VANTAGE CANCER CENTERS OF GEORGIA, LLC v. GEORGIA DEPARTMENT OF COMMUNITY HEALTH (Three Cases)

318 Ga. 361
Supreme Court of Georgia·Decided February 20, 2024·No. S23G0405, S23G0408, S23G0409·Published·Cited by 2 cases

Opinion

318 Ga. 361 FINAL COPY

S23G0405. VANTAGE CANCER CENTERS of GEORGIA, LLC et al. v. DEPARTMENT OF COMMUNITY HEALTH et al.

S23G0408. NORTHEAST GEORGIA MEDICAL CENTER, INC. et al. v. NORTHSIDE HOSPITAL, INC.

S23G0409. NORTHEAST GEORGIA MEDICAL CENTER, INC. et al. v. DEPARTMENT OF COMMUNITY HEALTH.

BOGGS, Chief Justice.

This case concerns the standard of review that the Commissioner of the Georgia Department of Community Health must apply when reviewing the decision of a hearing officer on an application for a certificate of need to establish a new health service. The Court of Appeals held that in this case the Commissioner applied the correct standard of review, see Northside Hosp. v. Northeast Ga. Med. Center, 365 Ga. App. 778, 782-785 (880 SE2d 286) (2022), and we granted certiorari to review that decision. We now vacate the Court of Appeals’ judgment, set forth the standard applicable to the Commissioner’s review, and remand the case to the Court of Appeals.

1. In 2020, Northside Hospital, Inc. d/b/a Northside Hospital Gwinnett (“Northside”) applied to the Georgia Department of Community Health (“the Department”) for a certificate of need (“CON”) to establish a new radiation therapy service at the Northside Gwinnett Hospital. Northside filed its application under a Department regulation permitting need exceptions for atypical barriers to care, asserting that atypical barriers impeded the delivery of radiation therapy services to inpatients at Northside Gwinnett.1 More specifically, Northside contended that its inpatient cancer patients had to be transported offsite for radiation therapy and that, as a result, its inpatients experienced negative quality issues, such as missed appointments and delayed treatment. The

1 Ga. Comp. R. & Regs., r. 111-2-2-.42 sets forth the requirements for a

CON to establish a new radiation therapy service. Among other things, an applicant must either show a need for the service, see Ga. Comp. R. & Regs., r. 111-2-2-.42 (3) (a), or establish grounds for applying an exception to the usual need requirement. See Ga. Comp. R. & Regs., r. 111-2-2-.42 (3) (b). The atypical barrier exception to the need standard permits the Department to issue a certificate “[t]o remedy an atypical barrier to [radiation therapy] services based on cost, quality, financial access and geographic accessibility.” Ga. Comp. R. & Regs., r. 111-2-2-.42 (3) (b) (4).

Northeast Georgia Medical Center (“Northeast”), RCOG Cancer Centers, LLC (“RCOG”), and Vantage Cancer Centers of Georgia, LLC (“Vantage”), opposed the application. Northeast provides radiation therapy service at three locations in Hall County, one of which is just across the Gwinnett County line. Northeast provides radiation therapy to numerous Gwinnett County residents. Vantage and RCOG provide radiation therapy at facilities in Gwinnett County that are about 0.3 miles and 0.8 miles from Northside, respectively.2 The Department’s staff granted the CON on June 16, 2020, concluding, among other things, that Northside had justified an exception to the numerical need methodology based on quality of care. See OCGA § 31-6-43 (b) (providing that Department staff makes an initial decision to grant or deny a CON).

(a) Appeal to Hearing Officer

2 See OCGA § 31-6-43 (d) (2) (A) (allowing certain parties to “oppose an

application for a certificate of need for a proposed project,” including parties who “offer[ ] substantially similar services as proposed within a 35 mile radius of the proposed project”).

Northeast, RCOG, and Vantage filed administrative appeals to a hearing officer. See OCGA § 31-6-44 (d). The hearing officers are part of a “Certificate of Need Appeal Panel” that is “an agency separate and apart from the department,” the purpose of which is “to serve as a panel of independent hearing officers to review the department’s initial decision to grant or deny a certificate of need application.” OCGA § 31-6-44 (a). The hearing officer conducts “a de novo review of the decision of the department.” OCGA § 31-6-44 (f).

Here, on April 21, 2021, following a hearing, the hearing officer reversed the Department’s decision approving the CON. The hearing officer’s decision contained 86 paragraphs designated as “Findings of Fact” (“FOF”). FOF 29, for example, stated that “the evidence at [the] hearing did not support the proposition that there is any atypical quality barrier to care associated with a hospital’s inpatients receiving radiation therapy at a nearby freestanding center, as they have for decades.” FOF 34 stated that “[t]here is nothing atypical about a hospital such as [Northside] utilizing nearby freestanding [radiation therapy] providers staffed by

physicians on the hospital’s medical staff to treat its inpatients, and that situation does not constitute an atypical barrier to care”; that “[t]his is consistent with the overwhelmingly-outpatient nature of the service, and medical transport to nearby radiation therapy centers offers good access and quality for those few patients who would benefit from radiation while admitted”; and that “[t]he available data presented at the hearing further indicated that inpatients at [Northside] are not accessing radiation at lower rates, thus confirming that inpatients at [Northside] have good access, and relying upon a detached nearby facility does not pose a barrier to care.” Meanwhile, FOF 37 stated that the “[m]edical transport of cancer inpatients for radiation therapy is routine, safe, and effective” and “has been the practice at [Northside] for many years.”

(b) Appeal to the Commissioner Northside and the Department appealed the hearing officer’s decision to the Commissioner of the Department. See OCGA § 31-6- 44 (i) (permitting parties, including the Department, to appeal the

hearing officer’s decision to the commissioner). The Commissioner’s scope of review is defined by OCGA § 31-6-44 (k) (1), which provides:

In the event an appeal of the hearing officer’s decision is filed, the commissioner may adopt the hearing officer’s order as the final order of the department or the commissioner may reject or modify the conclusions of law over which the department has substantive jurisdiction and the interpretation of administrative rules over which it has substantive jurisdiction. By rejecting or modifying such conclusion of law or interpretation of administrative rule, the department must state with particularity its reasons for rejecting or modifying such conclusion of law or interpretation of administrative rule and must make a finding that its substituted conclusion of law or interpretation of administrative rule is as or more reasonable than that which was rejected or modified.

Rejection or modification of conclusions of law may not form the basis for rejection or modification of findings of fact. The commissioner may not reject or modify the findings of fact unless the commissioner first determines from a review of the entire record, and states with particularity in the order, that the findings of fact were not based upon any competent substantial evidence or that the proceedings on which the findings were based did not comply with the essential requirements of law.

Here, in conducting this review, the Commissioner quoted the standard of review set forth in OCGA § 31-6-44 (k) (1), overturned the hearing officer’s decision, and granted a CON for the project. The

Commissioner rejected many of the FOFs of the hearing officer on the grounds that they were “conclusion[s] couched as a finding of fact,” “irrelevant,” or “contain[ed] opinions.” The Commissioner concluded, among other things, that

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VANTAGE CANCER CENTERS OF GEORGIA, LLC v. GEORGIA DEPARTMENT OF COMMUNITY HEALTH (Three Cases), 318 Ga. 361 (Ga. 2024).

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