Maryland General Hospital v. Maryland Health Resources Planning Commission

653 A.2d 1029, 103 Md. App. 525, 1995 Md. App. LEXIS 38
CourtCourt of Special Appeals of Maryland
DecidedFebruary 14, 1995
DocketNo. 1243
StatusPublished
Cited by4 cases

This text of 653 A.2d 1029 (Maryland General Hospital v. Maryland Health Resources Planning Commission) is published on Counsel Stack Legal Research, covering Court of Special Appeals of Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Maryland General Hospital v. Maryland Health Resources Planning Commission, 653 A.2d 1029, 103 Md. App. 525, 1995 Md. App. LEXIS 38 (Md. Ct. App. 1995).

Opinion

WILNER, Chief Judge.

This appeal arises from a competition among three Baltimore-area hospitals—Union Memorial, Maryland General, and St. Agnes—to obtain a Certificate of Need (CON) to establish an Open Heart Surgery/Percutaneous Transluminal Coronary Angiography (OHS/PTCA) unit. When the Health Resources Planning Commission awarded the CON to Union Memorial, Maryland General and St. Agnes sought judicial review of the award in the Circuit Court for Baltimore City. That court affirmed the Commission award, and we now have this appeal, raising both procedural and substantive issues. We shall affirm.

BACKGROUND

In an effort to assure an efficient and effective health care system for Maryland, the General Assembly created the Health Resources Planning Commission (the Commission) and charged it with developing, adopting, periodically updating, and implementing a State Health Plan. See, in general, Md.Code, Health-General art., §§ 19-101-19-123. The principal mechanism for implementing the plan is the requirement in § 19-115 that health care facilities obtain a CON from the [529]*529Commission before commencing any major change in their plant or operation. The Commission is directed to include in the State Health Plan standards and policies relating to the CON program—standards addressing the availability, accessibility, cost, and quality of health care. § 19-114(e). The Commission has done so. See COMAR, title 10, subt. 24, ch. 01.

In October, 1990, the State Health Plan for Cardiac Surgery and Therapeutic Catheterization Services—that part of the State Health Plan at issue here—was amended to project the need for one additional OHS/PTCA program in the Baltimore Metropolitan Planning Region. In January, 1991, preliminary letters of intent were filed by several metropolitan hospitals. In March, 1991, following preapplication conferences, formal applications for a CON were filed by five hospitals, including the parties to this appeal. After extensive review of the applications, the Commission staff, on March 29, 1992, recommended that Union Memorial be awarded the CON. The Commission then designated Commission-member James T. Estes as a hearing officer to conduct an evidentiary hearing.

The proceeding before the Commission was a “comparative review,” i.e., the review of two or more applications for similar projects serving the same or overlapping service areas. See COMAR 10.24.01.07B(2). At issue was not simply whether a particular applicant satisfied the basic criteria for a CON, but which of the applicants best satisfied the criteria. In that regard, the Commission was obliged to consider the eight criteria set forth in COMAR 10.24.01.07H, a general regulation governing the procedure for considering applications for CONs. Among those criteria are (1) consistency with the State Health Plan, (2) the availability of less costly or more effective alternatives for addressing the unmet needs identified by the applicants, (3) the immediate and long-term financial viability of the proposal, and (4) a positive impact on the existing health care system of the area.

We are informed that the State Health Plan for Cardiac Surgery and Therapeutic Catheterization Services itself con[530]*530tains 17 standards and eight “approval policies” against which applications were to be judged. The COMAR requirement that applications be examined for consistency with the State Health Plan thus required the Commission to consider those standards and approval policies as well. A complete listing of the applicable standards and approval policies does not appear either in COMAR or in the record extract or any of the briefs.1

Taking account of these standards and approval policies and the other criteria stated in the regulation, Dr. Estes identified 18 Genuine Issues raised by the applications, some of which pertained to all of the applicants, others to one or more but less than all of them. Among those issues were:

“Issue 12: Which applicant is least costly? The analysis may include costs of any particular program, including existing as well as proposed programs, to the health care system.
Issue 13: Are each hospital’s OHS/PTCA financial and operating projections reasonable?
Issue 15: What would be the impact of an OHS/PTCA program at each applicant hospital on each applicant’s hospital operations, including the impact of an OHS/PTCA program on the overall financial viability of the provider?”

In May, 1992, the applicants each submitted “pre-filed” written testimony supporting their respective applications and addressing the 18 Genuine Issues identified by Dr. Estes. Hearings were then held in June and July, during which the applicants were allowed to cross-examine the witnesses produced by the other applicants. On August 31, the Commission [531]*531staff and the applicants each filed their rebuttal testimony; the staff confirmed its earlier recommendation that the CON go to Union Memorial. Cross-examination on the rebuttal testimony occurred in September, 1992. On November 9, 1992, following the filing of closing and reply briefs, the record was closed.

The day the record was closed, Maryland General filed a Motion to Reopen the Record and Admit Information of Material Changes in Financial Projections of Union Memorial Hospital. The point of this motion, which we shall discuss in further detail later, was to challenge certain testimony given by Edward Kelly, Union Memorial’s chief financial officer, with respect to (1) Union Memorial’s projected FY 1992 income in light of its later-published audited FY 1992 statement and (2) its request of the Health Services Cost Review Commission for a retroactive rate adjustment.

The hearing officer initially referred the issue raised with respect to the retroactive rate adjustment to John Colmers, Executive Director of the Cost Review Commission who, on December 10, 1992, reported that Union Memorial’s request for rate adjustment had no impact on the hospital’s financial viability. Dr. Estes then reopened the record to allow cross-examination of Messrs. Colmers and Kelly. An additional hearing for that purpose was held on February 8, 1993. On February 16, St. Agnes asked the hearing officer to direct Union Memorial to have its accountants produce certain working papers related to the preparation of the 1992 statement. Three days later, Maryland General insisted that Dr. Estes make additional inquiries of the accountants. Those requests were denied, as were motions to reconsider the denials.

On April 23, 1993, Dr. Estes filed an 83-page opinion in which he recommended that Union Memorial receive the CON. The opinion consisted of a comparative analysis of the applications in terms of program effectiveness, cost, access for the underserved, and impact on the health care system. The entire opinion has not been reproduced in the record extract, presumably because the parties have not thought those parts [532]*532excluded to be germane. We shall therefore consider only the portions included in the extract.

Among the decisive factors considered by Dr. Estes were approval policies (7) and (8). Approval policies are, in essence, preferences, or tie-breakers; they come into play when all of the applicants otherwise would qualify for the CON because they meet all of the other standards and policies. Approval policies (7) and (8) provide as follows:

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Bluebook (online)
653 A.2d 1029, 103 Md. App. 525, 1995 Md. App. LEXIS 38, Counsel Stack Legal Research, https://law.counselstack.com/opinion/maryland-general-hospital-v-maryland-health-resources-planning-commission-mdctspecapp-1995.