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COLUMBIA/JFK MEDICAL CENTER LIMITED PARTNERSHIP, D/B/A JFK MEDICAL CENTER vs AGENCY FOR HEALTH CARE ADMINISTRATION AND BETHESDA HEALTHCARE SYSTEM, INC., D/B/A WEST BOYNTON COMMUNITY HOSPITAL, 03-002829CON (2003)

Division of Administrative Hearings, Florida Filed:Tallahassee, Florida Jul. 31, 2003 Number: 03-002829CON Latest Update: Mar. 11, 2005

The Issue The issue is whether the Agency should approve the Certificate of Need applications filed by Bethesda and/or JFK, each of which proposes to establish an 80-bed satellite hospital in the West Boynton area of Acute Care Subdistrict 9-5.

Recommendation Based upon the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the Agency issue a final order denying Bethesda’s CON application No. 9659 and also denying JFK’s CON application No. 9660. DONE AND ENTERED this 29th day of September, 2004, in Tallahassee, Leon County, Florida. S T. KENT WETHERELL, II Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 29th day of September, 2004.

Florida Laws (8) 120.569, 120.57, 17.001, 408.035, 408.0361, 408.039, 7.36, 7.60

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HCA WEST FLORIDA REGIONAL MEDICAL CENTER vs. DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES, 88-001983 (1988)

Division of Administrative Hearings, Florida Number: 88-001983 Latest Update: Mar. 30, 1989

Findings Of Fact The Application West Florida Regional Medical Center is a 400-bed acute care hospital in Pensacola, Escambia County, Florida. The hospital is located in a subdistrict which has the greatest population aged 65 and over who are living in poverty. That group constitutes the population qualified for Medicare. Some 17 percent of Escambia County's population falls into the medicare category. Prior to October, 1987, HRS had determined that there was a fixed pool need in the Escambia County area for 120 nursing home or extended care beds. Several hospitals in the Escambia County area applied for the 120 nursing home beds. Those beds were granted to Advocare (60 beds) and Baptist Manor (60 beds). The award of the 120 beds to Baptist Manor and Advocare is not being challenged in this action. West Florida, likewise, filed an application for an award of nursing home beds in the same batch as Advocare and Baptist Manor. However, Petitioner's application sought to convert 8 acute care beds to nursing home or extended care beds. West Florida's claim to these beds was not based on the 120 bed need established under the fixed need pool formula. West Florida's application was based on the unavailability of appropriately designated bed space for patients who no longer required acute care, but who continued to require a high skill level of care and/or medicare patients. The whole purpose behind West Florida's CON application stems from the fact that the federal Medicare system will not reimburse a hospital beyond the amount established for acute care needs as long as that bed space is designated as acute care. However, if the patient no longer requires acute care the patient may be re-designated to a skilled care category which includes nursing home or extended care beds. If the patient is appropriately reclassified to a skilled care category, the hospital can receive additional reimbursement from Medicare above its acute care reimbursement as long as a designated ECF bed is available for the patient. Designation or re-designation of beds in a facility requires a Certificate of Need. Petitioner's application for the 8 beds was denied. When the application at issue in this proceeding was filed Petitioner's 13-bed ECF unit had been approved but not yet opened. At the time the State Agency Action Report was written, the unit had just opened. Therefore, historical data on the 13 bed unit was not available at the time the application was filed. Reasons given for denying West Florida's application was that there was low occupancy at Baptist Hospital's ECF unit, that Sacred Heart Hospital had 10 approved ECF beds and that there was no historical utilization of West Florida 13 beds. At the hearing the HRS witness, Elizabeth Dudek stated that it was assumed that Baptist Hospital and Sacred Heart Hospital beds were available for West Florida patients. In 1985 West Florida applied for a CON to establish a 21-bed ECF unit. HRS granted West Florida 13 of those 21 beds. The 8 beds being sought by West Florida in CON 5319 are the remaining beds which were not granted to West Florida in its 1985 CON application. In order to support its 1985 CON application the hospital conducted a survey of its patient records to determine an estimate of the number of patients and patient days which were non acute but still occupied acute care beds. The hospital utilized its regularly kept records of Medicare patients whose length of stay or charges exceeded the Medicare averages by at least two standard deviations for reimbursement and records of Medicare patients whose charges exceed Medicare reimbursement by at least $5,000. These excess days or charges are known as cost outliers and, if the charge exceeds the Medicare reimbursement by $5000 or more, the excess charge is additionally known as a contractual adjustment. The survey conducted by the hospital consisted of the above records for the calendar year 1986. The hospital assumed that if the charges or length of stay for patients were excessive, then there was a probability that the patient was difficult to place. The above inference is reasonable since, under the Medicare system, a hospital's records are regularly reviewed by the Professional Review Organization to determine if appropriate care is rendered. If a patient does not meet criteria for acute care, but remains in the hospital, the hospital is required to document efforts to place the patient in a nursing home. Sanctions are imposed if a hospital misuses resources by keeping patients who did not need acute care in acute care bed spaces even if the amount of reimbursement is not at issue. The hospital, therefore goes to extraordinary lengths to place patients in nursing home facilities outside the hospital. Additionally, the inference is reasonable since the review of hospital records did not capture all non-acute patient days. Only Medicare records were used. Medicare only constitutes about half of all of West Florida's admissions. Therefore, it is likely that the number of excess patient days or charges was underestimated in 1986 for the 1985 CON application. The review of the hospital's records was completed in March, 1987, and showed that 485 patients experienced an average of 10.8 excess non-acute days at the hospital for a total of 5,259 patient days. The hospital was not receiving reimbursement from Medicare for those excess days. West Florida maintained that the above numbers demonstrated a "not normal need" for 21 additional ECF beds at West Florida. However as indicated earlier, HRS agreed to certify only 13 of those beds. The 13 beds were certified in 1987. The 13-bed unit opened in February, 1988. Since West Florida had planned for 21 beds, all renovations necessary to obtain the 8-bed certification were accomplished when the 13- bed unit was certified in 1987. Therefore, no capital expenditures will be required for the additional 8 beds under review here. The space and beds are already available. The same study was submitted with the application for the additional eight beds at issue in these proceedings. In the present application it was assumed that the average length of stay in the extended care unit would be 14 days. However, since the 13 bed unit opened, the average length of stay experienced by the 13-bed unit has been approximately 15 days and corroborates the data found in the earlier records survey. Such corroboration would indicate that the study's data and assumptions are still valid in reference to the problem placements. However, the 15- day figure reflects only those patients who were appropriately placed in West Florida's ECF unit. The 15-day figure does not shed any light on those patients who have not been appropriately placed and remain in acute care beds. That light comes from two additional factors: The problems West Florida experiences in placing sub-acute, high skill, medicare patients; and the fact that West Florida continues to have a waiting list for its 13 bed unit. Problem Placements Problem placements particularly occur with Medicare patients who require a high skill level of care but who no longer require an acute level of care. The problem is created by the fact that Medicare does not reimburse medical facilities based on the costs of a particular patients level of care. Generally, the higher the level of care a patient requires the more costs a facility will incur on behalf of that patient. The higher costs in and of themselves limit some facilities in the services that facility can or is willing to offer from a profitability standpoint. Medicare exacerbates the problem since its reimbursement does not cover the cost of care. The profitability of a facility is even more affected by the number of high skill Medicare patients resident at the facility. Therefore, availability of particular services at a facility and patient mix of Medicare to other private payors becomes important considerations on whether other facilities will accept West Florida' s patients. As indicated earlier, the hospital goes to extraordinary lengths to place non- acute patients in area nursing homes, including providing nurses and covering costs at area nursing homes. Discharge planning is thorough at West Florida and begins when the patient is admitted. Only area nursing homes are used as referrals. West Florida's has attempted to place patients at Bluff's and Bay Breeze nursing homes operated by Advocare. Patients have regularly been refused admission to those facilities due to acuity level or patient mix. West Florida also has attempted to place patients at Baptist Manor and Baptist Specialty Care operated by Baptist Hospital. Patients have also been refused admission to those facilities due to acuity level and patient mix. 16 The beds originally rented to Sacred Heart Hospital have been relinquished by that hospital and apparently will not come on line. Moreover the evidence showed that these screening practices would continue into the future in regard to the 120 beds granted to Advocare and Baptist Manor. The president of Advocare testified that his new facility would accept some acute patients. However, his policies on screening would not change. Moreover, Advocare's CON proposes an 85 percent medicaid level which will not allow for reimbursement of much skilled care. The staffing ratio and charges proposed by Advocare are not at levels at which more severe sub-acute care can be provided. Baptist Manor likewise screens for acuity and does not provide treatment for extensive decubitus ulcers, or new tracheostomies, or IV feeding or therapy seven days a week. Its policies would not change with the possible exception of ventilated patients, but then, only if additional funding can be obtained. There is no requirement imposed by HRS that these applicants accept the sub-acute-patients which West Florida is unable to place. These efforts have continued subsequent to the 13-bed unit's opening. However, the evidence showed that certain types of patients could not be placed in area nursing homes. The difficulty was with those who need central lines (subclavian) for hyperalimentation; whirlpool therapy such as a Hubbard tank; physical therapy dither twice a day or seven days a week; respiratory or ventilator care; frequent suctioning for a recent tracheostomy; skeletal traction; or a Clinitron bed, either due to severe dicubiti or a recent skin graft. The 13-bed unit was used only when a patient could not be placed outside the hospital. The skill or care level in the unit at West Florida is considerably higher than that found at a nursing home. This is reflected in the staffing level and cost of operating the unit. Finally, both Advocare and Baptist Manor involve new construction and will take approximately two years to open. West Florida's special need is current and will carry into the future. The Waiting List Because of such placement problems, West Florida currently has a waiting list of approximately five patients, who are no longer acute care but who cannot be placed in a community nursing home. The 13-bed unit has operated at full occupancy for the last several months and is the placement of last resort. The evidence showed that the patients on the waiting list are actually subacute patients awaiting an ECF bed. The historical screening for acuity and patient mix along with the waiting list demonstrates that currently at least five patients currently have needs which are unmet by other facilities even though those facilities may have empty beds. West Florida has therefore demonstrated a special unmet need for five ECF beds. Moreover, the appropriate designation and placement of patients as to care level is considered by HRS to be a desirable goal when considering CON applications because the level of care provided in an ECF unit is less intense than the level of care required in an acute care unit. Thus, theoretically, better skill level placement results in more efficient bed use which results in greater cost savings to the hospital. In this case, Petitioner offers a multi-disciplinary approach to care in its ECF unit. The approach concentrates on rehabilitation and independence which is more appropriate for patients at a sub-acute level of care. For the patients on the awaiting proper placement on the waiting list quality of care would be improved by the expansion of the ECF unit by five beds. Finally, there are no capital costs associated with the conversion of these five beds and no increase in licensed bed capacity. There are approximately five patients on any given day who could be better served in an ECF unit, but who are forced to remain in an acute care unit because no space is available for them. This misallocation of resources will cost nothing to correct.

Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health and Rehabilitative Services issue a CON to Petitioner for five ECF beds. DONE and ORDERED this 30th day of March, 1989, in Tallahassee, Florida. DIANE CLEAVINGER Hearing Officer Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 30th day of March, 1989. APPENDIX The facts contained in paragraph 1-29 of Petitioner's proposed Findings of Fact are adopted in substance, insofar as material. The facts contained in paragraph 1, 2, 3, 4, 5, 6, 8, 12, 15, 16, 20, 27, 28, 29, 31 and 33 of Respondent's Proposed Findings of Fact are subordinate. The first sentence of paragraph 7 of Respondent's Proposed Findings of Fact was not shown to be the evidence. Strict compliance with the local health plan was not shown to be an absolute requirement for CON certification. The remainder of paragraph 7 is subordinate. The facts contained in paragraph 9, 10, 11 and 30 of Respondent's Proposed Findings of Fact were not shown by the evidence. The first part of the first sentence of paragraph 13 of Respondent's Proposed Findings of Fact before the semicolon is adopted. The remainder of the sentence and paragraph is rejected. The first sentence of paragraph 14 of Respondent's Proposed Findings of Fact was not shown by the evidence. The remainder of the paragraph is subordinate. The facts contained in paragraph 17, 26 and 32 of Respondent's Proposed Findings of Fact are adopted in substance, insofar as material. The acts contained in paragraph 18 are rejected as supportive of the conclusion contained therein. The first (4) sentences of paragraph 19 are subordinate. The remainder of the paragraph was not shown by the evidence. The first (2) sentences of paragraph 21 are adopted. The remainder of the paragraph is rejected. The facts contained in paragraph 22 of Respondent's Proposed Findings of Fact are irrelevant. The first sentence of paragraph 23 is adopted. The remainder of paragraph 23 is subordinate. The first sentence of paragraph 24 is rejected. The second, third, and fourth sentences are subordinate. The remainder of the paragraph is rejected. The first sentence of paragraph 25 is subordinate. The remainder of the paragraph is rejected. COPIES FURNISHED: Lesley Mendelson, Esquire Department of Health and Rehabilitative Services 2727 Mahan Drive Tallahassee, Florida 32308 Donna H. Stinson, Esquire MOYLE, FLANIGAN, KATZ, FITZGERALD & SHEEHAN, P.A. The Perkins House - Suite 100 118 North Gadsden Street Tallahassee, Florida 32301 Sam Power, Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 =================================================================

Florida Laws (2) 120.57, 90.956

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TARPON SPRINGS HOSPITAL FOUNDATION, INC., D/B/A HELEN ELLIS MEMORIAL HOSPITAL vs AGENCY FOR HEALTH CARE ADMINISTRATION AND NEW PORT RICHEY, INC., D/B/A COMMUNITY HOSPITAL, 02-003234CON (2002)

Division of Administrative Hearings, Florida Filed:Tallahassee, Florida Aug. 14, 2002 Number: 02-003234CON Latest Update: May 17, 2004

The Issue Whether the certificate of need (CON) applications filed by New Port Richey Hospital, Inc., d/b/a Community Hospital of New Port Richey (Community Hospital) (CON No. 9539), and Morton Plant Hospital Association, Inc., d/b/a North Bay Hospital (North Bay) (CON No. 9538), each seeking to replace and relocate their respective general acute care hospital, satisfy, on balance, the applicable statutory and rule criteria.

Florida Laws (3) 120.569, 408.035, 408.039

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GALEN OF FLORIDA, INC., D/B/A ORANGE PARK MEDICAL CENTER vs AGENCY FOR HEALTH CARE ADMINISTRATION, 93-004880CON (1993)

Division of Administrative Hearings, Florida Filed:Tallahassee, Florida Aug. 25, 1993 Number: 93-004880CON Latest Update: Jul. 05, 1994

Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a summary final order be entered dismissing the Petition for Formal Administrative Hearing filed by Galen of Florida, Inc., d/b/a Westside Regional Medical Centers in this case. DONE and ORDERED this 11th day of May 1994, in Tallahassee, Florida. JAMES W. YORK, Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 904/488-9675 FILED with the Clerk of the Division of Administrative Hearings this 11th day of May 1994.

Florida Laws (3) 120.57, 408.037, 408.039 Florida Administrative Code (2) 59C-1.008, 59C-1.010

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ST. JOSEPH`S HOSPITAL, INC., D/B/A ST. JOSEPH`S HOSPITAL vs AGENCY FOR HEALTH CARE ADMINISTRATION, 05-002754CON (2005)

Division of Administrative Hearings, Florida Filed:Tallahassee, Florida Jul. 28, 2005 Number: 05-002754CON Latest Update: Aug. 19, 2008

The Issue The Petitioner, St. Joseph's Hospital, Inc., d/b/a St. Joseph's Hospital (Petitioner, Applicant, or St. Joseph's) filed Certificate of Need (CON) Application No. 9833 with the Agency for Health Care Administration (Agency or AHCA). The application seeks authority to establish a 90-bed acute care satellite hospital in southeastern Hillsborough County, Florida. St. Joseph's intends to transfer 90 acute care beds from its existing location in Tampa to the new facility. The issue in this case is whether the Agency should approve the CON application.

Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered by the Agency for Health Care Administration that approves CON Application No. 9833 with the conditions noted. DONE AND ENTERED this 13th day of May, 2008, in Tallahassee, Leon County, Florida. J. D. PARRISH Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 13th day of May, 2008. COPIES FURNISHED: Richard J. Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Station 3 Tallahassee, Florida 32308 Craig H. Smith, General Counsel Agency for Health Care Administration Fort Knox Building, Suite 3431 Tallahassee, Florida 32308 Holly Benson, Secretary Agency for Health Care Administration Fort Knox Building, Suite 3116 2727 Mahan Drive Tallahassee, Florida 32308 Stephen A. Ecenia, Esquire Richard M. Ellis, Esquire Rutledge, Ecenia, Purnell & Hoffman, P. A. 215 South Monroe Street, Suite 420 Post Office Box 551 Tallahassee, Florida 32304-0551 Robert A. Weiss, Esquire Karen A. Putnal, Esquire Parker, Hudson, Rainer & Dobbs, LLP The Perkins House, Suite 200 118 North Gadsden Street Tallahassee, Florida 32301 Elizabeth McArthur, Esquire Jeffrey L. Frehn, Esquire Radey, Thomas, Yon & Clark, P.A. 301 South Bronough Street, Suite 200 Post Office Box 10967 Tallahassee, Florida 32301 Karin M. Byrne, Esquire Agency for Health Care Administration 2727 Mahan Drive, Building 3 Mail Station 3 Tallahassee, Florida 32308

Florida Laws (6) 120.569, 120.57, 408.034, 408.035, 408.037, 408.039 Florida Administrative Code (4) 59C-1.002, 59C-1.008, 59C-1.010, 59C-1.030

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ORCHARD RIDGE NURSING CENTER CORPORATION, D/B/A HARBORSIDE HEALTHCARE-GULF COAST AND HARBORSIDE HEALTHCARE LIMITED PARTNERSHIP vs AGENCY FOR HEALTH CARE ADMINISTRATION, 01-002778 (2001)

Division of Administrative Hearings, Florida Filed:New Port Richey, Florida Jul. 13, 2001 Number: 01-002778 Latest Update: Jul. 04, 2024

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UNIVERSITY COMMUNITY HOSPITAL vs. DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES, 81-002976 (1981)

Division of Administrative Hearings, Florida Number: 81-002976 Latest Update: May 31, 1983

The Issue Assuming a need for additional hospital beds in Broward County by 1987, the agreed "planning horizon," the question becomes which, if any, of the six or seven proposals advanced in these proceedings would be the best means of meeting the need. Central to the bed need issue in this case is the parties' enigmatic stipulation: 2/ that there is a need for acute care beds in Broward County in 1987, and this need should be determined on a regionalized basis. Pembroke Pines joins in this stipulation only to the extent that a need does not exist in the proposed service area of SBHD. Prehearing Stipulation C.8. The parties were unable to agree on where these regional boundaries should be drawn, among other things.

Recommendation It is accordingly, RECOMMENDED: That HRS dismiss Lifemark as a party to these proceedings. That HRS grant NBHD's application for a CON to build a 200-bed hospital, in its entirety. That HRS grant HCA's application to build NWBRMC but only at 150 beds and without an obstetric service; and that HCA be authorized to expend to that end $25,969,403.00, less an appropriate adjustment for the lack of an obstetric service. That HRS deny the application for a CON to build a new hospital filed by South Broward Hospital District in its entirety. That HRS deny the application for a CON to build a new hospital filed by Humedicenter, Inc. d/b/a Coral Ridge General Hospital in its entirety. That HRS deny University Community Hospital's application for a CON to add beds there in its entirety. That HRS deny the application for a CON to add beds filed by Humana of Florida, Inc. d/b/a Bennett Community Hospital, in its entirety. DONE and RECOMMENDED this 12th day of April, 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 12th day of April, 1983.

Florida Laws (4) 120.52, 120.54, 120.57, 120.60

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RAINBOW COMMUNITY HOSPITAL, INC. vs. DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES, 83-000013CON (1983)

Division of Administrative Hearings, Florida Number: 83-000013CON Latest Update: Dec. 06, 1983

Findings Of Fact Petitioner is a nonprofit corporation presently owned by three osteopathic physicians who propose to construct a 64-bed osteopathic hospital in Dunnellon, Florida, at a cost of $12,500,000. The hospital, as proposed, would be a teaching hospital getting its rotating interns and externs for short periods from Suncoast Hospital, an osteopathic teaching hospital at Largo, Florida. The number of students at the Southeast College of Osteopathy in the Miami area is increasing each year and the expectation is that by 1983 a total of 120 students will be enrolled per class. There are presently five osteopathic teaching hospitals in Florida and additional teaching facilities will be required to accommodate the students and graduates of the Southeast College of Osteopathy. Although Petitioner's stated intent is to become a teaching hospital, before this can become a reality it is necessary for Petitioner to have qualified people heading up all of its departments and receive approval of the American Osteopathic Association. Financing of the proposed hospital will be by tax exempt revenue bonds issued by the Marion County Industrial Development Authority (Exhibit 1). Alternatively, conventional financing is under consideration (Exhibits 2 and 7). The site for the proposed hospital has been selected but not secured. Negotiations for this site are delayed pending the outcome of these proceedings. No evidence regarding plans or construction costs was presented other than general testimony that construction costs are in line with the proposed expenditures. Once constructed, the hospital would be managed by Osteopathic Hospitals of America, Inc., a professional management corporation. The proposed fee for such services, excluding the salary of the administrator and comptroller, is $225,000 per year. Pro forma revenue and expense data presented show the hospital to be financially feasible if the patient mix and population projected are attained. However, the expenses listed did not include the management fee or costs of administrator and comptroller. The costs of free emergency room service for patients 65 and over for the first six months, which is proposed by Petitioner, are not included in this pro forma data and the percentage of Medicaid patients is different than that experienced by the other five hospitals in this service area. All of these factors would lower the estimated profits of Petitioner. Dunnellon is in District III, which includes some 16 counties in Northwest Central Florida. Using the methodology prescribed by Rule 5- 10.11(23), Florida Administrative Code, and projecting the population through 1988 (five years planning horizon), there is a need for 24 additional beds in District III. Dunnellon is located in the southwest part of Marion County near the county line. The other hospitals in Marion County, which was formerly designated a subdistrict, are Munroe Regional Medical Center and Marion Community Hospital, both of which are located in Ocala, some 23 miles from Dunnellon. However, this is a rural area and driving time from Dunnellon to either of these hospitals in Ocala is approximately 30 minutes. Rainbow proposes to serve the population living within 30 minutes driving time of Dunnellon. The accessibility standard commonly applied by HRS for rural areas is that 90 percent of the population should be within 45 minutes of a hospital. In addition to Marion Community and Munroe Regional in Ocala, Citizens Memorial Hospital in Inverness, some 17 miles distant; Seven Rivers Community Hospital near Crystal River, some 13.5 miles distant; and Memorial Hospital in Williston, some 23 miles distant, are all serving patients in the service area proposed by Rainbow and are within 45 minutes travel time from Dunnellon. These hospitals encircle the location proposed for Rainbow. In addition, Oakhill Community Hospital located near Spring Hill has been approved as a 96-bed hospital and will be opened in 1984. This new hospital will also obtain patients from Rainbow's proposed service area. Munroe Regional hospital has been issued a certificate of need for 78 additional medical/surgical beds which will come on line in the near future. There are no osteopathic hospitals in District III. Residents of this area who desire treatment at an osteopathic hospital generally go to the Tampa Bay area. One potential user of Rainbow who lives in Ocala, presently uses an osteopathic hospital in Largo when she or her family needs hospitalization. She is a member of Jehovah Witnesses, and as such is opposed to blood transfusions. Allopathic physicians generally will not guarantee no blood transfusions if they are the admitting physician for surgical procedures. There are more than 200 families who are members of Jehovah Witnesses in the proposed service area. This witness acknowledged, however, that this is a decision of the doctor and not of the hospital. In the proposed service area there are 11 osteopathic physicians, five of whom specialize in emergency medicine and practice in Ocala, one is a cardiologist in Lake County, and five are in family practice, with one in Citrus County and two each in Lake and Sumter Counties (Exhibits 8 and 9). Of those practicing in the proposed service area who testified they would practice at Rainbow if placed in operation, two are admitted to the staff at Seven Rivers Community Hospital and one is also on the staff at Munroe Regional Medical Center. No osteopathic physician testified that he was treated differently than an allopathic physician in being admitted to the staff of any hospital serving the proposed service area. All of these hospitals have open admissions and any physician, either allopathic or osteopathic, who meets the requirements for staff privileges is admitted. Numerous osteopathic physicians testified that they would consider moving their practice to Dunnellon if Rainbow is approved. Eighty-seven percent of osteopathic physicians are in family practice. None of those currently practicing in the proposed service area who testified in these proceedings is unable to take additional patients. Some could double their patient load without being overworked. In short, there are presently not enough patients in the proposed service area who desire osteopathic treatment to justify immigration of additional osteopathic physicians which an osteopathic hospital is presumed to attract. Williston Memorial Hospital is a 40-bed nonprofit hospital. In 1982 it obtained nearly 20 percent of its patients from Dunnellon. Losing these patients would create serious financial problems for this hospital whose occupancy rate in 1982 was 60 percent. Seven Rivers Community Hospital is a 75-bed hospital, of which 67 are acute care and eight are ICU-CCU, located 13.5 miles from the proposed Rainbow Hospital. Its occupancy rate in 1982 was 70 percent. To date the occupancy rate in 1983 has been 81.3 percent. Many of Seven Rivers employees live in the Dunnellon area. Some of these employees would quit to work at Rainbow if approved. Seven Rivers takes Medicaid patients only on an emergency basis and transfers them to a nonprofit hospital as soon as possible. Accordingly, its protest to the competition Rainbow would provide is given less weight despite the obvious loss of patients that would result if Rainbow is opened. In 1982 Citrus Memorial Hospital in Inverness had an occupancy rate of 68 percent. Opening of Rainbow would take some patients that would otherwise go to Citrus. Oakhill Community Hospital near Spring Hill has been authorized as a 96-bed hospital which will open in 1984. The opening of Oakhill will take some patients that would otherwise go to Seven Rivers Community Hospital from the service area proposed to be served by Rainbow. None of the hospitals serving the area proposed to be served by Rainbow had an occupancy rate as high as 80 percent in 1982 and only Munroe Regional Medical Center in Ocala approached 80 percent occupancy.

Florida Laws (1) 10.11

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UNIVERSITY COMMUNITY HOSPITAL, INC., D/B/A UNIVERSITY COMMUNITY HOSPITAL AND UNIVERSITY COMMUNITY HOSPITAL, INC., D/B/A UNIVERSITY COMMUNITY HOSPITAL AT CARROLLWOOD vs AGENCY FOR HEALTH CARE ADMINISTRATION AND ST. JOSEPH`S HOSPITAL, INC., D/B/A ST. JOSEPH`S HOSPITAL, 03-000337CON (2003)

Division of Administrative Hearings, Florida Filed:Tallahassee, Florida Jan. 30, 2003 Number: 03-000337CON Latest Update: Dec. 06, 2004

The Issue Whether the Certificate of Need (CON) Application No. 9610, filed by St. Joseph's Hospital to establish a new 76-bed acute care satellite hospital in Hillsborough County, through the transfer of 76 acute care beds from the existing St. Joseph's Hospital, should be approved.

Florida Laws (6) 120.569, 120.57, 400.235, 408.034, 408.035, 408.039

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COLUMBIA HOSPITAL CORPORATION OF SOUTH BROWARD, D/B/A WESTSIDE REGIONAL MEDICAL CENTER vs AGENCY FOR HEALTH CARE ADMINISTRATION, 01-002891CON (2001)

Division of Administrative Hearings, Florida Filed:Tallahassee, Florida Jul. 23, 2001 Number: 01-002891CON Latest Update: Oct. 13, 2004

The Issue Whether the Certificate of Need application of the South Broward Hospital District (CON 9459) to establish a 100-bed hospital in Health Planning District 10, Broward County, should be granted by the Agency for Health Care Administration?