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

Court of Appeals of Virginia·Decided February 4, 2014·No. 0963132·Unpublished

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Present: Judges Huff, Chafin and Decker UNPUBLISHED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

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.

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.

1.25 beds from Retreat Hospital for every new bed established in the Goochland hospital.4 St. Francis’s COPN did not have a similar condition.

Pursuant to the Virginia Administrative Process Act (“VAPA”), West Creek appealed the Commissioner’s decision to award a COPN in favor of St. Francis to the circuit court. St. Francis and the Commissioner both filed motions to dismiss West Creek’s petition for appeal, arguing that West Creek failed to allege in its petition that it was aggrieved by the Commissioner’s decision. The circuit court subsequently granted West Creek’s motion for leave to amend its petition for appeal over objections by St. Francis and the Commissioner.

In its amended petition, West Creek alleged the following to support its standing to appeal the Commissioner’s decision:

7. First, [West Creek] was a competing applicant against [St.

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

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