04-003156CON Baycare Long Term Acute Care, Inc. vs. Agency For Health Care Administration
 Status: Closed
Recommended Order on Tuesday, November 29, 2005.


View Dockets  
Summary: Two hospital systems sought to establish long-term acute care hospitals in Respondent`s District 5. Need was established for both under Section 408.035, Florida Statutes.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8UNIVERSITY COMMUNITY HOSPITAL, )

12)

13Petitioner, )

15)

16vs. ) Case No. 04 - 3133CON

23)

24AGENCY FOR HEALTH CARE )

29ADMINISTRATION, )

31)

32Respondent, )

34)

35and )

37)

38HEALTHSOUTH OF LARGO LIMITED )

43PARTNERSHIP, d/b/a HEALTHSOUTH )

47REHABILITATION HOSPITAL OF )

51LARGO, )

53)

54Intervenor. )

56)

57BAYCARE LONG TERM ACUTE CARE, )

63INC., )

65)

66Petitioner, )

68)

69vs. ) Case No. 04 - 3156CON

76)

77AGENCY FOR HEALTH CARE )

82ADMINISTRATION, )

84)

85Respondent, )

87)

88and )

90)

91HEALTHSOUTH OF LARGO LIMITED )

96PARTNERSHIP, d/b/a HEALTHSOUTH )

100REHABILITATION HOS PITAL OF )

105LARGO, AND KINDRED HOSPITALS )

110EAST, LLC, )

113)

114Intervenors. )

116)

117UNIVERSITY COMMUNITY HOSPITAL, )

121)

122Petitioner, )

124)

125vs. ) Case No. 04 - 3157CON

132)

133AGENCY FOR HEALTH CARE )

138ADMINISTRATION AND BAYCARE LONG )

143TERM ACUTE CARE, INC., )

148)

149Respondents, )

151)

152and )

154)

155HEALTHSOUTH OF LARGO LIMITED )

160PARTNERSHIP, d/b/a HEALTHSOUTH )

164REHABILITATION HOSPITAL OF )

168LARGO, )

170)

171Intervenor. )

173)

174RECOMMENDED ORDER

176This cause came on for formal hearing before William R.

186Pfeiffer , Administrative Law Judge with the Division of

194Administrative Hearing s , on November 29 and 30 , 2004 , and on

205December 1 - 3, 6 and 7, 2004, in Tallahassee, Florida .

217Subsequent to the submissions of Proposed Recommended Orders,

225the case was assigned to Administrative Law Judge Harry L.

235Hooper.

236APPEARANCES

237For University Community Hospital, Inc. :

243James C. Hauser, Esquire

247Metz, Hauser, Husband and Daughton, P.A.

253215 South Monroe Street, Suite 505

259Tallahassee, Florida 32301

262Geoffrey D. Smith, Esquire

266Blank, Meenan & Smith, P.A.

271204 South Monroe Street

275Tallahassee, Florida 32301

278For Bay C are Long Term Acute Care, Inc.:

287Robert A. Weiss, Esquire

291Karen A. Putnel, Esquire

295Parker, Hudson, Rainer & Dobbs, LLP

301The Perkins House, Sutie 200

306118 North Gads den Street

311Tallahassee, Florida 32301

314For HealthSouth of Largo Limited Partnership,

320d/b/a HealthSouth Rehabilitation Hospital of Largo:

326J. Robert Griffin, Esquire

330J. Robert Griffin, P.A.

3341342 Timberlane Road, Suite 102 - A

341Tallahassee, Florida 32312 - 1762

346For Kindred Hospitals East, LLC":

352Patricia A. Renovitch, Esquire

356Oertel, Hoffman, Fernandez,

359Cole & Bryant, P.A.

363Post Office Box 1110

367Tallahassee, Florida 32302 - 1110

372For Agency for Healt h Care Administration:

379Kenneth W. Giesking, Esquire

383Agency for Health Care Administration

3882727 Mahan Drive

391Building Three, Suite 3421

395Tallahassee, Florida 32308

398STATEMENT OF THE ISSUE

402The issue is whether BayCare Long Te rm Acute Care Hospital,

413Inc.'s Certificate of Need Application N o. 9753 and University

423Community Hospital's Certificate of Need Application N o. 9754,

432both submitted to the Agency for Health Care Administration,

441should be approved.

444PRELIMINARY STATEMENT

446I n an application dated March 10, 2004, BayCare Long Term

457Acute Care, Inc. (BayCare), submitted a Certificate of Need

466(CON) application to the Agency for Health Care Administration

475( the Agency ) seeking a pproval to establish a new long - term acute

490care hospit al (LTCH). In an application dated April 14 , 2004,

501University Community Hospital, Inc. (UCH) , also a submitted a

510Certificate of Need (CON) application to the Agency for Health

520Care Administration seeking approval to establish a new long -

530term acute care ho spital. The applications sought permission to

540establish these LTCHs in the Agency 's Health Planning District 5

551(District 5). On June 10, 2004, the Agency issued a State

562Agency Action Report (SAAR) preliminarily denying both

569applications.

570Both applicatio ns were filed in the First Hospital Beds and

581Facilities Batching Cycle of 2004.

586On July 16, 2004, a Petition for Formal Administrative

595Hearing, which became DOAH Case N o. 04 - 3157 CON , was filed by UCH

610naming both the Agency and BayCare, as Respondents. On

619August 17, 2004, UCH filed a Petition for Formal Administrative

629Hearing naming only the Agency a s Respondent, and this became

640DOAH Case N o. 04 - 3133 CON . Both p etition s w ere filed with the

658Division of Administrative Hearings (DOAH) on September 2, 2004 .

668On the same date, Kindred Hospitals East, LLC (Kindred) , an

678existing LTCH in District 5, file d a Petition for Leave to

690Intervene .

692On July 15, 2004, BayCare filed a Petition for Formal

702Administrative H earing , naming the Agency as Respondent , and it

712was file d with DOAH as Case N o. 04 - 3156 CON on September 2, 2004.

729On that same date, Kindred filed a Petition for Leave to

740Intervene .

742On September 23, 2004, Case N o s . 04 - 3156 CON and 04 - 3157 CON

760were consolidated and on October 13, 2004, Case N o. 04 - 3133 CON

774was jo ined . On September 17, 2004, HealthSouth of Largo Limited

786Partnership , a Comprehensive Medical Rehabilitation hospital

792(CMR), filed an Amended Petition to Intervene and was granted

802intervention on Oct 13, 2004. The Order Granting Petition to

812Intervene re served ruling on Kindred's Petitions for Leave to

822Intervene. Ultimately, Kindred was permitted to intervene.

829On November 3, 2004, Kindred , and on November 29, 2004,

839HealthSouth, withdrew their Petitions to Intervene in the UCH

848cases. Thus, the final ali gnment of the parties resulted in

859only the Agency contesting UCH's application while Kindred,

867HealthSouth, the Agency , and UCH opposed BayCare's application.

875UCH's opposition to BayCare 's application was not vigorous.

884At the hearing, UCH presented the tes timony of nine

894witnesses and offered Exhibit Nos. 1 through 34 , which were

904received into evidence. The depositions of seven witnesses were

913offered and received into evidence.

918BayCare presented the testimony of nine witnesses and

926offered Exhibit Nos. 1 t hrough 24 , which were received into

937evidence. The depositions of seven witnesses were offered and

946received into evidence.

949HealthSouth presented the testimony of t wo witnesses and

958offered E xhibit Nos. 1 through 3 , which were received into

969evidence. The deposition testimony of one witness was received

978into evidence.

980Kindred presented the testimony of one witness and offered

989Exhibit Nos. 1 through 4 , which were received into evidence.

999The Agency presented the testimony of one witness and

1008offered Exhibit No s. 1 and 2 , which were received into evidence.

1020All parties entered into a Joint Stipulation that was

1029received into evidence as Joint Exhibit No. 1.

1037A Transcript was filed on February 1, 2005 . After orders

1048granting enlargements of time for filing P roposed R ecommended

1058O rders, all parties timely filed their Proposed Recommended

1067Orders on May 23, 2005 , and they were considered in the

1078preparation of this Recommended Order .

1084The parties agreed that the case should be decided pursuant

1094to the law contained in Flo rida Statutes (200 4 ) and any statutes

1108cited are to that law unless otherwise noted .

1117FINDINGS OF FACT

1120LTCH s defined

11231. An LTCH is a medical facility which provides extended

1133medical and rehabilitation care to patients with multiple,

1141chronic, or clinically complex acute medical conditions. These

1149conditions include , but are not limited to, ventilator

1157dependency, tracheotomy care , total parenteral nutrition, long -

1165term intravenous anti - biotic treatment, complex wound care,

1174dialysis at bedside, and multiple sys tems failure .

11832. LTCH s provide an interdisciplinary team approach to the

1193complex medical needs of the patient. LTCH s provide a continuum

1204of care between short - term acute care hospitals and nursing

1215homes, skilled nursing facilities (SNFs), or comprehensi ve

1223medical rehabilitation facilities. Patients who have been

1230treated in an intensive acute care unit at a short - term acute

1243care hospital and who continue to require intensive care once

1253stabilized, are excellent candidates for care at an LTCH .

12633. Include d in the interdisciplinary approach is the

1272desired involvement of the patient's family. A substantial

1280number of the patients suitable for treatment in an LTCH a re in

1293excess of 65 years of age , and are eligible for Medicare.

13044. Licensure and Medicare re quirements dictate that an

1313LTCH have an average length of stay (ALOS) of 25 days. The

1325Center for Medicare and Medicaid Services (CMS) reimburse s for

1335care received through the prospective payment system (PPS).

1343Through this system, CMS reimburses the servi ces of LTCH s

1354separately from short - term acute care providers and other post

1365acute care providers. The reimbursement rate for an LTCH under

1375PPS exceeds that of other providers. The reimbursement rate for

1385an LTCH is about twice that of a rehabilitation fac ility. The

1397increase d reimbursement rate indicates the increased cost due to

1407the more intensive care required in an LTCH .

1416The Agency

14185. The Agency is a state agency created pursuant to

1428Section 20.42. It is the chief health policy and planning

1438entity f or the State of Florida. The Agency administers the

1449Health Facility and Services Development Act found at Sections

1458408.031 - 408.045. Pursuant to Section 408.034, t he Agency is

1469designated as the single state Agency to issue, revoke, or deny

1480certificates of need.

14836. The Agency has established 11 health service planning

1492districts. The applications in this case are for facilities in

1502District 5 , which comprise s Pinellas and Pasco counties.

1511UCH

15127 . UCH is a not - for - profit organization that owns and

1526operat es a 431 - bed tertiary level general acute care hospital

1538and a 120 - bed acute care general hospital. Both are located in

1551Hillsborough County. UCH also has management responsibilities

1558and affiliations to operate Helen Ellis Hospital, a 300 - bed

1569hospital loca ted in Tarpon Springs , and manages the 300 - bed

1581Suncoast Hospital. Both of these facilities are in Pinellas

1590County. UCH also has an affiliation to manage the open heart

1601surgery program at East Pasco Medical Center, a general acute

1611care hospital located in Pasco County.

16178. As a not - for - profit organization, the mission of UCH is

1631to provide quality health care services to meet the needs of the

1643communities where it operates regardless of their patients'

1651ability to pay.

1654Baycare

16559. BayCare is a wholly - owne d subsidiary of BayCare

1666Healthsystems, Inc. (BayCare Systems). BayCare Systems is a

1674not - for - profit entity comprising three members that operate

1685Catholic Health East, Morton Plant Mease Healthcare, and South

1694Florida Baptist. The facilities owned by these organizations

1702are operated pursuant to a Joint Operating Agreement (JOA)

1711entered into by each of the participants.

171810. BayCare Systems hospitals include Morton Plant

1725Hospital, a 687 - bed tertiary level facility located in

1735Clearwater , Pinellas County; St. Joseph's Hospital, an 887 - bed

1745tertiary level general acute care hospital located in Tampa,

1754Hillsborough County; St. Anthony's Hospital, a 407 - bed general

1764acute care hospital located in St. Petersburg, Pinellas County;

1773and Morton Plant North Bay, a 120 - bed hospital located in New

1786Port Ri chey, Pasco County.

179111. Morton Plant Mease Health Care is a partnership

1800between Morton Plant Hospital and Mease Hospital. Although

1808Morton Plant Mease Healthcare is a part of the BayCare System,

1819the hospitals that are owned by the Trustees of Mease Hospital,

1830Mease Hospital Dunedin , and Mease Hospital Countryside, are not

1839directly members of the BayCare System and are not signatories

1849to the JOA.

1852HealthSouth

185312. HealthSouth is a national company with the largest

1862market shar e in inpatient rehabilitation. It is also a large

1873provider of ambulatory services. HealthSouth has about 1,380

1882facilities across the nation. HealthSouth operates nine LTCH s.

1891The facility that is the Intervenor in this case is a CMR

1903located in Largo, Pi nellas County.

1909Kindred

191013. Kindred, through its parent company, operates LTCH

1918facilities throughout Florida and is the predominant provider of

1927LTCH services in the state. In the Tampa Bay area, Kindred

1938operates three LTCH s. Two are located in Tampa and one is

1950located in St. Petersburg, Pinellas County.

195614. The currently operating LTCH in District 5 that may be

1967affected by the CON applications at issue is Kin dred - St.

1979Petersburg. Kindred - St. Petersburg is a licensed 82 - bed LTCH

1991with 52 private be ds, 22 semi - private beds, and an 8 - bed

2006intensive care unit. It operates the array of services normally

2016offered by an LTCH . It is important to note that Kindred - St.

2030Petersburg is located in the far south of heavily populated

2040District 5.

2042The Applications

204415. UCH proposes a new freestanding LTCH which will

2053consist of 50 private rooms and which will be located in

2064Connerton, a new town being developed in Pasco County. UCH's

2074proposal will cost approximately $16,982,715. By agreement of

2084the parties, t his c ost is deemed reasonable.

209316. BayCare proposes a "hospital within a hospital" LTCH

2102that will be located within Mease Hospital - Dunedin. The LTCH

2113will be located in an area of the hospital currently used for

2125obstetrics and women's services. The services currently

2132provided in this area will be relocated to Mease Hospital -

2143Countryside. BayCare proposes the establishment of 48 beds in

2152private and semi - private rooms.

2158Review criteria which was stipulated as satisfied by all parties

216817. Section 408.035(1) - (9) set s forth the standards for

2179granting certificates of need. The parties stipulated to

2187satisfying the requirements of subsections (3) through (9) as

2196follows .

2198a . With regard to subsection (3), ' The

2207ability of the applicant to provide quality

2214of care and th e applicant's record of

2222providing quality of care , ' all parties

2229stipulated that this statutory criterion is

2235not in dispute and that both applicants may

2243be deemed to have satisfied such criteria.

2250b . With regard to subsection (4), ' The

2259availability of re sources, including health

2265personnel, management personnel, and funds

2270for capital and operating expenditures, for

2276project accomplishment and operation , ' it

2282was stipulated that both applicants have all

2289resources necessary in terms of both capital

2296and staff t o accomplish the proposed

2303projects , and therefore, b oth applicants

2309satisfy this requirement.

2312c . With regard to subsection (5), ' The

2321extent to which the proposed services will

2328enhance access to health care for residents

2335of the service district , ' i t was st ipulated

2345that both proposals will increase access.

2351Currently there are geographic, financial

2356and programmatic barriers to access in

2362District 5. The only extant LTCH is located

2370in the southernmost part of District 5.

2377d . With regard to subsection (6), ' The

2386immediate and long - term financial

2392feasibility of the proposal, ' the parties

2399stipulated that UCH satisfied the criterion.

2405With regard to BayCare, it was stipulated

2412that its proposal satisfied the criterion so

2419long as BayCare can achieve its utilization

2426projections and obtain Medicare

2430certification as an LTCH and thus

2436demonstrate short - term and long - term

2444feasibility. This issue will be addressed

2450below.

2451e. With regard to subsection (7), ' The

2459extent to which the proposal will foster

2466competition that p romotes quality and cost -

2474effectiveness , ' the parties stipulated that

2480approval of both applications will foster

2486competition that will promote quality and

2492cost effectiveness. The only currently

2497available LTCH in District 5, unlike BayCare

2504and UCH, is a for - profit establishment.

2512f. With regard to subsection (8), ' The

2520costs and methods of the proposed

2526construction, including the costs and

2531methods of energy provision and the

2537availability of alternative, less costly, or

2543more effective methods of construction , ' the

2550parties stipulated that the costs and

2556methods of construction for both proposals

2562ar e reasonable.

2565g . With regard to subsection (9), ' t he

2575applicant's past and proposed provision of

2581health care services to Medicaid patients

2587and the medically indigent , ' it was

2594stipulated that both UCH and BayCare have a

2602demonstrated history and a commitment to

2608providing services to Medicaid, Medicaid

2613HMO, self - pay, and underinsured payments.

2620Technically, of course, BayCare has no

2626history at all. However, its sponsors do,

2633and it is they that will shape the mission

2642for BayCare.

2644BayCare's Medicare certification as an LTCH

265018. The evidence of record demonstrates that BayCare can

2659comply with Medicare reimbursement regulations and therefore can

2667achieve its utilization pr ojections and obtain Medicare

2675certification as an LTCH . Thus short - term and long - term

2688feasibility is proven.

269119. Because BayCare will be situated as a hospital within

2701a hospital, in Mease Hospital Dunedin, and because there is a

2712relationship between th at hospital and BayCare Systems, Medicare

2721reimbursement regulations limit to 25 percent the number of

2730patients that may be acquired from Mease Hospital Dunedin or

2740from an organization that controls directly or indirectly the

2749Mease Hospital Dunedin .

275320. Because of this limitation, i t is, therefore,

2762theoretically possible that the regulator of Medicare p ayments,

2771CMS , would not allow payment where more than 25 percent of

2782admissions were from the entire BayCare System. Should that

2791occur it would present a s erious but not insurmountable problem

2802to BayCare. BayCare projects that 21 percent of its admissions

2812will come from Mease Hospital Dunedin and the rest will come

2823from other sources.

282621. BayCare is structured as an independent entity with an

2836independent board of directors and has its own chief executive

2846officer. The medical director and the medical staff will be

2856employed by the independent board of directors. Upon the

2865greater weight of the evidence, under this structure, BayCare is

2875a separate corporate entity that neither controls , nor is

2884controlled by, BayCare Systems or any of its entities or

2894affiliates.

289522. One must bear in mind that because of the shifting

2906paradigms of federal medical regulation, predictability in this

2914regard is less than perfect . However , the evidence indicates

2924that CMS will apply the 25 percent rule only in the case of

2937patients transferring to BayCare from Mease Hospital Dunedin.

2945M ost of the Medicare - certified LTCHs in the U nited S tates

2959operate as hospitals within hospitals . I t is apparent ,

2969therefore, that adjusting to the CMS limitations is something

2978that is typically accomplished.

298223. BayCare will lease space in Mease Hospital Dunedin

2991which will be vacated by it current program. BayCare will

3001contract with Mease Hospital Dun edin for services such as

3011laboratory analysis and radiology. This arrangement will result

3019in lower costs , both in the short term and in the long term ,

3032than would be experienced in a free - standing facility , and

3043contributes to the likelihood that BayCare is feasible in the

3053short term and long term.

3058Criteria related to need

306224. The contested subsections of S ection 408.035 not

3071heretofore addressed, are (1) and (2). These sub sections are

3081illuminated by Florida Administrative Code Rule 59C -

30891.008(2)(e)2 . , whi ch provide s standards when, as in this case,

3101there is no fixed - need pool.

310825 . Florida Administrative Code Rule 59C - 1.008(2)(e)2 . ,

3118provides as follows:

31212. If no agency policy exists, the

3128applicant will be responsible for

3133demonstrating need through a needs

3138assessment methodology which must include,

3143at a minimum, consideration of the following

3150topics, except where they are inconsistent

3156with the applicable statutory or rule

3162criteria:

3163a. Population demographics and dynamics;

3168b. Availability, utilization an d quality of

3175like services in the district, sub district

3182or both;

3184c. Medical treatment trends; and

3189d. Market conditions.

3192Population Demographics and Dynamics

31962 6 . The applicants presented an analysis of the population

3207demographics and dynamics in sup port of their applicat i ons in

3219District 5 . The evidence demonstrated that the population of

3229District 5 was 1,335,021 in 2004. It is anticipated that it

3242will grow to 1,406,990 by 2009. The projected growth rate is

32555.4 percent. The elderly population in t he district, which is

3266defined as persons over the age of 65, is expected to grow from

3279314,623 in 2004, to 340,676, in 2009, which represents an 8.3

3292percent increase.

3294BayCare

32952 7 . BayCare's service area is defined generally by the

3306geographic locations of Mo rton Plant Hospital, Morton Plant

3315North Bay Hospital , St. Anthony's Hospital, Mease Hospital

3323Dunedin , and Mease Hospital Countryside . These hospitals are

3332geographically distributed throughout Pinellas County and

3338southwest Pasco County and are expect ed to provide a base for

3350referrals to BayCare.

33532 8 . There is only one extant LTCH in Pinellas County,

3365Kindred, and it is located in the very southernmost part of this

3377densely populated county. Persons who become patients in an

3386LTCH are almost always moved to th e LTCH by ambulance , so their

3399movement over a long distance through heavy traffic generates

3408little or no problem for the patient. Accordingly, if patient

3418transportation were the only consideration, movement from the

3426north end of the county to Kindred in t he far south, would

3439present no problem.

344229. However, family involvement is a substantial factor in

3451an interdisciplinary approach to addressing the needs of LTCH

3460patients. The requirement of frequent movement of family

3468members from northern Pinellas to Kindred through congested

3476traffic will often result in the denial of LTCH services to

3487patients residing in northern Pinellas County or, in the

3496alternative, deny family involvement in the interdisciplinary

3503treatment of LTCH patients .

350830 . Approximately 70 l etters requesting the establishment

3517of an LTCH in northern Pinellas County were provided in

3527BayCare's application . These letters were written by medical

3536personnel , case managers and social workers, business persons,

3544and government officials. The thread c ommon to these letters

3554was , with regard to LTCH services, that the population in

3564northern Pinellas County is underserved .

3570UCH

357131 . Pasco County has experienced a rapid population

3580growth. It is anticipated that the population will swell to

3590426,273, in 200 9, which represents a 10.1 percent increase over

3602the population in 2004.

360632 . The elderly population accounts for 28 percent of the

3617population. This is about 50 percent higher than Florida as a

3628whole.

362933 . Rapid population growth in Pasco County, and expected

3639future growth, has resulted in numerous new housing developments

3648including Developments of Regional Impact (DRI). Among the

3656approved DRI's is the planned community of Connerton , which has

3666been designated a "new town" in Pasco County's Comprehensi ve

3676Plan. Connerton is a planned community of 8,600 residential

3686units. The plan includes space for a hospital and UCH has

3697negotiated for the purchase of a parcel for that purpose within

3708Connerton.

370934 . The rate of growth, and the elderly population

3719perce ntages, will support the proposed UCH LTCH and this is so

3731even if BayCare establishes an LTCH in northern Pinellas County.

3741Availability, utilization, and quality of like services in the

3750district, sub - district, or both

375635 . The Agency has not established s ub - districts for

3768LTCHs.

376936 . As previously noted, Kindred is the only LTCH extant

3780in District 5. It is a for - profit facility. Kindred was well

3793utilized when it had its pediatric unit and added 22 additional

3804beds. Subsequently, in October 2002, some ch anges in Medicare

3814reimbursement rules resulted in a reduction of the reimbursement

3823rate. This affected Kindred's income because over 70 percent of

3833its patients are Medicare recipients . Kindred now uses

3842admission criteria that have resulted in a decline i n patient

3853admissions .

38553 7 . From 1998, the year after Kindred was established,

3866until 2002, annual utilization was in excess of 90 percent.

3876Thereafter, utilization has declined, the 22 - bed addition has

3886been shut down, and Kindred projects an occupancy of 55 percent

3897in 2005.

38993 8 . Kindred must make a profit. Therefore, it denies

3910access to a significant number of patients in District 5. It

3921denies the admission of patients who have too few "Medicare -

3932reimbursable days" or "Medicaid - reimbursable days" remai ning.

3941The record indicates that Kindred only incurs charity care or

3951Medicaid patient days when a patient admitted to Kindred with

3961seemingly adequate funding unexpectedly exhausts his or her

3969funding prior to discharge.

397339 . Because of the constraints of P PS, Kindred has

3984established admission criteria that excludes certain patients

3991with conditions whose prognosis is so uncertain that it cannot

4001adequately predict how long they will require treatment .

4010Kindred's availability to potential patients is thus

4017cons trained.

401940 . HealthSouth, a licensed CMR, is not a substitute for

4030an LTCH. Although it is clear that there is some overlap

4041between a CMR and an LTC H, HealthSouth, for instance, does not

4053provide inpatient dialysis , will not accept ventilator patients,

4061an d does not treat complex wound patients .

407041 . The nurse staffing level at HealthSouth is inadequate

4080to provide for the type of patient that is eligible for

4091treatment in an LTCH. The fact that LTCHs are reimbursed by

4102Medicare at approximately twice the r ate that a CMR is

4113reimbursed , demonstrates the higher acuity level of LTCH

4121services when compared to a CMR.

412742 . HealthSouth is a facility which consistently operates

4136at high occupancy levels and even if it were capable of

4147providing the services typical o f an LTCH, it would not have

4159sufficient capacity to provide for the need.

416643 . A CMR is a facility to which persons who make progress

4179in an LTCH might repair so that they can return to the

4191activities of daily living.

419544 . SNFs are not substitutes for LTC Hs although the re

4207could be some limited overlap. SNFs are generally not

4216appropriate for patients otherwise eligible for the type of care

4226provided by an LTCH. They do not provide the range of se rvices

4239typically provided by an LTCH and do not maintain the registered

4250nurse staffing levels required for delivering the types of

4259services needed for patients appropriate for an LTCH.

426745 . LTCHs are a stage in the continuum of care. Short -

4280term acute care hospitals take in very sick or injured patients

4291and treat t hem. Thereafter, the survivors are discharged to

4301home, or to a CMR, or to a SNF, or, if the patients are still

4316acutely ill but stable, and if an LTCH is available, to an LTCH.

4329A s noted above , currently in northern Pinellas County and in

4340Pasco County, the re is no reasonable access to an LTCH.

435146 . An intensive care unit (ICU) is, ideally, a treatment

4362phase that is short. If treatment has been provided in an ICU

4374and the patient remains acutely ill but stable, and is required

4385to remain in the ICU because t here is no alternative, greater

4397than necessary costs are incurred .

440347 . Staff in an ICU are not trained or disposed to provide

4416the extensive therapy and nursing required by patients suitable

4425for an LTCH and are not trained to provide support and training

4437to members of the patient's family in preparation for the

4447patient's return home.

445048 . The majority of patients suitable for an LTCH have

4461some potential for recovery. This potential is not realized in

4471an ICU , which is often counterproductive for patients who are

4481stabilized but who require specialized long - term acute care.

4491Patients who remain in an ICU beyond five to seven days have an

4504increased morbidity/mortality rate.

450749 . Maintaining patients suitable for an LTCH in an ICU

4518also results in over - utili zation of ICU services and can cause

4531congestion when ICU beds are fully occupied.

453850 . UCH in Pasco County, and to a lesser extent BayCare in

4551northern Pinellas County, will bring to the northern part of

4561District 5 services which heretofore have not been a vailable in

4572the district, or, at least, have not been readily available.

4582Persons in Pasco County and northern Pinellas County, who would

4592benefit from a stay in an LTCH , have often had to settle for

4605some less appropriate care situation.

4610Medical Treatment T rends

461451 . LTCHs are relatively new cogs in the continuum of care

4626and the evidence indicates that they will play an important role

4637in that continuum in the future .

464452 . The evidence of record demonstrates that the current

4654trend in medical treatment is to find appropriate post acute

4664placements in an LTCH setting for those patients in need of

4675long - term acute care beyond the stay normally experienced in a

4687short - term acute care hospital.

4693Market conditions

469553 . The federal government's development of the

4703dist inctive PPS for LTCHs has created a market condition which

4714is favorable for the development of LTCH facilities.

472254 . Although the Agency has not formally adopted by rule a

4734need methodology specifically for LTCHs, by final order it has

4744recently relied upon the "geometric mean length of stay 7"

4754(GMLOS ) need methodology. The GMLOS is a statistical

4763calculation used by CMS in administering the PPS reimbursement

4772system in determining an appropriate reimbursement for a

4780particular "diagnostic related grou p" (DRG).

478655 . Other need methodologies have been found to be

4796unsatisfactory because they do not accurately reflect the need

4805for LTCH services in areas where LTCH services are not

4815available, or where the market for LTCH services is not

4825competitive. GMLOS is the best analysis the Agency has at

4835this point. Because the population for whom an LTCH might be

4846appropriate is unique, and because it overlaps with other

4855populations, finding an algebraic need expression is difficult.

4863An acuity measure would be t he best marker of patient

4874appropriateness , but insufficient dat a are available to

4882calculate that.

488456 . BayCare's proposal will provide beneficial competition

4892for LTCH services in District 5 for the first time and will

4904promote geographic, financial, and pro grammatic access to LTCH

4913services.

491457 . BayCare, in conducting its need calcula tions used a

4925data pool from Morton Plant Hospital, Mease Dunedin Hospital,

4934Mease Countryside Hospital , Morton Plant North Bay Hospital, and

4943St. Anthony's Hospital for the 12 m onths ending September 2003.

4954The hospitals included in the establishment of the pool are

4964hospitals that would be important referral sources for BayCare.

497358 . BayCare then identified 160 specific DRGs historically

4982s erved by existing Florida LTCHs, or whi ch could have been

4994served by Florida LTCHs, and lengths of stay greater than the

5005GMLOS for acute care patients , and compared them to the data

5016pool. This resulted in a pool of 871 potential patients. The

5027calculation did not factor in the certain growth in the

5037population of the geographic area, and therefore the growth of

5047potential LTCH patients.

505059 . BayCare then applied assumptions based on the

5059proximity of the referring hospitals to the propose d LTCH to

5070project how many of the patients eligible for LT CH services

5081would actually be referred and admitted to the proposed LTC H .

5093That exercise resulted in a projected potential volume of 20,265

5104LTCH patient days originating just from the three District 5

5114BayCare hospitals and the two Mease hospitals.

512160 . Ba yCare assumes, and the assumption is found to be

5133reasonable, that 25 percent of their LTCH volume will originate

5143from facilities other than BayCare or Mease hospitals. Adding

5152this factor resulted in a total of 27,020 patient days for a

5165total net need of 8 2 beds at 90 percent occupancy.

517661 . BayCare's GM LOS bed n eed methodology reasonably

5186projects a bed need of 82 beds based on BayCare's analysis of

5198the demand arising from the three District 5 BayCare hospitals

5208and the two Mease hospitals.

521362 . UCH prov ided both a GMLOS and a use rate analysis .

5227T he use rate analysis is suspect in a noncompetitive environment

5238and, obviously, in an environment where LTCHs do not exist .

5249UCH's GMLOS analyses resulted in the identification of a need

5259for 159 additional LTCH beds in District 5. This was broken

5270down into a need of 60 beds in Pasco County and 99 additional

5283beds in Pinellas County.

528763 . There is no not - for - profit LTCH provider in District

53015. The addition of BayCare and UCH LTCHs to the district will

5313meet a need in the case of Medicaid, indigent, and underinsured

5324patients. Both BayCare and UCH have agreed in their

5333applications to address the needs of patients who depend on

5343Medicaid, or who are indigent, or who have private insurance

5353that is inadequate to c over the cost of their treatment.

536464 . The statistical analyses provide d by both applicants

5374support the proposed projects of both applicants.

538165 . Testimony from doctors who treat patients of the type

5392who might benefit from an LTCH testified that those ty pes of

5404facilities would be utilized. Numerous letters from physicians,

5412nurses, and case managers support the need for these facilities.

5422Adverse impacts

542466 . HealthSouth and Kindred failed to persuade that

5433BayCare's proposal will adversely impact them . H ealthSouth

5442provides little of the type of care normally provided at an

5453LTCH. Moreover, HealthSouth is currently operating near

5460capacity.

546167 . Kindred is geographically remote from BayCare's

5469proposed facility, and , more importantly, remote in terms of

5478tra vel time, which is a major consideration for the families of

5490patients. Kindred did not demonstrate that it was currently

5499receiving a large number of patients from the geographic

5508vicinity of the proposed BayCare facility, although it did

5517receive some patie nts from BayCare Systems facilities and would

5527likely lose some admissions if BayCare's application is

5535approved . The evidence did not establish that Kindred would

5545suffer a material adverse impact should BayCare establish an

5554LTCH in Mease Dunedin Hospital. HealthSouth and Kindred

5562conceded that UCH's program would not adversely impact them.

5571The Agency 's Position

557568 . The Agency denied the applications of BayCare and UCH

5586in the SAAR s . At the time of the hearing the Agency continued

5600to maintain that granting the proposals was inappropriate.

560869 . The Agency's basic concern with these proposals, and

5618in fact, the establishments of LTCHs throughout the state,

5627according to the Agency's representative Jeffrey N. Gregg , is

5636the oversupply of beds . The Agency believes it will be a long

5649time before it can see any measure of clinical efficiency and

5660whether the LTCH route is the appropriate way to go. The Agency

5672has approved a number of LTCHs in recent years and is studying

5684them in order to get a better understanding of what the future

5696might hold.

569870 . The Agency noted that the establishment of an LTCH by

5710ongoing providers, BayCare Systems and UCH, where there are

5719extant built - in referring facilities, were more likely to be

5730successful than an out - of - state provider having no prior

5742relationships with short - term acute care hospitals in the

5752geographic vicinity of the LTCH .

575871 . The Agency noted that both a referring hospital and an

5770LTCH could benefit financially by decompressing its intensive

5778care unit, and thus maximizing th eir efficiency.

578672 . The Agency did not explain how, if these LTCHs are

5798established, a subsequent failure would negatively affect the

5806delivery of health services in District 5.

581373 . The Agency, when it issued its SAAR, did not have the

5826additional informa tion which became available during the hearing

5835process.

5836CONCLUSIONS OF LAW

583974 . The Division of Administrative Hearings has

5847jurisdiction over the subject matter of and the parties to this

5858proceeding. § § 120.57(1) and 408.039(5), Fla. Stat.

586675 . The ap plicant s ha ve the burden of proving entitlement

5879to a CON. Boca Raton Artificial Kidney C tr. , Inc. v s . Dept. o f

5895Health and Rehabilitative Services , 47 5 So. 2d 260 (Fla. 1st DCA

59071985). The award of a CON must be based on a balanced

5919consideration of all app licable statutory and rule criteria.

5928Humana, Inc. v s . Departme n t of Health and Rehabilitative

5940Services , 469 So. 2d 889 (Fla. 1st DCA 1985). The weight to be

5953given each criterion is not fixed, but depends on the facts and

5965circumstances of each case. Coll ier Medical Center, Inc. v s .

5977Dept. of Health and Rehabilitative Services , 462 So. 2d 83 (Fla.

59881st DCA 1985).

599176 . The CON criteria set forth in Section 408.035, with

6002the exception of Section (10) are applicable to the proposed

6012LTCHs. The parties stipul ated to all of the subsections except

6023(1), (2), and the p ortion of (6) that addresses the long - term

6037feasibility issue of whether BayCare's proposal is consistent

6045with federal reimbursement requirements. Therefore the only

6052real issue presented for final de termination is whether the

6062applicants demonstrated need for their proposals in the absence

6071of a published numeric need, and whether approval of their

6081proposals will enhance access and foster competition that

6089promotes quality and cost effectiveness.

609477 . T he requirements set forth in Florida Administrative

6104Code Rules 59C - 1.002(28), 59C - 1.030, and 59C - 1.008 are

6117applicable , as previously discussed, and no fixed need pool is

6127provided by the Agency for LTCH beds.

613478 . As previously discussed, the criteri a for deciding

6144this issue are provided in Section 408.035 as illuminated by

6154Florida Administrative Code Rule 59C - 1.008(2)(e)2. The criteri a

6164w ere satisfied by both applicants.

617079 . The applicants utilized bed need methodologies that

6179have been accepted as reas onable in Select Specialty Hospital -

6190Marion , Inc. v s . AHCA , et al . , Case N o. 03 - 248 3 CON (DOAH July

62091 4 , 2005) , ( AHCA Final Order, September 17 , 200 4 ) and Select

6223Specialty Hospital - Escambia, Inc. v s . AHCA , Case N o. 05 - 0319 CON

6239(DOAH June 17, 2005), (AHCA Final Order, July 11, 2005).

6249RECOMMENDATION

6250Based upon the Findings of Fact and Conclusions of Law, it

6261is

6262RECOMMENDED that UCH Certificate of Need Application N o.

62719754 and BayCare Certificate of Need Application N o. 9753

6281sati sfy the applicable criteria and bo th a pplications should be

6293approved.

6294DONE AND ENTERED this 29th day of November , 200 5 , in

6305Tallahassee, Leon County, Florida.

6309S

6310HARRY L. HOOPER

6313Administrative Law Judge

6316Division of Administrative Hearings

6320The DeSoto Building

63231230 Apalachee Parkway

6326Tallahassee, Florida 32399 - 3060

6331(850) 488 - 9675 SUNCOM 278 - 9675

6339Fax Filing (850) 921 - 6847

6345www.doah.state.fl.us

6346Filed with the Clerk of the

6352Division of Administrative Hearings

6356this 29th day of November , 2005 .

6363COPIES FURNISHED :

6366Robert A. Weiss, Esquir e

6371Parker, Hudson, Rainer

6374& Dobbs, LLP

6377The Perkins House, Suite 200

6382118 North Gadsden Street

6386Tallahassee, Florida 32301

6389J. Robert Griffin, Esquire

6393J. Robert Griffin, P.A.

63971342 Timberlane Road, Suite 102 - A

6404Tallahassee, Florida 32312 - 1762

6409Patricia A. R enovitch, Esquire

6414Oertel, Hoffman, Fernandez ,

6417Cole , & Bryant P.A.

6421Post Office Box 1110

6425Tallahassee, Florida 32302 - 1110

6430Geoffrey D. Smith, Esquire

6434Blank, Meenan & Smith, P.A.

6439204 S outh Monroe Street

6444Tallahassee, Florida 3230 1

6448Timothy Elliott, Esquir e

6452Agency for Health Care Administration

64572727 Mahan Drive

6460Building Three, Mail Station 3

6465Tallahassee, Florida 32308

6468Alan Levine, Secretary

6471Agency for Health Care Administration

6476Fort Knox Building, Suite 3116

64812727 Mahan Drive

6484Tallahassee, Florida 32308

6487C hrista Calamas, General Counsel

6492Agency for Health Care Administration

6497Fort Knox Building, Suite 3431

65022727 Mahan Drive

6505Tallahassee, Florida 32308

6508Richard Shoop, Agency Clerk

6512Agency for Health Care Administration

6517Fort Knox Building, Mail Station 3

65232727 Mah an Drive

6527Tallahassee, Florida 32308

6530NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

6536All parties have the right to submit written exceptions within

654615 days from the date of this Recommended Order. Any exceptions

6557to this Recommended Order should be filed with the Agency that

6568will issue the Final Order in this case.

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Date
Proceedings
PDF:
Date: 04/13/2006
Proceedings: Final Order filed.
PDF:
Date: 04/11/2006
Proceedings: Agency Final Order
PDF:
Date: 01/04/2006
Proceedings: Motion for Extension of Time to File Responses to Exceptions to Recommended Order filed.
PDF:
Date: 12/27/2005
Proceedings: Intervenor Kindred`s Exceptions to Recommended Order filed.
PDF:
Date: 11/29/2005
Proceedings: Recommended Order
PDF:
Date: 11/29/2005
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 11/29/2005
Proceedings: Recommended Order (hearing held November 29 and 30, 2004 and December 1-3, and 6-7, 2004). CASE CLOSED.
PDF:
Date: 08/16/2005
Proceedings: Notice of Appearance and Substitution of Counsel (filed by T. Elliott).
Date: 05/23/2005
Proceedings: Proposed Recommended Order of Kindred Hospital East, LLC d/b/a Kindred Hospital Bay Area-St. Petersburg filed.
PDF:
Date: 05/23/2005
Proceedings: Notice of Filling Recommended Order filed.
PDF:
Date: 05/23/2005
Proceedings: Recommended Order filed.
PDF:
Date: 05/23/2005
Proceedings: Healthsouth of Largo Limited Partnership`s Proposed Recommended Order filed.
PDF:
Date: 05/23/2005
Proceedings: Baycare`s Proposed Recommended Order filed.
PDF:
Date: 05/19/2005
Proceedings: Order Granting Extension of Time (proposed recommended orders due on or before May 23, 2005).
PDF:
Date: 05/18/2005
Proceedings: Unopposed Motion for One-day Extension of Time to File Proposed Recommended Orders filed.
PDF:
Date: 05/06/2005
Proceedings: Order Granting Motion for Enlargement of Time (proposed recommended orders due on or before May 20, 2005).
PDF:
Date: 05/05/2005
Proceedings: Unopposed Motion for Extension of Time to File Proposed Recommended Orders filed.
PDF:
Date: 05/04/2005
Proceedings: Deposition of Mark Richardson filed.
PDF:
Date: 05/04/2005
Proceedings: Deposition of Jay Cushman filed.
PDF:
Date: 05/04/2005
Proceedings: Baycare`s Second Notice of Submission of Deposition Transcripts filed.
PDF:
Date: 03/10/2005
Proceedings: Deposition (6) filed.
PDF:
Date: 03/10/2005
Proceedings: Notice of Submission of Deposition Transcripts (filed by K. Putnal).
PDF:
Date: 02/16/2005
Proceedings: Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 02/01/2005
Proceedings: Notice of Appearance filed.
Date: 02/01/2005
Proceedings: Transcripts (8 volumes) filed.
PDF:
Date: 01/21/2005
Proceedings: Order Cancelling Hearing.
PDF:
Date: 12/20/2004
Proceedings: Notice of Hearing (hearing set for January 27, 2005; 9:30 a.m.; Tallahassee, FL.).
PDF:
Date: 12/20/2004
Proceedings: Order (proposed recommended orders will be filed no later than March 1, 2005).
Date: 11/29/2004
Proceedings: CASE STATUS: Hearing Partially Held; continued to date not certain.
PDF:
Date: 11/24/2004
Proceedings: UCH Prehearing Statement (filed via facsimile).
PDF:
Date: 11/16/2004
Proceedings: Baycare`s Notice of Taking Deposition Duces Tecum (filed via facsimile).
PDF:
Date: 11/08/2004
Proceedings: Baycare`s Notice of Taking Deposition (K. Konger) filed via facsimile.
PDF:
Date: 11/08/2004
Proceedings: Healthsouth of Largo Limited Partnership`s Notice of Taking Deposition Duces Tecum (all scheduled witnesses at previously agreed to times) filed via facsimile.
PDF:
Date: 11/08/2004
Proceedings: UCH`s Emergency Motion to Prohibit Telephone Deposition of Dr. Olenbach on November 16 (filed in DOAH Case No. 04-3156CON via facsimile).
PDF:
Date: 11/05/2004
Proceedings: Confidentially Order.
PDF:
Date: 11/05/2004
Proceedings: Notice of Taking Deposition Duces Tecum (via efiling by Patricia Renovitch).
PDF:
Date: 11/05/2004
Proceedings: Baycare`s Notice of Taking Deposition Duces Tecum (D. Amin) filed via facsimile.
PDF:
Date: 11/05/2004
Proceedings: Baycare`s Notice of Taking Deposition Duces Tecum (G. Greenspan) filed via facsimile.
PDF:
Date: 11/05/2004
Proceedings: Notice of Taking Depositions Duces Tecum (filed in DOAH Case No. 04-3156CON via facsimile).
PDF:
Date: 11/05/2004
Proceedings: Notice of Taking Deposition Duces Tecum (via efiling by Patricia Renovitch).
PDF:
Date: 11/04/2004
Proceedings: Notice of Taking Deposition Duces Tecum (3 deponents) filed via facsimile.
PDF:
Date: 11/04/2004
Proceedings: Notice of Taking Deposition Duces Tecum (17 Deponents) filed via facsimile.
PDF:
Date: 11/04/2004
Proceedings: UCH`s Notice and Cross-notice of Taking Deposition Duces Tecum (representatives of UCH, Baycare, and Kindred) (filed in DOAH Case No. 04-3156CON via facsimile).
PDF:
Date: 11/04/2004
Proceedings: Baycare`s Witness and Exhibit Lists (filed via facsimile).
PDF:
Date: 11/03/2004
Proceedings: Healthsouth of Largo Limited Partnership`s Responses and Objections to UCH`s First Request for Admissions to Healthsouth filed.
PDF:
Date: 11/03/2004
Proceedings: Healthsouth of Largo Limited Partnership`s Responses and Objections to Baycare`s First Request for Production of Documents filed.
PDF:
Date: 11/03/2004
Proceedings: Healthsouth of Largo Limited Partnership`s Responses and Objections to UCH`s Second Request for Production of Documents filed.
PDF:
Date: 11/03/2004
Proceedings: Healthsouth of Largo Limited Partnership`s Responses and Objections to UCH`s First Request for Production of Documents filed.
PDF:
Date: 11/03/2004
Proceedings: Healthsouth of Largo Limited Partnership`s Notice of Service of Responses and Objections to Baycare`s First Interrogatories filed.
PDF:
Date: 11/03/2004
Proceedings: Healthsouth of Largo Limited Partnership`s Notice of Service of Responses and Objections to UCH`s First Interrogatories filed.
PDF:
Date: 11/03/2004
Proceedings: Healthsouth`s Witness List filed.
PDF:
Date: 11/03/2004
Proceedings: Healthsouth`s Exhibit List filed.
PDF:
Date: 11/03/2004
Proceedings: Baycare`s Notice of Serving Answers to Kindred`s First Interrogatories (filed in DOAH Case No. 04-3156CON via facsimile).
PDF:
Date: 11/03/2004
Proceedings: Baycare`s Notice of Serving Answers to UCH`s First and Second Interrogatories (filed in DOAH Case No. 04-3156CON via facsimile).
PDF:
Date: 11/03/2004
Proceedings: UCH`s Witness and Exhibit List (filed in DOAH Case No. 04-3156CON).
PDF:
Date: 11/03/2004
Proceedings: Notice of Service of UCH`s Answers to Baycare`s First Set of Interrogatories (filed in DOAH Case No. 04-3156CON).
PDF:
Date: 11/03/2004
Proceedings: UCH`s Response to Baycare`s Written Discovery Requests (filed in DOAH Case No. 04-3156CON).
PDF:
Date: 11/03/2004
Proceedings: UCH`s Response to Healthsouth`s Written Discovery Requests (filed in DOAH Case No. 04-3156CON).
PDF:
Date: 11/03/2004
Proceedings: UCH`s Response to Healthsouth`s Written Discovery Requests (filed in DOAH Case No. 04-3156CON via facsimile).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Witness and Exhibit Lists (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Notice of Serving Responses and Objections to the First Set of Interrogatories from University Community Hospital Inc (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Responses and Objections to the First Request for Production of Documents from University of Community Hospital (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Notice of Service of Responses and Objections to the First Set of Interrogatories from BayCare Long Term Acute Care Inc (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Responses and Objections to Baycares Second Request for Production of Documents (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Responses and Objections to Baycares First Request for Production of Documents (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Notice of Withdrawal of Petition to Intervene to Challenge University Community Hospital CON Application No. 9754 (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Notice of Serving Responses and Objections to the First Set of Interrogatories from University Community Hospital Inc (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Responses and Objections to the First Request for Production of Documents from University of Community Hospital (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Notice of Service of Responses and Objections to the First Set of Interrogatories from BayCare Long Term Acute Care Inc (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Responses and Objections to Baycares Second Request for Production of Documents (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Responses and Objections to Baycares First Request for Production of Documents (via efiling by Patricia Renovitch).
PDF:
Date: 11/03/2004
Proceedings: Kindreds Notice of Withdrawal of Petition to Intervene to Challenge University Community Hospital CON Application No. 9754 (via efiling by Patricia Renovitch).
PDF:
Date: 11/02/2004
Proceedings: Facsimile Cover Sheet to Judge Pfeiffer from J. Hauser notifying of telephonic hearing to be held November 2, 2004 at 3:00 p.m. (filed via facsimile).
PDF:
Date: 11/02/2004
Proceedings: (Proposed) Confidentiality Order (filed in DOAH Case No. 04-3156CON by J. Hauser via facsimile).
PDF:
Date: 11/02/2004
Proceedings: UCH`s Response to Baycare`s Emergency Motion (filed in DOAH Case No. 04-3156CON via facsimile).
PDF:
Date: 11/02/2004
Proceedings: Emergency Motion to Compel UCH to Disclose Time and Location of View of UCH Site (filed in DOAH Case No. 04-3156CON by R. Weiss).
PDF:
Date: 11/02/2004
Proceedings: Notice of Telephonic Hearing (motions hearing set for November 2, 2004; at 3:00 p.m.) filed by R. Weiss via facsimile.
Date: 11/02/2004
Proceedings: (Proposed) Order (to memorialize ruling on UCH`s request for additional days to complete final hearing filed in DOAH Case No. 04-3156) filed by J. Hauser.
PDF:
Date: 11/02/2004
Proceedings: (Proposed) Order (regarding rules for the inspection of Mease Hospital Dunedin filed in DOAH Case No. 04-3156) filed by J. Hauser.
PDF:
Date: 11/02/2004
Proceedings: UCH`s Emergency Motion to Allow Telephonic Deposition of Jeff Newhams (filed in DOAH Case No. 04-3156CON via facsimile).
Date: 11/01/2004
Proceedings: (Proposed) Order (to memorialize ruling on UCH`s request for additional days to complete final hearing) filed by J. Hauser.
PDF:
Date: 11/01/2004
Proceedings: (Proposed) Order Establishing Parameters for View (filed with letter of November 1, 2004, in DOAH Case No. 04-3156CON by K. Putnal).
PDF:
Date: 10/29/2004
Proceedings: UCH`s Request to Reserve Additional Days to Complete Final Hearing (filed in DOAH Case Nos. 04-3156CON and 04-3157CON).
PDF:
Date: 10/29/2004
Proceedings: (Proposed) Order Establishing Parameters for View (filed in DOAH Case No. 04-3156CON by K. Putnal via facsimile).
PDF:
Date: 10/29/2004
Proceedings: Memorandum to Judge Pfeiffer from J. Hauser regarding modifications to proposed order (filed in DOAH Case No. 04-3156CON via facsimile).
PDF:
Date: 10/29/2004
Proceedings: Letter to Judge Pfeiffer from K. Putnal objecting to UCH`s proposed order filed October 28, 2004 (filed in DOAH Case No. 04-3156CON).
PDF:
Date: 10/28/2004
Proceedings: (Proposed) Order (regarding motion hearing held October 27, 2004) filed.
PDF:
Date: 10/27/2004
Proceedings: UCH`s Reply to Joint Response to Motion for Prehearing Instructions (filed via facsimile).
PDF:
Date: 10/26/2004
Proceedings: Notice of Telephonic Hearing (motion hearing set for October 27, 2004; at 10:00 a.m.) filed by J. Hauser.
PDF:
Date: 10/26/2004
Proceedings: Joint Response to UCH`s Motion for Prehearing Instructions filed.
PDF:
Date: 10/25/2004
Proceedings: Baycare`s Motion for 2-day Extension of Time to Produce Documents (filed via facsimile).
Date: 10/25/2004
Proceedings: Transcript of October 12, 2004, Pre-hearing Conference filed.
PDF:
Date: 10/25/2004
Proceedings: Notice of Telephonic Hearing (via efiling by Patricia Renovitch).
PDF:
Date: 10/21/2004
Proceedings: UCH`s Motion for Prehearing Instructions (filed by J. Hauser).
PDF:
Date: 10/18/2004
Proceedings: UCH`s Supplement to Response in Opposition to Kindred`s Petition to Intervene (filed).
PDF:
Date: 10/18/2004
Proceedings: Baycare`s Notice of Serving First Interrogatories to Healthsouth (filed via facsimile).
PDF:
Date: 10/18/2004
Proceedings: Baycare`s Notice of Serving First Interrogatories to Kindred (filed via facsimile).
PDF:
Date: 10/18/2004
Proceedings: Healthsouth of Largo Limited Partnership`s First Request for Production of Documents to University Community Hospital, Inc. (filed via facsimile).
PDF:
Date: 10/18/2004
Proceedings: Healthsouth of Largo Limited Partnership`s First Request for Production of Documents to Baycare Long Term Care Hospital, Inc. (filed via facsimile).
PDF:
Date: 10/18/2004
Proceedings: Baycare`s Notice of Adoption of UCH`s First Request to Produce and First Interrogatories to Kindred (filed via facsimile).
PDF:
Date: 10/18/2004
Proceedings: Baycare`s Notice of Adoption of UCH`s First and Second Requests to Produce and First Interrogatories to Healthsouth (filed via facsimile).
PDF:
Date: 10/15/2004
Proceedings: Kindred`s First Request for Production of Documents to Baycare Long Term Acute Care, Inc. (via efiling by Patricia Renovitch).
PDF:
Date: 10/15/2004
Proceedings: Kindred`s Notice of Serving First Set of Interrogatoreis to BayCare Long Term Acute Care, Inc. (via efiling by Patricia Renovitch).
PDF:
Date: 10/15/2004
Proceedings: Kindred`s First Request for Production of Documents to Baycare Long Term Acute Care, Inc. (via efiling by Patricia Renovitch).
PDF:
Date: 10/15/2004
Proceedings: UCH`s Second Request for Production of Documents to Baycare filed.
PDF:
Date: 10/15/2004
Proceedings: UCH`s First Request for Admissions to Baycare filed.
PDF:
Date: 10/15/2004
Proceedings: UCH`s First Request for Admissions to Healthsouth filed.
PDF:
Date: 10/15/2004
Proceedings: UCH`s First Request for Admissions to Kindred filed.
PDF:
Date: 10/15/2004
Proceedings: Notice of Service of UCH`s Second Set of Interrogatories to Baycare filed.
PDF:
Date: 10/15/2004
Proceedings: UCH`s Second Request for Production of Documents to Healthsouth filed.
PDF:
Date: 10/15/2004
Proceedings: Notice of Telephonic Hearing (via efiling by Patricia Renovitch).
PDF:
Date: 10/15/2004
Proceedings: Kindred`s First Request for Production of Documents to Baycare Long Term Acute Care, Inc. (via efiling by Patricia Renovitch).
PDF:
Date: 10/15/2004
Proceedings: Kindred`s Notice of Serving First Set of Interrogatoreis to BayCare Long Term Acute Care, Inc. (via efiling by Patricia Renovitch).
PDF:
Date: 10/15/2004
Proceedings: Kindred`s First Request for Production of Documents to Baycare Long Term Acute Care, Inc. (via efiling by Patricia Renovitch).
PDF:
Date: 10/13/2004
Proceedings: Order Granting Petition to Intervene. (Healthsouth of Largo Limited Partnership, d/b/a Healthsouth Rehabilitation Hospital of Largo
PDF:
Date: 10/13/2004
Proceedings: Order of Consolidation. Case No. 04-3133CON was added to the consolidated batch.
PDF:
Date: 10/11/2004
Proceedings: UCH`s Response to Motion to Expedite Discovery (filed via facsimile).
Date: 10/11/2004
Proceedings: UCH`s Response in Opposition to Healthsouth`s Amended Petition to Intervene (filed).
PDF:
Date: 10/08/2004
Proceedings: Notice of Service of UCH`s First Set of Interrogatories to Healthsouth filed.
PDF:
Date: 10/08/2004
Proceedings: Notice of Service of UCH`s First Set of Interrogatories to Kindred filed.
PDF:
Date: 10/08/2004
Proceedings: UCH`s First Request for Production of Documents to Healthsouth filed.
PDF:
Date: 10/08/2004
Proceedings: UCH`s First Request for Production of Documents to Kindred filed.
PDF:
Date: 10/08/2004
Proceedings: UCH`s Response in Opposition to Kindred`s Petition to Intervene (filed).
PDF:
Date: 10/07/2004
Proceedings: UCH`s Request ot Enter Upon Land of Mease Hospital Dunedin for Inspection and Other Purposes filed.
PDF:
Date: 10/06/2004
Proceedings: Healthsouth of Largo Limited Partnership`s Amended Petition to Intervene (filed by via facsimile).
PDF:
Date: 10/06/2004
Proceedings: UCH`s First Request for Production of Documents to Baycare filed.
PDF:
Date: 10/06/2004
Proceedings: Notice of Service of UCH`s First Set of Interrogatories to Baycare filed.
PDF:
Date: 10/05/2004
Proceedings: Baycare`s Motion to Expedite UCH Responses to Baycare Discovery (filed via facsimile).
PDF:
Date: 10/05/2004
Proceedings: Baycare`s Notice of Serving First Interrogatories to University Community Hospital, Inc. (filed via facsimile).
PDF:
Date: 10/05/2004
Proceedings: Notice of Pre-hearing Conference. (pre-hearing conference will be held October 12, 2004, at 2:00pm)
PDF:
Date: 10/05/2004
Proceedings: Kindred`s Notice of Service of Petition for Leave to Intervene (filed).
PDF:
Date: 10/05/2004
Proceedings: Notice of Hearing (hearing set for November 29 through December 3, 6, and 7, 2004; 9:30 a.m.; Tallahassee, FL).
PDF:
Date: 10/01/2004
Proceedings: Letter to L. Sloan from S. Cartwright enclosing the September 10, 2004, Response to Initial Order and regarding case consolidation (filed via facsimile).
PDF:
Date: 09/28/2004
Proceedings: Notice of Pre-Hearing Conference. (pre-hearing conferrence will be held on Monday, October 4, 2004, at 2:00)
PDF:
Date: 09/24/2004
Proceedings: Letter to r. Weiss from J. Hauser regarding availability for hearing filed.
PDF:
Date: 09/23/2004
Proceedings: Order Granting Consolidation. (consolidated cases are: 04-003156CON, 04-003157CON)
PDF:
Date: 09/20/2004
Proceedings: UCH`s Response in Opposition to Healthsouth`s Petition to Intervene filed.
PDF:
Date: 09/20/2004
Proceedings: UCH`s Second Reply to Baycare`s Positions Regarding the Scheduling of this Final Hearing filed.
PDF:
Date: 09/17/2004
Proceedings: Healtsouth of Largo Limited Partnership`s Unilateral Response to Initial Order (filed via facsimile).
PDF:
Date: 09/17/2004
Proceedings: Supplemetal Response to Initial Order (filed by Petitioner via facsimile).
PDF:
Date: 09/15/2004
Proceedings: UCH`s Reply to Baycare`s Response to Initial Order filed.
PDF:
Date: 09/14/2004
Proceedings: Healthsouth of Largo Limited Parternership`s Petition to Intervene filed.
PDF:
Date: 09/14/2004
Proceedings: Response to Initial Order (filed by Petitioner via facsimile).
PDF:
Date: 09/10/2004
Proceedings: Joint Response to Initial Order filed by J. Hauser.
PDF:
Date: 09/08/2004
Proceedings: UCH`s Unopposed Motion to Consolidate (cases requested 04-3156 CON and 04-3157 CON) filed by J. Hauser.
PDF:
Date: 09/08/2004
Proceedings: Initial Order.
PDF:
Date: 09/02/2004
Proceedings: Petition for Leave to Intervene (filed by Kindred Hospitals East, LLC d/b/a Kindred Hospital-Bay Area-Tampa and Transitional Hospitals Corporation of Tampa, Inc. d/b/a Kindred Hos[ital-Central Tampa).
PDF:
Date: 09/02/2004
Proceedings: Pages from the Florida Administrative Weekly filed.
PDF:
Date: 09/02/2004
Proceedings: Petition for Leave to Intervene (filed by Kindred Hospitals East, LLC).
PDF:
Date: 09/02/2004
Proceedings: Order of Dismissal without Prejudice Pursuant to Sections 120.54 and 120.569, Florida Statues and Rules 28-106.111 and 28-106.201, Florida Administrative Code to allow for Amendment and Resubmission of Petition filed.
PDF:
Date: 09/02/2004
Proceedings: Amended Petition for Formal Administrative Proceeding filed.
PDF:
Date: 09/02/2004
Proceedings: Petition for Formal Administrative Proceeding filed.
PDF:
Date: 09/02/2004
Proceedings: Notice (of Agency referral) filed.

Case Information

Judge:
HARRY L. HOOPER
Date Filed:
09/02/2004
Date Assignment:
09/29/2005
Last Docket Entry:
04/13/2006
Location:
Tallahassee, Florida
District:
Northern
Agency:
ADOPTED IN PART OR MODIFIED
Suffix:
CON
 

Counsels

Related Florida Statute(s) (7):