00-003209CON Sarasota Doctor`s Hospital, Inc., D/B/A Doctor`s Hospital Of Sarasota vs. Agency For Health Care Administration Status: Closed Recommended Order on Friday, March 30, 2001.

Summary: Need for additional acute care beds demonstrated by seasonal demand, inappropriateness of use of special units, emergency room admissions and availability of beds to convert to use at low cost.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

SARASOTA DOCTORS HOSPITAL, INC. , )

d/b/a DOCTORS HOSPITAL OF SARASOTA, )

)

Petitioner , )

)

vs. ) Case No. 00-3209

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION , )

)

Respondent. )

____________________________________)

RECOMMENDED ORDER

This cause was heard by Eleanor M. Hunter, the assigned

Administrative Law Judge of the Division of Administrative

Hearings, on December 18-19, 2000, in Tallahassee, Florida.

APPEARANCES

For Petitioner : Stephen A. Ecenia, Esquire

Thomas W. Konrad, Esquire

Rutledge, Ecenia, Purnell & Hoffman, P.A.

215 South Monroe Street, Suite 420

Post Office Box 551

Tallahassee, Florida 32302-0551

For Respondent : Richard A. Patterson, Esquire

Agency for Health Care Administration

2727 Mahan Drive

Fort Knox Building Three, Suite 3431

Tallahassee, Florida 32308-5403

STATEMENT OF THE ISSUE

Whether the evidence presented by Sarasota Doctors

Hospital, Inc., d/b/a Doctors Hospital of Sarasota, established

its entitlement to approval of Certificate of Need Application

No. 9320 for the addition of 21 acute care beds.

PRELIMINARY STATEMENT

Sarasota Doctors Hospital, Inc., d/b/a Doctors Hospital of

Sarasota (Doctors Hospital), is the applicant for Certificate of

N eed Number 9320 to add 21 acute care beds to the hospital,

which is located in Agency for Health Care Administration

(AHCA), District 8, Subdistrict 6, for Sarasota County. AHCA

reviewed and preliminarily denied the application, and published

its decision in the Florida Administrative Weekly, Volume 26,

Number 26, dated June 30, 2000.

On August 4, 2000, Doctors Hospital's Petition for Formal

Administrative Hearing was received at the Division of

Administrative Hearings. Initially scheduled for October, the

final hearing was postponed until December, after an Unopposed

Joint Motion for Continuance was granted.

Prior to the final hearing, counsel for the parties filed a

pre-hearing stipulation, agreeing that the disputed criteria are

as follows:

(1 ) the preference for the addition of

general acute care beds in a subdistrict

where all acute care hospitals in the

specific subdistrict are maintaining a 12-

month average occupancy of at least 75

percent;

(2 ) the preference for the addition of

acute care beds at an existing hospital if

its average annual occupancy exceeds 80

percent for all licensed beds;

(3 ) Subsection 408.035(1)(b), Florida

Statutes (1999), the availability, quality

of care, efficiency, appropriateness,

accessibility, extent of utilization and

adequacy of like and existing facilities and

services in the service area;

(4 ) Subsection 408.035(1)(l), Florida

Statutes (1999), the probable impact on

costs, competition, improvements or

innovations in financing and delivery of

services, quality assurance, and cost-

effectiveness;

(5 ) Subsection 408.035(1)(o), Florida

Statutes (1999), the continuum of care in a

multilevel system;

(6 ) Florida Administrative Code Rule 59C-

1.030(2)(a), the need for additional acute

care capacity at the hospital;

(7 ) Florida Administrative Code Rule 59C-

1.038(4), not normal approval if average

annual subdistrict occupancy rate is below

75 percent; and

(8 ) Florida Administrative Code Rule 59C-

1.038(5), not normal approval, regardless of

the average annual subdistrict occupancy, if

12-month occupancy in acute care beds at the

hospital equals or exceeds 80 percent.

The parties stipulated that the criteria in all other local

health plan preferences, in Subsections 408.035(1)(c)-(k), (m),

(n), (p), and Subsections 408.035(2)(a)-(e), Florida Statutes

(1999), and in Florida Administrative Code Rules 59C-1.030(2)(a)

- for service to underserved groups, (2)(b)-(d )4., and 59C-1.038

(6)(a) and (b) are satisfied or are not at issue in this case.

At the final hearing, Doctors Hospital presented the

testimony of the following witnesses : Charles Scott, an expert

in hospital administration; Colleen Flick, an expert in critical

care nursing and nursing administration; and Sharon Gordon-

Girvin, an expert in health planning. Doctors Hospital's

Exhibits numbered 1-45 were received in evidence.

AHCA presented the testimony of Jeffrey N. Gregg, an expert

in health planning. AHCA's Exhibits 1-5 were received in

evidence. AHCA's Exhibit 6 was received in evidence subject to

a Motion to Strike certain deposition exhibits, for which the

deponent failed to provide source documents as required in the

notice of deposition. As a result, deposition E xhibits 3, 5,

and 6, and related testimony in AHCA Exhibit 6 were stricken by

Order dated January 22, 2001.

The transcript of the final hearing was filed on

January 10 , 2001. Proposed recommended orders were received on

February 14, 2001, after the parties requested and were granted

two brief extensions of time.

FINDINGS OF FACT

1. The Agency for Health Care Administration (AHCA) is the

state agency authorized to administer the certificate of need

(CON) program for health care services and facilities in

Florida.

2. For the January 2000 batching cycle, AHCA published a

fixed need of zero for additional acute care beds in District 8,

Subdistrict 6, for Sarasota County.

3. Sarasota Doctors Hospital, Inc., d/b/a Doctors Hospital

of Sarasota (Doctors Hospital) applied for Certificate of Need

(CON) Number 9320, to add 21 acute care beds to those licensed

and in service at its hospital in Sarasota County. If approved,

the CON will have, as a condition, Doctors Hospital's commitment

to provide 3.8 percent of patient days in the 21 beds to

charity/self-pay and 3.2 percent to Medicaid patients.

4. Doctors Hospital is owned and operated by The Health

Care Company (HCA), formerly Columbia HCA, the largest investor-

owned, for-profit hospital company in the United States. HCA

owns and operates two hundred hospitals nationwide, forty-two of

those in the S tate of Florida.

5. Doctors Hospital is licensed to operate 147 acute care

beds, in a five-story building. The first floor is used for

ancillary, support, and diagnostic functions. These include

radiology, cardiovascular and laboratory services, as well as

the kitchen, cafeteria, administrative offices and medical

records. The second floor is occupied by inpatient and

outpatient surgical units, the central processing department, an

endoscopy unit and a unit with 16 intensive care beds (ICU).

The third floor is largely dedicated to acute care beds in

specialty units, including a 9-bed surgical progressive care

unit, a 14-bed oncology unit, a 9-bed unit for pediatrics, and a

17-bed obstetrics unit.

6. The fourth floor has 42 licensed acute care beds and an

additional 21 unlicensed beds which are used for observation or

overflow patients. Observation patients are technically

outpatients who occupy inpatient beds for less than 23 hours.

From 30 to 50 outpatients use Doctors Hospital daily, although

not all of those need acute care beds. In general, post-surgery

patients who have moved from the recovery room or patients who

require evaluations of their progress for a relatively short

period of time occupy observation beds. The 21-bed observation

unit, which was previously a licensed substance abuse unit, is

the subject of the application at issue in this case. AHCA's

expert witness testified that ". . . whenever the hospital is

using these unlicensed beds, it is illegal." (Transcript,

p. 218).

7. Finally, the fifth floor at Doctors Hospital is used

primarily for cardiac care. All of the 40 beds are telemetry

monitored, eight of which are grouped together in a cardiac

progressive care unit. Doctors Hospital is pursuing a pending

application to perform open heart surgery, as a part of its plan

to expand cardiac services. Approximately 25 percent of all

admissions, the single largest diagnostic group, receive cardiac

care. Approximately 800 cardiac catheterizations are performed

annually at Doctors Hospital.

8. Doctors Hospital also expects to expand women's' health

services, based on increasing levels of inpatient admissions.

Obstetrics admissions, for example, increased in volume by eight

percent in one year.

9. Doctors Hospital operates an emergency department,

which was expected to reach a volume of 24,000 visits, or a

three percent increase last year over the prior year. Almost 20

percent of the emergency room visits result in admissions to the

hospital, which accounts for approximately 60 percent of total

hospital admissions. The proportion of visits as compared to

admissions is slightly higher than the subdistrict rate of 16.76

percent.

10. The medical staff at Doctors Hospital is composed of

close to 550 B oard-certified or B oard-eligible physicians who,

as required by the hospital's bylaws, live or have offices

within the Sarasota area or in southern and eastern areas of

Manatee County.

Subdistrict occupancy of at least 75 percent; and Rule 59C-

1.038(4)-not normal circumstances if below 75 percent

11. AHCA determined that additional acute care beds are

not needed in Sarasota County, partly because the occupancy

requirement in the local health plan preference was not met.

That requirement, for at least 75 percent average 12-month

occupancy in acute care beds in the subdistrict, is

substantially the same as that required by rule, to find need

under normal circumstances. See Rule 59C-1.038(4)(a), Florida

Administrative Code (1999).

12. Four hospitals in Sarasota County have licensed acute

care beds. In addition to Doctors Hospital, which is located in

eastern Sarasota County, one and a half blocks east of

Interstate 75, there are Sarasota Memorial Hospital (Sarasota

Memorial), which is six miles to the west, Bon Secours-Venice

Hospital (Bon Secours) and Englewood Community Hospital

(Englewood), both of which are approximately 25 miles from

Doctors Hospital in southern Sarasota County.

13. At the four Sarasota County hospitals, the average

annual acute care bed occupancy, calculated by AHCA, was 47.21

percent from July 1998 to June 1999. Average occupancy rates

reported for each hospital separately, for that same period of

time, for calendar year 1999, and from July 1999 to June 2000,

were as shown below:

7/98-6/ 99 1999 7/99-6/2000

Doctors Hospital 69.95 68.84 68.48

Sarasota Memorial 38.23 40.59 39.68

Bon Secours 46.39 48.24 47.98

Englewood 55.80 63.11 64.98

14. The average annual occupancy for each hospital in AHCA

District 8, subdistrict 6 is below 75 percent. Therefore, no

additional acute care beds should be needed under normal

circumstances.

H ospital occupancy in acute care beds of at least 80 percent;

Rule 59C-1.030(2)(a) -need for additional capacity; and Rule

59C-1.038(5) - not normal circumstances if over 80 percent

15. The hospital-specific acute care bed occupancy

preference, requiring at least 80 percent occupancy is also not

met by Doctors Hospital. AHCA calculated the hospital's

occupancy as 70.40 percent for what it termed "the reporting

period."

16. Doctors Hospital contends that a more realistic

appraisal of the demand for beds requires the exclusion of the

beds in the pediatrics and obstetrics units. The obstetrics

unit, with 17 beds, is locked to limit access to newborns with

limited immune system capabilities and to prevent abductions.

Newborns stay in the rooms with their mothers, and it is not

practical to use those beds for other medical/surgical patients.

Although overflow post-surgical patients are sometimes placed in

available beds in the nine-bed pediatric unit, concerns similar

to those related to the obstetrics unit limit the use of

designated pediatric beds for general acute care patients.

17. Excluding pediatrics and obstetrics, Doctors Hospital

has 121 acute care beds. Using only 121 acute care beds, to

represent those which are generally available for adult

medical/surgical patients, the occupancy rates in those beds

were 84.14 percent in 1998, 79.02 percent in 1999, and 79.69

percent in 2000 (from January through September). For 2000,

adjusted to include the remaining three months of the year, the

occupancy rate is approximately 81 percent.

18. Some of the 121 general adult acute care beds, even

when available, are inappropriate for many medical/surgical

patients. The 16-bed ICU on the second floor of Doctors

Hospital is uncomfortable and unnecessarily costly for the

hospital to operate for patients who do not require intensive

care. The ICU does not have the same degree of privacy as

patient rooms. Toilet facilities are located behind curtains.

There are no showers. Lights are turned on almost 24 hours a

day.

19. For similar reasons, the surgical progressive care,

cardiac progressive care units may be inappropriate for many

patients. The oncology unit is not acceptable to some doctors

due to the presence of terminally ill patients. There are also

financial inefficiencies like those associated with intensive

care, due to higher costs for the services provided in units

which routinely care for more severely ill patients.

20. Doctors Hospital evaluated occupancy levels excluding

the specialty units. The occupancy levels in the remaining 74

acute care beds exceeded 70 percent, more than 80 percent of the

time between January and November 2000.

21. The most accurate measure of utilization of the

facility, based on the evidence presented by Doctors Hospital,

is not the midnight census. Although traditionally used by the

hospital industry, in fact, the midnight census is typically the

lowest of the day. When taken into account, outpatient and

emergency room admissions, often arriving in the morning or

during the day and discharged in the afternoon or evening,

increase the midnight census at Doctors Hospital by five to ten

patients each day.

22. Doctors Hospital reported the effects of daily and

seasonal variations on the utilization of acute care beds. From

January through March, occupancy levels are higher than any

other months. The same is true of weekdays, particularly

towards the middle or end of the week, when occupancy levels

range from four to seven percent higher than on weekends or at

the beginning of the week. With average lengths of stay of four

to four and a half days, utilization is uneven and usually at

its peak on Thursdays of each week.

23. Average monthly occupancy levels for the first nine

months of 2000, ranged from lows of 67.88 percent in September

and 70.35 percent in August to highs of 92.96 percent in January

and 94.04 percent in February.

24. AHCA rejected the notion that seasonal occupancy is a

not normal basis for the approval of additional beds at Doctors'

Hospital, because it is typical for all hospitals in Florida to

experience higher volumes in winter due to the increase in the

population of so-called "snowbirds." That group of older winter

residents usually causes an increase in hospital occupancy in

the first quarter of each year.

25. AHCA found that additional acute care beds are not

needed at Doctors Hospital because occupancy rates are leveling

off. What Doctors Hospital projected, in the CON application,

was an increase in utilization from 1999 to 2000, despite a

historical drop by a little less than 5 percentage points from

1998 to 1999. The historical experience, explained by a

temporary loss of a contract with a health maintenance

organization is no longer a factor, however, since that contract

has been renegotiated and re-instituted.

26. By the end of 2001, Doctors Hospital reasonably

projected 85 percent occupancy without the 21 additional acute

care beds, and 72 percent with them. For the year 2002,

occupancy levels could reach 89 percent without, and 75 percent

with 21 more licensed beds included in the inventory.

27. AHCA, by rule, has recognized that 80 percent

occupancy is excessive. In order to accommodate unexpected

demand, to move patients into appropriate units, and to operate

at peak efficiencies, 75 percent occupancy is recommended.

408.035(1)(b) - availability, quality of care, efficiency,

appropriateness, accessibility, extent of utilization, and

adequacy of like and existing facilities in the area

28. AHCA found no geographical, financial, or other access

problems in Sarasota County. The population growth rate for

Sarasota County is slower than that of the rest of District 8

and the State, although the fastest growing areas of the County

are the zip codes in the Doctors Hospital service area.

29. AHCA considered Sarasota Memorial a viable alternative

to the use of additional beds at Doctors Hospital. Sarasota

Memorial is six miles from Doctors Hospital, is larger, and

offers the same services. It is also a disproportionate share

provider, meaning it delivers a higher percentage of care to

Medicaid-funded and other low income patients.

30. AHCA proposed that Doctors Hospital respond to any

capacity constraints by transferring patients to other under-

utilized hospitals, particularly Sarasota Memorial. There was

no issue raised concerning the quality of care at any of the

other hospitals. Doctors Hospital may be able to redirect some

but not all its inpatient admissions to Sarasota Memorial.

Based on the proximity of Interstate 75, the lack of any trauma

protocols in the district and federal regulations requiring the

receiving hospital to treat some emergency room patients,

Doctors Hospital cannot divert many of those patients to

Sarasota Memorial. These patients represent 60 percent of total

admissions to Doctors Hospital. Although the significant

overlap in medical staffs allows the medical staff to respond to

any over-crowding at Doctors Hospital, they are not re-directing

their patients in sufficient numbers to alleviate the need to

use the 21 unlicensed beds at Doctors Hospital.

31. Another alternative to the CON proposal is a

reallocation of beds from obstetrics, pediatrics, or other

special units to increase the supply for general

medical/surgical patients. The physical limitations on the

accessibility and appropriateness of obstetrics and pediatrics

units which justify their exclusion from any realistic

evaluation of demand, also render infeasible any partial

reallocation of their beds for general acute care use. Unit

sizes based on staffing requirements and the efficient

allocation of resources should not be altered as long as those

special services are provided.

408.035(1)(l) - probable impact on costs, competition,

innovations in financing and delivery of services, quality

assurance and cost-effectiveness

32. The 21 beds, which are proposed for acute care

licensure are located on the fourth floor of Doctors Hospital.

The equipment and staff available for the unit, currently used

largely for observation patients, is substantially the same as

that for other beds and units in the hospital. The nurse's

station, corridors, furniture, bathrooms and medical air and

gases are also the same. The only difference is that, unlike

the existing acute care beds, most of the 21 beds are in semi-

private rather than private rooms.

33. The total estimated building cost for the project is,

at most, $123,500 for refurbishing and cosmetic work. No

additional fixed costs will be added to the health care system

as a result of the approval of this CON application.

34. There is no evidence of any adverse impacts on the

other three acute care hospitals in the subdistrict.

408.035(1)(o) - continuum of care in multilevel system

35. Although Doctors Hospital described community

relationships and outpatient programs in its CON application, it

is not a part of a multilevel health care system.

Summary of criteria and prior AHCA decisions

36. On balance, the evidence shows a need for the use of

the 21 additional beds for acute care, as proposed in CON

application number 9320. Doctors Hospital has demonstrated that

it substantially meets all the CON criteria at issue in this

proceeding, except the subdistrict occupancy of 75 percent and

the operation of a multilevel health care system.

37. In a case concerning Doctors Hospital's application

for approval of an open heart surgery program, AHCA agreed that

certain constraints on capacity exist at the facility. As

described by the Administrative Law Judge and agreed by AHCA,

the situation at Doctors Hospital, based on evidence presented

in February and March of 1999, was as follows:

63. Doctors' Capacity to Accommodate an OHS

Program.

Doctors' daily inpatient census has steadily

grown since Doctors opened its new facility

in 1995 in part because of the changed

perception among physicians that the new

facility is better able to handle more

complex patients. Doctors' daily in-patient

census will continue to grow in the

foreseeable future as Doctors continues its

successful efforts to increase the number of

inpatient admissions at its hospital.

64. At times, Doctors currently operates

over its licensed bed capacity during the

busy season. It has had as many as 188 in-

patients in the facility for its 147 beds.

Asked at hearing about operating in excess

of capacity, Mr. Lievense replied,

[B ]ut they're not all in beds . .

. in the middle of the day . . .

you've got people down in the cath

labs, . . . in the ORs, you've got

them in the PACU, the recovery

area . . . scattered all over the

hospital. So you can have them .

. . moving around like that and

they're classified as inpatients,

but in terms of the operation of

the hospital, we don't look at

them as inpatient, we look at them

as a patient in process.

(Tr. 116). Since opening its new facility,

from time to time, Doctors has had to alert

the Emergency Medical Services Office of

Sarasota County to divert emergency patients

from Doctors because of lack of beds.

Because of its current constraints, during

the busy season, Doctors will not be able to

accommodate the incremental increase in

daily census of 14 patients that is

associated with implementation of an OHS

program at Doctors, without operating in

excess of its licensed bed capacity,

regardless of the efforts of special bed

coordinators who attempt to appropriately

locate and relocate patients throughout the

hospital.

65. Doctors has 16 ICU beds grouped in two

8-bed pods. It plans to use five of them

for the open heart patients. A review of

Doctors' census shows that two-thirds of the

time during the peak season (January through

March), Doctors does not have five beds

available for the open heart program. The

problem is not limited to the peak season.

Doctors has critical care capacity problems

"year-wide." (Tr. 2082).

66. Doctors' capacity constraints seriously

compromise Doctors' ability to operate a

high quality OHS program. Doctors does not

have adequate numbers of OHS critical care

beds to ensure its ability to provide high

quality postoperative critical care to fresh

OHS patients. At times, the five beds

reserved for OHS patients might be occupied

by both OHS and general ICU patients. At

other times, an ICU bed might not be

available for an OHS patient and the patient

would have to be in another unit. Mixing

OHS patients and general ICU patients is not

good practice because it increases the

exposure of the OHS patients to infection.

Doctors' lack of adequate OHS critical care

beds adversely impacts Doctors' ability to

provide high quality of care to OHS

patients.

67. Doctors' ability to accommodate an OHS

program is also compromised by the absence

from Doctors' proposal of plans to construct

and equip an additional cath lab, which will

be necessary to accommodate the anticipated

increase in diagnostic cardiac caths and

angioplasties that are associated with an

OHS program.

Punta Gorda HMA, Inc., etc., et al. vs. AHCA, et al. , DOAH Case

No. 98-1134 (F.O. 2/9/2000 ; R.O. 9/16/1999).

38. At the final hearing in this case, AHCA's expert

attempted to distinguish the OHS case from this case, as

follows:

Q Did you review the Doctor's Hospital

open-heart surgery final order?

A Yes.

Q What is your understanding of the

capacity constraints indicated in the final

order for Doctor's Hospital?

A That is a final order related to the

addition of a new service at an existing

provider. And issues of capacity related to

their ability to successfully integrate a

new service are in play.

Q Do you view that as a situation that we

are discussing today?

A No.

Q How does it differ?

A Here we are talking about adding beds to

a service area where there are many beds of

the types already available.

Transcript, page 206.

39. Although it does appear that critical care beds are

the focus of concern in the open heart surgery case, the

findings also clearly demonstrated that AHCA determined that

utilization at Doctors Hospital exceeded licensed acute care bed

capacity. AHCA's position in this case is not consistent with

the evidence in this case or its findings in the prior open

heart surgery case.

40. Doctors Hospital also demonstrated some

inconsistencies in AHCA's interpretation of subdistrict and

hospital occupancy requirements and not normal circumstances for

the addition of acute care beds in other recent cases. In its

review of CON applications to add acute care beds, AHCA has

preliminarily approved 14, since 1997, in which subdistrict

occupancies ranged from a low of 36.66 percent in 1998-1999 at a

Lake City hospital, to a high of 74.74 percent in 1997-1998 in a

Marion County hospital. In 10 of those, the hospital occupancy

rate was below the 80 percent standard, ranging from 57.66

percent to 77.61 percent. Although each set of special

circumstance is different, in nine of the applications, seasonal

demand was, at least, one factor. Hospital specific occupancy

levels ranged from 65.9 to 76.29 percent in five of the nine

approvals based, in part, on seasonal demand. See Doctors

Hospital Exhibits 23, 24, and 25; and Transcript, pages 141-145

and page 209.

CONCLUSIONS OF LAW

41. The Division of Administrative Hearings has

jurisdiction over the parties to and the subject matter of these

proceedings. Sections 120.569, 120.57(1), and 120.60(5),

Florida Statutes.

42. The applicant, Doctors Hospital, has the burden of

demonstrating its entitlement to a CON based on a balanced

consideration of the criteria. Boca Raton Artificial Kidney

Center v. Department of Health and Rehabilitative Services , 475.

So. 2d 250 (Fla. 1st DCA 1985). Department of Health and

Rehabilitative Services v. Johnson and Johnson Home Health Care,

Inc. , 447 So. 2d 361 (Fla. 1st DCA 1984) ; Balsam v. Department

of Health and Rehabilitative Services , 486 So. 2d 1341 (Fla. 1st

DCA 1988).

43. As the parties stipulated, the criteria in Subsections

408.035(1)(c)-(k), (m), (n), (p), and Subsections 408.035(2)

(a)-(e), Florida Statutes; and Florida Administrative Code Rules

59C-1.030(2)(a)-for service to underserved groups, 2(b)-(d )4.

and 59C-1.038(6)(a) and (b) are satisfied or not at issue in

this proceeding.

44. Need in the subdistrict for additional acute care

beds, quantified in the local health plan preference and in Rule

59C-1.038(4), is indicated under normal circumstances if the

average annual occupancy in acute care beds is at least 75

percent. Otherwise, not normal circumstances are required. In

this case, need is not demonstrated based on subdistrict

occupancy.

45. Need may also be demonstrated at an applicant hospital

in which acute care occupancy levels equal or exceed 80 percent.

At Doctors Hospital, occupancy exceeds and is reasonably

projected to continue to exceed 80 percent in the remaining

available acute care beds when the total number of acute care

beds is reduced by the number of beds in unavailable or

inappropriate specialty units.

46. Doctors Hospital established that the alternatives

raised by AHCA, the transfer of patients to other hospitals, or

the reallocation of beds at Doctors Hospital were inappropriate

and inadequate to alleviate the need for additional beds.

47. There is evidence that other hospitals in the

subdistrict have unused capacity and provide the quality of care

necessary to treat the same types of acute care patients as

Doctors Hospital. Subsection 408.035(1)(b), Florida Statutes

(1999).

48. Doctors Hospital's proposal will not adversely affect

its competitors or health care costs in the subdistrict.

Subsection 408.035(1)(l), Florida Statutes (1999).

49. Doctors Hospital does not propose to offer a continuum

of care in a multilevel system, as described in Subsection

408.035(1)(o), Florida Statutes (1999).

50. Although the circumstances in each case vary greatly,

AHCA has taken a position which is inconsistent with its

findings in a prior case concerning inpatient capacity at

Doctors Hospital. AHCA has also previously accepted conditions

very similar to those at Doctors Hospital as not normal

circumstances for the approval of additional acute care beds.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is

RECOMMENDED that a final order be entered granting the

application for Certificate of Need Number 9320 for Sarasota

Doctors Hospital, Inc., d/b/a Doctors Hospital of Sarasota to

add 21 licensed acute care beds.

DONE AND ENTERED this 30th day of March, 2001, in

Tallahassee, Leon County, Florida.

___________________________________

ELEANOR M. HUNTER

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

(850) 488- 9675 SUNCOM 278-9675

Fax Filing [phone]

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 30th day of March, 2001.

COPIES FURNISHED:

Richard A. Patterson, Esquire

Agency for Health Care Administration

2727 Mahan Drive

Fort Knox Building Three, Suite 3431

Tallahassee, Florida 32308-5403

Stephen A. Ecenia, Esquire

R. David Prescott, Esquire

Rutledge, Ecenia, Purnell & Hoffman, P.A.

215 South Monroe Street, Suite 420

Post Office Box 551

Tallahassee, Florida 32302-0551

Sam Power, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive

Fort Knox Building Three, Suite 3431

Tallahassee, Florida 32308-5403

Julie Gallagher, General Counsel

Agency for Health Care Administration

2727 Mahan Drive

Fort Knox Building Three, Suite 3431

Tallahassee, Florida 32308-5403

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this Recommended Order. Any exceptions

to this Recommended Order should be filed with the agency that

will issue the Final Order in this case.