West Creek Medical Center, Inc. v. Cynthia C. Romero, M.D., etc.

CourtCourt of Appeals of Virginia
DecidedFebruary 4, 2014
Docket0963132
StatusUnpublished

This text of West Creek Medical Center, Inc. v. Cynthia C. Romero, M.D., etc. (West Creek Medical Center, Inc. v. Cynthia C. Romero, M.D., etc.) is published on Counsel Stack Legal Research, covering Court of Appeals of Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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West Creek Medical Center, Inc. v. Cynthia C. Romero, M.D., etc., (Va. Ct. App. 2014).

Opinion

COURT OF APPEALS OF VIRGINIA

Present: Judges Huff, Chafin and Decker UNPUBLISHED

Argued at Richmond, Virginia

WEST CREEK MEDICAL CENTER, INC. MEMORANDUM OPINION* BY v. Record No. 0963-13-2 JUDGE GLEN A. HUFF FEBRUARY 4, 2014 CYNTHIA C. ROMERO, M.D., F.A.A.P., STATE HEALTH COMMISSIONER AND BON SECOURS – ST. FRANCIS MEDICAL CENTER, INC.

FROM THE CIRCUIT COURT OF CHESTERFIELD COUNTY Paul M. Peatross, Jr., Judge Designate

Robert L. Hodges (Nathan A. Kottkamp; Thomas J. Stallings; Jeffrey D. McMahan, Jr.; McGuireWoods LLP, on briefs), for appellant.

Ishneila G. Moore, Assistant Attorney General (Kenneth T. Cuccinelli, II, Attorney General; Rita W. Beale, Deputy Attorney General; Allyson K. Tysinger, Senior Assistant Attorney General, on brief), for appellee Cynthia C. Romero, M.D., F.A.A.P., State Health Commissioner.

Matthew D. Jenkins (Elizabeth A. Breen; Hunton & Williams, LLP, on brief), for appellee Bon Secours - St. Francis Medical Center, Inc.

West Creek Medical Center, Inc. (“West Creek”) appeals a ruling of the Chesterfield

County Circuit Court (“circuit court”) dismissing West Creek’s appeal of a decision by the State

Health Commissioner (“Commissioner”) to issue a certificate of public need (“COPN”) in favor

of St. Francis Medical Center, Inc. (“St. Francis”). In dismissing West Creek’s appeal, the

circuit court held that West Creek was not an aggrieved party and therefore did not have standing

* Pursuant to Code § 17.1-413, this opinion is not designated for publication. to appeal the Commissioner’s decision because the administrative record was devoid of any

evidence of harm to West Creek.

On appeal, West Creek contends that the circuit court erred by 1) requiring West Creek to

present evidence of harm in order to prove its standing, 2) holding that West Creek was not

aggrieved and lacked standing, and 3) denying West Creek its right to an evidentiary hearing on

the issue of standing. In an assignment of cross-error, the Commissioner contends that the

circuit court erred by overruling the Commissioner’s motion to dismiss and plea of sovereign

immunity and finding that West Creek was a proper party to appeal St. Francis’s COPN award.

For the following reasons, this Court reverses the decision of the circuit court and remands the

case for further proceedings consistent with this opinion.

I. BACKGROUND

On appeal, “[w]e view the facts in this case ‘in the light most favorable to sustaining the

[Commissioner’s] action and take due account of the presumption of official regularity, the

experience and specialized competence of the [Commissioner], and the purposes of the basic law

under which the [Commissioner] has acted.’” Nat’l College v. Davenport, 57 Va. App. 677,

680-81, 705 S.E.2d 519, 521 (2011) (alterations in orginal) (quoting Sentara Norfolk Gen. Hosp.

v. State Health Comm’r, 30 Va. App. 267, 279, 516 S.E.2d 690, 696 (1999)). So viewed, the

evidence is as follows.

Under Code § 32.1-102.3(A), any person who wishes to provide medical services in the

Commonwealth of Virginia must first obtain a COPN from the Commissioner by demonstrating

the existence of a public need for the services proposed. West Creek and St. Francis both

applied to the Commissioner for a COPN to provide the same services – acute care beds – in the

-2- same planning district – PD 15.1 Accordingly, the Commissioner deemed the two applications

“Competing Applications,” defined as “applications for the same or similar services and facilities

that are proposed for the same planning district or medical service area and which are in the

same review cycle.” 12 VAC 5-220-10.

West Creek’s application requested to establish a new hospital, with 97 acute care beds,

in Goochland County. Acknowledging an underutilization of existing beds in PD 15, West

Creek proposed the relocation of 97 beds from another HCA2 hospital in PD 15, Retreat

Hospital, as part of its application. St. Francis’s application, on the other hand, claimed an

institutional need for more beds and proposed to add 54 beds to its existing hospital in

Chesterfield County.

Through her adjudication officer, the Commissioner held an informal fact finding

conference (“IFFC”) in which both West Creek and St. Francis argued for the approval of their

COPN applications and the denial of the other’s. At this conference, West Creek argued that

granting St. Francis a COPN would exacerbate a surplus of acute care beds in PD 15, thereby

harming West Creek through decreased utilization and increased costs. In support of this

argument, West Creek introduced evidence that the average bed occupancy in PD 15 in 2007 was

54.8%, while the State Medical Facilities Plan standard was 85%. Further, from 2004 to 2006,

PD 15 saw a steady decline in bed occupancy. West Creek also introduced evidence that in

2007, St. Francis was licensed for 130 acute care beds in PD 15, but only had an average

occupancy of 63.1%; nevertheless, St. Francis’s COPN application was requesting a 42%

increase in beds.

1 The Commonwealth of Virginia is divided into “health planning regions” and smaller “planning districts.” Code § 32.1-102.1; 12 VAC 5-220-10. 2 West Creek is a subsidiary of the Hospital Corporation of America. -3- Furthermore, West Creek’s and St. Francis’s service areas significantly overlap each

other. West Creek presented testimonial evidence that, based on St. Francis’s current bed

occupancy averages, its projected “11.2% [bed occupancy] growth rate is either totally

unrealistic or predatory or both.” Indeed, “the only way St. Francis could begin to approach their

utilization projections is by diverting patients from other hospitals” in its service area, like West

Creek.

In his recommendation to the Commissioner,3 the hearing adjudication officer

commented on the competition for patients between West Creek and St. Francis, stating that

“[e]ach project, and each applicant’s opposition to the other’s, reflects a keenly-interested effort

to maintain and enhance an established presence in a growing area of a metropolitan region.”

Indeed, “[St. Francis] and [West Creek] compete in an energetic manner in the health care

marketplace of PD 15.” He further commented that “considerable shortages of health care

workers . . . are projected to last and worsen for the next several years in Virginia. As a general

principle, competition for scarce resources does not lower costs associated with them.”

Notwithstanding the increase in competition between West Creek and St. Francis, the hearing

adjudication officer recommended that the Commissioner approve both applications for a COPN.

On November 10, 2008, the Commissioner “reviewed and adopted the . . . findings . . . of

the adjudication officer,” approving both West Creek’s and St. Francis’s applications. The

Commissioner conditioned West Creek’s approval, however, on the requirement that it relocate

3 The hearing adjudication officer addressed 21 statutory factors, as was required by Code § 32.1-102.3 at the time of the hearing, in his recommendation to the Commissioner. This code section, however, has since been amended to include only eight statutory factors. Code § 32.1-102.3.

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