KENNESTONE HOSPITAL, INC. v. EMORY UNIVERSITY

318 Ga. 169
Supreme Court of Georgia·Decided February 6, 2024·No. S22G1282·Published·Cited by 3 cases

Opinion

318 Ga. 169 FINAL COPY

S22G1282. KENNESTONE HOSPITAL, INC. v. EMORY UNVER-

SITY et al.

PINSON, Justice.

In Georgia, if someone wants to build a hospital or offer new or different health services there, they need a certificate of need (“CON”) from the Department of Community Health. See OCGA § 31-6-40. This case is ultimately about whether Windy Hill Hospital (“Windy Hill”) needs a CON to change from a long-term care hospital to a short-term care hospital—and if it does, whether that require- ment violates the constitutional prohibition against retroactive laws. We granted review, however, to consider only two preliminary questions: First, if a CON authorizes an entity to operate a particu- lar kind of hospital—in this case, a general acute care hospital—has the CON conferred a private right or a public right? And second, did the Court of Appeals apply the proper framework for interpreting certain of the Department’s CON regulations?

The first question is relevant to “retroactive law” claims—for example, the hospital’s claim here that the Department is applying the CON laws to its existing CON rights in a way that violates our Constitution’s prohibition against “retroactive law,” Ga. Const. of 1983, Art. I, Sec. I, Par. X. That provision applies only when the rights in question are “vested rights,” and only private rights are capable of the kind of vesting that resists retroactive laws. As we explain in detail below, we conclude that a right under a CON to operate a particular kind of hospital is a private right because the right to use one’s property in a particular way is a traditional prop- erty right, and when conferred by a CON, this right is held by an individual—usually a corporate entity—rather than the public at large.

The second question, although framed in the context of this case, matters every time a court has to interpret and apply an ad- ministrative rule to resolve a legal dispute where the agency that promulgated the rule has weighed in about what the rule means. In such cases, “our long-held rule” is that courts may defer to an

agency’s construction of its own rule only if the rule’s meaning is ambiguous. City of Guyton v. Barrow, 305 Ga. 799, 802 (2) (828 SE2d 366) (2019). The only way to know whether the meaning of a rule is ambiguous is to do the work of textual construction, so a court’s first step in these cases is simply to construe the text: consider the rule in light of its full legal and historical context and apply the tradi- tional tools of statutory construction to figure out what the relevant language means. That work probably will yield a clear meaning, since “few statutes or regulations . . . are truly ambiguous” after the tools of textual construction run out. Id. at 804 (2). In the rare event that a genuine ambiguity remains, the court must then (and only then) consider whether to settle on the agency’s interpretation of the rule.

These answers require us to vacate the Court of Appeals’ deci-

sion, which held that CONs confer only public rights, and which did not clearly apply the proper framework for interpreting the admin- istrative rules at issue here. Because these answers do not resolve

the ultimate questions in this case (and we do not decide any of sev- eral other issues that could), we remand the case to the Court of Appeals for further proceedings consistent with this opinion.

1. Background (a) Certificates of Need The CON Act was originally enacted in 1979 to help address the General Assembly’s concerns about health care services in Geor- gia. The Act was meant to ensure that health care services and fa- cilities are “developed in an orderly and economical manner,” that “only those health care services found to be in the public interest” are provided, and that health care services are provided “in a man- ner that avoids unnecessary duplication of services, that is cost ef- fective, that provides quality health care services, and that is com- patible with the health care needs of the various areas and popula- tions of the state.” OCGA § 31-6-1.

To that end, the CON Act requires “new institutional health service[s]” to obtain a CON. OCGA § 31-6-40 (a). A CON is issued by

the Department of Community Health to applicants that satisfy cer- tain statutory considerations, including whether the new health ser- vice will serve a population that “has a need for such services,” whether “[e]xisting alternatives” could offer the same services in the same area, and whether the proposed new service has a “positive relationship” with existing health care services in the same area. OCGA § 31-6-42 (a) (2), (3), (8).

When the Department awards a CON, it is “valid only for the defined scope, location, cost, service area, and person named in [the] application.” OCGA § 31-6-41 (a). Further, the recipient has 12 months to use the CON—that is, to begin to develop the “new insti- tutional health service” proposed in the application—or it lapses. See OCGA § 31-6-41 (b). The Department can revoke a CON for rea- sons including a failure to comply with the statutory considerations. See OCGA § 31-6-45 (a).

Several different kinds of health care services are considered “new” and therefore require a CON. Among other things, a provider

needs a CON to build a new facility, increase bed capacity in an ex- isting facility, to offer “[c]linical health services” in an existing facil- ity that the facility has not regularly offered within the last 12 months, or convert or upgrade a “general acute care hospital” to a specialty hospital. See OCGA § 31-6-40 (a) (1), (4), (5), (6).

Some facilities and services are exempt from CON require-

ments. See OCGA § 31-6-47. Health care services that predated the CON Act are not new, so they are “grandfathered.” See HCA Health Svcs., Inc. v. Roach, 263 Ga. 798, 801 (3) (a) (439 SE2d 494) (1994), overruled in part on other grounds by Marsh v. Clarke County School Dist., 292 Ga. 28, 29-30 (732 SE2d 443) (2012). And the De- partment can otherwise grant or approve an exemption from CON requirements (as could its predecessor, the State Health Planning Agency). See OCGA §§ 31-6-40 (c) (1), 31-6-47 (b); Phoebe Putney Mem. Hosp., Inc. v. Roach, 267 Ga. 619, 620 (1) (480 SE2d 595) (1997).

When an applicant seeks a CON, certain parties can object.

The statute allows objections from anyone who “offers substantially

similar services as proposed within a 35 mile radius of the proposed project or has a service area that overlaps the applicant’s proposed service area,” or who “has submitted a competing application in the same batching cycle and is proposing to establish the same type of facility proposed or offers substantially similar services as proposed and has a service area that overlaps the applicant’s proposed service area.” See OCGA § 31-6-43 (d) (2). Once the Department decides whether to award the CON, “[a]ny party” to the administrative pro- cess, other than the Department, can seek judicial review in the su- perior court. OCGA § 31-6-44.1 (a).

Finally, the CON Act also empowers the Department to “adopt, promulgate, and implement rules and regulations sufficient to ad- minister the provisions of this chapter including the certificate of need program.” OCGA § 31-6-21 (b) (4). The statute specifically au- thorizes the Department to establish “need methodologies for new institutional health services and health care facilities.” OCGA § 31- 6-21 (b) (8). As explained further below, two of these Department regulations are central to this case.

(b) This Case (i) Windy Hill’s CON History Windy Hill opened in the 1970s as a general acute care hospi-

tal.1 At that time, the CON Act had not yet gone into effect, so Windy Hill did not obtain a new CON when it first opened. And when the CON Act went into effect in 1979, Windy Hill was grandfathered, so it did not need to apply for a CON at that time, either. Windy Hill operated as a general acute care hospital until 1996.

In 1996, Windy Hill sought Medicare certification as a long-

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KENNESTONE HOSPITAL, INC. v. EMORY UNIVERSITY, 318 Ga. 169 (Ga. 2024).

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