17-002754 Galencare, Inc., D/B/A Northside Hospital vs. Florida Department Of Health
 Status: Closed
Recommended Order on Wednesday, December 20, 2017.


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Summary: Northside Hospital met its burden of establishing that its trauma center application meets all applicable criteria, thereby entitling it to provisional status as a Level II trauma center.

1number or paragraph, that does not identify the legal basis for the exception, or that

16does not include appropriate and specific citations to the record.

26An agency may not reject or modify findings of fact in a recommended order

40unless the agency first determines from a review of the entire record, and states with

55particularity in the order, that the findings of fact were not based upon competent

69substantial evidence or that the proceedings on which the findings were based did not

83comply with essential requirements oflaw. See § 120.57(1)(1), Fla. Stat.

93An agency may reject or modify the conclusions oflaw over which the agency has

107substantive jurisdiction and interpretation of administrative rules over which the agency

118has substantive jurisdiction. When rejecting or modifying such conclusion oflaw or

129interpretation of administrative rule, the agency must state with particularity its reasons

141for rejecting or modifying such conclusion of law or interpretation of administrative rule

154and must make a finding that its substituted conclusion of law or interpretation of

168administrative rule is as or more reasonable than that which was rejected or modified.

182See § 120.57(1)(1), Fla. Stat.

187SUMMARY OF THE APPROVAL

191The approval of applications submitted by hospitals that desire to be trauma

203centers spans over a 21 month timeframe. See § 395-4025, Fla. Stat., and Fla. Admin.

218Code R. 64J -2.012. The application approval occurs in stages and includes the

231invitation to submit letters of intent, the submission of letters of intent, the submission

245of applications, a provisional review, an in-depth review, an on-site visit and final

258selection. See§ 395-4025, Fla. Stat.; Fla. Admin. CodeR. 64J-2.012 and R. 64J-2.016.

270The Department shall annually notify each acute care hospital that the

281Department is accepting letters of intent from hospitals interested in becoming trauma

293centers. See § 395.4025(2)(a), Fla. Stat. Hospitals must submit letters of intent

305postmarked no later than midnight on October 1. See id. By October 15, the

319Department shall send to all hospitals that submitted a letter of intent an application

333package with instructions. See§ 395-4025(2)(b), Fla. Stat. Applications from hospitals

343seeking selection as trauma centers must be submitted no later than April1. See §

357395-4025(2)(c), Fla. Stat.

360Provisional Review

362The Department "shall conduct a provisional review of each application to

373determine if the hospital has the critical elements of a trauma center" including the

387equipment, facilities, personnel in sufficient number with proper qualifications, and an

398effective quality assurance process. See§ 395-4025(2)(c), Fla. Stat. (emphasis added)

408After April 30, "any hospital that submitted an application found acceptable by

420the Department based on the provisional review shall be eligible to operate as a

434provisional trauma center." § 395-4025(3), Fla. Stat. (emphasis added)

443For each step described above, section 395-4025, Florida Statutes, uses the term

"455shall," a mandatory term that normally creates an obligation impervious to judicial

467discretion. See City of St. Petersburg v. Remia, 41 So. 3d 322,326 (Fla. 2d DCA 2010).

484The description of the letters of intent, application submission and provisional

495review in sections 395-4025(2) and (3), Florida Statutes, does not make any reference to

509the consideration of need for trauma centers in the applicable TSA. State of Florida,

523Dep't of Health v. Bayfront HMA Medical Center, LLC, et al, and Galencare Inc. d/b/a

538Northside Hospital v. Bayfront HMA Medical Center, LLC, Case Nos. 1D17-2174 and

5501D17-2229 (consol.) Florida 1st DCA January 2, 2018) (statutory framework and trauma

562center application process); see also The Public Health Trust of Miami-Dade County v.

575Dep't of Health and Kendall Healthcare Group, Case No. 16-3370, 16-3372 (DOAH Oct.

5886, 2016) (Order Granting Motion to Partially Dismiss Petition for Administrative

599Hearing); see also. At the provisional review stage, the statute only describes the

612categories of critical elements that the hospital must meet, directing that "any hospital

625found acceptable ... shall be eligible to operate as a provisional trauma center." See §

640395-4025(3), Fla. Stat. (emphasis added)

645Between May 1 and October 1 of each year, the Department shall conduct an in­

660depth evaluation of all the applications found acceptable in the provisional review. See §

674395-4025(4), Fla. Stat.

677Beginning October 1 of each year and ending no later than June 1 of the following

693year, a review team of out-of-state experts, assembled by the Department, shall make

706on-site visits to all provisional trauma centers. See § 395-4025(5), Fla. Stat. Final

719selection of trauma centers occurs after the on-site review. See§ 395.4025(6), Fla. Stat.

732At this point, the statute requires the Department to take need into consideration stating

746that "[t]he hospitals being considered as provisional trauma centers shall meet all the

759requirements of a trauma center and shall be located in a TSA that has a need for such a

778trauma center." § 395.4025(5), Fla. Stat. Because the requirement to consider need is

791located in the portion of the statute that discusses the final stage of the review, not the

808provisional review stage, the need requirement cannot be interjected into the

819provisional review. In addition, the sentence concerning need in section 395-4025(5)

830clarifies that it is not referring to the provisional review, stating that hospitals being

844considered "as provisional trauma centers shall meet all the requirements of a trauma

857center .... " Id. (emphasis added). The provisional review does not require a hospital to

871meet all the requirements of a trauma center, but only the standards involving the

885critical elements. See § 395-4025(2)(c), Fla. Stat.

892Final Review

894The plain language of the statute must be followed unless it leads to an

908unreasonable result or a result contrary to legislative intent. See Daniels v. Fla. Dep't of

923Health, 898 So. 2d 61, 64 (Fla. 2005). Considering need at the final review stage, rather

939than at the front end of the application review, does not lead to an unreasonable result

955or a result contrary to legislative intent. The Department's duty, based on the structure

969of the trauma statutes and the legislative intent expressed, is to establish and maintain,

983on a yearly basis, an inclusive, current, and effective trauma system that provides

996quality trauma care to all Florida residents and visitors. It is reasonable to allow any

1011applicant hospital that meets the critical elements to operate as a provisional trauma

1024center because this provides the Department with additional important information

1034about the impact and effectiveness of adding trauma centers to a TSA. 1

1047RULINGS ON EXCEPTIONS

1050Exception 1: The June 9, 2017 order limited Bayfront's intervention

1060[Conclusion of Law #63]. Bayfront takes exception the limitations on its intervention,

1072saying it was prevented from raising "other substantive issues including ... whether the

1085DOH may process and approve Northside's application in the absence of need or an

1099available position in TSA 9."

11041 All trauma centers, including provisional trauma centers, must provide data to the trauma registry for the purpose

1122of monitoring patient outcome and ensuring compliance with the standards of approval. See§ 395.404, Fla. Stat.

1138The Department has substantive jurisdiction in matters governed by the trauma

1149statutes and rules. However, the Department has no substantive jurisdiction over the

1161decisional authority of administrative law judges shared equally with every other state

1173agency, and therefore is absent authority to reject this Conclusions of Law in relation to

1188the limitations placed upon Bayfront's intervention. For this reason, Bayfront's

1198Exception 1 is DENIED.

1202Exception 2: Bayfront takes exception to the ALJ's finding that Northside had

1214until May 1, 2017- rather than April22, 2017- to cure deficiencies in its application

1228[Findings of Fact ##33, 34, 36-42; Conclusions of Law 65-67,71,76-79, 84]. The

1242Department lacks jurisdiction to reverse Findings of Fact entered by an Administrative

1254Law Judge when those findings are based on competent substantial evidence, nor may it

1268reweigh the evidence. The Department has substantive jurisdiction in matters governed

1279by the trauma statutes and rules. The Administrative Law Judge, however, exercised de

1292novo review of the Department's denial of Northside's application and the deadlines for

1305Northside to demonstrate critical elements of a provisional trauma approval, based on

1317his Section 120.57(1), Fla. Stat. authority. The Department has no substantive

1328jurisdiction over the decisional authority of administrative law judges not shared equally

1340with every other state agency, and therefore is absent authority to reject his Conclusions

1354of Law regarding compliance with those timelines, based on the facts determined in the

1368case. Bayfront's Exception 2 is DENIED.

1374WHEREFORE, the Recommended Order entered in this proceeding on

1383December 20, 2017 is adopted and incorporated by reference.

1392Based on the foregoing, Galencare, Inc., d/b/a Northside Hospital is

1402APPROVED as a provisional Level II trauma center.

1410DONE and ENTERED this day of _ _;_jj,--=---'.i.,.....J_v J_/:.._-- ___ , 2018 in

1425Tallahassee, Leon County, Florida.

1429Celeste . Philip, MD, M

1434State Surgeon General & Secretary

1439Florida Department of Health

1443NOTICE OF RIGHT TO JUDICIAL REVIEW

1449A PARTY ADVERSELY AFFECTED BY THIS ORDER IS ENTITLED TO

1459JUDICIAL REVIEW PURSUANT TO SECTION 120.68, FLORIDA STATUTES.

1467REVIEW PROCEEDINGS ARE GOVERNED BY THE FLORIDA RULES OF

1476APPELLATE PROCEDURE. A REVIEW PROCEEDING IS INITIATED BY

1484FILING A NOTICE OF APPEAL WITH THE CLERK OF THE DEPARTMENT

1495OF HEALTH AND A COPY ACCOMPANIED BY THE FILING FEE WITH THE

1507DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE

1516THE PARTY RESIDES OR IN THE FIRST DISTRICT COURT OF APPEAL.

1527THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE

1539FILING DATE OF THIS ORDER.

1544Copies furnished to:

1547Stephen A. Ecenia, Esq.

1551J. Stephen Menton, Esq.

1555Gabriel F.V. Warren, Esq.

1559Rutledge Ecenia, P.A.

1562119 South Monroe St., Suite 202

1568Post Office Box 551

1572Tallahassee, FL 32302-0551

1575steve@rutledge-ecenia.com

1576smenton@rutledge-ecenia.com

1577gwarren@rutlegde-ecenia.com

1578Michael J. Williams, Esq.

1582Department of Health

15854052 Bald Cypress Way, BinA-02

1590Tallahassee, FL 32399

1593Michael. Williams2@flhealth.gov

1595Geoffrey D. Smith, Esq.

1599Susan C. Smith, Esq.

1603Corinne T. Porcher, Esq.

1607Timothy Elliot, Esq.

1610Smith & Associates

16133301 Thomasville Road

1616Tallahassee, FL 32308

1619Geoff@smithlawtlh.com

1620Susan@smithlawtlh.com

1621Corinne@smithlawtlh.com

1622tim@smithlawtlh.com

1623Karen A. Putnal, Esq.

1627Jon C. Moyle, Esq.

1631Moyle Law Firm

1634118 N. Gadsden Street

1638Tallahassee, Florida 32301

1641kputnal@moylelaw.com

1642jmoyle@moylelaw.com

1643Shannon Revels

1645Agency Clerk

1647Department of Health

16504052 Bald Cypress Way, BinAo2

1655Tallahassee, Florida 32399-1703

1658Celeste M. Philip, M.D., M.P.H.

1663State Surgeon General

1666Department of Health

16694052 Bald Cypress Way, BinAoo

1674Tallahassee, Florida 32399-1701

1677Nichole C. Geary, Esquire

1681General Counsel

1683Department of Health

16864052 Bald Cypress Way, BinA02

1691Tallahassee, Florida 32399-1701

1694CERTIFICATE OF SERVICE

1697I HEREBY CERTIFY that a true and correct copy of the foregoing Order has been

1712sent by electronic mail and regular U.b mail and/ or by inter-office mail to each of the

1729above-named persons this of 2018.

1734Agency Clerk

1736Department of Health

17394052 Bald Cypress Way, BIN A-02

1745Tallahassee, Florida 32399-1703

Select the PDF icon to view the document.
PDF
Date
Proceedings
PDF:
Date: 08/27/2018
Proceedings: Motion to Vacate Final Order filed.
PDF:
Date: 08/24/2018
Proceedings: Agency Final Order
PDF:
Date: 08/24/2018
Proceedings: Agency Final Order filed.
PDF:
Date: 12/20/2017
Proceedings: Recommended Order
PDF:
Date: 12/20/2017
Proceedings: Transmittal letter from Claudia Llado forwarding Bayfront HMA Medical Center's Exhibits numbered 17-20, which were not admitted into evidence to Intervenor.
PDF:
Date: 12/20/2017
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 12/20/2017
Proceedings: Recommended Order (hearing held July 12 and 13, 2017). CASE CLOSED.
PDF:
Date: 10/02/2017
Proceedings: Notice of Filing Proposed Recommended Order filed.
PDF:
Date: 10/02/2017
Proceedings: Proposed Recommended Order filed.
PDF:
Date: 10/02/2017
Proceedings: Bayfront's Proposed Recommended Order filed.
PDF:
Date: 10/02/2017
Proceedings: (Northside's) Proposed Recommended Order filed.
PDF:
Date: 09/26/2017
Proceedings: Order Granting Extension of Time.
PDF:
Date: 09/25/2017
Proceedings: Motion for additional Extension of Time to File Proposed Recommended Orders filed.
PDF:
Date: 09/14/2017
Proceedings: Order Granting Extension of Time.
PDF:
Date: 09/14/2017
Proceedings: Additional Unopposed Motion for Extension of Time to File Proposed Recommended Orders filed.
PDF:
Date: 09/13/2017
Proceedings: Order Granting Extension of Time.
PDF:
Date: 09/13/2017
Proceedings: Unopposed Motion for Extension of Time to File Proposed Recommended Orders filed.
PDF:
Date: 08/30/2017
Proceedings: Order Granting Extension of Time.
PDF:
Date: 08/29/2017
Proceedings: Unopposed Motion for Extension of Time to File Proposed Recommended Orders filed.
Date: 07/31/2017
Proceedings: Transcript of Proceedings (not available for viewing) filed.
Date: 07/12/2017
Proceedings: CASE STATUS: Hearing Held.
PDF:
Date: 07/10/2017
Proceedings: Department of Health's Notice of Service of Unverified Responses to Galencare, Inc., d/b/a Northside Hospital's First Request for Interrogatories and Request for Production filed.
PDF:
Date: 07/10/2017
Proceedings: Order Allowing Testimony by Video Teleconference.
PDF:
Date: 07/10/2017
Proceedings: Petitioner's Unopposed Motion to Allow Remote-Site Testimony filed.
PDF:
Date: 07/07/2017
Proceedings: Bayfront Health - St. Petersburg's Cross-Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 07/07/2017
Proceedings: Galencare, Inc., d/b/a Northside Hospital's Cross-Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 07/06/2017
Proceedings: Galencare, Inc., d/b/a Northside Hospital's Cross-Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 07/06/2017
Proceedings: Bayfront Health's Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 07/06/2017
Proceedings: Bayfront Health - St. Petersburg's Cross-Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 07/06/2017
Proceedings: Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 07/05/2017
Proceedings: Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 07/03/2017
Proceedings: (Joint) Pre-hearing Stipulation filed.
PDF:
Date: 07/03/2017
Proceedings: Order Approving Confidentiality Agreement.
PDF:
Date: 07/03/2017
Proceedings: Motion for Entry of An Order Approving Confidentiality Agreement filed.
PDF:
Date: 06/27/2017
Proceedings: Order Denying Bayfront's Motion for Continuance of Final Hearing.
PDF:
Date: 06/26/2017
Proceedings: Petitioner Galencare, Inc. d/b/a Northside Hospital's Response in Opposition to Bayfront's Motion to Continue filed.
PDF:
Date: 06/26/2017
Proceedings: Department of Health's Response to Bayfront's Motion for Continuance filed.
PDF:
Date: 06/23/2017
Proceedings: Bayfront Health - St. Petersburg's Cross-Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 06/23/2017
Proceedings: Bayfront Health's First Request for Production of Documents to Northside Hospital filed.
PDF:
Date: 06/23/2017
Proceedings: Bayfront Health's First Request for Admissions to Department of Health filed.
PDF:
Date: 06/23/2017
Proceedings: Bayfront Health's Notice of Serving First Interrogatories to Northside Hospital filed.
PDF:
Date: 06/23/2017
Proceedings: Amended Notice of Taking Deposition Duces Tecum filed.
PDF:
Date: 06/22/2017
Proceedings: Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 06/22/2017
Proceedings: Notice of Taking Deposition Duces Tecum filed.
PDF:
Date: 06/19/2017
Proceedings: Bayfront Health's Motion for Continuance of Final Hearing filed.
PDF:
Date: 06/09/2017
Proceedings: Galencare, Inc.'s Notice of Service of First Set of Interrogatories to Department of Health filed.
PDF:
Date: 06/09/2017
Proceedings: Galencare, Inc.'s First Request for Production of Documents to Department of Health filed.
PDF:
Date: 06/09/2017
Proceedings: Order Denying Bayfront's Motion to Consolidate, Granting Bayfront's Petition to Intervene and Motion for Leave to Intervene with Restrictions, and Granting St. Joseph's Petition to Intervene with Limited Status.
PDF:
Date: 06/06/2017
Proceedings: Department of Health's Response in Opposition to Bayfront's Motion to Consolidate filed.
PDF:
Date: 06/06/2017
Proceedings: Petitioner Galencare, Inc. d/b/a Northside Hospital's Response in Opposition to Bayfront's Motion to Consolidate filed.
PDF:
Date: 06/05/2017
Proceedings: Notice of Appearance (Jon Moyle) filed.
PDF:
Date: 06/02/2017
Proceedings: Department of Health's Response in Opposition to St. Joseph's Hospital, Inc.'s Petition to Intervene with Full-Party Status filed.
PDF:
Date: 06/01/2017
Proceedings: Petitioner Galencare, Inc. d/b/a Northside Hospital's Opposition to St. Joseph's Hospital, Inc. d/b/a St. Joseph's Hospital's Petition to Intervene with Full-party Status filed.
PDF:
Date: 05/30/2017
Proceedings: Bayfront's Motion to Consolidate filed.
PDF:
Date: 05/26/2017
Proceedings: Department of Health's Response in Opposition to Bayfront HMA Medical Center, LLC d/b/a Bayfront Health-St. Petersburg's Petition to Intervene and Motion for Leave to Intervene filed.
PDF:
Date: 05/26/2017
Proceedings: Department of Health's Response in Opposition to Bayfront HMA Medical Center, LLC d/b/a Bayfront Health- St. Petersburg's Petition to Intervene and Motion for Leave to Intervene filed.
PDF:
Date: 05/26/2017
Proceedings: Petitioner Galencare, Inc. d/b/a Northside Hospital's Opposition to Bayfront HMA Medical Center, LLC d/b/a Bayfront Health - St. Petersburg's Petition to Intervene and Motion for Leave to Intervene filed.
PDF:
Date: 05/26/2017
Proceedings: Notice of Appearance (Timothy Elliott) filed.
PDF:
Date: 05/25/2017
Proceedings: ST. Joseph's Hospital, Inc's Petition to Intervene With Full-party Status filed.
PDF:
Date: 05/19/2017
Proceedings: Bayfront's Motion for Leave to Intervene filed.
PDF:
Date: 05/19/2017
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 05/19/2017
Proceedings: Notice of Hearing (hearing set for July 12 and 13, 2017; 9:00 a.m.; Tallahassee, FL).
PDF:
Date: 05/19/2017
Proceedings: Response to Initial Order filed.
PDF:
Date: 05/18/2017
Proceedings: Bayfront's Petition to Intervene filed.
PDF:
Date: 05/18/2017
Proceedings: Notice of Appearance (Corinne Porcher) filed.
PDF:
Date: 05/18/2017
Proceedings: Notice of Appearance (Geoffrey Smith) filed.
PDF:
Date: 05/16/2017
Proceedings: Notice of Appearance (Michael Williams) filed.
PDF:
Date: 05/16/2017
Proceedings: Initial Order.
Date: 05/15/2017
Proceedings: Agency action letter filed.  Confidential document; not available for viewing.
PDF:
Date: 05/15/2017
Proceedings: Petition for Formal Administrative Proceeding filed.
PDF:
Date: 05/15/2017
Proceedings: Notice (of Agency referral) filed.

Case Information

Judge:
ROBERT S. COHEN
Date Filed:
05/15/2017
Date Assignment:
05/16/2017
Last Docket Entry:
08/27/2018
Location:
Tallahassee, Florida
District:
Northern
Agency:
ADOPTED IN TOTO
 

Counsels

Related DOAH Cases(s) (1):

Related Florida Statute(s) (8):

Related Florida Rule(s) (3):