June 17, 2014 4:37 PM Division of Administrative Hearings 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. Lighthouse Inn North agrees as follows: a. The Notice of Intent to Deny letter is deemed superseded; b. A Change of Ownership application for an eligible provider shall be filed within 180 days of the execution of the settlement agreement; c. Lighthouse Inn North will pay the fine of $2,500.00 plus $237.00 survey fee' and $3,250.00 for a total of $5,987.00 before the Change of Ownership is complete, but not later than 90 days after the execution of the settlement agreement. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. 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 ORDERED at Tallahassee, Florida, on this /3 day of Serena , 2014. Elizabeth 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. 1 Paragraph 4(c) of the Settlement Agreement contains a scrivener’s error. It indicates a survey fee of $500.00, but the correct survey fee amount is $237.00. CERTIFICATE OF SERVICE I CERTIFY that a true and corr persons by the method designated on this Jan Mills Facilities Intake Unit (Electronic Mail) as py of this Final Order was served on the below-named day of ’ a / foo Ws bo , 2014. Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Finance & Accounting Revenue Management Unit (Electronic Mail) Alba M. Rodriguez, Senior Attorney Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Robert C. Wallach, Esq. Wallach Law, P.A. 4171 West Hillsborough Blvd. ~ Suite 9 Coconut Creek, Florida 33073 (U.S. Mail) Robert E. Meale Claude B. Arrington Administrative Law Judges Division of Administrative Hearings (Electronic Mail) Richard J. Saliba Presiding Officer Agency for Health Care Administration (Electronic Mail)
Findings Of Fact THE PARTIES Health Management Associates, Inc. (HMA), is a publicly owned hospital corporation with corporate offices located in Naples, Florida. It owns and/or operates 17 hospitals in the United States, including 2 owned facilities in the State of Florida, and one which it operates for the State under contract. Psychiatric service is limited in scope. Charter Medical Corporation, operating 66 hospitals, owns and operates Charter Glade Hospital, a 104-bed specialty psychiatric hospital located in Ft. Myers, Lee County, Florida. The facility is located approximately 2 miles west of I-75 and approximately 22 miles north of the site identified by HMA for its facility. As an existing facility in the service area, it has intervened herein to protest any award of a Certificate of Need to a competing facility, here, HMA proposed hospital. THE FACILITIES Of Charter Glades' 104 beds, 80 are licensed as short-term psychiatric beds, of which 56 are utilized for adults and 24 for adolescents. The remaining 24 beds are licensed as short-term substance abuse beds. It draws approximately 91 percent of its patients from Lee County, where it is located, and the remaining 9 percent from Collier County, contiguous to the south. It also operates an outpatient program in Naples, Florida, further south in Collier County, and utilizes substantial marketing and advertising programs within Collier County to inform and attract patients from that area. HMA proposes to establish a 50-bed, freestanding, psychiatric hospital in Collier County, 30 beds of which will be on a unit dedicated to adult patients and 20 beds dedicated to adolescents. The facility is designed to be built on an 8 to 10 acre tract of land and due to efforts by HMA's vice president for psychiatric operations, Mr. Beatty, who has personally surveyed the northern Collier County area, at least one adequate tract of property, already appropriately zoned, with access to adequate roads and utilities, has been identified. The project was designed by Architect Bruce Hartwigson, a professional with over 20 years experience in the design of health care facilities. Construction is projected to take approximately 8 months from the beginning of construction, with the facility being ready for operations within one month after completion of construction. As designed, the facility will provide a state of the art atmosphere for the psychiatric patients. Design provides for a residential appearance with allowance for quiet space, counseling offices, and recreational and therapeutic areas in addition to patient rooms. The adult and adolescent units will be physically separated and those areas scheduled for use by both categories of patient, such as dining and recreation areas, will not be utilized by both at the same time. The building, consisting of approximately 47,670 square feet, will also include, in addition to those facilities described above, necessary support facilities including doctors' and nurses' offices, administrative and business offices, storage, educational and physical activities areas, a swimming pool, and various therapy and treatment/examination rooms, as well as a chapel, beauty and barber shops, and support activities. The design proposed provides good visibility from the nurses' station to the entire unit served by that facility. All outside doors and those between units will be secured. Outdoor courtyards will be enclosed by fences or walls, and security/seclusion rooms have been designed to promote patient safety. The design proposed by HMA, complies with all codes and regulations of state and local agencies, and the size and layout proposed is reasonable. NEED HRS District 8 includes Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. HMA's proposed facility will serve, primarily, Collier county. Collier county is located, along with Lee county, in the southernmost of two separate marketing regions within District 8. Currently, almost all psychiatric inpatient services provided in both Lee and Collier counties are provided by Charter Glade Hospital in Lee county, and in the limited psychiatric service at Naples Community Hospital in Collier county. These two facilities are the only facilities licensed to provide hospital inpatient psychiatric services in their respective counties and the services are substantially different. Whereas Charter Glade Hospital is a freestanding psychiatric facility, Naples Community Hospital is a general, acute care hospital with a hospital-based psychiatric unit. In the Naples Community Hospital psychiatric facility, the average length of stay is 7.8 days. Naples Community Hospital is currently licensed to operate a 32-bed short-term psychiatric unit, and an 11-bed substance abuse unit. Consistent with the terms of a Certificate of Need issued to Naples Community Hospital for the establishment of a satellite facility, the hospital has agreed to de-license 9 of the 32 short-term psychiatric beds and the 11 short-term substance abuse beds. At the time of the hearing, the psychiatric unit at Naples Community Hospital had 20 beds staffed. The unit is used by area psychiatrists primarily for providing crisis intervention and the treating of immediate symptoms. Crisis stabilization/intervention is a psychiatric service which in normal circumstances results in an average length of stay of between 10 and 12 days. It differs substantially from longer term care, available in a psychiatric hospital. Under the shorter term programs, the disturbed and disoriented patient does not have sufficient opportunity to benefit from the programs available in a more comprehensive long term program. In short, Naples Community Hospital's program is oriented primarily to short term treatment, and this would not be contradicted or duplicated by the proposed service to be offered by HMA in its facility. Additional psychiatric care is provided by the David Lawrence Center located in Naples, which is Collier county's comprehensive community mental health center. At this facility, psychiatric care ranges from outpatient care through group and family therapy, to inpatient crisis stabilization and residential treatment programs for substance abuse or mental health problems. As a part of its inpatient program, David Lawrence operates a 12-bed crisis stabilization unit and a 12-bed short-term residential treatment program, with the former operating at an average occupancy of 66 percent and the latter at an average occupancy of 70 percent. The average length of stay at David Lawrence Center is generally between 5 and 7 days, at which time the patient is generally released and medicated for outpatient care with the opportunity then existing to obtain appropriate therapeutic care from other sources. As a publicly funded facility, David Lawrence refers most paying patients to either Naples Community Hospital or Charter Glade. Little difficulty has been experienced in placing inpatient referrals with the exception of younger children. There is also a community health center operating 30 crisis stabilization and short-term residential treatment service beds located in Lee County. Since this facility's mandate includes providing provision of services for all of the southwest portion of District 8, some patients come from Collier county as well as Lee county. This facility also operates an adult residential treatment service, which has been funded to add an additional 80 to 100 beds in the foreseeable future. Other relevant resources, either actual or potential, include an adult residential treatment service funded to begin operation in Charlotte county, which will give access to geriatric psychiatric patients residing in Collier county, and the Naples Research and Counseling Center (The Willows), located in Collier county, whose program is primarily oriented to the treatment of bulimia and other food disorders. This facility, under the terms of its license, is primarily oriented to serving patients outside District 8, but may devote up to 3 percent of its total patient days to District 8 patients. Though it does serve as a resource, its impact on the need for psychiatric services in the southernmost portion of District 8 is minimal. Other outpatient psychiatric services available to Collier county residents include the activities of the six practicing psychiatrists located within the county, who provide outpatient services in conjunction with non- medical professionals. There is also psychologists and psychiatric social workers practicing within the county. In February, 1987, DHRS published projections for the January, 1992 Planning Horizon which revealed the net need for 61 short-term psychiatric beds in District 8. It was noted at the time that the short-term psychiatric bed need projection had not yet been adjusted for occupancy rates according to the terms of Rule 10-5.011(1)(o), Florida Administrative Code. The Agency thereafter promulgated Rule 10-5.008(2), which established the "fixed pool" concept for Certificate of Need Review. HMA submitted its application based on the 61-bed projection. Upon review of the applications, during which time the Agency calculated a net need numerically for 55 additional short-term psychiatric beds, DHRS denied HMA's application on September 9, 1987, even though a 55-bed need was established. Under the provisions of Rule 10-5.011(o)(4)(e), Florida Administrative Code, the Department determined the numeric need to be inapplicable, because the average annual occupancy rates for all existing adult short-term inpatient psychiatric beds in District 8 did not exceed 75 percent for the preceding 12 month period. By the same token, the same rate for adolescents and children did not exceed 70 percent for the same time period. DHRS's observation regarding occupancy rate thresholds was accepted by HMA's health planner. The difference between the 61-bed need published by DHRS initially and the 55-bed projection is an award of 6 short-term psychiatric beds to Venice Hospital. During the course of the hearing, and after HMA had presented its case in chief, the Department revised its numeric need calculation to reflect a 44- bed net need for January, 1992. This change was attributed to the mistaken assumption that 20 beds at Naples Community Hospital would be de-licensed. In reality, only 9 beds will actually be de-licensed. Under the terms of the Rule, gross need is calculated upon a standard of 35 beds per 1,000 population, and this figure must be reduced by the number of licensed and approved beds within the District. The proper count, therefore, should be a total of 295 beds including 23 at Naples Community Hospital instead of 12. HMA objected to the introduction of evidence relating to the change in numeric bed need on the basis that it had already presented its case in chief, and had not been advised of the change in advance. The basis for the original denial of HMA's application by the Department included as a important part thereof the fact that the occupancy standards outlined in the Department's Rules had not been met regardless of the bed need established by use of the methodology. This is as much a factor with a numeric need of 44, as it was with a numeric need of 55. The evidence did not establish that the occupancy rates had increased so as to meet the Department's standards. It is nonetheless appropriate for the Department to correct, at the hearing, an obvious miscalculation which goes to the very heart of the numeric need methodology. If accurate information is not included in the calculations under the methodology, then the methodology result is totally unreliable. Consequently, it is found that the appropriate bed need for the January, 1992 Planning Horizon is 44 beds. Turning to the question of occupancy levels, statistics compiled for District 8 for the years 1984 through 1987, reflect that district wide, the average occupancy for 1984 was 54.7 percent; for 1985, 69.22 percent; for 1986, 59.29 percent; and for 1987 through October, 59.12 percent. Though the health plan does not call for sub-district districting, if one looks at the two major facilities located in the Lee and Collier counties, that is Naples Community Hospital and Charter Glade Hospital, the average for those two is 51.35 percent, with Charter Glade at 33.2 percent. For 1985, the two had an average occupancy of 55.75 percent; for 1986, an average of 49.92 percent, and for 1987, an average of 50.81 percent. Therefore, no matter how it is looked at, either on a district wide basis or considering only the two counties, the average occupancy is well below the 75 percent standard for adults or 70 percent for adolescents. Under the provisions of the DHRS Rule, when numeric need has not been established, no new beds will "normally be approved." It has long been settled that this means that if other circumstances exist which indicate the need, outside of the numeric calculation, for additional beds, DHRS may consider and award them. The occupancy rates catalogued above would be one possible example of abnormal circumstances, if they had exceeded the Rule standards. Another is the access standard, contained in Rule 10-5.011(o)4g, which provides that 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 the service area population. As was stated above, service area means the entire District 8. It was clearly established at final hearing that more than 90 percent of the District 8 population is within a 45 minute travel time of short-term, inpatient hospital psychiatric services with only 6.3 percent falling outside that parameter. In fact, the local health plan indicates that 90 percent of the district population falls within 30 minutes travel time. Other real factors which may be considered are the shortage of psychiatrists in the area, in both counties, and a definite shortage of psychiatrically trained nurses in both counties. It has been shown, however, that physicians, like nature, abhor a vacuum. If facilities are available, medically trained personnel will generally gravitate to the area of availability, and it is consequently found that these two factors are not controlling. OTHER FACTORS The issue of the financial feasibility of the project is always pertinent. HMA proposes to develop this project, utilizing 20 percent equity contribution, and 80 percent debt financing. HMA has access to a $75,000,000.00 line of credit and financing drawn on that line would be at prime rate. It is estimated that costs and fees associated with financing will total approximately $57,000.00. The method of funding and the proposed interest expense and fees are considered reasonable. The applicant proposes to charge an all-inclusive rate of $398.00 per patient day in the first year and $415.00 per patient day in the second year. These are not contested and are considered reasonable. During the first year, total deductions of $508,000.00 include contractual allowances of $400,000.00, plus a bad debt allowance of approximately $100,000.00. Intervenor contends that HMA's bad debt factor of 4 percent is unrealistic, and Charter Glade's experience of 5 percent would be more reasonable. An adjustment of that nature would total $41,600.00, which is not particularly significant when compared against the overall project estimated yearly income. The second year's proposed revenue deductions of $716,500.00 are also contested by the Intervenor on the basis of what it considers unrealistic projections, but again, there is insufficient evidence to indicate HMA's projections are unreasonable. Intervenor has contested many of the line items on HMA's pro forma statement. Whereas HMA projects a 4 to 5 percent per year inflation rate for salaries and benefits, Intervenor suggests that an inflation rate of 6 percent would be more appropriate. Supplies and expenses figures should be increased according to Intervenor, who also contends that HMA's projected depreciation and other expense is understated, as were the projected pre- opening expenses. If all adjustments suggested by the Intervenor were to be made, HMA's facility would lose $588,000.00 in its second year of operation, in the event HMA's projected second year occupancy of 55 percent were to be realized. Intervenor contests this, contending that because of lack of bed need and lack of demand, it is doubtful HMA will achieve the projected occupancy and its position is well taken. The growth rate in the two county area is projected to be a sum equivalent to 19.6 percent of the 1980 population. Applying this same figure to the average daily census for the two existing facilities reveals an additional 12.4 patients per day available to HMA, if one assumes Naples Community Hospital and Charter Glade would continue to serve the existing population base. The 12.4 patient census would constitute a 25 percent occupancy rate, as opposed to 55 percent. In light of the currently existing occupancy rates, it is found that HMA's projected 55 percent occupancy rate at year two is overly generous and would likely not be achieved in light of the various factors discussed previously. While the criticisms and suggested adjustments by the Intervenor as to expense and salary items are considered unconvincing, there is some question, in light of proposed occupancy rates, whether Petitioner can operate the facility feasibly within two years. There is, however, little doubt that HMA would construct a quality facility and operate it in such a manner as to meet, if not exceed, all state standards. Its prior record would tend to establish that. Proposed staffing ratios are reasonable and consistent with industry standards, and the programs incorporated within the proposal are appropriate and reasonable. HMA has access to adequate capital resources to fund the construction and operate it for the first several years. There is some question, however, as to whether adequate, qualified staff can be recruited in sufficient numbers. HMA proposes to serve indigent patients in numbers sufficiently high to meet its proportionate share of indigent mental health problems within the service area. There was some evidence, through the deposition of Dr. Mack, which tends to indicate that from time to time, psychiatrists practicing in Collier county have difficulty from a logistical standpoints securing inpatient placement for their psychiatric patients at Charter Glade, and there can be little doubt that the distribution of psychiatric beds in District 8 is unbalanced, with far more beds in the northern portion of the district than in the south. Whether this justifies construction of a new psychiatric hospital in Collier county, however, is another matter. The evidence clearly indicates that the short- term beds at Naples Community Hospital are not fully utilized and the occupancy rates would tend to indicate that the demand within the two counties, as it currently exists and is proposed to exist within the framework of the Planning Horizon, is currently being met. Another legitimate factor to be considered is the adverse impact construction of a new facility, such as proposed by HMA, would have on the existing Charter Glade facility which, more than any other existing facility, provides the same service. Evidence of record indicates that Charter Glade gets 85 percent of its patients from Lee county, in which it is located, and 17 percent of that number comes from that area of Lee county, south of the Charter Glade facility. In addition, 9.3 percent of Charter Glade's patients come from Collier county. Adding the south Lee county patients to the north Collier county patients, accounts for approximately 23.75 percent of Charter Glade's total patients. (.17 X .85 .1445 + .093 .2375) If HMA's new facility were to draw 50 percent of that figure, approximately 12 percent of Charter Glade's total patient days would be lost. (.2375 X .50 .11875) In 1987, Charter Glade's charge per day was slightly in excess of $431.00, which resulted in a net profit of slightly over $105,000.00. Were Charter Glade to lose approximately 12 percent of its patient days, the net adverse effect to its revenue picture would be substantial.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is therefore: RECOMMENDED that Petitioner, Health Management Associates, Inc.'s application for Certificate of Need Number 5170 to establish a 50-bed, freestanding, short-term psychiatric hospital in Collier county be denied. Recommended in Tallahassee this 30th day of June, 1988. ARNOLD H. POLLOCK 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 30th day of June, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-4741 The following constitutes my ruling on Proposed Findings of Fact submitted by the parties hereto, consistent with Section 120.59(2), Florida Statutes. For HMA: 1 - 2. Accepted and incorporated herein. 3. Irrelevant. 4 - 5. Accepted and incorporated herein. 6 - 14. Accepted and incorporated herein. 15 - 16. Accepted and incorporated herein. 17. First and third sentences accepted and incorporated herein. Second sentence is irrelevant. 18. First and second sentences accepted and incorporated herein. Third sentence is irrelevant. 19 - 22. Accepted and incorporated herein. Accepted and incorporated herein. Cumulative. 25 - 26. Accepted and incorporated herein. Not a finding but a restatement of evidence. Accepted. First sentence accepted and incorporated herein. Second sentence rejected as a restatement of evidence. 30 - 37. Accepted and incorporated herein. Rejected as a restatement of evidence. Accepted. Accepted. Accepted and incorporated herein. 42 - 43. Accepted. 44 - 46. Accepted and incorporated herein. 47 - 48. Accepted. 49. Rejected as contra to the weight of the evidence. 50. Irrelevant. 51 - 53. Accepted and incorporated herein. 54 - 58. Accepted and incorporated herein. 59 - 61. Accepted and incorporated herein. 62. Accepted and incorporated herein. 63 - 69. Accepted and incorporated herein. 70. Rejected as contra to the weight of the evidence. 71 - 81. Accepted and incorporated herein. 82. Rejected. 83. Irrelevant. 84. Accepted. 85 - 87. Rejected as an overstatement of the situation as it exists. By DHRS: 1 - 2. Accepted and incorporated herein. 3 - 6. Accepted and incorporated herein. 7 - 8. Accepted and incorporated herein. 9 - 10. Accepted. 11. Accepted and incorporated herein. 12 - 14. Accepted and incorporated herein. By Charter Glade Hospital: 1 - 4. Not Findings of Fact but Introduction. 5 - 8. Accepted and incorporated herein. 9. Accepted. 10 - 12. Accepted and incorporated herein. 13 - 15. Accepted and incorporated herein. 16 - 17. Accepted and incorporated herein. 18 - 20. Accepted and incorporated herein. 21 - 22. Accepted. Not a Finding of Fact but a comment on the evidence. Accepted. Not a Finding of Fact but a comment on the evidence. 26 - 27. Accepted. 28. Accepted and incorporated herein. 29 - 34. Accepted and incorporated herein. 35 - 36. Accepted and incorporated herein. Accepted and incorporated herein. Accepted. 39 - 40. Accepted and incorporated herein. First sentence accepted and incorporated herein. Remainder is irrelevant. Accepted. 43. Accepted and incorporated herein. 44 - 46. Accepted and incorporated herein. 47. Irrelevant. 48 - 51. Accepted and incorporated herein. 52. Accepted and incorporated herein. 53 - 55. Accepted and incorporated herein. 56 - 59. Accepted and incorporated herein. 60 - 65. Accepted and incorporated herein. Not a Finding of Fact. Accepted. 68 - 70. Not a Finding of Fact but a comment on the evidence. 71 - 72. Accepted and incorporated herein. Accepted. Not a Finding of Fact but a comment on the evidence. 75. Accepted. Accepted. Accepted. Accepted and incorporated herein. Not a Finding of Fact but a recitation of and comment on the evidence. Not a Finding of Fact but a restatement of and comment on the evidence. 81-83(o). Accepted in part by HMA and commented on in Recommended Order. 84 - 86. Not a Finding of Fact but a speculative projection. 87 - 89. Accepted and incorporated herein. 90. First sentence accepted - Second sentence rejected as a restatement of evidence designed to bolster first sentence. 91 - 94. Accepted and incorporated herein. COPIES FURNISHED: John F. Gilroy, III, Esquire Robert S. Cohen, Esquire Haben and Culpepper Post Office Box 10095 Tallahassee, Florida 32302 John Rodriguez, Esquire Assistant General Counsel Department of Health and Rehabilitative Services 2727 Mahan Drive Tallahassee, Florida 32308 Michael Cherniga, Esquire Roberts, Baggett, Laface & Richards 101 East College Avenue Tallahassee, Florida 32301 Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 R. S. Power, Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
Conclusions Having reviewed the Amended Notice of Intent to Deny, the Amended Administrative Complaint, and 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 pursuant to Chapter 408, Part IJ, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Amended Notice of Intent to Deny, the Amended Administrative Complaint, the Administrative Complaint, and the Election of Rights forms (Composite Ex. 1). The Election of Rights forms 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: Filed June 17, 2014 4:38 PM Division of Administrative Hearings 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. Lighthouse Inn North agrees as follows: a. The Notice of Intent to Deny letter is deemed superseded; b. A Change of Ownership application for an eligible provider shall be filed within 180 days of the execution of the settlement agreement; c. Lighthouse Inn North will pay the fine of $2,500.00 plus $237.00 survey fee' and $3,250.00 for a total of $5,987.00 before the Change of Ownership is complete, but not later than 90 days after the execution of the settlement agreement. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. 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 ORDERED at Tallahassee, Florida, on this /3 day of Serena , 2014. Elizabeth Agency for Health Care Administration
Findings Of Fact Douglas L. Adams is an inmate at Union Correctional Institution. On August 26, 1985, he was awakened early in the morning and brought before a disciplinary hearing for an alleged violation of institutional rules and regulations. Prior to the hearing, he was advised by a correctional officer to pack up all his personal property and to bring it with him to the hearing. Mr. Adams took with him as much as he could which included his clothing and other personal effects, but he was unable to carry all he owned with him at one time. He did not ask for either help in carrying his property or a cart to carry it in prior to leaving his cell area to go to the hearing. When he arrived at the movement center where the hearing was to be held, he advised the authorities there that he did not have all his property with him. At that point, he asked for help or the use of a cart to go get the rest of his property but he was refused because no cart was there. As a result, he went to the hearing leaving some of his property in his cell area and while in the hearing, contends he was required to leave his property in the control center. This property was secured in a storage room behind the control center which, while not locked, was not available for access to other inmates unless they were accompanied by a corrections officer. When the hearing was over and Mr. Adams, who had been directed to administrative confinement requested to go back to his former cell area to get the rest of his property, his request was refused. His property was inventoried by UCI personnel at that time, but because in his opinion the inventory was not complete, Mr. Adams refused to sign the form. When he was released from administrative confinement he claims he did not get all his property back. He relates that he was told he had forfeited whatever property he had not brought to the hearing. As a result, he filed a complaint on September 16, 1985, which was subsequently denied. Petitioner has been incarcerated in 7 or 8 institutions within the Department of Corrections including Florida State Prison, River Junction Correctional Institution, Baker Correctional Institution, Polk Correctional Institution, Old Unit, the Reception and Medical Center, and DeSoto Correctional Institution. At each one of these institutions a rule similar to this one was in existence. At Baker Correctional Institution, the inmate was required to bring his mattress as well. Robert Craig has been in prison for a total of 27 years and has been incarcerated in almost every major penal institution in the State of Florida that was built prior to the last five years. At Avon Park Correctional Institution he underwent a disciplinary hearing and was told at the time to bring all his personal property with him to the hearing. While in the hearing, he was required to leave all his property outside in the hall. At Cross City Correctional Institution the guards took him to the hearing without his property, bringing his property along afterwards. In essence, at all the institutions where he was incarcerated, there was some variation of the same procedure regarding his personal property. He either had to bring it to the hearing or it was packed up prior to the hearing. At no institution was his property inventoried prior to the hearing. As a result, he has lost personal property including a calculator for which he was subsequently reimbursed by the institution. According to Mr. Craig, if the inmate does not bring his personal property with him he either is given a deficiency report or is precluded from going back to get it when the hearing is over. Sgt. Denmark has worked for approximately 8 1/2 years with the Department of Corrections, all at UCI, where he formerly worked at the movement center. One of the functions he performed there was to handle prisoners coming for a disciplinary hearing. The rule as explained to him regarding the inmates' personal property is that the inmate is required to bring all of it with him to the hearing. Once the property is brought with the inmate to the hearing, the inmate is free to either take it into the hearing with him or to leave it in the storage room in back of the movement center during the hearing. If the inmate is sentenced to disciplinary confinement as a result of the hearing, in that case, and at that point, the inmate's property is inventoried. If the inmate is not sentenced to disciplinary confinement, the property is returned to the prisoner who is returned to his area. In the instant case, Mr. Denmark heard the Petitioner tell Sgt. Howe, when he arrived at the movement center, that he had left some of his property in his cell. However, when Adams went into his hearing, he neither took his property with him nor requested that it be secured. According to Mr. Cunningham, the Chief Classification Supervisor, the Union Correctional Institution Policy, (85-52.9 B1) requires inmates to bring all their property to disciplinary hearings. It is an old policy, and the reason for it is to protect the property from theft. In a disciplinary hearing, there is a chance that an inmate might not get back to his old cell to retrieve his property after the hearing. For security reasons, institution officials prefer not to take a prisoner back to his old cell after a hearing because, at that point, he is often angry as a result of the hearing and disruptive. All Department of Corrections' institutions in the region incorporating UCI, except Florida State Prison, have a similar policy. Inquiry of corrections personnel at the agency headquarters in Tallahassee reveals that most major DOC facilities have a similar policy. There are a total of 33 other facilities which hold less than 100 inmates each. These smaller institutions do not, generally, have a similar policy and Florida State Prison has a different situation because of the different security problems. It is the needs of the institution, however, which determine the use of the policy. Mr. Cunnningham is aware of Mr. Adams' hearing and the complaint filed as a result thereof. Upon inquiry it was determined that Mr. Adams had failed to establish a loss and the complaint was denied. Mr. Cunningham does not know whether there was an investigation into the loss of the property left in the cell. It is Mr. Cunningham's understanding that if the witness cannot carry all his property at one time, normally, if the inmate asks for permission to do so, he will be allowed to go back and get the balance before the hearing. This is not in the procedure approved by DOC, however, nor in the IOP at UCI. Corrections Officer Howe is also aware of the fact that Mr. Adams had a hearing on August 26, 1985. He, in fact, was called to the movement center to escort several prisoners, including Adams, to the confinement barracks after the hearings. A part of this duty involves inventorying the prisoners property. Howe told Adams to get his property and bring it in for inventory. At this point, after the hearing Adams said he did not have all his property with him and asked to be taken back to his old cell to get the rest. Howe declined to do this and explained the security reasons for his decision to Adams. He did advise Adams, however, that he would call down to Adams' old cell area and have his property packed which, in fact, he did. It is standard practice at UCI, according to Howe, that if an inmate has a large amount of property, he can request the use of a cart or wheelbarrow which is assigned to each housing area for carrying this excess property. This cart will be returned by a runner who can also help carry the excess. To his knowledge, inmates are not denied the use of these carts. Howe declined to return Adams to his old cell area after the hearing because, at the time, Adams was belligerent and unstable and presented a security risk in his opinion and also, because Adams had previously been advised to bring all his property with him and had failed to do this even though there was a way for him to accomplish it.
The Issue Determination, after remand, of an appropriate award for reasonable attorneys’ fees and costs incurred by Petitioners in consolidated appeals.
Findings Of Fact As the First District has determined Petitioners’ entitlement to an award of fees, the only issue remaining to be determined at the time the above-styled case was opened after remand was the amount of fees and costs. After a telephonic status conference and the scheduling of this case for a final hearing, on June 1, 2017, the parties to this case filed a Stipulation for Entry of Agreed Final Order for Appellate Attorneys’ Fees and Costs (Stipulation). In the Stipulation, the parties agreed to the entry of a final order for the award of $35,658.03 as reasonable attorneys' fees and $192.87, for taxation of costs incurred, in the consolidated appeals, to be paid within 30 days from the entry of a final order thereon. The amounts for fees and costs set forth in the Stipulation are consistent with the attachments to the Motion.
Findings Of Fact Charter is a wholly owned subsidiary of Charter Medical Corporation, (CMC), a hospital corporation established in 1969. CMC presently owns and operates health care facilities and health related organizations throughout the United States and abroad. Within its inventory are 27 psychiatric and addictive disease hospitals and 12 medical/surgical hospitals in addition to several other health related entities. Charter, by application filed on November 15, 1983 and subsequently amended, proposed to develop Charter Haven Hospital, (Charter Haven), a freestanding hospital containing 52 short term psychiatric and addictive disease beds, in Bradenton, Manatee County, Florida. The bed makeup will consist of 25 beds for adult and geriatric psychiatric patients, 16 beds for adolescent psychiatric and addictive disease patients, and 11 beds for adults with alcohol and drug-related problems. The geriatric patients will have the benefit of a specialized program designed specifically for the special problems of geriatric patients. Treatment will be open to all on a nondiscriminatory basis. Charter's application was denied in March, 1983, and denial was reaffirmed in June, 1983, on the basis that Petitioner failed to show need for the proposed facility in HRS District VI as defined by Rule 10-5.11(25), Florida Administrative Code. Intervenor, MMHC's application for a similar facility, filed in a later batching cycle, was also denied on the same basis. Petitioner's proposed facility would be located on a 9.34 acre site on Cortez Road in Bradenton, approximately 1 - 2 miles from the currently existing Blake Memorial Hospital and 4 - 5 miles from MMH. MMHC is located about 2 - 3 miles from the site which is readily available to staff, prospective patients, and physicians. Its reasonable proximity to the cited hospitals facilitates the providing of medical treatment to patients on a routine or emergency basis. The facility in question was designed for CMC within standardized design parameters developed specifically to create a facility in which psychiatric care could be provided in a non-institutional atmosphere. The building, proposed as a one-story, self-contained structure incorporating within it all treatment services and program elements, is to be constructed so as to be compatible with the Florida climate and environment and the complex will include facilities, both indoor and outdoor, to take advantage of the Florida life- style. All patient rooms will have outside windows. Considerable attention has been given in design to cost efficiency and professionally appropriate design criteria as well. The patient units, (adult, geriatric, and adolescent), can be utilized as either open or closed units by the use of doors adjacent to the main nursing station which, itself, is located in a centralized spot which affords nurses and staff members visual control of the major corridors in each unit. The facility is equipped to handle violent, disruptive, or involuntarily committed patients whose special needs can be handled by the use of seclusion rooms on the units. Areas to be utilized for such activities as classrooms, occupational therapy, and recreation are generally outside the nursing units and are designed to serve patients from more than one unit, on a scheduled basis. Some facilities, such as the gym, serve a multipurpose function. Design organization incorporates numerous cost and energy saving concepts. For example, each room will be individually temperature controlled; all corridors have rooms on both sides; and specialty areas with special design requirements are grouped together where possible. This facility, which CMC considers to be the state of the art in psychiatric hospital design, was designed with the intent to have it economically expandable to meet proposed prospective future needs. It is anticipated that its design will comply with the requirements of all standardizing and licensing agencies as they pertain to psychiatric hospital construction. MMH, a community based, not for profit general acute care hospital in Bradenton, operates an inpatient psychiatric care unit identified as the Mental Health Unit, (MHU). Approximately 22 percent of the MHU patients are Baker Act eligible under a contract with the MMHC which requires the MHU and MMH to accept Baker Act patients regardless of the fact that reimbursement funds may be insufficient or depleted. In fact, as of the hearing, insufficient funds were available to pay for the total care provided to Baker Act and indigent patients treated in the MHU. MMHC, also a nonprofit, community based organization, is a part of the community's public-funded mental health care system. It provides an extensive range of mental health care in the Bradenton community for the prevention and rehabilitation of mental, emotional, and substance abuse disorders. MMHC operates 13 separate programs including crisis intervention and counselling to approximately 5,500 outpatient and residential psychiatric and substance abuse patients per year regardless of the individual's ability to pay. The MMHC provides inpatient and substance abuse care at its Glenridge center which is licensed to operate crisis stabilization, short term residential care, and substance abuse units. The substance abuse unit operates both detoxification and 28-day treatment programs with the former having 9 beds and the latter 20. The short term residential and crisis stabilization unit has 8 inpatient beds. Staffing includes nursing personnel, counselors, psychiatric technicians, physicians, and support staff. The facility is housed in an inadequate 60 year old frame building which is to be replaced by a new facility funded by the Florida Legislature. It will contain 54 beds (12 substance abuse and 42 psychiatric) and is scheduled for opening in 1985. MMHC has applied for a CON to operate the new facility as a psychiatric hospital rather than as Glenridge is presently operated. MMHC is the Baker Act receiving facility for Manatee County and nearly 100 percent of its patients are either Baker Act eligible or indigent. While currently unable to handle disruptive patients and required to transfer them to MMH's MHU, the opening of the new facility, it hopes, will enable it to care for all Baker Act eligible, indigent, and disruptive patients in-house without referral to MMH. Charter's project is estimated to have a total cost of approximately $5,102,000. The individual factors which go into the total cost makeup are reasonable and supportable and include such items as development costs and feasibility studies, financing (interest) fees and loan origination fees; professional services (legal, accounting, architectural, and engineering); site survey and preparation; land acquisition; construction; and equipment. Because of its widespread and high-volume purchases, CMC is able to get reduced prices on much of its equipment and supplies. Further, its support services to the individual hospitals in the areas of consultations, planning and development, and personnel recruitment are designed to and generally do reduce costs. MMHC, on the other hand, contends that CMC's demonstrated willingness to pay higher salaries could tend to drive local personnel costs up. There is no demonstrable evidence, outside the professed intentions on the one hand and the speculation about results on the other to show what in fact, would happen. On the question of financial feasibility, during its first year of operation (projected August 1, 1985 - July 31, 1986) the 52 bed facility is expected to experience a 61 percent occupancy rate which would translate into 11,578 patient days. Bad debt in the first year, based on CMC's experience in opening other hospitals, is anticipated at 6 percent in the first year of operation and 5 percent in the second. This is in addition to "Charter Care," a policy within CMC which in the instant case, would provide 2 free beds (a $250,000.00 value) for indigent patients within the first year of the facility's operation. Indigent care and bad debts (including contractual adjustments) are expected to constitute 11 percent of the first year's total patient days. Since projected total revenue is based on a rate of $350.00 per patient day 1/ for a total of $4,052,00.00 (11,578 x $350.00), deductions for Charter Care, bad debts, and Baker Act patients result in a net revenue during the first year of $3,384,000.00. Medicaid is not available as a reimbursement mechanism for this facility. Further deductions for salary and benefits, figured at $19,500.00 per person, on CMC's historical and reasonable average, and supplies and expenses of $85.00 per patient day are reasonable in both categories. Projections for both income and expense are considered reasonable as is the profit margin projected for the first two years of operation. In determining where to locate its proposed facility in this area, Charter utilized two criteria: (1) the site must have accessibility to users, practitioners, and other facilities; and, (2) the site must be capable of being built on. The site selected appears to meet both criteria. In addition, however, Charter personnel also considered alternates to new construction (the conversion of an existing building, for example) but were unable to find anything suitable that was available. They talked, in advance, with representatives of MMH and MMHC with a view towards some sort of cooperative endeavor, but while the response was originally not negative, it became so after the proposal was brought to Intervenors' Boards. Notwithstanding that initial rejection, Charter indicates its desire to open and keep open lines of communication with these facilities and to, in fact, engage in some cooperative efforts where possible. In fact, it is, Charter contends, its policy and intent, consistent with its practice in all its facilities, to maintain an interface with the local community on community issues. It will enter into memoranda of understanding here, such as it has done in the past in other areas into which it has come, such as Ocala, Florida; Macon, Georgia; and Ft. Wayne, Indiana. Regarding Charter's policy on the provision of care to indigents, CMC has a two-part program. Part I deals with emergency care and states that anyone will be treated on an emergency basis and further disposition of that patient is made when it is medically safe to do so. In Part II, Charter Care, as mentioned above, provides for free care to some percentage of patients on a longer term basis. Here it is anticipated that two beds from the facility inventory of 52 beds will be available to indigent patients within the first year. Admittedly, some of the older Charter hospitals do not have a clearly defined pre-need Charter Care policy. In those cases, a decision is made regarding indigent patients on a case by case basis. Here, Charter Care will be provided to low income patients based on criteria still to be set. In these cases, the local hospital administrator will have the authority to make the determination as to whether a particular applicant meets that criteria. It was acknowledged, however, that this Charter Care policy could be terminated at any time. CMC indicates this hospital would be available for and would like to receive Baker Act patients. However, the Charter management realizes that MMHC is the area's primary Baker Act receiving facility. Nonetheless, if possible, they could be desirous of striking an agreement with MMHC to take those patients who cannot be served there. In this regard, Petitioner's representation of its proposed occupancy rate includes 5 percent Baker Act patients. Charter's representative believes, however, that there are sufficient other non-Baker Act patients available to ensure that a reduction in patient census would not occur as a result of the absence of this type of patient. In any case, Charter's admission policy is for this facility to take patients without discriminating against any group on any basis. Charter predicts occupancy rates which, if achieved, would meet the requirements of Respondent's rules. These are: 70 percent for adult and 60 percent for child psychiatric in the second year; 80 percent for adult and 70 percent for child psychiatric in the third year; and 70 percent and 80 percent for substance abuse in the second and third years respectively. In that regard, the 11,578 overall patient days in 1985 referred to above in the discussion of financial feasibility constitutes only a 64 percent occupancy rate, but it is expected that there will be 15,184 overall patient days in 1986 which would constitute an 80 percent rate and these projections appear reasonable when the data from the Office of Graduate Medical Education, (OGME), showing 20,000 patient days available to this facility, as testified to by Charter's health planning expert, is considered. In fact, the number of anticipated 1989 admissions projected by the Petitioner's and Intervenor's experts, of 1,105 and 1,114, respectively, are quite close. If, in fact, as represented by Intervenor's expert, freestanding psychiatric units have longer average patient stays than psychiatric units in general hospitals, Petitioner's expert's expectations of patient stays of 15 days at MMH's MHU and 30 days at Charter's proposed facility are not unreasonable. The majority of experts from both sides agreed that average stay lengths at the freestanding hospital could be expected to be: adults, 25-30 days; adolescents, 45 days; and substance abuse, 28-30 days. When these figures are correlated with the demonstrated occupancy rates at MMH's MHU, an overall community length of stay is shown to be 25 days. Applying those figures to the existing bed inventory plus CMC's proposed beds, it is not at all unreasonable to assume that both facilities would stay fully occupied. Another factor to be considered here is the size of the projected Baker Act patient load in the service area of Manatee County. Intervenors' expert contends that 42 percent of the entire county population would be Baker Act eligible based on family income. However, Petitioner introduced evidence to indicate the income figure was met in that county by only 11.6 percent of the population. Assuming, arguendo, that the real figure falls somewhere in between the two, this is still moderated by the fact that some Baker Act eligible patients who are employed, have health insurance which would enable that patient to receive treatment outside the Baker Act. CMC's proposed facility would be located in HRS Health District VI which encompasses Hillsborough and Manatee Counties as well as Hardee, Highlands, and Polk Counties. It defines its primary service area for the facility as Manatee County and the secondary service would take in the additional southern portion of Hillsborough County, an area more closely related in identity with the more relaxed Bradenton life style rather than the more urban Tampa life style. In addition, demographic makeup aligns the area more with Bradenton than with Tampa because of the large percentage of over 65 individuals there currently and predicted for the future. Population statistics developed by the University of Florida's Bureau of Economics and Business Research (BEBR) indicated a 1980 Manatee County population of 142,442 and a projected 1990 of 197,000 (medium) or 212,800 (high). Whichever figure is accepted, there is a definite substantial increase in population projected which does not take into account a seasonal influx of winter residents which can reasonably be expected. Considering also the potential increase in the percentage of younger people in the projected population, the projections are conservative and not at all unreasonable. Further, any accurate analysis must also consider the population projected for the southern portion of Hillsborough County which was previously identified as forming a part of the projected secondary area. No doubt the majority of these individuals, who by the BEBR projections will number between 48,500 and 52,000, will utilize facilities in the Bradenton area rather than going the greater distance through much heavier traffic to Tampa. At the present time, District VI has 562 licensed psychiatric beds with 94 additional CON approved. Of this total of 656 beds, only the 25 located at MMH's MHU are within the immediate or secondary service areas as defined by Petitioner. The majority of the remainder are in Tampa with a lesser number in the other counties. The District also currently has 72 licensed substance abuse beds with 22 additional CON approved. None of these beds are currently located in Manatee or lower Hillsborough Counties. Under the currently utilized HRS bed need methodology as set out in Rule 10-5.11(25) and (27), Florida Administrative Code, the fixed ratio for psychiatric inpatient bed need is .35 per 1,000 population, and for substance abuse, .06 per 1,000. Additional beds may not be approved unless existing inpatient adult psychiatric beds show an occupancy rate of 75 percent or greater (70 percent for adolescent beds), and substance abuse beds a rate of 80 percent or greater for the preceding 12 months district wide. The rule for proposed facilities requires new adult psychiatric and substance abuse facilities to meet a 70 percent and 80 percent occupancy rate for the second and third years of operation respectively, and 60 percent and 70 percent for adolescent beds for the same time frame. Review of occupancy rates for 1983 reflects a rate of approximately 65 percent combined psychiatric and substance abuse in District VI. The proposed rule which would have made Manatee County a sub-district of District VI was never adopted by HRS and has been withdrawn. Consequently, there is currently a substantial surplus of licensed and approved psychiatric and substance abuse beds over those computed as needed using the above rule. This surplus, to some degree or other, is acknowledged by all parties. Considering what other facilities are or will be available in the 5 year out time frame, as required, it can be seen that the MMH's MHU will still be in operation and providing inpatient facilities to some degree. Whether approved as a psychiatric hospital or not, MMHC will have inpatient treatment capability which will, to a substantial degree at least, satisfy the Baker Act population need. Another major factor is that provision of Rule 10-5.11(25) which dictates that short term inpatient psychiatric care should be available within a maximum travel time of 45 minutes, under average travel conditions, for 90 percent of the area population. There can be little doubt that those individuals in Manatee County, and, for the most part, the southernmost part of Hillsborough County contiguous to Manatee County, are not within 45 minutes normal driving time of the facilities in Tampa, or, for that matter, those in the other, less urban, portions of the District such as Polk, Highlands, and Hardee counties. Consequently, if patients from the immediate service area in question here can be considered to relate only to District VI facilities, there is little doubt that from the access standpoint, there is a definite need. Respondent contends there is an alternative, however, that there are three hospitals in Sarasota, well within the access criteria, which have 99 licensed and 37 approved psychiatric beds currently utilized at less than 80 percent occupancy. These Sarasota based beds, admittedly in a different District, are nonetheless at least partially available to patients from Bradenton, Manatee County, and southern Hillsborough County within 45 minutes normal driving time. However, the beds in Sarasota (District VIII) were predicated upon the population in that District which does not include the Manatee and southern Hillsborough County patients. Consequently, a tangible impact on these District VIII facilities can be expected from an influx of District VI patients and it is not reasonable to expect the current surplus to be available in the 1989 time frame since the District VIII population, is itself in a state of rapid growth. There are many valid reasons why health care professionals feel that hospitalization within the community, especially in the area of psychiatric and substance abuse treatment, is imperative. As to adolescents, this discipline requires the involvement of the whole family. Repeated lengthy drives on an every-two-day basis, even to Sarasota, especially during the high traffic volume winter months, is disruptive to the course of treatment. The inconvenience of the long trip quite often lessens an already minimal desire for involvement on the part of the family and without family involvement, the potential for recurrence of the illness is higher. In the case of geriatric patients, the problem is similar. Family involvement is of great importance and here, with older spouses, the difficulty of long distance travel in relatively unfamiliar areas heightens the risk and increases the stress on both the patient and the family. Family involvement plays an integral part in the treatment of addictive diseases as well. In fact, in the opinion of one expert in the field, the recovery rate for alcoholic patients is 20 percent higher when the family is involved. In light of the above, there can be little question that the availability of easy access to local treatment is of major importance. What then is currently available to satisfy the area's need for short term inpatient psychiatric care? The only locally available short-term psychiatric beds are in the Mental Health Unit at MMH. However, because of the shortage of beds, that facility treats, as a rule, only acute psychiatric patients. The average length of stay there, in the experience of one physician who has used it, is from 10 to 11 1/2 days. Many of this practitioner's patients who could have benefited from longer term treatment once the acute phase was over, were not able to get it there because of the shortage of beds. As of the date of the hearing, the 25 bed unit had 37 patients with the addition of beds to already occupied patient rooms and to the hallways. This overcrowding, to one extent or another, has existed for several years. Further, this unit, located within MMH, does not have space for and therefore does not offer such beneficial items as recreational programs or occupational and physical treatment programs that might be expected at a free standing psychiatric hospital. In addition, it cannot reasonably, and does not, separate patients by age. In the experience of at least the testifying physician, it is difficult to get patients admitted to this facility. The other local facility is the MMHC. This facility does not permit admissions by private physicians in the area who desire to continue to assist in the care of their patients. The current facility has only 8 beds in operation and does not have the capability to handle disruptive patients who, as stated above, must be transferred to the MHU at MMH. From all the above, it becomes very clear and it is so found that: Less costly, more efficient, or more appropriate alternatives to the proposed inpatient service, are not reasonably available except outside the health district involved or within, but far beyond a 45-minute driving time for the potential patient, in the immediate geographic area described here. Existing inpatient facilities within the area to be served, providing services similar to those proposed are overcrowded and currently overtaxed and unable to accommodate more patients. Alternatives to new construction have been considered and found to be unsatisfactory or as nonexistent. Patients are now and will continue to experience serious problems in obtaining inpatient care of the type proposed within a reasonable distance within the District. Use of facilities outside the District would be only an interim, stopgap measure.
Recommendation Based on the above Findings of Fact and Conclusions of Law, it is: RECOMMENDED THAT Petitioner, Charter Medical-Southeast, Inc., d/b/a Charter Haven Hospital, be DENIED a Certificate of Need to construct and operate a 52 bed short term psychiatric and substance abuse hospital in Manatee County, Florida. RECOMMENDED this 27th day of September, 1984, in Tallahassee, Leon County, Florida. ARNOLD H. POLLOCK Hearing Officer Division of Administrative Hearings 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 27th day of September, 1984.
Conclusions THIS CAUSE comes before the AGENCY FOR HEALTH CARE ADMINISTRATION (the "Agency") regarding Certificate of Need ("CON") Application No. 10097, which concerned the establishment of a comprehensive medical rehabilitation hospital of up to 40 beds and CON Application No. 10098, which concerned the establishment of a 20-bed comprehensive medical rehabilitation unit, both in the Second Batching Cycle of 2010. On January 13, 2011, SHANDS TEACHING HOSPITAL AND CLINICS, INC. d/b/a SHANDS REHAB HOSPITAL (hereinafter “Shands”) filed a Petition for Formal Administrative Hearing challenging the preliminary approval of Filed March 31, 2011 9:01 AM Division of Administrative Hearings CON Application Nos. 10097 and 10098, which was preliminarily awarded to HealthSouth Rehabilitation Hospital of Marion County, LLC. On March 16, 2011, Shands filed its Notice of Voluntary Dismissal. On March 16, 2011, the Administrative Law Judge (ALJ) issued an Order Closing File. IT IS THEREFORE ORDERED AND ADJUDGED THAT: 1. The voluntary dismissal by Shands and the Order Closing File by DOAH are hereby acknowledged and accepted. 2. The Petition filed by Shands is hereby dismissed. 3. Each party shall be solely responsible for its respective costs and attorney’s fees. 4. The above-styled case is hereby closed. DONE and ORDERED this ZS day of Shack — , 2011, in Tallahassee, Florida. k, Enterim Secretary AGENCY FOR WEALTH CARE ADMINISTRATION
