Mercy Ambulance of Evansville, Inc. D/B/A Lifeguard Emergency Medical Services v. Commonwealth of Kentucky, Cabinet for Health and Family Services, Office of Inspector General, Division of Certificate of Need

CourtCourt of Appeals of Kentucky
DecidedJanuary 27, 2022
Docket2020 CA 001457
StatusUnknown

This text of Mercy Ambulance of Evansville, Inc. D/B/A Lifeguard Emergency Medical Services v. Commonwealth of Kentucky, Cabinet for Health and Family Services, Office of Inspector General, Division of Certificate of Need (Mercy Ambulance of Evansville, Inc. D/B/A Lifeguard Emergency Medical Services v. Commonwealth of Kentucky, Cabinet for Health and Family Services, Office of Inspector General, Division of Certificate of Need) is published on Counsel Stack Legal Research, covering Court of Appeals of Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Mercy Ambulance of Evansville, Inc. D/B/A Lifeguard Emergency Medical Services v. Commonwealth of Kentucky, Cabinet for Health and Family Services, Office of Inspector General, Division of Certificate of Need, (Ky. Ct. App. 2022).

Opinion

RENDERED: JANUARY 28, 2022; 10:00 A.M. NOT TO BE PUBLISHED

Commonwealth of Kentucky Court of Appeals

NO. 2020-CA-1457-MR

MERCY AMBULANCE OF EVANSVILLE, INC. d/b/a LIFEGUARD EMERGENCY MEDICAL SERVICES APPELLANT

APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE THOMAS D. WINGATE, JUDGE ACTION NO. 20-CI-00303

COMMONWEALTH OF KENTUCKY, CABINET FOR HEALTH AND FAMILY SERVICES, OFFICE OF INSPECTOR GENERAL, DIVISION OF CERTIFICATE OF NEED; EMERGENT CARE EMS, LLC; AND ERIC FRIEDLANDER, SECRETARY, CABINET FOR HEALTH AND FAMILY SERVICES, IN HIS OFFICIAL CAPACITY APPELLEES

OPINION AFFIRMING

** ** ** ** ** BEFORE: CALDWELL, MAZE, AND McNEILL, JUDGES.

MAZE, JUDGE: Appellant/Mercy Ambulance of Evansville, Inc. d/b/a Lifeguard

Emergency Medical Services (“Lifeguard”) appeals the Franklin Circuit Court’s

order reversing the decision of the Cabinet for Health and Family Services (“the

Cabinet”) denying Appellee/Emergent Care EMS, LLC’s certificate of need

(“CON”) application. For the following reasons, we affirm.

BACKGROUND

In 2019, Appellee/Emergent Care EMS, LLC (“Emergent”) filed a

CON application with the Cabinet seeking approval to establish ground ambulance

services in Floyd County, Kentucky. Emergent noted that existing ambulance

providers in Floyd County could not accommodate the demand level for

ambulance services, as documented by slow response times. In response,

Appellant/Lifeguard challenged Emergent’s CON application and, as an “affected

person” under KRS1 216B.015(3), submitted a request for a public hearing.

A public hearing took place on February 24 and 25, 2020. At the

hearing, Emergent presented two witnesses: (1) Robert Osborne, Emergent’s sole

member;2 and (2) Dan Sullivan, an expert in healthcare. In opposition, Lifeguard

1 Kentucky Revised Statutes. 2 At the time, Robert Osborne was Emergent’s sole member. He passed away between the filing of the CON and the circuit court’s October 16, 2020, order.

-2- presented three witnesses: (1) Aaron Paul Walther, a manager with American

Medical Response; (2) E. Janie Ward, a director with Global Medical Response,

the parent company of Lifeguard; and (3) Kathryn M.T. Platt, an expert in

healthcare.

On March 18, 2020, the Cabinet issued its final order. The Cabinet

found that Mr. Osborne lived in Floyd County and had worked for Lifeguard’s

predecessor, Trans-Star Ambulance Service, since 2013. In 2019, after Lifeguard

took over Trans-Star’s operations, Mr. Osborne resigned due to concerns over the

long hours he had to work and complaints of long response times from patients’

family members. Mr. Osborne testified that he intended to purchase two

ambulances and operate Emergent to serve the Floyd County area.

As to Lifeguard, the Cabinet found that it provided services to eight

counties, including Floyd County, and held a license for twelve ambulances. Ms.

Ward testified that Lifeguard had taken recent steps to address staffing issues and

response times in Floyd County. However, the Cabinet noted that no Lifeguard

employees testified at the hearing.

Ultimately, the Cabinet denied Emergent’s CON application,

concluding that Emergent failed to satisfy two of the five Review Criteria

enumerated in KRS 216B.040(2)(a)(2), to wit: Criterion One (“consistency with

plans,” which requires an applicant to notify all licensed agencies providing similar

-3- services in the proposed geographic area pursuant to applicable administrative

regulations3 and the State Health Plan) and Criterion Four (“costs, economic

feasibility, and resources availability”). Specifically, the Cabinet held that

Emergent failed to satisfy Criterion One by not notifying two air ambulance

services of its CON application. And, the Cabinet held that Emergent failed to

satisfy Criterion Four because it could not meet its run projections.

Emergent then filed a petition for review/appeal in Franklin Circuit

Court. On October 16, 2020, the circuit court reversed the Cabinet’s decision,

finding it arbitrary and not supported by substantial evidence. First, the circuit

court held that Criterion One was met because Emergent notified the ground

ambulances within the proposed area and, thus, complied with the State Health

Plan. Second, the circuit court held that Criterion Four was met because an

additional ambulance service was needed in the area, Emergent had adequate

capital to run an ambulance service, and Emergent’s operation would be

economically feasible.

Lifeguard now appeals, arguing that the circuit court erred in

reversing the Cabinet’s final order instead of remanding the case for a new

evidentiary hearing. Also, Lifeguard contends that the circuit court incorrectly

3 See generally 900 Kentucky Administrative Regulations (KAR) 6:020 ff.

-4- considered and relied upon information outside of the administrative record to

arrive at its decision.

Additional facts will be developed as necessary.

STANDARD OF REVIEW

When reviewing the circuit court’s ruling on an agency’s decision, an

appellate court stands in the shoes of the circuit court and reviews the agency’s

decision for arbitrariness. Martin County Home Health Care v. Cabinet for Health

and Family Services, 214 S.W.3d 324, 326 (Ky. App. 2007) (citations omitted). If

the agency’s findings of fact are supported by substantial evidence of probative

value, “they must be accepted as binding and it must then be determined whether

or not the agency has applied the correct rule of law to the facts[.]” Liquor Outlet,

LLC v. Alcoholic Beverage Control Bd., 141 S.W.3d 378, 381 (Ky. App. 2004)

(citation omitted). The Court of Appeals reviews issues of law involving an

administrative agency decision on a de novo basis. Id. “In particular, an

interpretation of a statute is a question of law and a reviewing court is not bound

by the agency’s interpretation of that statute.” Id.

ANALYSIS

I. The circuit court properly reversed the Cabinet’s decision, which was arbitrary and not supported by substantial evidence.

The CON application and review process is controlled by the Cabinet,

the administrative agency vested with statutory authority to promulgate

-5- administrative regulations concerning the CON process. KRS 216B.040(2)(a)1.

Emergent’s CON application was governed by five Review Criteria set forth in

KRS 216B.040(2)(a)2 a.-e.,4 the formal review criteria established by 900 KAR

6:070, and the CON review standards at Section V, Part A of the November 2018

Update to the 2017-19 State Health Plan (“SHP”) in 900 KAR 5:020.

As stated, the administrative hearing officer for the Cabinet

determined that Emergent’s CON application did not meet Criterion One and

Criterion Four. We will address Criterion One first.

A. Criterion One

In its final order, the Cabinet found that Emergent failed to notify two

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Mercy Ambulance of Evansville, Inc. D/B/A Lifeguard Emergency Medical Services v. Commonwealth of Kentucky, Cabinet for Health and Family Services, Office of Inspector General, Division of Certificate of Need, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mercy-ambulance-of-evansville-inc-dba-lifeguard-emergency-medical-kyctapp-2022.