05-002754CON St. Joseph`s Hospital, Inc., D/B/A St. Joseph`s Hospital vs. Agency For Health Care Administration
 Status: Closed
Recommended Order on Tuesday, May 13, 2008.


View Dockets  
Summary: Petitioner`s satellite hospital will better serve the residents in the remote area of southeastern Hillsborough County so that emergency room access is enhanced and more readily available.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8ST. JOSEPH'S HOSPITAL, INC., )

13d/b/a ST. JOSEPH'S HOSPITAL, )

18)

19Petitioner, )

21)

22vs. ) Case No. 05-2754CON

27)

28AGENCY FOR HEALTH CARE ADMINISTRATION, )

34)

35)

36Respondent, )

38)

39and )

41)

42FLORIDA HEALTH SCIENCES CENTER, )

47INC., d/b/a TAMPA GENERAL )

52HOSPITAL AND SUN CITY HOSPITAL )

58INC., d/b/a SOUTH BAY HOSPITAL )

64AND GALENCARE, INC., d/b/a )

69BRANDON REGIONAL HOSPITAL, )

73)

74Intervenors. )

76)

77RECOMMENDED ORDER

79Pursuant to notice, the Division of Administrative

86Hearings, by its designated Administrative Law Judge, J. D.

95Parrish, held a final hearing in the above-styled case on

105October 29-November 1, November 5-9, and November 13-15, 2007,

114in Tallahassee, Florida.

117APPEARANCES

118For St. Joseph's Hospital, Inc.:

123Robert A. Weiss, Esquire

127Karen A. Putnal, Esquire

131Parker, Hudson, Rainer & Dobbs, LLP

137The Perkins House, Suite 200

142118 North Gadsden Street

146Tallahassee, Florida 32301

149For Agency for Health Care Administration:

155Karin M. Byrne, Esquire

159Agency for Health Care Administration

1642727 Mahan Drive

167Building 3, Mail Station 3

172Tallahassee, Florida 32308

175For Florida Health Sciences Center, Inc., d/b/a

182Tampa General Hospital:

185Elizabeth McArthur, Esquire

188Jeffrey L. Frehn, Esquire

192Radey Thomas Yon & Clark, P.A.

198301 South Bronough Street, Suite 200

204Post Office Box 10967

208Tallahassee, Florida 32301

211For Sun City Hospital, Inc., d/b/a South Bay Hospital and

221Galencare, Inc., d/b/a Brandon Regional Hospital:

227Stephen A. Ecenia, Esquire

231Richard M. Ellis, Esquire

235Rutledge, Ecenia, Purnell & Hoffman, P.A.

241215 South Monroe Street, Suite 420

247Post Office Box 551

251Tallahassee, Florida 32301

254STATEMENT OF THE ISSUE

258The Petitioner, St. Joseph's Hospital, Inc., d/b/a St.

266Joseph's Hospital (Petitioner, Applicant, or St. Joseph's) filed

274Certificate of Need (CON) Application No. 9833 with the Agency

284for Health Care Administration (Agency or AHCA). The

292application seeks authority to establish a 90-bed acute care

301satellite hospital in southeastern Hillsborough County, Florida.

308St. Joseph's intends to transfer 90 acute care beds from its

319existing location in Tampa to the new facility. The issue in

330this case is whether the Agency should approve the CON

340application.

341PRELIMINARY STATEMENT

343St. Joseph's filed CON application No. 9833 in the February

3532005 batching cycle. The proposed site for the new satellite

363hospital is in an area of southeastern Hillsborough County and

373is referred to as "St. Joseph's Hospital Big Bend" to be located

385in Riverview, Florida 33573, an area of AHCA's District

3946/Subdistrict 1. By letter dated June 17, 2005, the Agency

404notified the Petitioner of its intent to deny the application.

414The State Agency Action Report (SAAR) that outlined AHCA's

423reasons and explanations for the denial was issued concurrent

432with its letter and St. Joseph's timely contested the decision.

442The case was forwarded to the Division of Administrative

451Hearings (DOAH).

453The parties filed a Joint Response to Initial Order and

463agreed, in part, to waive their right to hearing within 60 days

475of assignment of the Administrative Law Judge. In accordance

484with the dates proposed by counsel for the parties, the case was

496scheduled for hearing for August 7 through 11 and 14 through 18,

5082006.

509On April 5, 2006, a Joint Motion for Continuance of Final

520Hearing was filed that sought a continuance in this matter.

530Moreover, the joint motion specified that the parties had agreed

540to a final hearing for July 9-13, 16-20, and 23-27, 2007.

551The parties (on September 11, 2006) filed yet another

560request to reschedule the hearing. That motion for continuance

569was granted and the case was set for November 2007. All hearing

581dates were agreed upon by the parties.

588Section 408.039, Florida Statutes (2007), details the

595review process by which this case is governed. The Florida

605Legislature has directed AHCA to, by rule, provide for CON

615applications to be submitted on a timetable or cycle basis.

625Applications should be reviewed timely and applications

632pertaining to similar types of services or facilities are to be

643comparatively considered in relation to each other. In this

652case, however, St. Joseph’s is the sole competitor for the

662facility sought. The approval of the CON application is opposed

672by Florida Health Sciences Center, Inc., d/b/a Tampa General

681Hospital (Tampa General); Sun City Hospital Inc., d/b/a South

690Bay Hospital (South Bay); and Galencare, Inc., d/b/a Brandon

699Regional Hospital (Brandon). These parties are existing

706providers within the same AHCA subdistrict and timely filed

715petitions to oppose the satellite hospital proposed by St.

724Joseph's.

725Prior to the hearing, all parties were advised that

734evidence to be presented would be held to the planning horizon

745and methodology set forth in the application at issue.

754Extraneous and other information not encompassed within the

762planning horizon set forth in CON application No. 9833 was

772deemed irrelevant. Updates to data encompassed within the

780planning horizon, was considered and deemed material to the

789issue at hand. It is concluded that by inaction and agreement

800the parties have waived any interest to seek a timely resolution

811of this case. Accordingly, the case proceeded to hearing based

821upon the methodology and planning horizon applicable to the 2005

831“batching cycle.” Efforts to materially amend the planning

839horizon or to extend the applicable timeframe of the batching

849cycle were deemed impermissible.

853The Agency, Tampa Bay, South Bay, and Brandon (the

862Opponents or Opponent providers if only the hospitals) filed a

872Prehearing Statement on October 27, 2007. That statement was

881later accepted by St. Joseph's. The Opponents maintain that CON

891application No. 9833 failed to meet the applicable criteria and

901requirements set by statute and rule. All Opponents argue that

911St. Joseph's CON application must be denied.

918All parties acknowledge that the statutory criteria

925applicable to this proceeding are found in Section 408.035,

934Florida Statutes. Additionally, the Agency rules applicable to

942this proceeding are set forth in Florida Administrative Code

951Rules 59C-1.002, 59C-1.008, 59C-1.010, and 59C-1.030.

957The parties have stipulated:

961A timely and complete letter of intent was

969filed by St. Joseph's in February 2005, and

977St. Joseph's timely submitted its CON

983application and omissions response. St.

988Joseph's application was timely deemed

993complete and reviewed by the Agency, leading

1000to a timely preliminary denial by the

1007Agency, in compliance with technical

1012requirements set forth in Section

1017408.039(2)(a), (c), and (d), Florida

1022Statutes (2005); and Rules 59C-1.002, 59C-

10281.008, and 59C-1.010, Fla. Admin. Code. The

1035St. Joseph application was complete in

1041compliance with the technical requirements

1046of Section 408.037, Florida Statutes, with

1052the exception of Section 408.037(1)(b) 3,

1058Florida Statutes (2005).

1061The methods of energy provision as described

1068in design narratives in St. Joseph

1074Hospital's CON application are reasonable.

1079The petitions in this matter were timely

1086filed.

1087At the final hearing, St. Joseph's presented the testimony

1096of the following witnesses: Issac Mallah, an expert in

1105healthcare administration; Lee Kirkman, M.D., an expert in

1113internal medicine, pulmonary medicine, and critical care

1120medicine; Frederick Taylor, D. O., an expert in family practice;

1130Mark D. Vaaler, M. D., an expert in critical care medicine and

1142quality assurance and improvement; Robert Pergolizzi, an expert

1150in traffic and transportation engineering; John LaRocca, an

1158expert in land use planning; Rick Knapp, an expert in healthcare

1169finance; Patricia Teeuwen, an expert in acute care resources

1178management; David Travis, an expert in emergency pre-hospital

1186medical services quality, education, delivery, and management;

1193Joseph E. Smith; and Mark M. Richardson, an expert in healthcare

1204planning. St. Joseph's also offered the deposition testimony of

1213Christopher L. Dausch, P. E., land development program director

1222for Bayside Engineering (SJH Ex. 31); Benjamin Marquez, M. D., a

1233board certified family practice physician (SJH Ex. 32); Kimberly

1242Guy, the Chief Operating Officer for St. Joseph's Women's

1251Hospital (SJH Ex. 33); Christine Tina Long, B. S. N., director

1262of patient care services for med/surg units and the oncology

1272unit at St. Joseph's Hospital (SJH Ex. 34); Deborah F. Shultz,

1283M. D., family practice physician (SJH Ex. 35); James Baron, M.

1294D., obstetrician/gynecologist (SJH Ex. 36); Bruce S. Houghton,

1302A. I. A., architect (SJH Ex. 37); Teri Lancaster, Ruskin,

1312Florida resident (SJH Ex. 38); Rodney L. Cadwell, president of

1322HELP International (SJH Ex. 39); Joseph Knight, resident of

1331Riverview and employee of Cadwell Laboratories (SJH Ex. 40);

1340Tommy Inzina, Executive Vice President and Chief Financial

1348Officer of BayCare Health System, (SJH Ex. 41); Jeffrey N.

1358Gregg, Chief of the Bureau of Health Facility Regulation at AHCA

1369(SJH Ex. 42); Robert M. Betzu, M. D., cardiologist (SJH Ex. 43);

1381Cathy R. Yoder, C.P.A., Chief Financial Officer at St. Joseph's-

1391Baptist Healthcare (SJH Ex. 44); and Lawrence Wu, Senior Vice

1401President of National Economic Research Associates, Inc. (SJH

1409Ex. 45). The Petitioner's exhibits, marked for identification

1417as SJH Ex. 1 through 50, were admitted into evidence. Rulings

1428on the objections to the deposition testimony are included in

1438Appendix A to this order.

1443South Bay and Brandon presented testimony from the

1451following witnesses: Steven Daugherty, an expert in hospital

1459administration; Michael Fencel, an expert in hospital

1466administration; Armand Balsano, an expert in healthcare planning

1474and healthcare finance; and Darryl Weiner, an expert in

1483healthcare finance and healthcare financial feasibility. South

1490Bay and Brandon also presented the deposition testimony of Linda

1500Karen Landfish, M. D., board certified neonatologist and board

1509certified pediatrician (South Bay/Brandon Ex. 44); Barry C.

1517Harris, Ph. D., an economist with Economists, Incorporated

1525(South Bay/Brandon Ex. 45); and Susan Ann Zinkel, an expert in

1536hospital human resources, staff compensation, recruitment, and

1543retention (South Bay/Brandon Ex. 46). South Bay and Brandon

1552Exhibits 1 through 49 were admitted into evidence.

1560Tampa General presented testimony from the following

1567witnesses: Ronald A. Hytoff, an expert in hospital

1575administration; Deana L. Nelson, an expert in patient

1583care/administration; Ernest J. Peters, an expert in traffic

1591engineering; Judith Ploszek, an expert in healthcare finance;

1599and Daniel Sullivan, an expert in healthcare planning and

1608finance. Tampa General presented the deposition testimony of

1616Steven L. Durbin, SPHR, Vice President for Human Resources at

1626Tampa General (Tampa General Ex. 33). Tampa General's Exhibits

16351 through 33 were admitted into evidence.

1642The Agency presented the testimony of Jeffrey N. Gregg, an

1652expert in healthcare planning and certificate of need review.

1661The Agency's exhibit, marked for identification as AHCA Ex. 1,

1671was received in evidence. No depositions were offered by AHCA.

1681The 15-volume Transcript of the final hearing was filed

1690with DOAH on December 3, 2007. On December 6, 2007, the parties

1702filed an Unopposed Motion for Extension of Time to file their

1713proposed recommended orders. Thereafter, by stipulation and

1720request of the parties, the time for filing proposed recommended

1730orders was extended twice. Additionally, the parties' request

1738to enlarge the page limitation for the proposed recommended

1747orders was granted. All parties timely filed proposed

1755recommended orders on March 7, 2007. The proposals have been

1765fully considered in the preparation of this Recommended Order.

1774FINDINGS OF FACT

1777The Parties

17791. AHCA is the state agency charged with the

1788responsibility of administering the CON program for the state of

1798Florida. The Agency serves as the state heath planning entity.

1808See § 408.034, Fla. Stat. (2007). As such, it was charged to

1820review the CON application at issue in this proceeding. AHCA

1830has preliminarily denied St. Joseph's CON application No. 9833.

18392. The Petitioner is the applicant for the CON in this

1850case. The Petitioner is a not-for-profit organization licensed

1858to operate St. Joseph's Hospital, a general acute care facility

1868located in the urban center of Tampa, Florida. It was

1878originally founded by a religious order and has grown from

1888approximately 40 beds to a licensed bed capacity of 883 beds.

1899St. Joseph's provides quality care in a comprehensive range of

1909services. Those services include tertiary and Level II trauma

1918services. St. Joseph's provides services to all patients

1926regardless of their ability to pay. To meet its perception of

1937the growing healthcare needs of the greater Hillsborough County

1946residents, St. Joseph's has proposed to construct a satellite

1955hospital on a site it purchased in the mid-1980s. According to

1966St. Joseph's, the satellite hospital, together with its main

1975campus, would better address the growing community needs for

1984acute care hospital services. To that end, St. Joseph's filed

1994CON application No. 9833 and seeks approval of its satellite

2004facility. It proposes to transfer 90 of its acute care beds

2015from its current hospital site to the new satellite facility.

2025The main hospital will offer support services as may be

2035necessary to the satellite facility.

20403. Tampa General is an 877-bed acute care hospital located

2050on Davis Island in urban Tampa, Florida. Prior to 1997, it was

2062a public hospital operated by the Hillsborough County Hospital

2071Authority but has since been operated and managed by a non-

2082profit corporation, Florida Health Sciences, Inc. Tampa General

2090provides quality care in a wide range of services that include

2101tertiary and Level I trauma. Tampa General addresses the

2110medical needs of its patients without consideration of their

2119ability to pay. It is a "safety net" provider and is the

2131largest provider of services to Medicaid and charity patients in

2141the AHCA District 6/Subdistrict 1. Medicaid has designated

2149Tampa General a "disproportionate share" provider.

21554. Tampa General is also a teaching hospital affiliated

2164with the University of South Florida's College of Medicine.

2173Recently, Tampa General has undergone a major construction

2181project that brings on line a new emergency trauma center as

2192well as additional acute care beds, a women's center, a

2202cardiovascular center and a digestive diagnostic and treatment

2210center. Tampa General opposes the CON request at issue.

22195. South Bay and Brandon also oppose St. Joseph's CON

2229application. South Bay is a 112-bed community acute care

2238hospital located in Sun City Center, Florida. South Bay has

2248served the community for about 25 years and offers quality care

2259but does not provide obstetrical services primarily because its

2268closest population and patient base is a retirement community

2277restricted to persons over 55 years of age.

22856. In contrast, Brandon is an acute care hospital with 367

2296beds located to South Bay's north in Brandon, Florida. Brandon

2306provides quality care with a full range of hospital services

2316including obstetrics, angioplasty, and open-heart surgery.

2322Brandon also has neonatal intensive care (NICU) beds to serve

2332Level II and Level III needs. It is expected that Brandon could

2344easily add beds to its facility as it has empty "shelled-in"

2355floors that could readily be converted to add 80 more acute care

2367beds.

23687. Both Brandon and South Bay are owned or controlled by

2379Hospital Corporation of America (HCA) and are part of its West

2390Florida Division.

2392The Proposal

23948. St. Joseph's has a wide variety of physicians on its

2405medical staff. Those physicians currently offer an array of

2414general acute care services as well as medical and surgical

2424specialties. St. Joseph's provides Levels II and III NICU, open

2434heart surgery, interventional radiology, primary stroke

2440services, oncology, orthopedic, gynecological oncology, and

2446pediatric surgical. Based upon its size, reputation for quality

2455care, and ability to offer this wide array of services, St.

2466Joseph's has enjoyed a well-deserved respect in its community.

24759. To expand its ties within AHCA's District 6/Subdistrict

24841 healthcare community, St. Joseph's affiliated with South

2492Florida Baptist Hospital a 147-bed community hospital located in

2501Plant City, Florida. This location is east of the main St.

2512Joseph Hospital site.

251510. Further, recognizing that the growth of greater

2523Hillsborough County, Florida, has significantly increased the

2530population of areas previously limited to agricultural or mining

2539ventures, St. Joseph's now seeks to construct a community

2548satellite hospital located in the unincorporated area of

2556southeastern Hillsborough County known as Riverview. The

2563Petitioner owns approximately 50 acres of land at the

2572intersection of Big Bend Road and Simmons Loop Road. This

2582parcel is approximately one mile east of the I-75 corridor that

2593runs north-south through the county.

259811. In relation to the other parties, the proposed site is

2609north and east of South Bay, south of Brandon, and east and

2621south of Tampa General. South Florida Baptist Hospital, not a

2631party, is located to the north and farther east of the proposed

2643site.

264412. The size of the parcel is adequate to construct the

2655proposed satellite as well as other ancillary structures that

2664might compliment the hospital (such as medical offices).

267213. If approved, the Petitioner's proposal will provide 66

2681medical-surgical beds, 14 beds within an intensive care unit,

2690and 10 labor and delivery beds. All 90 beds will be "state-of-

2702the-art" private rooms along with a full-service emergency

2710department. The hospital will be fully digital, use an

2719electronic medical record and picture archiving system, and

2727specialists at the main St. Joseph's hospital will be able to

2738access images and data at the satellite site in real time. A

2750consultation would be, theoretically, as close as a computer.

275914. In reaching its decision to seek the satellite

2768hospital, St. Joseph's considered input from many sources; among

2777them: HealthPoint Medical Group (HealthPoint) and BayCare Health

2785System, Inc. (BayCare). HealthPoint is a physician group owned

2794by an affiliate of St. Joseph's. HealthPoint has approximately

280380 physicians who operate 21 offices throughout Hillsborough

2811County. All of the HealthPoint physicians are board certified.

2820At least five of the HealthPoint offices would have quicker

2830access to the proposed satellite hospital than to the main St.

2841Joseph's Hospital site. The HealthPoint physicians support the

2849proposal so that their patients will have access to, and the

2860option of choosing, a St. Joseph facility in the southeastern

2870part of the county.

287415. BayCare is an organization governed by a cooperative

2883agreement among nonprofit hospitals. Its purpose is to assist

2892its member hospitals to centralize and coordinate hospital

2900functions such as purchasing, staffing, managed care

2907contracting, billing, and information technology. By

2913cooperatively working together, its members are able to enjoy a

2923cost efficiency that individually they did not enjoy. The

"2932synergy" of their effort results in enhanced quality of care,

2942efficient practices, and a financial savings to their

2950operations. The proposed St. Joseph's satellite would also

2958share in this economy of efforts. Understandably, BayCare

2966supports the proposal.

2969Review Criteria

297116. Every new hospital project in Florida must be reviewed

2981pursuant to the statutory criteria set forth in Section 408.035,

2991Florida Statutes (2007). Accordingly, the ten subparts of that

3000provision must be weighed to determine whether or not a proposal

3011meets the requisite criteria.

301517. Section 408.035(1), Florida Statutes (2007) requires

3022that the need for the health care facilities and health services

3033being proposed be considered. In the context of this case,

"3043need" will not be addressed in terms of its historical meaning.

3054The Agency no longer calculates "need" pursuant to a need

3064methodology. Therefore, looking to Florida Administrative Code

3071Rule 59C-1.008, requires consideration of the following

3078pertinent provisions:

3080...If an agency need methodology does not

3087exist for the proposed project:

30921. The agency will provide to the

3099applicant, if one exists, any policy upon

3106which to determine need for the proposed

3113beds or service. The applicant is not

3120precluded from using other methodologies to

3126compare and contrast with the agency policy.

31332. If no agency policy exists, the

3140applicant will be responsible for

3145demonstrating need through a needs

3150assessment methodology which must include,

3155at a minimum, consideration of the following

3162topics, except where they are inconsistent

3168with the applicable statutory or rule

3174criteria:

3175a. Population demographics and dynamics;

3180b. Availability, utilization and quality of

3186like services in the district, subdistrict

3192or both;

3194c. Medical treatment trends; and,

3199d. Market conditions.

32023. The existence of unmet need will not be

3211based solely on the absence of a health

3219service, health care facility, or beds in

3226the district, subdistrict, region or

3231proposed service area.

323418. According to St. Joseph's, "need" is evidenced by a

3244large and growing population in the proposed service area (PSA),

3254sustained population growth that exceeds the District and state

3263average, highly occupied and seasonally over capacity acute care

3272beds at the existing providers, highly occupied and sustained

3281increases in demand for hospital services, a scarcity of

3290emergency medical service resources within the PSA compounded by

3299budget cuts, increases in traffic congestion and travel times to

3309the existing hospitals, the lack of a nonprofit community

3318hospital near the proposed site, and the lack of local

3328obstetrical services.

333019. In this case the Petitioner has identified the PSA as

3341a 10 zip code area with 7 being designated the "primary" area of

3354service (PSA) and 3 zip codes to the north being identified as

3366the "secondary" area of service (SSA). The population of this

3376PSA is projected to reach 322,913 by the year 2011 (from its

3389current 274,696).

339220. All parties used Claritas data to estimate population,

3401the PSA growth, and various projections. Claritas is a

3410conservative estimator in the sense that it relies on the most

3421recent U. S. census reports that may or may not track the most

3434recent growth indicators such as building starts or new home

3444sales. Nevertheless, if accurate, the estimated 17.5 percent

3452population growth expected in the new satellite hospital's PSA

3461exceeds the rate of growth estimated for AHCA District 6 as well

3473as the projected State of Florida growth rate. From the 7

3484primary zip codes within the PSA alone the area immediately

3494adjacent to the subject site is estimated to grow by 14,900

3506residents between 2006 and 2011.

351121. Over the last 20 years the PSA has developed from

3522rural farming and mining expanses with scattered housing and

3531trailer parks to an area characterized by modern shopping

3540centers, apartment complexes, housing subdivisions, churches,

3546libraries, and new schools. Physicians in the area now see as

3557many as 60 patients per day and during the winter peak months

3569may admit up to 20 patients per week to hospitals.

3579avel times from the southern portion of the PSA to

3589St. Joseph's Hospital, Tampa General, or Brandon, can easily

3598exceed 30 minutesavel times to the same providers during

"3607rush" or high traffic times can be longer.

361523. All of the opponent providers have high occupancy

3624rates and experience seasonal over capacity. During the winter

3633months visitors from the north and seasonal residents add

3642significant numbers to the population in Hillsborough County.

3650These "snow birds" drive the utilization of all District

36596/Subdistrict 1 hospitals up. Further, increased population

3666tends to slow and congest traffic adding to travel times within

3677AHCA District 6/Subdistrict 1.

368124. Both Brandon and Tampa General have recently added

3690beds to address the concerns of increased utilization.

3698Additionally, Tampa General has expanded its emergency

3705department to provide more beds. South Bay has elected to not

3716increase its bed size or emergency department. South Bay has

3726experienced difficulty staffing its emergency department. When

3733faced with capacity problems, South Bay "diverts" admissions to

3742other hospitals.

374425. When the emergency rooms of the Opponent providers are

3754unable to accommodate additional patients, the county emergency

3762transport is diverted to other facilities so that patients have

3772access to emergency services. During the winter season and peak

3782flu periods this diversion is more likely to occur. Another

3792hospital in the southeastern portion of the county, within St.

3802Joseph's satellite PSA, would alleviate some of the crowding.

381126. More specifically, South Bay's annual occupancy rate

3819in 2006 was 80.1 percent. For the first seven months of 2007,

3831South Bay's average occupancy rate was 88.4 percent. These

3840rates indicate that South Bay is operating at a high occupancy.

3851Operating at or near capacity is not recommended for any

3861hospital facility. Long term operation at or near occupancy

3870proves to be detrimental to hospital efficiencies.

387727. Similarly, Brandon operates at 70 percent of its bed

3887capacity. Even though it has recently added beds it intends to

3898add more beds to address continuing increases in admissions.

3907Brandon's emergency room is also experiencing overcrowded

3914conditions. When Brandon's emergency room diverts patients

3921their best option may be to leave District 6/Subdistrict 1 for

3932care.

393328. Tampa General is a large complex and its emergency

3943department has been expanded to attempt to address an obvious

3953need for more services. It is unknown whether the new emergency

3964department will adequately cure the high rates of diversion

3973Tampa General experienced in 2007. New beds were added and an

3984improved emergency department was designed and constructed with

3992the expectation that Tampa General's patients would be better

4001served.

400229. Based upon Tampa General's expansion and its projected

4011growth, Tampa General could experience an occupancy rate over 75

4021percent by 2011. If so, Tampa General could easily return to

4032the utilization problems previously experienced.

403730. There are no obstetrical services offered south of

4046Brandon in AHCA District 6/Subdistrict 1. The proposed

4054St. Joseph's satellite hospital would offer obstetrics and has

4063designated a 10-bed unit to accommodate those patients.

407131. There are no nonprofit hospitals south of Brandon in

4081AHCA District 6/Subdistrict 1. The proposed St. Joseph's

4089satellite hospital would offer patients in the PSA with the

4099option of using such a hospital.

410532. Section 408.035(2), Florida Statutes (2007), requires

4112the consideration of the availability, quality of care,

4120accessibility, and extent of utilization of existing health care

4129facilities and health services in the service district of the

4139applicant.

414033. As previously stated, all of the parties provide

4149quality care to their patients. Although delays in emergency

4158departments may inconvenience patients, the quality of the

4166medical care they receive is excellent.

417234. Similarly, hospital services are available and can be

4181accessed in AHCA District 6/Subdistrict 1. The parties provide

4190a full range of healthcare service options that address the

4200medical and surgical needs of the residents of AHCA District 6

4211Subdistrict 1. An additional hospital would afford patients

4219with another choice of provider in the southeastern portion of

4229the county. The St. Joseph satellite hospital would afford such

4239patients with a hospital option within 30 minutes of the areas

4250within the PSA. This access would promote shorter wait times

4260and less crowded facilities.

426435. Section 408.035(3), Florida Statutes (2007), mandates

4271review of CON applications in light of the ability of the

4282applicant to provide quality of care and the applicant's record

4292of providing quality of care.

429736. As previously stated St. Joseph's has a well-deserved

4306reputation for providing quality care within a wide range of

4316hospital services to its patients. It is reasonable to expect

4326the satellite hospital would continue in the provision of such

4336care. The management team and affiliations established by

4344St. Joseph's will continue to pursue quality care to all its

4355patients regardless of their ability to pay.

436237. Section 408.035(4), Florida Statutes (2007), considers

4369the availability of resources for project accomplishment and

4377operation. Resources that must be considered include healthcare

4385personnel, management personnel, and funds for capital and

4393operating expenditures.

439538. St. Joseph's has the resources to accomplish and

4404operate the satellite hospital proposed. St. Joseph's has a

4413successful history of recruiting and retaining healthcare

4420personnel and management personnel. The estimates set forth in

4429its CON application for these persons were reasonable and

4438conservative. Salaries and benefits for healthcare personnel

4445and management personnel should be within the estimated

4453provisions set forth in the application.

445939. Although there is a nationwide shortage of nursing

4468personnel and physicians in certain specialties, St. Joseph's

4476has demonstrated it has a track record of staffing its facility

4487to meet appropriate standards and provide quality care. There

4496is no reason to presume it will not be similarly successful at

4508the satellite facility.

451140. St. Joseph's has also demonstrated it has the

4520financial ability to construct and operate the proposed

4528satellite hospital. The occupancy rates projected for the new

4537hospital will produce a revenue adequate to make the hospital

4547financially feasible. Further, if patients who reside closer to

4556the satellite facility use it instead of the main St. Joseph

4567Hospital, a lower census at the main hospital will not adversely

4578impact the financial strength of the organization. There will

4587be adequate growth in the healthcare market for this PSA to

4598support the new facility as well as the existing providers.

460841. It must be noted, however, that construction costs for

4618the satellite hospital will exceed the amounts disclosed by the

4628CON application. Some of the increases in cost are significant.

4638For example, the estimate for the earthwork necessary for site

4648preparation has risen from $417,440 to $1,159,296.

4658Additionally, most of the unit prices for construction have gone

4668up dramatically in the past couple of years. Hurricanes and the

4679resulting increased standards for building codes have also

4687driven construction costs higher. More stringent storm water

4695provisions have resulted in higher construction costs. For this

4704project it is estimated the storm water expense will be $500,000

4716instead of the original $287,000 proposed by the CON

4726application. In total these increases are remarkable. They may

4735also signal why development in AHCA's District 6/Subdistrict 1

4744has slowed since the CON application was filed. Regardless, St.

4754Joseph's should have the financial strength to construct and

4763operate the project.

476642. Section 408.035(5), Florida Statutes (2007), specifies

4773that the Agency must evaluate the extent to which the proposed

4784services will enhance access to health care for residents of the

4795service district. In the findings reached in this regard, the

4805criteria set forth in Administrative Code Rule 59C-1.030(2) have

4814been fully considered. Those provisions are:

4820(2) Health Care Access Criteria.

4825(a) The need that the population served or

4833to be served has for the health or hospice

4842services proposed to be offered or changed,

4849and the extent to which all residents of the

4858district, and in particular low income

4864persons, racial and ethnic minorities,

4869women, handicapped persons, other

4873underserved groups and the elderly, are

4879likely to have access to those services.

4886(b) The extent to which that need will be

4895met adequately under a proposed reduction,

4901elimination or relocation of a service,

4907under a proposed substantial change in

4913admissions policies or practices, or by

4919alternative arrangements, and the effect of

4925the proposed change on the ability of

4932members of medically underserved groups

4937which have traditionally experienced

4941difficulties in obtaining equal access to

4947health services to obtain needed health

4953care.

4954(c) The contribution of the proposed

4960service in meeting the health needs of

4967members of such medically underserved

4972groups, particularly those needs identified

4977in the applicable local health plan and

4984State health plan as deserving of priority.

4991(d) In determining the extent to which a

4999proposed service will be accessible, the

5005following will be considered:

50091. The extent to which medically

5015underserved individuals currently use the

5020applicant’s services, as a proportion of the

5027medically underserved population in the

5032applicant’s proposed service area(s), and

5037the extent to which medically underserved

5043individuals are expected to use the proposed

5050services, if approved;

50532. The performance of the applicant in

5060meeting any applicable Federal regulations

5065requiring uncompensated care, community

5069service, or access by minorities and

5075handicapped persons to programs receiving

5080Federal financial assistance, including the

5085existence of any civil rights access

5091complaints against the applicant;

50953. The extent to which Medicare, Medicaid

5102and medically indigent patients are served

5108by the applicant; and

51124. The extent to which the applicant

5119offers a range of means by which a person

5128will have access to its services.

5134(e) In any case where it is determined that

5143an approved project does not satisfy the

5150criteria specified in paragraphs (a) through

5156(d), the agency may, if it approves the

5164application, impose the condition that the

5170applicant must take affirmative steps to

5176meet those criteria.

5179(f) In evaluating the accessibility of a

5186proposed project, the accessibility of the

5192current facility as a whole must be taken

5200into consideration. If the proposed project

5206is disapproved because it fails to meet the

5214need and access criteria specified herein,

5220the Department will so state in its written

5228findings.

522943. AHCA does not require a CON applicant to demonstrate

5239that the existing acute care providers within the PSA are

5249failing in order to approve a satellite hospital. Also, AHCA

5259does not have a travel time standard with respect to the

5270provision of acute care hospital services. In other words,

5279there is no set geographical distance or travel time that

5289dictates when a satellite hospital would be appropriate or

5298inappropriate. In fact, AHCA has approved satellite hospitals

5306when residents of the PSA live within 20 minutes of an existing

5318hospital. As a practical matter this means that travel time or

5329distance do not dictate whether a satellite should be approved

5339based upon access. With regard to access to emergency services,

5349however, AHCA does consider patient convenience.

535544. In this case the proposed satellite hospital will

5364provide a convenience to residents of southeastern Hillsborough

5372County in terms of access to an additional emergency department.

5382Further, physicians serving the growing population will have the

5391convenience of admitting patients closer to their residences.

5399Medical and surgical opportunities at closer locations is also a

5409convenience to the families of patients because they do not have

5420to travel farther distances to visit the patient. Patients and

5430the families of patients seeking obstetrical services will also

5439have the convenience of the satellite hospital.

544645. Patients who would not benefit from the convenience of

5456the proposed satellite hospital would be those requiring

5464tertiary health services. Florida Administrative Code Rule 59C-

54721.002(41) defines such services as:

5477(41) Tertiary health service means a health

5484service which, due to its high level of

5492intensity, complexity, specialized or

5496limited applicability, and cost, should be

5502limited to, and concentrated in, a limited

5509number of hospitals to ensure the quality,

5516availability, and cost effectiveness of such

5522service. Examples of such service include,

5528but are not limited to, organ

5534transplantation, specialty burn units,

5538neonatal intensive care units, comprehensive

5543rehabilitation, and medical or surgical

5548services which are experimental or

5553developmental in nature to the extent that

5560the provision of such services is not yet

5568contemplated within the commonly accepted

5573course of diagnosis or treatment for the

5580condition addressed by a given service.

558646. In terms of tertiary health services, residents of

5595AHCA District 6/Subdistrict 1 will continue to use the existing

5605providers who offer those services. The approval of the St.

5615Joseph satellite will not adversely affect the tertiary

5623providers in AHCA District 6/Subdistrict 1 in terms of their

5633ability to continue to provide those services. The new

5642satellite will not compete for those services.

564947. Tampa General has a unique opportunity to provide

5658tertiary services and will continue to be a strong candidate for

5669any patient in the PSA requiring such services. As a teaching

5680hospital and major NICU and trauma center, Tampa General offers

5690specialties that will not be available at the satellite

5699hospital. If non-tertiary patients elect to use the satellite

5708hospital, Tampa General should not be adversely affected. Tampa

5717General has performed well financially of late and its revenues

5727have exceeded its past projections. With the added conveniences

5736of its expanded and improved facilities it will continue to play

5747a significant roll in the delivery of quality health care to the

5759residents of the greater Tampa area.

576548. Section 408.035(6), Florida Statutes (2007) provides

5772that the financial feasibility of the proposal both in the

5782immediate and long-term be assessed in order to approve a CON

5793application.

579449. In this case, as previously indicated, the

5802utilizations expected for the new satellite hospital should

5810adequately assure the financial feasibility of the project both

5819in the immediate and long-term time frames. Population growth,

5828a growing older population, and technologies that improve the

5837delivery of healthcare will contribute to make the project

5846successful.

584750. The satellite hospital will afford PSA residents a

5856meaningful option in choosing healthcare and will not give any

5866one provider an unreasonable or dominant position in the market.

587651. Section 408.035(7), Florida Statutes (2007) specifies

5883that the extent to which the proposal will foster competition

5893that promotes quality and cost-effectiveness must be addressed.

590152. AHCA's District 6/Subdistrict 1 enjoys a varied range

5910of healthcare providers. From the teaching hospital at Tampa

5919General to the community hospital at South Bay, all demonstrate

5929strong financial stability and utilization. A new satellite

5937hospital will promote continued quality and cost-effectiveness.

5944As a member of the BayCare group the satellite will benefit from

5956the economies of its group and provide the residents of its PSA

5968with quality care. Physicians will have another option for

5977admissions and convenience.

598053. Section 408.035(8), Florida Statutes (2007), notes

5987that the costs and methods of the proposed construction,

5996including the costs and methods of energy provision and the

6006availability of alternative, less costly, or more effective

6014methods of construction should be reviewed.

602054. The methodology used to compute the construction costs

6029associated with this project were reasonable and accurate at the

6039time prepared. The costs, however, are not accurate in that

6049most have gone up appreciably since the filing of the CON

6060application. No more effective method of construction has been

6069proposed but the financial soundness of the proposal should

6078cover the increased costs associated with the construction of

6087the project. The delays in resolving this case have worked to

6098disadvantage the Applicant in this regard. Unforeseeable acts

6106of nature, limitations of building supplies, and increases

6114inherent with the passage of time will make this project more

6125costly than St. Joseph's envisioned when it filed the CON

6135application. Further, it would be imprudent to disregard the

6144common knowledge that oil prices have escalated while interest

6153rates have dropped. These factors may also impact the project's

6163cost.

616455. Section 408.035(9), Florida Statutes (2007), provides

6171that the applicant's past and proposed provision of health care

6181services to Medicaid patients and the medically indigent should

6190be weighed in consideration of the proposal.

619756. St. Joseph's has a track record of providing health

6207care services to Medicaid patients and the medically indigent

6216without consideration of any patient's ability to pay. The

6225satellite hospital would be expected to continue this tradition.

6234Moreover, as a provision of its CON application, St. Joseph's

6244has represented it will provide 12.5 percent of its patient days

6255to Medicaid/Medicaid HMO/Charity/Indigent patients.

625957 Section 408.035(10), Florida Statutes, relates to

6266nursing home beds and is not at issue in this proceeding.

6277The Opposition

627958. The SAAR set forth the Agency's rationale for the

6289proposed denial of the CON application. The SAAR acknowledged

6298that the proposal had received 633 letters of support (80 from

6309physicians, 365 from St. Joseph employees, and 191 from members

6319of the community); that funding for the project would be

6329available; that the short-term position, long-term position,

6336capital requirements, and staffing for the proposal were

6344adequate; that the project was financially feasible if the

6353Applicant meets its projected occupancy levels; that the project

6362would have a marginally positive effect on competition to

6371promote quality and cost-effectiveness; and that the

6378construction schedule "seems to be reasonable" for the project.

638759. Notably in opposition to the CON application, the SAAR

6397represented that:

6399It is not clear that projected population

6406growth for this area will outpace the

6413ability of subdistrict facilities to add

6419beds to accommodate population growth. The

6425subdistrict's most recent average

6429utilization rate was 63.40 percent, and an

6436additional facility has already been

6441approved for this applicant in this county

6448for the purpose of handling forecasted

6454growth. Growth projected for females aged

646015-44 is not significantly higher for the

6467county than for the district or state, and

6475it is not demonstrated that need exists for

6483obstetric services in the subdistrict.

648860. The foregoing analysis did not credit the projected

6497population growth for the PSA applicable to this proposal

6506heavily. The population growth expected for the PSA will

6515support the utilization necessary for the proposed project.

6523Applying the Agency's assessment, all existing hospital

6530providers could add beds to meet "need" for a Subdistrict and

6541thereby eliminate the approval of any satellite community

6549facility that would address local concerns. Also, South Bay has

6559conceded it will not add beds at its location.

656861. Additionally, the SAAR stated:

6573While both South Bay Hospital and Brandon

6580Regional Hospital have occupancy rates such

6586that the introduction of a competing

6592facility would not likely inhibit their

6598abilities to maintain operations, the same

6604cannot be stated for Tampa General Hospital,

6611the only designated Disproportionate Share

6616Hospital in this subdistrict. Any impact on

6623Tampa General Hospital as a result of the

6631proposed project would likely be negative,

6637limiting Tampa General's ability to offset

6643its Medicaid and charity care services.

6649The applicant facility does not currently

6655have a significant presence in the proposed

6662market, and would have to gain market share

6670in this PSA in order to meet its projected

6679occupancy levels. Much of the market share

6686gained by the applicant with the proposed

6693facility would likely be at the expense of

6701existing facilities in this area, most

6707notably Tampa General due to its lower

6714occupancy level and higher Medicaid and

6720charity care provisions.

672362. In reaching its decision, the Agency has elected to

6733protect Tampa General from any negative impact that the proposed

6743satellite hospital might inflict.

674763. Tampa General has invested $300 million in

6755improvements. It is a stand-alone, single venue hospital that

6764has not joined any group or integrated system. It relies on its

6776utilization levels, management skill and economies of practice

6784to remain solvent. Tampa General considers itself a unique

6793provider that should be protected from the financial risks

6802inherent in increased competition. It is the largest provider

6811of services to indigent patients in AHCA District 6/Subdistrict.

682064. Brandon opposes the proposed satellite hospital in

6828part because it, too, has expanded its facility and does not

6839believe additional beds are needed in AHCA District

68476/Subdistrict 1. Nevertheless when a related facility sought to

6856establish a satellite near the St. Joseph's site, Brandon

6865supported the project. Brandon provides excellent quality of

6873care and has a strong physician supported system. It will not

6884be adversely affected in the long run by the addition of a

6896satellite hospital in St. Joseph's PSA.

690265. Similarly, South Bay opposes the project. South Bay

6911will not expand and does not provide obstetric services. It has

6922had difficulty staffing its facility and believes the addition

6931of another competitor will exacerbate the problem.

6938Nevertheless, South Bay has a strong utilization level, a track

6948record of financial strength, and will not likely be adversely

6958impacted by the St. Joseph satellite.

696466. The opponents maintain that enhanced access for

6972residents of the PSA does not justify the establishment of a new

6984satellite hospital since the residents there already have good

6993access to acute care services.

6998CONCLUSIONS OF LAW

700167. The Division of Administrative Hearings has

7008jurisdiction over the parties to and the subject matter of these

7019proceedings. §§ 120.569 and 120.57(1), Fla. Stat. (2007).

702768. St. Joseph's has the burden to prove by a

7037preponderance of the evidence that its CON application should be

7047approved. See , e.g. , Boca Raton Artificial Kidney Center, Inc.

7056v. Dept. of Health and Rehabilitative Servs. , 475 So. 2d 260,

7067263 (Fla. 1st DCA 1985); § 120.57(1)(j), Fla. Stat. (2007).

707769. The Agency's preliminary decision on CON Application

7085No. 9833 and its findings in the SAAR are not entitled to a

7098presumption of correctness in this de novo proceeding. See

7107generally Dept. of Transportation v. J.W.C. Co., Inc. , 396 So.

71172d 778, 787 (Fla. 1st DCA 1981). The Agency's construction and

7128interpretation of its rules and the statutes that it is charged

7139to implement, however, are entitled to deference. See , e.g. ,

7148State Contracting & Engineering Corp., v. Dept. of

7156Transportation , 709 So. 2d 607, 610 (Fla. 1st DCA 1998); §

7167120.57(1)(l), Fla. Stat. (2007).

717170. The decision of whether to approve a CON application

7181must be based on a balanced consideration of all statutory and

7192rule criteria. Department of Health and Rehabilitative Services

7200v. Johnson & Johnson Home Healthcare, Inc. , 477 So. 2d 261 (Fla.

72121st DCA 1984); Balsam v. Department of Health and Rehabilitative

7222Services , 486 So. 2d 1341 (Fla. 1st DCA 1988). The weight to be

7235given to each criterion is not fixed, but depends on the facts

7247and circumstances of each case. Collier Medical Center, Inc. v.

7257Department of Health and Rehabilitative Services , 462 So. 2d 83

7267(Fla. 1st DCA 1985).

727171. All parties in this cause have the requisite standing

7281to participate in this proceeding pursuant to Section

7289408.039(5)(c), Florida Statutes (2007).

729372. In this case the Applicant has presented a need

7303methodology that argues the satellite facility should be

7311approved. The opponents disagree (for the most part) based upon

7321their perception that the area growth has slowed, that the

7331utilizations projected are not reasonable, and that the existing

7340providers will be adversely affected by the new satellite

7349hospital.

735073. As to the Applicant's methodology, St. Joseph's has

7359demonstrated a new satellite hospital at the Big Bend location

7369will enhance emergency department access. Further, the new

7377satellite will provide patients with a meaningful option for

7386hospital services in the southeastern portion of Hillsborough

7394County. The satellite will offer enhanced access to obstetrical

7403services to residents of the PSA. And finally, it will offer

7414reduced travel times for patients and their families using the

7424facility. These conveniences of access have been established.

743274. As to the Agency's concern that the satellite will

7442siphon patients from Tampa General, a fragile Disproportionate

7450Share provider that must be protected, the projected growth in

7460population in the PSA as well as the county as a whole should

7473adequately generate sufficient patient days to alleviate such

7481fears. Moreover, since St. Joseph's intends to transfer beds

7490from its main site, the overall number of beds in AHCA District

75026/Subdistrict 1 will remain unchanged. If freezing the number

7511of hospital beds were an option, the Legislature could do so.

7522It has not. St. Joseph can easily resolve the issue by agreeing

7534to not add the beds back to its main campus for a designated

7547period of time. Such a stipulation would allow the new

7557satellite facility to realize the utilization levels projected.

7565If St. Joseph's is correct in its assessment, all of the

7576providers in AHCA District 6/Subdistrict 1 will continue to grow

7586their admissions and/or patient days based upon population

7594growth and increased utilization.

759875. Improving access to acute care hospital services

7606including emergency services in non-urban areas experiencing

7613growth (similar to the PSA herein) is the trend in medical

7624treatment. The addition of the subject satellite will provide

7633such services to a growing area of southeastern Hillsborough

7642County.

764376. Patients requiring tertiary services will not be

7651benefited by the new satellite but those who require emergency

7661services will have a second option that will lessen emergency

7671department wait time. On balance St. Joseph's has established

7680need for its proposed satellite hospital based upon its

7689methodology, Florida Administrative Code Rule 59C-1.008(2)(e),

7695as well as the criteria found in Section 408.035, Florida

7705Statutes (2007). To the extent that the Agency remains

7714concerned that the project will unduly adversely affect

7722competition, such concern should be cured by condition.

7730Otherwise, St. Joseph's CON application generally meets the CON

7739statutory and rule criteria. With conditions for the provision

7748of Medicaid/Indigent care at 12.5 percent and a time limit

7758before beds are added back to the main St. Joseph's facility,

7769the Applicant's request for a satellite facility should be

7778approved.

7779RECOMMENDATION

7780Based on the foregoing Findings of Fact and Conclusions of

7790Law, it is

7793RECOMMENDED that a Final Order be entered by the Agency for

7804Health Care Administration that approves CON Application No.

78129833 with the conditions noted.

7817DONE AND ENTERED this 13th day of May, 2008, in

7827Tallahassee, Leon County, Florida.

7831J. D. PARRISH

7834Administrative Law Judge

7837Division of Administrative Hearings

7841The DeSoto Building

78441230 Apalachee Parkway

7847Tallahassee, Florida 32399-3060

7850(850) 488-9675 SUNCOM 278-9675

7854Fax Filing (850) 921-6847

7858www.doah.state.fl.us

7859Filed with the Clerk of the

7865Division of Administrative Hearings

7869this 13th day of May, 2008.

7875COPIES FURNISHED :

7878Richard J. Shoop, Agency Clerk

7883Agency for Health Care Administration

78882727 Mahan Drive, Mail Station 3

7894Tallahassee, Florida 32308

7897Craig H. Smith, General Counsel

7902Agency for Health Care Administration

7907Fort Knox Building, Suite 3431

7912Tallahassee, Florida 32308

7915Holly Benson, Secretary

7918Agency for Health Care Administration

7923Fort Knox Building, Suite 3116

79282727 Mahan Drive

7931Tallahassee, Florida 32308

7934Stephen A. Ecenia, Esquire

7938Richard M. Ellis, Esquire

7942Rutledge, Ecenia, Purnell &

7946Hoffman, P. A.

7949215 South Monroe Street, Suite 420

7955Post Office Box 551

7959Tallahassee, Florida 32304-0551

7962Robert A. Weiss, Esquire

7966Karen A. Putnal, Esquire

7970Parker, Hudson, Rainer &

7974Dobbs, LLP

7976The Perkins House, Suite 200

7981118 North Gadsden Street

7985Tallahassee, Florida 32301

7988Elizabeth McArthur, Esquire

7991Jeffrey L. Frehn, Esquire

7995Radey, Thomas, Yon & Clark, P.A.

8001301 South Bronough Street, Suite 200

8007Post Office Box 10967

8011Tallahassee, Florida 32301

8014Karin M. Byrne, Esquire

8018Agency for Health Care Administration

80232727 Mahan Drive, Building 3

8028Mail Station 3

8031Tallahassee, Florida 32308

8034NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

8040All parties have the right to submit written exceptions within

805015 days from the date of this Recommended Order. Any exceptions

8061to this Recommended Order should be filed with the agency that

8072will issue the Final Order in this case.

8080APPENDIX A

8082Rulings on the objections raised by Tampa General :

80911. Objection to Christopher Dausch, SJH Ex. #31: Overruled.

81002. Objection to Christine Long, SJH Ex. #34:

8108Motion to Strike Ex. 4 to the Deposition: Granted.

8117Motion to Strike Ex. 3 to the Deposition: Granted.

8126Motion to Strike Deponent's Opinions: Denied. Tampa

8133General's objection has been duly considered in the weight that

8143should reasonably be given the opinions expressed by the

8152Deponent.

81533. Objection to Rodney Cadwell, SJH Ex. #39: Overruled.

81624. Objection to Robert Betzu, M.D., SJH Ex. #43: Overruled.

81725. Rulings on other objections raised by Tampa General (in

8182joining those raised by South Bay and Brandon) are addressed

8192below.

8193Rulings on the Objections to Depositions raised by South Bay and

8204Brandon:

82051. Objection to Rodney Cadwell, SJH Ex. #39: Overruled.

82142. Objection to Christopher Dausch, SJH Ex. 31: Overruled.

82233. Objection to Bruce Houghton, SJH Ex. #37: Overruled.

82324. Objection to Christine Long, SJH Ex. #34: Overruled. See

8242note above.

82445. Objection to Kimberly Guy, SJH Ex. #33: Overruled.

82536. Objection to Teri Lancaster, SJH Ex. #38: Overruled.

82627. Objection to Joseph Knight, SJH Ex. #39: Overruled.

82718. Objections to Jeffrey Gregg, SJH Ex. #42: Overruled.

82809. Objection to Benjamin Marquez, M. D., SJH Ex. #32:

8290Overruled.

829110. Objections to Robert Betzu, M. D., SJH Ex. #43: Overruled.

830211. Objection to Tommy Inzina, SJH Ex. #41: Overruled.

831112. Objections to Deborah Shultz, M. D., SJH Ex. #35:

8321Overruled.

8322At hearing the parties stipulated that depositions would be

8331offered in lieu of live testimony. Objections that could have

8341been readily raised at deposition, have been deemed waived and

8351if submitted, overruled. Secondly, hearsay not supported by

8359direct evidence in the proceeding has not been relied upon to

8370reach a finding of fact in this cause. Additionally, data

8380beyond the planning horizon has not been accepted.

8388Neither St. Joseph's nor the Agency filed objections to the

8398depositions offered in this cause.

Select the PDF icon to view the document.
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Date
Proceedings
PDF:
Date: 08/19/2008
Proceedings: Final Order filed.
PDF:
Date: 08/15/2008
Proceedings: Agency Final Order
PDF:
Date: 05/13/2008
Proceedings: Recommended Order
PDF:
Date: 05/13/2008
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 05/13/2008
Proceedings: Recommended Order (hearing held October 29-November 1, 5-9 and 13-15, 2007). CASE CLOSED.
PDF:
Date: 03/07/2008
Proceedings: AHCA`s and Tampa General`s Joint Proposed Recommended Order filed.
PDF:
Date: 03/07/2008
Proceedings: South Bay and Brandon`s Proposed Recommended Order filed.
PDF:
Date: 03/07/2008
Proceedings: Proposed Recommended Order of St. Joseph`s Hospital, Inc. filed.
PDF:
Date: 02/28/2008
Proceedings: Order Enlarging Page Limitation for Proposed Recommended Orders to a Maximum of 50 Pages.
PDF:
Date: 02/26/2008
Proceedings: Unopposed Motion to Enlarge Page Limitation for Proposed Recommended Orders filed.
PDF:
Date: 02/20/2008
Proceedings: Order Granting Extension of Time (proposed recommended orders to be filed by March 7, 2008).
PDF:
Date: 02/15/2008
Proceedings: Agreed Motion for Additional Week to File Proposed Recommended Orders filed.
PDF:
Date: 01/24/2008
Proceedings: Order Granting Extension of Time (proposed recommended orders to be filed by February 29, 2008).
PDF:
Date: 01/18/2008
Proceedings: Agreed Motion for Extension of Time to File Proposed Recommended Orders filed.
PDF:
Date: 01/16/2008
Proceedings: Order on South Bay and Brandon`s Second Motion for Taking Official Recognition.
PDF:
Date: 01/09/2008
Proceedings: St. Joseph`s Hospital`s Response in Opposition to South Bay and Brandon`s Second Motion for Taking Official Recognition filed.
PDF:
Date: 01/02/2008
Proceedings: South Bay and Brandon`s Second Motion for Taking Official Recognition filed.
PDF:
Date: 12/31/2007
Proceedings: Order Granting Extension of Time (Proposed Recommended Orders to be filed by January 31, 2008).
PDF:
Date: 12/27/2007
Proceedings: Unopposed Motion for Amended Order Extending Time to File Proposed Recommended Orders filed.
PDF:
Date: 12/13/2007
Proceedings: Tampa General`s Written Objections to Depositions filed.
PDF:
Date: 12/13/2007
Proceedings: South Bay and Brandon`s Objections to Deposition Testimony and Deposition Exhibits Offered by St. Joseph`s filed.
PDF:
Date: 12/13/2007
Proceedings: Order on Requests for Official Recognition.
PDF:
Date: 12/13/2007
Proceedings: Order Granting Extension of Time (proposed recommended orders to be filed by January 18, 2008).
PDF:
Date: 12/06/2007
Proceedings: Unopposed Motion for Extension of Time to File Proposed Recommended Orders filed.
Date: 12/03/2007
Proceedings: Transcript (volumes 1 through 15) filed.
PDF:
Date: 11/30/2007
Proceedings: Tampa General`s Response to St. Joseph`s Hospital`s Objections to Items Submitted for Official Recognition filed.
PDF:
Date: 11/27/2007
Proceedings: St. Joseph`s Hospital`s Response in Opposition to Tampa General`s Motion for Official Recognition filed.
PDF:
Date: 11/26/2007
Proceedings: Order Granting Extension of Time (responses to pending motions for official recognition to be filed by November 27, 2007).
PDF:
Date: 11/20/2007
Proceedings: Motion for Extension of Time for Parties to File Responses to Pending Motions for Official Recognition filed.
Date: 11/15/2007
Proceedings: CASE STATUS: Hearing Held.
PDF:
Date: 11/14/2007
Proceedings: Tampa General`s Motion for Official Recognition filed.
PDF:
Date: 11/07/2007
Proceedings: South Bay and Brandon`s Motion for Taking Official Recognition filed.
PDF:
Date: 10/29/2007
Proceedings: SJH`s Supplemental Motion for Official Recognition filed.
PDF:
Date: 10/29/2007
Proceedings: SJH`s Motion for Official Recognition filed.
PDF:
Date: 10/26/2007
Proceedings: Prehearing Statement of Agency for Health Care Administration, Florida Health Sciences Center, Inc.,d/b/a Tampa General Hospital Sun City Hospital, Inc., d/b/a South Bay Hospital, and Galencare, Inc., d/b/a Brandon Regional Hospital filed.
PDF:
Date: 10/26/2007
Proceedings: SJH`s Exhibit List filed.
PDF:
Date: 10/25/2007
Proceedings: Order on Outstanding Motions.
Date: 10/24/2007
Proceedings: CASE STATUS: Motion Hearing Partially Held; continued to October 29, 9:00 a.m., Tallahassee, Florida
PDF:
Date: 10/24/2007
Proceedings: Notice of Filing filed.
PDF:
Date: 10/22/2007
Proceedings: St. Joseph`s Hospital`s Response to South Bay, Brandon, and TGH Motions in Limine filed.
PDF:
Date: 10/16/2007
Proceedings: St. Joseph`s Hospital`s Motion for Extension of Time to File Responses to South Bay, Brandon, and TGH Motions in Limine filed.
PDF:
Date: 10/16/2007
Proceedings: Notice of Motion Hearing. (Scheduled for October 24, 2007, at DOAH)
PDF:
Date: 10/16/2007
Proceedings: SJH`s Notice of Taking Preservation Deposition of Kimberly Guy filed.
PDF:
Date: 10/16/2007
Proceedings: SJH`s Notice of Taking Preservation Deposition of Tina Long filed.
PDF:
Date: 10/15/2007
Proceedings: Letter to Judge Parrish from S. Ecenia requesting an oral argument on South Bay and Brandon`s Motion in Limine or, Alternatively, for Abeyance of Final Hearing filed.
PDF:
Date: 10/15/2007
Proceedings: South Bay Hospital`s Amended Final Witness List filed.
PDF:
Date: 10/12/2007
Proceedings: SJH`s Final Witness List filed.
PDF:
Date: 10/12/2007
Proceedings: South Bay Hospital`s Final Witness List filed.
PDF:
Date: 10/12/2007
Proceedings: Tampa General`s Final Witness List filed.
PDF:
Date: 10/12/2007
Proceedings: The Agency for Health Care Administration`s Final Witness List filed.
PDF:
Date: 10/10/2007
Proceedings: Motion in Limine and Alternative Motion for Abeyance (exhibits not available) filed.
PDF:
Date: 10/09/2007
Proceedings: SJH`s Notice of Taking Preservation Deposition of John Martin filed.
PDF:
Date: 10/09/2007
Proceedings: Southbay and Brandon`s Motion in Limine or, Alternatively, for Abeyance of Final Hearing filed.
PDF:
Date: 10/04/2007
Proceedings: Notice of Taking Deposition Duces Tecum of Jeff Gregg filed.
PDF:
Date: 10/01/2007
Proceedings: SJH Response to South Bay`S Motion to Compel Documents Responsive to South Bay`s First Request to Produce filed.
PDF:
Date: 09/28/2007
Proceedings: Response of the Agency for Health Care Administration to the Expedited Motion of St. Josephs`s Hospital for Protective Order and Motion in Limine and Motion for Extension of Time to File Transfer filed.
PDF:
Date: 09/26/2007
Proceedings: Notice of Taking Deposition Duces Tecum of Susan Zinkel filed.
PDF:
Date: 09/26/2007
Proceedings: Notice of Taking Deposition Duces Tecum of Cathy Yoder filed.
PDF:
Date: 09/25/2007
Proceedings: Tampa General`s Response in Opposition to SJH`s Expedited Motion for Protective Order and Motion in Limine filed.
PDF:
Date: 09/25/2007
Proceedings: Response to SJH`s Motion to Compel South Bay`s Responses to SJH`s First Request for Production of Documents filed.
PDF:
Date: 09/25/2007
Proceedings: South Bay`s and Brandon`s Response to St. Joseph`s Hospital`s Expedited Motion for Protective Order and Motion in Limine filed.
PDF:
Date: 09/19/2007
Proceedings: Response to SJH`s Second Request for Production of Documents to South Bay filed.
PDF:
Date: 09/18/2007
Proceedings: Expedited Motion for Protective Order and Motion in Limine filed.
PDF:
Date: 09/18/2007
Proceedings: Unopposed Motion for Brief Extension of Time to Respond to South Bay`s Motion to Compel Documents in Response to South Bay`s First Request to Produce filed.
PDF:
Date: 09/17/2007
Proceedings: Order Granting Petition to Intervene (Galencare, Inc., d/b/a Brandon Regional Hospital).
PDF:
Date: 09/14/2007
Proceedings: SJH`s Notice of Taking Deposition Duces Tecum of Deborah Shultz, M.D. filed.
PDF:
Date: 09/13/2007
Proceedings: SJH`s Motion to Compel SouthBay`s Responses to SJH`s First Request for Production of Documents filed.
PDF:
Date: 09/11/2007
Proceedings: Amended Notice of Taking Deposition Duces Tecum of Randy Spivey filed.
PDF:
Date: 09/11/2007
Proceedings: Amended Order Granting Petition to Intervene (Sun City Hospital, Inc., d/b/a South Bay Hospital).
PDF:
Date: 09/11/2007
Proceedings: The Agency for Health Care Administration`s Preliminary Witness List filed.
PDF:
Date: 09/10/2007
Proceedings: Tampa General`s Preliminary Witness List filed.
PDF:
Date: 09/10/2007
Proceedings: Notice of Taking Deposition Duces Tecum filed.
PDF:
Date: 09/10/2007
Proceedings: Sun City Hospital, Inc. d/b/a South Bay Hospital`s Preliminary Witness List filed.
PDF:
Date: 09/10/2007
Proceedings: SJH`s Preliminary Witness List filed.
PDF:
Date: 09/07/2007
Proceedings: South Bay`s Second Request for Production of Documents to St. Joseph`s Hospital, Inc. filed.
PDF:
Date: 09/07/2007
Proceedings: Notice of Voluntary Dismissal in Case No. 05-2622CON filed.
PDF:
Date: 09/06/2007
Proceedings: Tampa General`s Second Request for Production of Documents to SJH filed.
PDF:
Date: 09/05/2007
Proceedings: Galencare, Inc., d/b/a Brandon Regional Hospital`s Petition to Intervene in Case No. 05-2754CON filed.
PDF:
Date: 09/04/2007
Proceedings: Order Granting Petition to Intervene (Sun City Hospital, Inc., d/b/a South Bay Hospital).
PDF:
Date: 08/31/2007
Proceedings: AJH`s Notice of Taking Deposition Duces Tecum of Randy Spivey, M.D. filed.
PDF:
Date: 08/24/2007
Proceedings: Sun City Hospital, Inc., d/b/a South Bay Hospital`s Petition to Intervene in Case No. 05-2754CON filed.
PDF:
Date: 08/22/2007
Proceedings: Notice of Service of Supplemental Answers and Objections to SJH`s First Set of Interrogatories to South Bay filed.
PDF:
Date: 08/16/2007
Proceedings: Tampa General`s Second Request to Sun City for Production of Documents filed.
PDF:
Date: 07/30/2007
Proceedings: South Bay`s Second Request for Production of Documents to Tampa General Hospital filed.
PDF:
Date: 07/23/2007
Proceedings: Notice of Unavailability filed.
PDF:
Date: 07/16/2007
Proceedings: Response to SJH`s First Request for Production of Documents to South Bay filed.
PDF:
Date: 07/16/2007
Proceedings: Notice of Service of Answers and Objections to SJH`s First Set of Interrogatories to South Bay filed.
PDF:
Date: 07/12/2007
Proceedings: Order on Motion for Second Amended Order of Pre-hearing Instructions.
PDF:
Date: 07/09/2007
Proceedings: Notice of Service of South Bay`s First Set of Interrogatories to St. Joseph`s Hospital, Inc. filed.
PDF:
Date: 07/09/2007
Proceedings: South Bay`s First Set of Interrogatories to St. Joseph`s Hospital filed.
PDF:
Date: 07/09/2007
Proceedings: South Bay`s First Request for Production of Documents to St. Joseph`s Hospital, Inc. filed.
PDF:
Date: 07/09/2007
Proceedings: Notice of Service of South Bay`s First Set of Interrogatories to Tampa General Hospital filed.
PDF:
Date: 07/09/2007
Proceedings: South Bay`s First Request for Production of Documents to Tampa General Hospital filed.
PDF:
Date: 07/09/2007
Proceedings: South Bay`s First Set of Interrogatories to Tampa General Hospital filed.
PDF:
Date: 07/03/2007
Proceedings: Joint Motion for Entry of Second Amended Order of Pre-hearing Instructions filed.
PDF:
Date: 06/18/2007
Proceedings: Order (within 15 days of this Order, parties shall file a proposed order of pre-hearing instructions).
PDF:
Date: 06/13/2007
Proceedings: Amended Notice of Hearing (hearing set for October 29 through November 2, 5 through 9 and 12 through 16, 2007; 9:00 a.m.; Tallahassee, FL; amended as to Dates of Hearing).
PDF:
Date: 06/04/2007
Proceedings: Agreed Motion to Adjust Final Hearing Dates filed.
PDF:
Date: 04/09/2007
Proceedings: Notice of Unavailability filed.
PDF:
Date: 03/15/2007
Proceedings: Response to Tampa General`s First Request to Sun City for Production of Documents filed.
PDF:
Date: 09/25/2006
Proceedings: Order Granting Continuance and Re-scheduling Hearing (hearing set for November 5 through 9, 12 through 16 and 19 through 23, 2007; 9:00 a.m.; Tallahassee, FL).
PDF:
Date: 09/11/2006
Proceedings: Motion for Continuance and to Reschedule Final Hearing filed.
PDF:
Date: 09/08/2006
Proceedings: Amendment to Motion for Coordination of Final Hearing Dates filed.
PDF:
Date: 09/05/2006
Proceedings: Motion for Coordination of Final Hearing Dates filed.
PDF:
Date: 08/16/2006
Proceedings: Notice of Unavailability filed.
PDF:
Date: 04/26/2006
Proceedings: Notice of Appearance and Substitution of Counsel (filed by K. Byrne).
PDF:
Date: 04/25/2006
Proceedings: Order Granting Continuance and Re-scheduling Hearing (hearing set for July 9 through 13, 16 through 20 and 23 through 27, 2007; 9:00 a.m.; Tallahassee, FL).
PDF:
Date: 04/05/2006
Proceedings: Joint Motion for Continuance of Final Hearing filed.
PDF:
Date: 03/08/2006
Proceedings: Tampa General`s First Request to SJH for Production of Documents filed.
PDF:
Date: 03/08/2006
Proceedings: Tampa General`s First Request to Sun City for Production of Documents filed.
PDF:
Date: 02/07/2006
Proceedings: Amended Order of Pre-hearing Instructions.
PDF:
Date: 08/24/2005
Proceedings: Notice of Transfer.
PDF:
Date: 08/22/2005
Proceedings: Order Granting Petition to Intervene (Florida Health Sciences Center, Inc., d/b/a St. Joseph`s Hospital).
PDF:
Date: 08/18/2005
Proceedings: South Bay`s Response to Tampa General`s Petition to Intervene filed.
PDF:
Date: 08/09/2005
Proceedings: Tampa General`s Petition to Intervene filed.
PDF:
Date: 08/04/2005
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 08/04/2005
Proceedings: Notice of Hearing (hearing set for August 7 through 11 and 14 through 18, 2006; 9:00 a.m.; Tallahassee, FL).
PDF:
Date: 08/04/2005
Proceedings: Order Consolidating Cases (consolidated cases are: 05-2622CON and 05-2754CON).
PDF:
Date: 08/03/2005
Proceedings: Joint Response to Initial Order and Motion to Consolidate (05-2622 and 05-2754) filed.
PDF:
Date: 07/29/2005
Proceedings: Initial Order.
PDF:
Date: 07/28/2005
Proceedings: Petition for Formal Administrative Proceeding filed.
PDF:
Date: 07/28/2005
Proceedings: Notice (of Agency referral) filed.

Case Information

Judge:
J. D. PARRISH
Date Filed:
07/28/2005
Date Assignment:
03/06/2006
Last Docket Entry:
08/19/2008
Location:
Tallahassee, Florida
District:
Northern
Agency:
ADOPTED IN PART OR MODIFIED
Suffix:
CON
 

Counsels

Related DOAH Cases(s) (1):

Related Florida Statute(s) (6):

Related Florida Rule(s) (4):