Lawnwood Med. Ctr. v. AGENCY FOR HEALTH CARE

678 So. 2d 421
CourtDistrict Court of Appeal of Florida
DecidedJuly 29, 1996
Docket95-2507, 95-2654
StatusPublished

This text of 678 So. 2d 421 (Lawnwood Med. Ctr. v. AGENCY FOR HEALTH CARE) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lawnwood Med. Ctr. v. AGENCY FOR HEALTH CARE, 678 So. 2d 421 (Fla. Ct. App. 1996).

Opinion

678 So.2d 421 (1996)

LAWNWOOD MEDICAL CENTER, INC., d/b/a Lawnwood Regional Medical Center and Palm Beach Gardens Community Hospital, Inc. d/b/a AMI Palm Beach Gardens Medical Center, Appellants,
v.
AGENCY FOR HEALTH CARE ADMINISTRATION and Martin Memorial Medical Center, Inc., Appellees.

Nos. 95-2507, 95-2654.

District Court of Appeal of Florida, First District.

July 29, 1996.
Rehearing Denied September 11, 1996.

*422 John Radey, Elizabeth McArthur and Jeffrey L. Frehn of Radey, Hinkle, Thomas & McArthur, Tallahassee, for appellant Lawnwood.

Michael J. Cherniga and David C. Ashburn of Greenberg, Traurig, Hoffman, Lipoff, Rosen & Quentel, Tallahassee, for appellant Palm Beach Gardens.

Lesley Mendelson, Senior Attorney, Agency for Health Care Administration, Tallahassee.

Michael J. Weber of Feldman, Gale & Weber, P.A., of Counsel; Byron B. Mathews, Jr. of Amundsen & Moore, Tallahassee, and Robert P. Smith and Connie C. Durrence of Hopping, Green, Sams & Smith, P.A., Tallahassee, for Martin Memorial Medical Center.

KAHN, Judge.

We have for review an award by the Agency for Health Care Administration (AHCA) of a Certificate of Need (CON) for an adult open heart surgery program in AHCA District 9 to appellee Martin Memorial Medical Center, Inc. We reverse because AHCA improperly opened the record after the administrative hearing in this case, and because it reweighed factual matters reserved for the hearing officer under Chapter 120, Florida Statutes.

District 9 is located generally along the southeast coast of Florida and includes from north to south, Indian River, Okeechobee, St. Lucie, Martin and Palm Beach counties. The applicants for this CON included Martin Memorial Medical Center, Inc. (Martin), Good Samaritan Hospital, Inc., St. Mary's Hospital, Inc. (St.Mary's) and appellant Lawnwood Regional Medical Center, Inc. (Lawnwood).

In July 1993, AHCA published its preliminary decision to issue CON 7243 for the adult open heart surgery program to Martin. The unsuccessful competing applicants, including Lawnwood, timely filed administrative challenges. In addition, appellant AMI-Palm Beach Gardens Medical Center, Inc. (PBG), and JFK Medical Center, Inc. (JFK) timely filed petitions to intervene in the administrative proceedings. JFK and PBG currently operate open heart programs in Palm Beach, in the southernmost part of District 9. JFK opposed the application filed by St. Mary's Hospital, also located in Palm Beach County, *423 and PBG opposed any new adult open heart surgery program in District 9.

After hearing all of the testimony and examining all of the evidence, hearing officer Eleanor Hunter issued a recommended final order on March 13, 1995, in which she set forth a detailed comparison of the applicants based upon a review of section 408.035, Florida Statutes (1993). The hearing officer first reviewed the need for health care facilities and services in relation to the applicable district and state health plans as required by section 408.035(1)(a). Four of the six preferences contained in the 1989 state health plan, Healthy Floridians, favored Lawnwood in the hearing officer's view. The other two criteria applied equally to Lawnwood and Martin.[1] The hearing officer then examined the two District 9 health plan allocation factors. The first factor gives priority to established cardiac catheterization programs. Both Martin and Lawnwood have established programs which exceed the 150 procedures minimum volume with Martin having a higher volume in an operational inpatient and outpatient lab. The other District 9 factor favors applicants with a documented commitment to provide services regardless of the patient's ability to pay. Lawnwood better met this factor in both the Medicaid and charity care categories. The hearing officer noted that more Medicaid recipients live in the primary service area of Lawnwood than that of Martin. She noted prior CON compliance reports filed by Martin demonstrating difficulty in meeting applicable Medicaid levels due to the demographics of Martin's service area.

The hearing officer next reviewed each of the criteria for comparison established by section 408.035(1)(b)-(o). Several criteria either did not apply or were neutral, since they were met by both Lawnwood and Martin. At least two of the statutory criteria, however, did not apply equally.

Reviewing section 408.035(1)(l), the hearing officer found that the existing open heart program at PBG would suffer an adverse impact from the approval of a program at Martin. Although PBG's program would remain profitable, it would experience, based upon the evidence, losses in a range between $2.8 and $3.1 million. The hearing officer concluded that PBG would be disproportionately adversely affected by a program at Martin. The hearing officer also ranked Lawnwood over Martin on the criteria in section 408.035(1)(n) which addresses applicant's past and proposed provision of health care services to Medicaid patients and medically indigent.

AHCA's Division Director, Dr. James Howell, testified he was told by staff that it was a "toss up" between Lawnwood and Martin for the CON. Dr. Howell recommended Martin because "Martin is a long-term community hospital with local community responsiveness or local community board of directors.... I felt more comfortable with giving the first CON in the area to a group that had a long heritage and commitment to the area."

The hearing officer also recognized the close comparability of Lawnwood and Martin. She determined, however:

Lawnwood is better situated to reverse district out-migration (of patients), and has to be preferred, under the state and local health plans and subsection 408.035(1)(n), Florida Statutes, for its history of providing a disproportionate share of its services to Medicaid and charity patients. Finally, the most significant distinction between the applicants is that the quality of care at existing providers, as measured by their volumes of open heart surgeries, will not be adversely affected by the approval of a new program at Lawnwood.

Despite the testimony offered by Dr. Howell, the hearing officer did not find that Martin's management was more stable than Lawnwood's or better suited for an open heart program. Accordingly, the hearing officer recommended that AHCA enter a final order issuing the CON to Lawnwood and denying Martin's application.

*424 Several weeks after the recommended order was issued, Martin filed a Motion for Official Recognition. Martin alleged in this motion that since the issuance of the recommended order, a consolidation of ownership of hospitals presently providing open heart surgery in District 9 resulted in only two for-profit corporations, one of which, Columbia/HCA, owns Lawnwood. With its motion Martin tendered three documents generated after the recommended order. These documents suggested that as a result of various mergers and acquisitions of hospitals in the district, Lawnwood would be commonly owned by Columbia/HCA, the company which also will own JFK, an existing open heart surgery provider. The documents also showed that a new company, Tenet Health Care Corporation, would control the other two existing providers in the district. The agency took official notice of these documents without a remand to the hearing officer for reopening the record.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Collier Med. Center v. STATE, DEPT. OF H. & RS
462 So. 2d 83 (District Court of Appeal of Florida, 1985)
Beverly Enterprises-Florida, Inc. v. DHRS
573 So. 2d 19 (District Court of Appeal of Florida, 1990)
Henderson Signs v. Fla. Dept. of Transp.
397 So. 2d 769 (District Court of Appeal of Florida, 1981)
Florida Dept. of Transp. v. JWC Co., Inc.
396 So. 2d 778 (District Court of Appeal of Florida, 1981)
Balsam v. Department of Health & Rehabilitative Services
486 So. 2d 1341 (District Court of Appeal of Florida, 1986)
Lawnwood Medical Center, Inc. v. Agency For Health Care Administration
678 So. 2d 421 (District Court of Appeal of Florida, 1996)

Cite This Page — Counsel Stack

Bluebook (online)
678 So. 2d 421, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lawnwood-med-ctr-v-agency-for-health-care-fladistctapp-1996.