15-002007CON West Florida Health, Inc. vs. Gulfside Hospice And Pasco Palliative Care, Inc.; Seasons Hospice Of Palliative Care Of Tampa, Llc; Vitas Healthcare Corporation Of Florida; And Life Path Hospice, Inc.
 Status: Closed
Recommended Order on Monday, March 21, 2016.


View Dockets  
Summary: On balance, Seasons best satisfied the criteria for approval of its Certificate of Need application in this comparative review.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8LIFEPATH HOSPICE, INC

11Petitioner,

12vs. Case No. 15 - 2001CON

18WEST FLORIDA HEALTH, INC.;

22AND AGENCY FOR HEALTH CARE

27ADMINISTRATION,

28Respondents.

29_______________________________/

30SEAS ONS HOSPICE & PALLIATIVE

35CARE OF TAMPA, LLC,

39Petitioner,

40vs. Case No. 15 - 2003CON

46WEST FLORIDA HEALTH, INC.;

50AND AGENCY FOR HEALTH CARE

55ADMINISTRATION,

56Respondents.

57_______________________________/

58WEST FLORIDA HEALTH, INC.,

62Pet itioner,

64vs. Case No. 15 - 2 007CON

71GULFSIDE HOSP ICE AND PASCO

76PALLIATIVE CARE, INC.; SEASONS

80HOSPICE & PALLIATIVE CARE OF

85TAMPA, LLC;LIFE PATH HOSPICE,

90INC.,

91Respondent s .

94_______________________________/

95GULFSIDE HOSPICE AND PASC O

100PALL I ATIVE CARE, INC.,

105Petitioner,

106vs. Case No. 15 - 2008CON

112AGENCY FOR HEALTH CARE

116ADMINISTRATION,

117Respondent.

118_______________________________/

119RECOMMENDED ORDER

121Pursuant to notice, the Division of Administrative

128Hearings, by its desig nated Administrative Law Judge, R. Bruce

138McKibben , held the final hearing in the above - styled case s on

151November 30 a nd December 1 through 4, 7 through 10, and

16314 through 16, 2015 , in Tallahassee, Florida.

170APPEARANCES

171For LifeP ath Hospice , Inc. :

177Seann M. Frazier, Esquire

181Parker, Hudson, Rainer & Dobbs , LLP

187215 South Monroe Street, Suite 750

193Tal lahassee, Florida 32301

197Jonathan L. Rue, Esquire

201Parker, Hudson, Rainer & Dobbs LLP

207303 Peachtree Street Northeast , Suite 3600

213Atlanta, Georgia 30308

216For Seasons Hospice & Palliative Care , Inc. :

224Ste phen C. Emmanuel, Esquire

229Michael J. Glazer, Esquire

233Ausley & McMullen

236123 South Calhoun Street

240Post Office Box 391

244Tallahassee, Florida 32301

247For West Florida Health, Inc. :

253Stephen K. Boone, Esquire

257Boone, Boone, Boone and Koda, P.A.

2631001 Avenida Del Circo

267Post Office Box 1596

271Venice, Florida 34284

274For Agency for Health C are Administration:

281Lorraine M arie Novak , Esquire

286Agency for Health Care A dministration

2922727 Mahan Drive, Mail Stop 3

298Tallahassee, Florida 32308

301For Gulfside Hospice and Pasco Palliative Care, Inc.

309Karl David Acuff, Esquire

313Law Office of Karl David Acuff, P.A.

3201615 Village Square Boulevard, Suite 2

326Tallahassee, Florida 32309 - 2770

331S TATEMENT OF THE ISSUE S

337Whether the Certificate of Need ( Ð CON Ñ ) applications filed

349by Seasons Hospice and Palliative Care , Inc. ( Ð Seasons Ñ );

361Gulfside Hospice and Pasco Palliativ e Care , Inc. ( Ð Gulfside Ñ );

374and West Florida Health , Inc. ( Ð West Florida Ñ ) ; for a new

388hospice program in Agency for Health Care Administration ( Ð AHCA Ñ

400or the Ð Agency Ñ ) Service Area 6A /Hillsborough County , satisfy

412the applicable statutory and r ule review cri teria sufficiently

422to war rant a pproval , and, if so, which of the three applications

435best meets the applicable criteria , on balance, for approval.

444PRELIMINARY STATEMENT

446On October 3 , 20 14 , the Agency published a fixed need pool

458for one new hospice progra m to be established in Service

469Area 6A, which consists of Hillsborough County, Florida .

478See Fla. Admin. Reg. , Vol. 40, No. 193, ID. No. 15126391. Nine

490applicants filed competing CON applications in response to the

499fixed need pool. On October 24 , 2015 , L ifepath Hospice, Inc.

510(ÐLifepathÑ ), submitted a letter to AHCA indicating its

519opposition to the applications filed by West Florida an d another

530applicant not a party to this proceeding.

537After a comparative review of the applications, o n

546February 2 0 , 2007, the Agency announced its intent to approve

557the application filed by West Florida (CON No. 10302), and to

568deny the other competing applications.

573Seasons and Gulfside timely filed petitions to contest the

582denial of their own applications (Nos. 10298 and 1 0294,

592respectively) and the approval of West Florida 's application.

601West Florida filed an approved applicant petition in support of

611its own application and in opposition to the Seasons and

621Gulfside applications.

623The Agency forwarded the petitions to t he Division of

633Administrative Hearings ( Ð DOAH Ñ ) for the assignment of an

645a dministrative l aw j udge to conduct a final hearing.

656LifeP ath , as the only existing hospice provider in Service

666Area 6A , filed a petition opposing the approval of the

676application fi led by West Florida. LifeP ath did not contest the

688approval of the applications filed by Seasons or Gulfside.

697On November 2 5 , 2015 , the parties filed a joint pre - hearing

710stipulation.

711During the final hearing, West Florida presented the

719testimony of Dr. Jim Burkhart, president and CEO of Tampa

729General Hospital ( Ð TGH Ñ or Ð Tampa General Ñ ), accepted as an

744expert in hospital operations and administration; Mike Schultz,

752division president of Adventist Health Systems West Florida

760(ÐFlorida HospitalÑ) , accepted as an expert in hospital

768operation and administration; Dr. Howard Tuch, director of

776palliative medicine at TGH, accepted as an expert in hospice and

787palliative care med icine; Dr. Vincent Perron, vice - president of

798medical affairs and associate chief medica l officer at TGH,

808accepted as an expert in hospice and palliative care medicine;

818Rev . William Baugh, retired director of pastoral care and

828clinical pastoral education ( Ð CPE Ñ ) at TGH, accepted as an

841expert in clinical chaplai ncy and CPE; Rev . Wayne Maberry,

852director of pastoral care and CPE at TGH, accepted as an expert

864in clinical chaplaincy and CPE; Ann Tellini, case manager and

874discharge planner at Florida Hospital , accepted as an expert in

884hospital case management and discharge planning; Rema Cole,

892direc tor of Florida Hospital - Flagler hospice care, accepted as

903an expert in hospice operations ; Armand Balsano, CON consultant,

912accepted as an expert in financial analysis and financial

921feasibility ; and David Levitt, CON consultant, accepted as an

930expert in hea lth planning . The testimony of Jennifer Cacioppo

941was also introduced into evidence by way of her deposition

951transcript. West Florida E xhibits 1 through 3, 5 through 8 , 8A,

96310 , 12 A through J, 14, and 15A through Z were admitted into

976evidence.

977Lifepath pr esented the testimony of Jay Cushman, hospital

986consultant, accepted as an expert in health planning; Darryl

995Weiner, CON consultant, accepted as an expert health care

1004finance; and Kathy Fernandez, president and CEO of Chapters

1013Hospice Systems, accepted as a n expert in hospice

1022administra tion. LifeP ath E xhibits 18 through 19, 22 through 29,

103432 through 37, 39, and 42 through 48 were admitted into

1045evidence.

1046Seasons presented the testimony of Todd Stern, CEO,

1054accepted as an expert in hospice development and admi nistration;

1064Joyce Simard, geriatric consultant, accepted as an expert in

1073dementia; Dr. Balakrishana Natarjan, medical director, accepted

1080as an expert in internal care medicine and hospice and

1090palliative care medicine; Dr. Russell Hilliard, senior vice

1098pres ident for patient experience and staff development, accepted

1107as an expert in music therapy, social work, hospice compliance,

1117and hospice programs; Pedro Del Campo , executive director of

1126Seasons H ospice in Miami, Florida, accepted as an expert in

1137hospice op erations ; Sharon Gordon - Girvin, CON consultant,

1146accepted as an expert in CON review and health care planning;

1157and Steven Jones, CPA, accepted as an expert in health care

1168finance and financial feasibility. The testimon ies of Rabbi

1177Elchonon B. Freedman, Dr. Daniel Maison, and Mary Lynn McPherson

1187were presented by way of deposition transcript s . Seasons

1197E xhibits 1 through 30 and 32 through 36 were admitted into

1209evidence.

1210Gulfside presented the testimony of Linda Ward, president

1218and CEO, accepted as an expert in hospice administration and

1228health care administration; Gene Nelson, CON consultant,

1235accepted as an expert in health planning, CON review criteria,

1245and CON procedures; Rick Knapp, CON consultant, accepted as an

1255expert in financial feasibility and CON pro jects; and Kathy

1265Postiglione, chief op erating officer and senior vice - president

1275of business development, accepted as an expert in hospice

1284operations. Gulfside E xhibits 1 through 8, 9 A through G , and

129610 A through K (including the deposition transcripts of D eborah

1307Gilles, Suzanne Johnson, Rabbi Aaron M. Lever, Tara Scalise,

1316Shelley Schneider, Dr. Charles L. Suggs, and Anthony Trovato)

1325were admitted into evidence.

1329AHCA presented the testimony of Marisol Fitch , Health

1337Services and Facilities consultant superv isor, accepted as an

1346expert in healt h care planning and CON. AHCA E xhibits 1 and

13592 were admitted into evidence.

1364The partiesÓ request for additional time to file proposed

1373recommended orders (PROs) and for extension of the page limit

1383for PROs to 50 pages was granted. The parties were given until

1395February 12, 2016, to file PROs. Each party timely submitted

1405its PRO. All post - hearing submissions have been considered in

1416the preparation of this Recommended Order.

1422Unless specifically stated otherwise herein, all references

1429to Florida Statutes shall be to the 2015 version.

1438FINDINGS OF FACT

1441I. Procedural History

1444A. The Fixed Need Pool

14491. On October 3, 2014, the Agency published a need for one

1461additional hospice program in Hospice Service Area 6A,

1469Hillsb orough County, for the January 2016 planning horizon.

14782. Under the Agency's need methodology, numeric need for

1487an additional hospice program exist s when the difference between

1497projected hospice admissions and the current admissions in a

1506service area is equal to or greater than 350.

15153. The need methodology promotes competition and access

1523because numeric need exists under the methodology when the

1532hospice use rate in a service area falls below the statewide

1543average use rate.

15464. I n a service area in which there is a sole hospice

1559provider, as in the present case, the existing provider has an

1570incentive to continually improve access to hospice services in

1579the service area in order to avoid numeric need for an

1590additional program under th e formula.

15965. For the January 2016 planning horizon, the Agency

1605determined that the difference between projected hospice

1612admissions and current admissions in Hospice Service Area 6A

1621was 759, and therefore a numeric need for an additional hospice

1632program exists in Hillsb orough County.

16386. AHCA is the s tate a gency authorized to evaluate and

1650render final determinations o n CON applications pursuant to

1659s ection 408.034(1) , Florida Statutes.

1664A. The Proposals and Preliminary Decision

16707. Nine applicants submitted CON applicat ions seeking to

1679establish a new hospice program in AHCA Service Area 6A,

1689Hillsborough County, in response to the fixed need pool .

1699LifePath , the only existing provider of hospice care in the

1709service area, opposed the hospice application which was

1717sponsored by a hospi tal system , i.e., West Florida Ós .

17288. After reviewing the applications, the Agency

1735preliminar il y approved West Florida's CON Application No. 10302

1745and preliminarily denied the remainder of the applications,

1753including Seasons Ó CON Application N o. 10298 and Gulfside's CON

1764Applica tion No. 10294 .

17699. At the final hearing, Marisol Fit ch, s upervisor of

1780AHCA's CON unit, testified that the Agency approved West

1789Florida's CON a pplication because it determined that West

1798Florida's a pplication best promot es increased access to hospice

1808services for residents of Hillsborough County. The Agency

1816concluded that Tampa General and Florida Hospital, West

1824Florida's parent organizations, already have large

1830infrastructures in place in Hillsborough County. According ly,

1838the Agency determined that West Florida's proposed hospice

1846program, if approved, would benefit from built - in access points

1857that would enable West Florida to improve hospice accessibility.

1866B . The Applicants , AHCA and Lifepath

1873West Florida

187510. West F lorida is a joint venture with 50 - 50 ownership

1888and control by Tampa General and Florida Hospital , two acute

1898care hospitals in Hillsborough County . The entity was created

1908for the purpose of seeking the CON at issue in this proceeding

1920for a new hospice in S ervice Area 6A. West Florida recently

1932became the owner/operator of three home health agencies which

1941had been operated for several years by the Florida Hospital

1951System. Tampa General has not operated hospices in the past,

1961while Flo rida Hospital has, and t he CON a pplication submitted by

1974W est Florida relied heavily upon the Florida Hospital - affiliated

1985hospiceÓs programs and history .

1990West Florida is the only applicant in this proceeding that is

2001hospital affiliated .

2004Seasons

200511. Seasons, the applicant, is a single purpose entity

2014created for the purpose of seeking a CON to operate a new

2026hospice in Service Area 6A. It is affiliated with Seasons

2036Hospice and Palliative Care, a for - profit company (hereinafter

2046referred to as ÐSeasons HPCÑ).

2051Seasons HPC is the largest family - owned hospice organization in

2062the country .

206512. The first Seasons HPC - affiliated hospice opened in

2075Chicago, Illinois , in 1997 . In 2003, Seasons HPC opened its

2086second hospice in Milwaukee, Wisconsin, and in 2004 , it acquired

2096a third hospic e in Baltimore, Maryland. Since 2004, Seasons HPC

2107has continued to grow nationally by opening, or in some cases

2118acquiring , hospices in new markets. Today, Seasons HPC is the

2128fourth largest hospice compa ny in the United States with

213825 separate hospices op erating in 18 different states.

214713. Each Seasons HPC - affiliated hospice is a separate

2157entity, with its own license, executive director, and staff.

2166However, each Seasons HPC hospice is connected via overlapping

2175ownership and via contracts with Seasons H ealthcare Management ,

2184its management company . Among the services that Seasons

2193Healthcare Management provides to each Seasons HPC hospice are :

2203education and training, quality management, financial planning

2210support, management of payrolls, tax preparation, cost report

2218preparation and coordination, IT services, corporate compliance

2225policies and programs, marketing and development expertise, in -

2234house legal services, and a wide variety of policies and

2244consultations including, but not limited to, clinical suppo rt

2253and physician oversight.

225614. Todd Stern is the CEO of Seasons Healthcare Management

2266and is also the CEO of the 25 separate hospices that Seasons HPC

2279operates throughout the country. Mr. Stern joined Seasons HPC

2288in 2001, and was appointed CEO in 2008 .

2297Gulfside

229815. Gulfside is a 501(c)3 community - based, not - for - profit

2311organization and is licensed by AHCA . Gulfside has been

2321providing hospice services in Pasco County (which is contiguous

2330to Hillsborough County) for more the 25 years. Gulfside

2339provide s service to all patients in need regardless of race,

2350creed, color, gender, sexual orientation, national origin, age,

2358qualified individual with a disability, military status, marital

2366status, pregnancy, or other protected status.

2372LifePath

237316. LifePath is the sole existing, licensed hospice

2381provider in Hospice Service Area 6A, Hillsborough County.

2389LifePath is a subsidiary of Chapters Health System.

239717. LifePath has provided hospice services in Hillsborough

2405County since 1983. It was the first hospice pr ogram in the state

2418to be accredited by The Joint Commission and has continuously

2428maintained that accreditation. LifePath is also accredited by

2436the National Institute for Jewish Hospice s .

244418. In addition to providing routine, continuous, and

2452respite car e to residents of Hillsborough County, LifePath also

2462provides inpatient hospice care in two , 24 - bed hospice houses

2473located in Temple Terrace and Sun City, Florida. Additionally,

2482LifePath has scatter - bed contracts with all of the acute care

2494hospitals in Hi llsborough C ounty to provide inpatient care .

250519. LifePath is an important part of the healthcare

2514continuum in Hillsborough County and works collaboratively with

2522other healthcare providers in the community, including hospitals,

2530nursing homes, and assiste d - living facilities.

2538AHCA

253920. AHCA is the state agency responsible for administering

2548the Florida CON program.

2552I. Overview of Hospice Services

255721. In Florida, a hospice program is required to provide a

2568continuum of palliative and supportive care for te rminally ill

2578patient s and their famil ies . A terminally ill patient has a

2591medical prognosis that his or her life expectancy is one year or

2603less if the illness runs its normal course. Under the Medicare

2614program administered by the federal government, a ter minally ill

2624patient is one who has a life expectancy of six months or less.

263722. Hospice services must be available 24 hours a day,

2647seven days a week, and must include certain core services, such

2658as nursing services, social work services, pastoral or

2666cou nseling services, dietary counseling, and bereavement

2673counseling services. Physician services may be provided by the

2682hospice directly or through contract.

268723. Hospice care and services provided in a private home

2697shall be the primary form of care. Hosp ice care and services

2709may also be provided by the hospice to a patient living in an

2722assisted living facility, adult family - care home, nursing home,

2732hospice residential unit or facility, or other non - domestic

2742place of permanent or temporary residence.

274824 . The inpatient component of care is a short - term

2760adjunct to hospice home care and hospice residential care and

2770shall be used only for pain control, symptom management, or

2780respite care. The hospice bereavement program must be a

2789comprehensive program, und er professional supervision, that

2796provides a continuum of formal and informal support services to

2806the family for a minimum of one ye ar after the patient's death.

281925. The goal of hospice is to provide physical, emotional,

2829psychological, and spiritual com fort and support to a dying

2839patient and their family. Hospice care provides palliative care

2848as opposed to curative care, with the focus of treatment

2858centering on palliative care and comfort measures.

286526. Hospice care is provided pursuant to a plan of c are

2877that is developed by an interdisciplinary team consisting of ,

2886e.g. , physicians, nurses, social workers, counselors, chaplains ,

2893and other disciplines .

289727. There are four levels of service in hospice care:

2907routine home care, continuous care, general inpatient care, and

2916respite care. Generally, hospice routine home care comprises

2924the vast majority of patient days and respite care is typically

2935a very minor percentage of days.

294128. Continuous care is basically emergency room - lik e or

2952crisis care that c an be provided in a home care setting or in

2966any setting where the patient resides. Continuous care is

2975provided for short amounts of time usually when symptoms become

2985severe and skilled and individual interventions are needed for

2994pain and symptom managemen t.

299929. The inpatient level of care provides the intensive

3008level of care within a hospital setting, a skilled nursing unit,

3019or in a free - standing hospice inpatient unit. Respite care is

3031generally designed for caregiver relief.

303630. Medicare reimburses different levels of care at

3044different rates. Approximately 85 - to - 90 percent of hospice care

3056is paid for by Medicare.

306131. There are certain services required or desired by some

3071patients that are not necessarily covered by Medicare and/or

3080private or com mercial insurance. These services include music

3089therapy, pet therapy, art therapy, massage therapy, and

3097aromatherapy , a mong others . There are other , more complicated

3107and expensive non - covered services , such as palliative

3116chemotherapy and radiation , that may be indicated for severe

3125pain control and symptom control. Hospices which provide these

3134additional services are said to have Ðopen accessÑ and foot the

3145bill for such services.

3149I I. The PartiesÓ Proposals

315432. Each of the applicants - - as well as LifeP ath and the

3168Agency Î - agree that any one of the applicants could provide

3180quality hospice services if approved. The following paragraphs

3188set out some of each applicantÓs attributes. Before each of the

3199applicantsÓ proposals is discussed more fully below, it is clear

3209that all of the applicants would likely be successful if

3219approved . As stated by the parties themselves: ÐAll three

3229applicants . . . have the ability to operate a high quality

3241hospice.Ñ West Florida counsel, Tr ., p. 12 . ÐT hese are all

3254excellen t providers Ñ and ÐThere are no bad choices here.Ñ AHCA

3266counsel, Tr., pp. 1802 and 2009 . ÐAll [applicants] would be

3277qualified; they all do good.Ñ Lifepath counsel, Tr., p. 1980 .

3288ÐAll applicants will undoubtedly provide the same level of

3297quality care.Ñ West Flo rida PRO, ¶ 59 . The ultimate concern of

3310AHCA regarding a new hospice provider in Hillsborough County is

3320not the quality of care that the applicants can provide. All

3331applicants will undoubtedly provide the same level of quality

3340care. The real con cern is costs, access, and availability.

3350The Agency believes that West Florida will be best suited to

3361promote cost effectiveness , as well as increase access and

3370availability .

3372A. West Florida

337533. West Florida is a collaborative effort by two existing ,

3385licensed hospitals in the service area. West Florida justifiably

3394touts its connection to educational institutions. West Florida

3402conditioned its approval on the funding of an additional

3411palliative care fellowship at the U niversity Of South Florida

3421Colle ge of Medicine at an annual cost of roughly $80,000 and an

3435additional CPE resident in Tampa GeneralÓs CPE program at an

3445annu al cost of $30,000 .

345234. H aving West Florida as part of the Tampa General

3463Ð f amilyÑ will expose not only the new palliative care fel low,

3476but also medical students, medical interns and residents, other

3485fellows, nurses, and a wide variety of allied health

3494professionals , to hospice services and the benefits of hospice

3503care.

350435. The new CPE resident could help to expand knowledge

3514about en d - of - life care and ultimately improve acc ess to hospice

3529services . West Florida will benefit the Tampa General pastoral

3539care and CPE program by extending pastoral palliative care and

3549end - of - life care training and experiences for all CPE students.

356236. Flo rida Hospital is a part of the Adventist Health

3573System, which operates all types of healthcare facilities

3581throughout the nation , including hospitals, rehab facilities,

3588h ome health agencies, hospices, long term acute care hospitals ,

3598nursing homes, and more. In Florida, Adventist operates a range

3608of facilities , including statutory teaching hospitals,

3614quaternary - level service providers, critical - access hospitals,

3623and safety net hospitals. In Hillsborough County, Florida

3631Hospital operates Florida Hospital Tam pa and Florida Hospital

3640Carrollwood, both acute care facilities, in addition to a

3649variety of outpatient facilities, physician practices, and the

3657like .

365937. West Florida has proposed and is committed to opening

3669a four - bed hospice inpatient unit at Florida Hospital

3679Carrollwood, located in the northwestern portion of the county.

3688Currently , there are two other inpatient hospice house units in

3698Hillsborough County, one on the eastern side and one in the far

3710south , both operated by LifePath . The unit w ould theor etically

3722benefit hospice patients by increasing the number of inpatient

3731beds and improving geographic distribution, thereby provid ing

3739more access to hospice care.

374438. An inpatient unit may operate better than contracted

3753Ðscatter bedsÑ because hospice st aff trained in end - of - life care

3767and symptom management would be the medical personnel providing

3776care to the patient ra ther than other hospital staff.

378639. Florida Hospital is an experienced provider of hospice

3795services in the State of Florida, operating Florida Hospital

3804Hospice Care in Volusia and Flagler Counties, as well as Hospice

3815of the Comforter in Orange and Osceola Counties. Ms. Rema Cole

3826is the a dministrator for Florida Hospital Hospice in Flagler and

3837Volusia Counties. She has been responsible f or opening two new

3848hospice programs in the State of Florida.

385540. West Florida will provide a wide variety of unfunded

3865Ðopen accessÑ services to its patients, such as : radiation and

3876chemotherapy, caring for patients on ventilators, and train ing

3885staff to provide these services.

389041. Combined, Florida Hospital and Tampa General touch

3898tens of thousands of lives in Hillsborough County, totaling

3907approximately 52,000 patients each year. Tampa General or

3916Florida Hospital could tell its patients and their fam ilies

3926about the goals and b enefits of hospice care . It is likely West

3940Florida would tend to promote its own hospice more prominently

3950than it would pro mote its competitor Ós (LifePath) services.

396042. West Florida suggests the possibility of a fully

3969integr ated electronic medical record. It would entail a long

3979process, but steps have already been taken to begin the

3989integration. The ability of the medical records of both Tampa

3999General Hospital and Florida Hospital to ÐtalkÑ to each other

4009and all related anc illary providers, including its clinically

4018integrated network, home health agency, and West Florida c ould

4028improve the abili ty to reduce costs, as well as emergency room

4040visits and unplanned admissions of hospice patients to

4048hospitals. Having a streamlined system that communicates

4055between the hospice, hospitals, and their ancillary providers

4063could reduce workload, unnecessary paperwork, and increase the

4071efficiency at which the hospice staff is able to operate. There

4082is no such system in operation yet, but West Florida has plans

4094to implement it once it is available.

410143. Florida Hospital Hospice Care provides a wide range of

4111non - compensated programs, including a pet partner program called

4121ÐHosPoochÑ that provides pet therapy to patients in inpatient

4130units, nursing homes, ALFs, and even to non - hospice patients at

4142their cancer centers. They also have a recording project called

4152Project Storytellers that has a group of volunteers going into

4162patientsÓ homes or wherever they may be to talk to the patient

4174about t heir life, record things that were important to them, and

4186give that recording to the families as a keepsake. Florida

4196Hospital Hospice Car e is involved with their local Veterans

4206A dministration nursing home and clinic, where volunteers perform

4215pinnings of v eterans. There is also music therapy, a group of

4227quilters, and vigil volunteers, who sit at the bedside of

4237patients to keep watch if the caregiver needs to take a break or

4250run errands.

42524 4 . West Florida can immediately tap into the existing

4263connections that both Florida Hospital and Tampa General have in

4273the community. These include relationships and connections with

4281physicians, churches, civic groups, and other organizations,

4288both healthcare and non - healthcare related. These existing

4297relationships w ou ld serve not only as opportunities to market

4308West Florida, but could also serve as educational opportunities

4317to inform more individuals, groups, and organizations about the

4326benefits of hospice care and the availability of the West

4336Florida.

433745. West Flor ida agreed to condition approval of its CON

4348application on the following eleven concepts :

43551) Annual funding for an additional

4361palliative care fellowship at the University

4367of South Florida;

43702) Annual funding for an additional CPE

4377resident;

43783) Annual s ponsorship of up to $5,000 for

4388childrenÓs bereavement camps;

43914) Up to $10,000 annually for a special

4400wish fund;

44025) Operating a 4 - bed inpatient unit at

4411Florida Hospital Carrollwood;

44146) Programs which are not paid by Medicare;

44227) Offices on the camp us of Tampa General

4431and Florida Hospital;

44348 ) Using a licensed clinical social worker

4442with at least a MasterÓs degree to lead the

4451psychological department;

44538 ) Establish an education program on

4460hospice care accessible to medical staff;

446610 ) Progr ams fo r the Hispanic population;

4475and

447611 ) Creation of a community resource

4483information website.

4485A. S easons

448846. Seasons described its proposal for services through

4496various key players within its parent organization .

450447. Dr. Balakrish an a Natarjan is the ch ief medical o fficer

4517for Seasons Healthcare Management. Dr. Natarjan plays an active

4526role in recruiting the medical directors for each Seasons

4535hospice, and the medical director of each hospice reports

4544directly to him. Dr. Natarjan has developed a detailed list of

4555the medical directorÓs qualifications and responsibilities, and

4562a list of what he deems to be Ð non - negotiable company values Ñ to

4578which each medical director must agree. It is difficult to

4588imagine how some of those values can be monitored (e.g., Ð T he

4601Medical Director must love holding the patientÓs hand Ñ ; ÐThe

4611Medical Director must go to bed each night knowing they made a

4623difference in the lives of specific dying patients, Ñ etc . ), but

4636the idea of non - negotiables is recognized as positive. Seasons

4647has also recently hired Daniel Maison, M.D. , as the associate

4657chief medical o fficer for the company.

466448. Dr. Russell Hilliard is Seasons Ó vice - p resident for

4676Patient Experience and Staff Development. He has a Ph.D. in

4686music education , with an emphasis i n music therapy and social

4697work from Florida State University. His work is well - recognized

4708in the hospice community. He was instrumental is starting the

4718music therapy programs at Big Bend Hospice in Tallahassee,

4727Florida, and at Hospice of Palm Beach Coun ty (Florida). His

4738concept of music therapy is innovative, inclusive, and well -

4748proven to achieve positive results. Dr. Hilliard will assist

4757Seasons in doing a community - oriented needs assessment to

4767ascertain what needs exist in Hillsborough County, examin e how

4777to meet those needs, and establish programs to be implemented

4787upon approval as a hospice provider in the area. SeasonsÓ music

4798therapies would then be implemented as necessary to meet the

4808identified needs.

481049. Seasons ha s also assembled a team of national experts

4821who are available to assist in various areas. One such expert

4832is Mary Lynn McPherson, Pharm.D. Dr. McPherson has developed an

4842online course entitled ÐMedication Management at the End of Life

4852for Clinical, Supportive, Hospice an d Palliati ve Care

4861Practitioners , Ñ that is offered through Seasons.

4868Dr. McPherson is purportedly available 24 hours a day, seven

4878days a week , to field numerous calls from Seasons physicians and

4889other staff regarding complex medication management issues.

489650. Joyc e Simard , a national expert in caring for people

4907with dementia , developed for Seasons HPC hospices a specialized

4916program for patients in the advanced stages of dementia. The

4926program uses person - centered approaches to improve the quality

4936of life for people suffering from dementia through meaningful

4945sensory activities that stimulate the senses and promote comfort

4954and serenity.

495651. Seasons Hospice Foundation ( Foundation ) is an

4965independent 501(c)(3) , non - profit foundation founded in 2011.

4974The Foundation wa s established because Seasons was receiving

4983unsolicited donations from grateful families and friends of

4991patients, and it wanted these funds to go to a charitable

5002purpose. Today the mission of the Foundation is to serve the

5013needs of patients outside the ho spice benefit. For example, the

5024Foundation will assist patients who are unable to cover basic

5034non - hospice needs, such as restoring electricity to a patientÓs

5045home or air fare so family members can travel to see a patient.

505852. Seasons do es not rely on ch aritable contributions or

5069other philanthropy to support its operations, nor does it rely

5079on any other types of non - hospice revenue sources such as thrift

5092shops.

509353. Unlike some new hospices which try to conserve

5102resources and hire part - time staff wh en o pening, Seasons invests

5115100 percent in new programs up front. All of the initial core

5127staff is full - time, even when the hospice may be starting out

5140with just a handful of patients. This allows the hospice team

5151to develop trust among the group and to beco me familiar with

5163SeasonsÓ policies, procedures and culture.

516854. Each Seasons HPC program and staff is reflective of

5178the ethnic and cultural make - up of the area it serves. However,

5191the mission statement, core values, service standards, operating

5199practic es, protocols, and policies are uniform in each Seasons

5209HPC hospice.

521155. Seasons provide s a large depth and breadth of programs

5222in its hospices. Included among those services are music

5231therapy, pet therapy (using certified pet therapy animals , as

5240well a s a specialized robotic seal for certain patients),

5250Namaste (a specialized program for patients in the advanced

5259states of dementia), Kangaroo Kids summer camp, Volunteer Vigil

5268program, Leaving a Legacy, and Careflash . Seasons also

5277partici pates in the We H onor Veterans p rogram.

528756. Seasons would provide Ð o pen a ccessÑ services in

5298Hillsborough County. Seasons w ould provide these services for

5307patients choosing to continue them so long as their prognosis

5317remains six months or less , and the treatment is appro ved by the

5330clinical leadership team for appropriateness. Such

5336interventions may include IV antibiotics, blood transfusions,

5343palliative cardiac drips, ventilator support, radiation therapy,

5350heart therapy, dialysis and other palliative therapies.

535757. As discussed earlier, Seasons offers a very robust and

5367highly professional music therapy program. But Seasons also

5375provides music companions when simple entertainment is what is

5384called for and Seasons makes sure the entire interdisciplinary

5393staff is trained in this subject.

539958. Seasons actively work s with hospitals in the markets

5409it serves to educate physicians and allied health professionals

5418in hospice and end - of - life care. Seasons hospices have

5430affiliation agreements with several medical schools around the

5438country to offer internships, fellowships, and other educational

5446opportunities to pre - med students, medical students, and

5455residents.

545659. Seasons hire s experienced nurses who have previously

5465worked in emergency rooms and intensive care unit s, and

5475con sequently is able to provide a much more clinically complex

5486service than some other hospices. As a result, Seasons is able

5497to serve patients that other organizations typically may not

5506have served.

550860. Seasons utilize s a hospice - specific electronic medi cal

5519record and is the largest hospice client of Cerner , a medical

5530records provider . When a patient is admitted to a Seasons

5541hospice, Seasons gathers the medical history of the patient,

5550including hospital records if the patient has recently been in

5560the hos pital, and all relevant non - hospital medical records,

5571including rehab notes, labs and other diagnostic testing

5579results. This integrated electronic medical record is

5586accessible to all Seasons hospice team members.

559361. Seasons ha s a centralized call center that takes calls

5604from patients and their families 24 hours a day, seven days a

5616we e k. At the call center, there are clinicians who are licensed

5629in every state where Seasons operates who can respond to

5639questions and provide consultation. The call center s taff has

5649full access to the patientÓs electronic medical record in real

5659time. Seasons also requires that all of its staff, including

5669management at all levels, make calls to check on patients during

5680the term of their treatment (i.e., not only when a patien t calls

5693or after the patient has died).

569962. In September 2010, Seasons acquired a controlling

5707interest in a hospice in Miami - Dade County that was formerly

5719known as Douglas Gardens Hospice. The hospice was acquired from

5729the Miami Jewish Health System, w hich retains a 20 - percent

5741ownership in the hospice. At the time Seasons took over Douglas

5752Gardens Hospice, the census was approximately 63 patients and

5761the hospice was largely dependent upon referrals from the

5770relatively small Miami Jewish Health System. Seasons retooled

5778the makeup of the staff to better reflect the c ountyÓs Hispanic

5790population and aggressively developed outreach efforts across

5797the entire c ounty. By the time of the final hearing, Douglas

5809Gardens had grown to be the second largest hospice in Miami - Dade

5822County with a census of 520 patients.

582963. When Seasons acquired its interest in the Miami - Dade

5840County hospice, it diligently pursued referrals from assisted

5848living facilities and nursing homes . In September 2010, Seasons

5858had 13 admission s from ALFs ; in September 2015 , that number had

5870risen to 154 admissions.

587464. Seasons Ó hospice in Miami - Dade County has contracts

5885with over 60 percent of the nursing homes in the c ounty. In

5898September 2015 , the hospice admitted 110 patients from skilled

5907nursing facilit ie s. It has also pursued marketing to more than

591930 acute care hospitals in the county. Today, approximately

592840 to 45 percent of Seasons Ó referrals in Miami - Dade County come

5942from acute care hospitals.

594665. The majority of Seasons Ó Miami - Da de County Ós staff,

5959including its executive director, is bilingual, and the hospice

5968serves a large number of Hispanic patients. It also employs

5978five to six chaplains, including non - denominational chaplains, a

5988rabbi, and a Catholic priest who is able to del iver the

6000sacrament of l ast rites. Seasons HPC requires all of its

6011chaplains to be either board - c ertified or become board - certified

6024within a year of being hired.

603066. Seasons HPC has developed a more formalized consulting

6039arrangement with another national expert, Rabbi Elchonon

6046Freedman from West Bloomfield, Michigan. Rabbi Freedman has

6054been involved in the hos pice field since the early 1990 s and has

6068four CPE units (equivalent to a m asterÓs degree) and is b oard -

6082certified . He heads t he Jewish Hospice & Ch aplaincy Network in

6095Michigan which is heavily involved in hospice education across

6104all denominations.

610667. Seasons participate s in the Ð We Honor Veterans Ñ

6117program, and its Miami program has achieved Level 3 status.

612768. Seasons opened a new ho spice in B roward County in

6139late 2014 , and it became Medicare certified in August 2015.

6149The Broward hospice h as achieved an average daily census of more

6161than 50 patients as of the date of the final hearing .

617369. Seasons HPC has been successful in opening and grow ing

6184new hospices in other large metropolitan markets throughout the

6193country, most of which have no CON requirements and therefore

6203present significantly higher hospice competition. Examples of

6210large metropolitan markets where Seasons has successfully opene d

6219and grown the census of new hospice s include: Phoenix, n orthern

6231California, San Bernandino, and Houston.

623670. Seasons also agreed to condition its CON application

6245approval on certain agreed services, including:

62511) Providing at least two continuing

6257educ ation units per year to registered

6264nurses and licensed social workers at no

6271charge;

62722) Offering internship experiences for

6277various disciplines involved in hospice

6282care;

62833) Donation of $25,000 per year to fund a

6293wish fulfillment program for its patients

6299and families;

63014) Provision of services outside the

6307therapies paid for by Medicare; and

63135) Voluntary reporting of the Family

6319Evaluation of Hospice Care survey to AHCA.

6326C . Gulfside

632971. Gulfside is a 501(c)3 community - based, not - for - profit

6342organizat ion licensed by the AHCA as a hospice .

6352Gulfside has been providing hospice services in Pasco County for

6362more the 25 years. Gulfside provides care to all individuals

6372eligible for care who meet the criteria of terminal illness and

6383reside within the servic e area. Gulfside is a ccredited by the

6395Joint Commission with Gold Seal status.

640172. Gulfside has grown in scope of services and in terms

6412of census and coverage. I n July 2004, it had 50 patients and

6425roughly 30 staff members. It had a limited reach withi n Pasco

6437County, primarily serving the community of New Port Richey.

6446Hernando - Pasco Hospice, now known as HPH, was the dominant

6457hospice provider in Pasco County . Gulfside grew, in part,

6467through extensive community education to physicians and other

6475healthc are and service providers, to its current average census

6485of 360, which makes it the dominant hospice provider in Pasco

6496County .

649873. The leadership at Gulfside has extensive experience in

6507hospice, senior living , and AlzheimerÓs care and management ,

6515includ ing the management of senior living and SNF facilities,

6525and developing new facilities and programs. Gulfside has a

6534depth of experience in oncology care, social work, nursing,

6543hospice and palliative medicine, health care administration,

6550technical developme nt, as well as prog ram and project

6560development. For example, GulfsideÓs CEO and COO were both part

6570of the team at LifePathÓs S ervice A rea 6B program (Polk,

6582Highland and Hardee Counties) as the program was developing ,

6591growing from a cen sus of 200 to 350 in one year.

660374. Each hospice patient at Gulfside meets with its

6612interdisciplinary team (Ð IDT Ñ) at least bi - weekly to discuss

6624patients and to review their plan of care and any adjustments to

6636the care plan. These meetings also include an educational

6645compo nent for IDT members. IDT meetings also take place when a

6657patient request s a change in their care plan or should a change

6670in the patientÓs status trigger a new IDT review.

667975. Additionally, the physician member of the IDT will

6688confer on a regular basis with the h ospice medical d irector to

6701obtain guidance and advice. The s piritual and pastoral care

6711staff are also part of the IDT .

671976. Gulfside has extensive orientation and training for

6727newly hired staff, requires that new staff must demonstrate core

6737c ompetencies before rendering services, and requires all staff

6746to regularly demonstrate their competencies at GulfsideÓs

6753recurring Ðskills days.Ñ Gulfside encourage s all disciplines of

6762its staff to maintain competencies, receive additional training,

6770and ea rn continuing education units in their respective fields .

678177. Field staff use web - connected laptops and smartphones

6791to assist with documentation and make live updates to the

6801Electronic Medical Record (Allscripts) which Gulfside phased in

6809over two years ago. Gulfside also has software programs which

6819help to identify potential hospice referrals, allowing them to

6828focus their outreach and education efforts to reach new

6837patients.

683878. Gulfside has inpatient and other hospice service

6846agreements with every h ospital and nursing home in Pasco County.

685779. Gulfside has a very involved structure for internal

6866improvement and regulatory compliance. There are a series of

6875audits conducted by supervisors and others throughout its

6883organization to ensure proper care, documentation and

6890compliance. This type of review for performance improvement has

6899been in place at Gulfside since 2005. Gulfside uses the

6909services of DEYTA, a national organization, to assist it with

6919the processing and data aggregation of its CHA Ps resu lts as part

6932of its benchmarking for excellence. GulfsideÓs commitment to

6940quality and compliance w as recognized in their las t CMS and

6952State Survey results, both of which were deficiency - free.

696280. GulfsideÓs v olunteer s ervices are well - developed,

6972allowin g trained and supervised v olunteers to work

6981in administration, patient care, patient support, and even as

6990part of the spiritual care team.

699681. Gulfside was awarded the Florida Hospices and

7004Palliative Care AssociationÓs Excellence Award in 2015 for its

7013specialized Spiritual Care Volunteer Program. That p rogram uses

7022volunteers with spiritual or counseling training, including

7029Stephen Ministers (lay - ministers) and retired clergy, to

7038primarily serve patients with memory impairments , allowing the

7046hospice ch aplains to focus their efforts on patients with a more

7058involved spiritual plan of care that might involve complicated

7067unresolved r elationships and life review.

707382. Community o utreach and e ducation and marketing efforts

7083by hospices are important for a ho spice to be part of the

7096community. Gulfside has an extensive history of outreach

7104programs that include educational programs for physicians and

7112facility staff, programs to honor local veterans, and to provide

7122education and support to caregivers, patients, and to others

7131caring for family and loved ones with life limiting illnesses.

714183. Local fundraisers and events help keep Gulfside in

7150touch with the community at large, in addition to raising fund s

7162which help support its mission. GulfsideÓs Thrift Shop

7170o perations are part and parcel of this community presence. The

7181thrift shop operations are a significant source of GulfsideÓs

7190operating revenues.

719284. If approved, Gulfside would focus its attention to

7201end - stage heart disease patients, as its research sho wed that

7213fewer patients with this diagnosis were currently being served

7222in Hillsborough County. Gulfside has developed special program

7230to serve these pati ents and their unique needs. The end - stage

7243heart disease incidence rate in Hillsborough County for t he

7253Hispanic population was 25 percent , much higher than the

7262incidence rate for the population at large of seven percent .

7273Gulfside sees this fact as evidence of need for more focused

7284services.

728585. Another unique trend Gulfside identified in

7292Hillsborough County is a comparatively higher infant mortality

7300rate when compared to the state average. In response to that

7311identified trend, Gulfside proposed a program to meet the need

7321for anticipatory grief and bereavement counseling for the

7329parents and siblings o f these infants and children.

733886. Gulfside currently has well - established relationships

7346with providers in Hillsborough County, physicians, hospitals,

7353SNFs, and conducts outreach and education as part of its mission

7364to educate about hospice , as well as t o serve the increasing

7376number of patients its serves who are Hillsborough County

7385residents.

738687 . Gulfside agreed to a number of conditions for approval

7397of its CON application:

7401• Condition 1 is for enhanced services to

7409Veterans. Gulfside is a Level 4 W e Honor

7418Veterans provider.

7420• Condition 2 is for special bereavement

7427programs and is consistent with GulfsideÓs

7433programs and includ es the traumatic loss

7440program.

7441• Condition 3 is for special programs not

7449covered by Medicare, and these programs all

7456complimen t the patient and family hospice

7463experience and are incorporated into how

7469Gulfside provides care. These programs

7474include:

7475• (a) Pet Peace of Mind program for ensuring

7484patients and families are not burdened with

7491additional stress worrying about the care of

7498their pets.

7500• (b) Treasured Memories, an interactive

7506craft - based activity to express feelings and

7514to create a tangible reminder of the

7521patient .

7523• (c) Heartstrings, a program using Reverie

7530Harps to provide a soothing focus for

7537patients and families, and include the

7543patient playing the Harp. The Reverie Harp

7550is a unique instrument which is auto - tuned

7559and harmonizing; anyone can play it and make

7567beautiful soothing music.

7570• Condition 4 provides for an Ethics Committee

7578to assist with dilemmas and concer ns for

7586professionals and others when there is a

7593question regarding cultural, religious, or

7598clinical questions about the appropriateness

7603or compatibility of a course of care or

7611other decisions related to a patient .

7618• Condition 5 is for GulfsideÓs Crisis

7625Stab ilization program which has become a

7632significant program as troubled family

7637dynamics and other at - risk situations seem

7645to arise with more frequency.

7650• Condition 6 is for the Patient and Family

7659Resource Navigator, a program already being

7665used in Pasco Coun ty which assists patients

7673and families to identify community and

7679governmental benefits and resources which

7684may be available to them and assisting them

7692with applying or acces sing the benefits or

7700resources.

7701• Condition 7 is to provide programs for

7709patients whose primary language is not

7715English. This will include providing for

7721translations and to recruit bilingual staff

7727and volunteers.

7729• Condition 8 reflects that Gulfside is an

7737Ðopen accessÑ hospice, providing complex

7742therapies such as infusion therapies,

7747d obutamine, special wound care, palliative

7753chemotherapy and palliati ve radiation to its

7760patients.

7761• C ondition 9 was for Gulfside to offer non -

7772cancer patient outreach and education. This

7778includes the previously discussed end - stage

7785heart disease and Alzheim erÓs patients.

7791• Condition 10, Gift of Presence for the

7799actively dying , will require the provision

7805of specially trained volunteers to be

7811present with patients and families during

7817the last stages to assist and c omfort them .

7827• Condition 11 is related to phy sician and

7836clinician education , and networking programs

7841to educate community practitioners and

7846aligned professionals about hospice and

7851palliative care and to provide peer - to - peer

7861networks.

7862• Condition 12, provides for professional and

7869physician internshi ps and residencies, as

7875well as the use of professional volunteers

7882to educate about hospice and pal liative care

7890services .

7892• Condition 13 is for the development and

7900implementation of the Patient and Family

7906s ecure web - portal .

7912• Condition 14 provides that Gu lfside will

7920establish a separate foundation for

7925Hillsborough County to help cover patient

7931needs and expensive treatments. Gulfside

7936will provide seed - money of $25,000 and

7945donations will remain in Hillsborough Cou nty

7952as part of this Condition.

7957• Condition 15 is for the rapid licensure of

7966the new Gulfside program in Hillsborough

7972County. Gulfside will file its licensure

7978application to add Hillsborough County to

7984its existing license within 5 days of

7991receipt of the CON.

799588. GulfsideÓs corporate office in L and OÓLakes and its

8005freestanding hospice inpatient facility in Zephyrhills would be

8013used to support the Hillsborough County program. Both are

8022located just north of the county line. Gulfside will not need

8033to add administrative capabilities or staff at its c orporate

8043o ffice to initially support staff and the incremental additional

8053patients served in Hillsborough County. The existing supports

8061for the new program would allow it to enjoy improved economies

8072of scale and efficiencies.

807689. Gulfside projects it will take approximately 45 days

8085to receive a license from AHCA . During that time, existing

8096staff will be canvassed to see which of them would like to work

8109in the new Hillsborough County program. Gulfside would only

8118need to assemble one additional IDT in itially to begin serving

8129the new service area. G ulfside would provide services in

8139Hillsborough County through existing experienced staff now

8146working in Pasco Countyavel requirements for the

8153Hillsborough County staff would not differ much from what is

8163commonly seen in Pasco County, because Pasco has many remote

8173areas that Gulfside serves. Gulfside already has 25 current

8182staff who reside in Hillsborough County.

818890. Because Gulfside is not creating a new Medicare

8197provider or newly licensed entity in Florida, it c ould begin

8208offering services as a fully - licensed and Medicare Certified

8218provider as soon as it has a license from AHCA. All of

8230GulfsideÓs current ancillary services and supply contractors

8237already serve Hillsborough (as well as Pasco) County a nd all of

8249these contracts necessary for delivering hospice care can

8257readily be expanded to include Hillsborough County.

826491. Gulfside will serve all of Hillsborough County through

8273its extensive network of relationships throughout the county.

8281Pasco and H illsborough Counties are part of the same recognized

8292healthcare market with patients flowing between the two

8300counties. Gulfside expects its initial referrals will origina te

8309in the northern part of the c ounty due to its strong referral

8322relationships with p roviders in that area , and GulfsideÓs

8331assessments showed greater unmet need in that same area. It

8341will later expand to cover the entire county.

834992. GulfsideÓs operations in Hillsborough County would be

8357more profitable on average than its current operat ions in Pasco

8368County despite the allocation of administration and corporate

8376overhead costs to the Hillsborough County program , and despite

8385the assessment of a seven percent fee for corporate services and

8396management from the Pasco home office. The cause of this

8406difference is that the new program in Hillsborough County will

8416benefit from economies of scale . A dding service volume does not

8428require the duplication of costs and services for administrative

8437and other support in place in Pasco County.

844593. Gulfsi de had a loss in fiscal year 2015 due to several

8458sig nificant non - recurring expenses . GulfsideÓs projected budget

8468for the 2016 fiscal year included a profit of $337,000, and

8480Gulfside for the first four months of the new fiscal year w as

8493ahead of budget. Th e 2016 fiscal year budget did not include

8505those items which Gulfside had identified as non - recurring, and

8516yet they out - performed that conservative budget, corroborating

8525that these were non - recurring expenses, and that Gulfside will

8536be more profitab le than projected in the 2016 fiscal year

8547budget.

854894. Gulfside had a one - year loss for the 2015 fiscal year,

8561but in that year , it also acquired a significant asset with the

8573purchase of its corporate center office. Gulfside also

8581maintained a good cash position and had significant additional

8590credit available should it have needed to draw on those

8600resources.

8601D . Life P ath Ós Position vis - à - vis Competition

861495. Due to Life P athÓs growth and its penetration rate

8625within Service Area 6A , there has not been a need esta blished by

8638AHCA for another hospice in Hillsborough County until recently.

864796. The events leading to the newly establi shed need are

8658partially of LifeP athÓ s own making, to wit: In May 2013 , the

8671Centers for Medicare and Medicaid Services (ÐCMSÑ) announce d a

8681decision to eliminate two categories of diagnosis often used for

8691hospice care Î Ðdebility, undefinedÑ and Ðfailure to thrive.Ñ The

8701initial pronouncement from CMS indicated the change would take

8710effect in approximately October 2013. LifeP ath decided to

8719immediately stop accepting patients with those diagnoses so as

8728to be in compliance with the new federal regulatio ns when they

8740took effect. LifeP ath also informed all its referring partners,

8750physicians, hospitals, discharge planners, etc., that it would

8758no t be taking those types of patients any longer. Then CMS

8770decided to delay implementation of the new policies fo r a year.

8782By then, LifeP ath had already taken actions resulting in the

8793loss of some 700 potential admissions. When AHCA did its

8803hospice need c alculations shortly thereafter, lo and behold ,

8812there was a ÐshortageÑ of some 700 cases in the use rate portion

8825of the need calculation formula. As a result, AHCA determined

8835there was a need for one additional hospice provider in Service

8846Area 6A. LifeP at h had been hoisted on its own petard.

885897. LifeP ath does not challenge the AgencyÓs fixed need

8868calculation or that another hospice should be approved for

8877Hillsborough County Service Area 6A. Rather, LifeP ath is

8886desirous that only the hospice with least potent ial for negative

8897impact on LifeP ath should be approved.

890498. Based on the preponderance of evidence, West Florida

8913would have the most negative impact on LifePath. Gulfside, due

8923to its lower census development, would have the least impact.

8933However , as Seasons would be more likely to completely meet the

8944need projected by AHCA and would impact LifePath less than would

8955West Florida, its proposal is the most acceptable.

8963IV . Statutory and Rule Review Criteria

897099. The parties stipulate that: (1) All three applicantsÓ

8979letters of intent and CON applications were timely and properly

8989filed with required fees; (2) AHCA duly noticed its preliminary

8999intent to approve West FloridaÓs CON application and to deny

9009Seasons and Gulfside; (3) Seasons, Gulfside and Life P ath timely

9020filed Petitions for Formal Administrative Hearings challenging

9027AHCAÓs preliminary decision; and (4) Each application contains

9035the minimum application content prescribed by sections 408.037

9043and 408.039, Fl orida Stat utes . Also, Schedules A, D - 1, and 10

9058in each CON application are acceptable and reasonable .

9067Section 408.035(1) C riteria S tipulations

9073100. (1)(a) ÐThe need for the health care facilities and

9083health services being proposed.Ñ Î - T here is a need for one

9096additional hospice program in Service Area 6A.

9103101. (1)(b) ÐThe availability, quality of care,

9110accessibility, and extent of utilization of existing health care

9119facilities and health services in the service district of the

9129applicant.Ñ - Î A consideration of this criterion supports the

9139n eed for one new hospice program in the service area.

9150102. (1)(d) ÐThe availability of resources, including

9157health personnel, management personnel, and funds for capital

9165and operating expenditures, for project accomplishment and

9172operation.Ñ Î - Each applica nt has adequately projected the

9182availability of personnel. Each partyÓs Schedul e 6 and staffing

9192projections are reasonable. Each partyÓs audited financial

9199statements present an adequate financial condition .

9206103. (1)(f) ÐThe immediate and long - term f inancial

9216feasibility of the proposal.Ñ Î - Schedules 1, 2, and 3 in each

9229application are reasonable and indicate that each applicantÓs

9237proposal is financially feasible in the short term and long

9247term.

9248104. (1)(h) Î ÐThe costs a nd methods of the proposed

9259cons truction, including the costs and methods of energy

9268provision and availability of alternative, less costly, or more

9277effi cient methods of construction.Ñ - This criterion is not

9287applicable.

9288Florida Administrative Code Rule 59C - 1.030 S tipulations :

9298105. (2)(d ) Î ÐIn determining the extent to which a

9309proposed service will be accessible, th e following will be

9319considered : . . . T he performance of the applicant in meeting

9332any applicable Federal regulations . Ñ - Î This criterion w ould

9344support approval of any of the t hree applicants.

9353Florida Administrative Code Rule 59C - 1.0355 S tipulations

9362106. ( 6) Ð An applican t for a new hospice program shall

9375provide a detailed program description in its certificate of

9384need appli cation . . . . Ñ Î - Each application contained adequate

9398evidence regarding the applicantsÓ proposals .

9404II I. Factors Mitigating Against Approval of West Florida

9413107. West Florida's proposal to establish a hospital - based

9423hospice program in Service Area 6A materially differs from

9432Seasons Ó and Gulfside's propo sals seeking to establish community -

9443based hospice programs in the service area. There are key

9453differences between a freestanding or community - based hospice, on

9463the one hand, and a hospital - based hospice, on the other.

9475108. Most significantly, in contra st to a community - based

9486hospice, a hospital - based hospice has ready access to a patient

9498population ( i.e. , acute care patients at its sponsoring hospital)

9508from which it may receive referrals.

9514109. Further, a hospital - based hospice primarily serves

9523patient s discharged from its sponsoring hospital and not the

9533community at large, thereby creating a silo of care in which

9544patients are funneled from the sponsoring hospital to the

9553affiliate d hospice. Nationally , for the period 2010 through

95622014, hospital - based h ospice programs obtained approximately

957171 percent of their admissions from hospitals within their own

9581health system and only six percent of admissions from out - of -

9594system hospitals.

9596110. Further, it is possible for a hospital - based hospice

9607program to quick ly obtain a large volume of admissions by virtue

9619of its relationship with its sponsoring hospital. The census

9628development for a community - based hospice program is more

9638gradual. H ospital - based hospices do not tend to serve the

9650broader community ; once they have captured all of the admissions

9660coming out of their own hospital or health system,

9669they cease to continue to achieve significant market share

9678growth.

9679111. Moreover, hospital - based hospices tend to have shorter

9689average lengths of stay and provide h igher levels of inpatient

9700care than community - based hospices because they tend to treat

9711patients with a higher acuity and have easy access to inpatient

9722beds where they can provide inpatient hospice care. Medicare

9731reimbursement for general inpatient care i s significantly higher

9740than for some other types of hospice care. T o the extent that a

9754hospice provider provides more inpatient care, they will

9762exper ience higher revenues. This would result in a concomitant

9772reduction in revenues for a competing hospice i n the same service

9784area.

9785112. A pproximately 36 percent of patients discharged from

9794an acute care hospital in Hillsborough County and admitted to a

9805hospice program are discharged from one of West Florida's

9814sponsoring hospitals. I n 2014, approximately 46 percent of

9823LifePath's admissions were referred from acute care hospitals.

9831Accordingly, even if West Florida made no effort to obtain

9841referrals to its program from sources other than its affiliate

9851organizations, approximately 16.6 percent of LifePath's

9857ad missions could be at risk if West Florida's proposed project is

9869approved.

9870113. Mr. Michael Schultz, the CEO of Florida Hospital's

9879West Florida Region, testified that the goal of Tampa General and

9890Florida Hospital is to manage a patient's entire episode of care

9901and that if West Florida's application were approved, both

9910hospital organizations would "absolutely" prefer to have West

9918Florida provide hospice care to patients discharged from its

9927hospitals. LifeP ath 's projection that it would lose 20 percent

9938o f its admissions if West Florida's a pplication w as approved is

9951reasonable.

9952114. Mr. Burkhart discussed West FloridaÓs desire to

9960develop a Ðcovered livesÑ strategy or network, where the

9969hospital system can control how the dollars are spent and how

9980the car e is delivered. West Florida applied for a hospice CON

9992for two reasons: 1) AHCA had published need; and 2) because Ðwe

10004wish to have more control over a piece of the hospice continuum

10016so that when weÓre doing things like narrow networks, we have

10027that in o ur portfolio under our control.Ñ T r . , p. 99. In a

10042covered lives network, a hospice patient would pay less if they

10053went to a West Florida affiliated hospice, and more if they went

10065to Lifepath or another out - of - network hospice.

10075115. West Florida plans t o open satellite hospice offices

10085in Tampa General and in the two Florida Hospitals located in

10096Hillsborough County. There was no mention of the desire or

10106possibility of opening satellite hospice offices in any of the

10116non - West Florida affiliated hospitals l ocated in Hillsborough

10126County. From a practical perspective, it seems unlikely that

10135competing hospital systems would welcome such involvement by a

10144competitor.

10145Seasons

10146116. Seasons is the only applicant without a current

10155connection to the healthcare com munity in Hillsborough County.

10164It has, however, some experience in other Florida markets.

10173117. Fewer of SeasonsÓ programmatic proposals are directly

10181tied to a Condition of CON approval, but the programs are

10192nonetheless generally universal in Seasons HP C operations.

10200Gulfside

10201118. Service Area 6A has a sizeable Hispanic population,

10210but Gulfside has very limited experience in treating Hispanics.

10219In fact, only 3.3 percent of its recent admissions are Hispanic.

10230GulfsideÓs COO did not know how many, if an y, of GulfsideÓs

10242existing staff was bilingual. Today, Gulfside relies on

10250interpreters who are accessed through a language line to

10259communicate with Hispanic patients and family members. Since

10267Gulfside plans to utilize existing staff to serve Hillsborough

10276County, it will need to continue to rely upon interpreters to

10287comm unicate with Hispanics in that c ounty. To the extent the

10299Hispanic population in Hillsborough County is underserved, or

10307there is a need to ensure that these patients have a choice of

10320hospice providers that are committed to meeting their needs,

10329Seasons demonstrated far more experience and ability than

10337Gulfside.

10338119. Seasons projected 516 admissions in year two while

10347Gulfside pro jected 276 admissions. Seasons ha s reasonably

10356projected to ac hieve 240 more admissions in year 2 than Gulfside

10368and thus will do a better job in meeting the unmet need. West

10381Florida also projects more admissions than Gulfside.

10388IV. Ultimate Findings of Fact

10393120. Each of the applicants, as advertised, could provide

10402quality hospice services to the residents of AHCA Service

10411Area 6A/Hillsborough County.

10414121. The proposal by West Florida would be more likely to

10425serve its own hospital patients than the community at large.

10435This would have the effect of less penetration by West Florida

10446in the service area as a whole. It would also likely result in

10459West Florida retaining more of the most critically ill hospice

10469patients (i.e., those with shorter lengths of stay) , thereby

10478benefitting from the new reimbursement rules to the exclusion of

10488the competing hospice.

10491122. Gulfside w ould be able to commence operations in

10501Hillsborough County more quickly than Seasons or West Florida .

10511It has connections with other healthcare providers in

10519Hillsborough County and c ould easily transit ion to that

10529geographic area. However, it proposes less growth and coverage

10538than either Seasons or West Florida, thus will less likely meet

10549the need which currently exists .

10555123. Seasons ha s the financial and operational wherewithal

10564to be successful in H illsborough County. It has more experience

10575(and success) in starting a new hospice than the other

10585applicants. Its programs are well - established and conducted by

10595experts in their fields. Seasons would meet the need for a new

10607hospice provider in Service A rea 6A b etter than the other

10619applicants .

10621124. Upon consideration of all the facts in this case,

10631Season s Ó application , on balance, is the most appropriate for

10642approval.

10643CONCLUSIONS OF LAW

10646Jurisdiction

10647125. The Division of Administrative Hearings has

10654j urisdiction over the parties to and the subject matter of this

10666proceeding. §§ 120.569 and 120.57(1), Fla. Stat.

10673Burden of Proof

10676126. As applicants, West Florida, Seasons, and Gulfside

10684each has the burden of proving, by the preponderance of the

10695evidence, entitlement to a CON. Boca Raton Artificial Kidney

10704C t r . , Inc. v. Dep Ó t of Health & Rehab . Servs . , 475 So. 2d 260

10724(Fla. 1st DCA 1985); § 120.57(1)(j), Fla. Stat. Each of the

10735applicants proved that they met all the necessary criteria for

10745approval. Howeve r, there is a need for only one of the three to

10759be approved.

10761127. The award of a CON must be based on a balanced

10773consideration of all applicable and statutory rule criteria in

10782section 408.035, Florida Statues . Balsam v. Dep Ó t of Health &

10795Rehab . Servs . , 486 So. 2d 1341 (Fla. 1st DCA 1986). Ð [T]he

10809appropriate weight to be given to each individual criterion is

10819not fixed, but rather must vary on a case - by - case basis,

10833depending upon the facts of each case." Collier Med . C tr. , Inc.

10846v. Dep Ó t of Health & Reha b . Servs . , 462 So. 2d 83, 84 (Fla. 1st

10865DCA 1985). In the present case, the weighing of criteria must

10876be done comparatively.

10879128. An administrative hearing involving disputed issues

10886of material fact is a de novo proceeding in which the

10897administrative la w judge independently evaluates the evidence

10905presented. Fla . Dep Ó t of Transp . v. J.W.C. Co. , 396 So. 2d 778,

10921787 (Fla. 1st DCA 1981); § 120.57(1), Fla. Stat. The Agency's

10932preliminary decisions on CON applications, including its

10939findings in the S tate A gen cy A ction R eport , are not entitled to

10955a presumption of correctness. Id.

10960129. Pursuant to the its hospice rule need methodology,

10969the Agency determined that there is a projected need for only

10980one new hospice program in Service Area 6A for the applicab le

10992planning horizon.

10994130. The existence of a numeric need pursuant to the rule

11005creates a rebuttable presumption of need for an additional

11014hospice program in the service area. Vitas Healthcare Corp. of

11024Cent . Fla . v. Ag. for Health Care Admin . , Case No. 04 - 3858CON,

110402005 Fla. Div. Admin. Hear. LEXIS 881, *61 - 62 (DOAH June 14,

110532005; AHCA July 7, 2005)(citation omitted).

110591 31 . There is no persuasive evi de nce to rebut the

11072presumption of need.

110751 32 . All of the applicants are well qualifie d to meet the

11089pro jected need for an additional hospice program in the service

11100area. One of them, Seasons, will meet the need more

11110appropriately than the other applicants.

111151 33 . Based upon the totality of the circumstances and for

11127all of the reasons stated in the Finding s of Fact, o n balance ,

11141the advantage goes to Seasons over Gulfside or West Florida .

11152RECOMMENDATION

11153Based on the foregoing Findings of Fact and Conclusions of

11163Law, it is

11166RECOMMENDED that a final order be entered approving Season s

11176Hospice and Palliative C are of Tampa, LLCÓs , CON No. 10298 and

11188denying West Florida Health, Inc.Ós , CON No. 10302 and Gulfside

11198Hospice & Palliative Care of Tampa, LLCÓs , CON No. 10294 .

11209DONE AND ENTE RED this 21st day of March, 2016 , in

11220Tallahassee, Leon County, Florida.

11224S

11225R. BRUCE MCKIBBEN

11228Administrative Law Judge

11231Division of Administrative Hearings

11235The DeSoto Building

112381230 Apalachee Parkway

11241Tallahassee, Florida 32399 - 3060

11246(850) 488 - 9675

11250Fax Filing (850) 921 - 6847

11256www.doah.state.fl.us

11257Filed with the Clerk of the

11263Division of Administrative Hearings

11267this 21st day of March, 2016 .

11274COPIES FURNISHED:

11276Stephen K. Boone, Esquire

11280Boone, Boone, Boone and Koda, P.A.

112861001 Avenida Del Circo

11290Post Office Box 1596

11294Venice, Florida 34284

11297(eServed)

11298Lorraine Mar ie Novak, Esquire

11303Agency for Health Care Administration

113082727 Mahan Drive, Mail Stop 3

11314Tallahassee, Florida 32308

11317(eServed)

11318Seann M. Frazier, Esquire

11322Parker, Hudson, Rainer and Dobbs, LLP

11328Suite 750

11330215 South Monroe Street

11334Tallahassee, Florida 32301

11337( eServed)

11339Jonathan L. Rue, Esquire

11343Parker, Hudson, Rainer

11346and Dobbs, LLC

11349303 Peachtree Street N ortheast , Suite 3600

11356Atlanta, Georgia 30308

11359(eServed)

11360Karl David Acuff, Esquire

11364Law Office of Karl David Acuff, P.A.

11371Suite 2

113731615 Village Square Boulevard

11377Ta llahassee, Florida 32309 - 2770

11383(eServed)

11384Stephen C. Emmanuel, Esquire

11388Michael J. Glazer, Esquire

11392Ausley & McMullen

11395123 South Calhoun Street

11399Post Office Box 391

11403Tallahassee, Florida 32301

11406(eServed)

11407Richard J. Shoop, Agency Clerk

11412Agency for Health Care Ad ministration

114182727 Mahan Drive, Mail Stop 3

11424Tallahassee, Florida 32308

11427(eServed)

11428Stuart Williams, Gen eral Co unsel

11434Agency for Health Care Administration

114392727 Mahan Drive, Mail Stop 3

11445Tallahassee, Florida 32308

11448(eServed)

11449Elizabeth Dudek, Secretary

11452Agency for Health Care Administration

114572727 Mahan Drive, Mail Stop 1

11463Tallahassee, Florida 32308

11466(eServed)

11467NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

11473All parties have the right to submit written exceptions within

1148315 days from the date of this Recommended Order. Any e xceptions

11495to this Recommended Order should be filed with the agency that

11506will issue the Final Order in this case.

Select the PDF icon to view the document.
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Date
Proceedings
PDF:
Date: 05/18/2016
Proceedings: Gulfside's Exceptions to the Recommended Order (filed in Case No. 15-002003CON).
PDF:
Date: 05/18/2016
Proceedings: Agency Final Order filed.
PDF:
Date: 05/17/2016
Proceedings: Agency Final Order
PDF:
Date: 03/21/2016
Proceedings: Recommended Order
PDF:
Date: 03/21/2016
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 03/21/2016
Proceedings: Recommended Order (hearing held November 30 and December 1-4, 7-10 and 14-16, 2015). CASE CLOSED.
PDF:
Date: 02/12/2016
Proceedings: Gulfside's Proposed Recommended Order (filed in Case No. 15-002008CON).
PDF:
Date: 02/12/2016
Proceedings: Gulfside's Proposed Recommended Order filed.
PDF:
Date: 02/12/2016
Proceedings: LifePath Hospice, Inc.'s, Notice of Filing Proposed Recommended Order filed.
PDF:
Date: 02/12/2016
Proceedings: Seasons' Proposed Recommended Order filed.
PDF:
Date: 02/12/2016
Proceedings: Joint Proposed Recommended Order on Behalf of West Florida Health, Inc. and Agency for Health Care Administration, Including the Statement of the Case, Statement of the Issues, Joint Proposed Conclusions of Law, and Joint Proposed Recommended Order filed.
PDF:
Date: 12/02/2015
Proceedings: Notice of Appearance (Michael Hardy) (filed in Case No. 15-002007CON).
PDF:
Date: 11/25/2015
Proceedings: West Florida's Witness and (Proposed) Exhibit List filed.
PDF:
Date: 11/25/2015
Proceedings: Agreed Joint Prehearing Stipulation filed.
PDF:
Date: 11/19/2015
Proceedings: Notice of Taking Telephonic Depositions (of Christine Thomas and Rema Cole) filed.
PDF:
Date: 11/18/2015
Proceedings: Order Regarding Order of Proof at Final Hearing.
PDF:
Date: 11/17/2015
Proceedings: Notice of Taking Telephonic Depositions (of Rick Knapp, Armand Balsano, and David Levitt) filed.
PDF:
Date: 11/17/2015
Proceedings: Letter to Judge McKibben from Stephen Emmanuel regarding schedule for the Final Hearing filed.
PDF:
Date: 11/09/2015
Proceedings: Notice of Taking Deposition Duces Tecum (of Armand Balsano) filed.
PDF:
Date: 11/04/2015
Proceedings: Notice of Taking Depositions Duces Tecum (of Armand Balsano and Kathy Ferenedez) filed.
PDF:
Date: 11/03/2015
Proceedings: Gulfside's Notice of Taking the Deposition of Jay Cushman (filed in Case No. 15-002007CON).
PDF:
Date: 11/03/2015
Proceedings: Notice of Taking Deposition Duces Tecum (of Marisol Fitch) filed.
PDF:
Date: 11/02/2015
Proceedings: Notice of Taking Deposition Duces Tecum (of David Levitt) filed.
PDF:
Date: 11/02/2015
Proceedings: Notice of Taking Depositions Duces Tecum (of Steve Jones, David Levitt and Sharon Gordon-Girvin, filed in Case No. 15-002007CON).
PDF:
Date: 11/02/2015
Proceedings: Notice of Taking Depositions Duces Tecum (of Jay Cushman and Darryl Weiner) filed.
PDF:
Date: 10/30/2015
Proceedings: Notice of Taking Depositions Duces Tecum (of David Levitt) filed.
PDF:
Date: 10/22/2015
Proceedings: Notice of Taking Telephonic Deposition to Preserve Testimony (of Mary Lynn Mc Pherson) filed.
PDF:
Date: 10/20/2015
Proceedings: Notice of Taking Depositions Duces Tecum (of Kathy Fernandez) filed.
PDF:
Date: 10/19/2015
Proceedings: Notice of Taking Depositions Duces Tecum (Russell HIlliard, Daniel Maison, M.D.,m and Rabbi E.B. Freedman; filed in Case No. 15-002007CON).
PDF:
Date: 10/14/2015
Proceedings: Notice of Taking Deposition to Preserve Testimony (of Daniel Maison) filed.
PDF:
Date: 10/08/2015
Proceedings: Notice of Taking Depositions Duces Tecum (filed in Case No. 15-002007CON).
PDF:
Date: 10/08/2015
Proceedings: Cross Notice of Taking Deposition Duces Tecum filed.
PDF:
Date: 10/08/2015
Proceedings: Notice of Taking Depositions Duces Tecum filed.
PDF:
Date: 09/25/2015
Proceedings: Cross-notice of Taking Deposition filed.
PDF:
Date: 09/23/2015
Proceedings: Notice of Taking Deposition Duces Tecum (of Kathy Postiglione) filed.
PDF:
Date: 09/23/2015
Proceedings: Notice of Taking Deposition Duces Tecum (of Tara Scalise) filed.
PDF:
Date: 09/23/2015
Proceedings: Notice of Taking Deposition Duces Tecum (of Linda Ward) filed.
PDF:
Date: 09/23/2015
Proceedings: Notice of Taking Deposition Duces Tecum (of Deborah Gills) filed.
PDF:
Date: 09/23/2015
Proceedings: Notice of Taking Deposition Duces Tecum (of Tony Trovato) filed.
PDF:
Date: 09/23/2015
Proceedings: Vitas Healthcare Corporation of Florida's Notice of Voluntary Dismissal filed.
PDF:
Date: 09/21/2015
Proceedings: [Gulfsides] Notice of Taking Depositions filed.
PDF:
Date: 09/10/2015
Proceedings: Gulfside's Supplement to Its Final Witness List (filed in Case No. 15-002007CON).
PDF:
Date: 09/10/2015
Proceedings: Gulfside's Supplement to its Final Witness List (filed in Case No. 15-002008CON).
PDF:
Date: 09/01/2015
Proceedings: Seasons Hospice & Palliative Care of Tampa, LLC's Final Witness List filed.
PDF:
Date: 09/01/2015
Proceedings: LifePath Hospice Inc.'s. Final Witness List filed.
PDF:
Date: 09/01/2015
Proceedings: Gulfside's Final Witness List (filed in Case No. 15-002008CON).
PDF:
Date: 09/01/2015
Proceedings: Vitas Healthcare Corporation of Florida's Final Witness List filed.
PDF:
Date: 09/01/2015
Proceedings: Gulfside's Preliminary Witness List filed.
PDF:
Date: 09/01/2015
Proceedings: West Florida Health, Inc.'s Witness List filed.
PDF:
Date: 08/21/2015
Proceedings: Seasons Response to Guflside's Second Request for Production filed.
PDF:
Date: 08/19/2015
Proceedings: LifePath Hospice, Inc.'s Resonses and Objections to West Florida Health, Inc.'s First Request for Production filed.
PDF:
Date: 08/19/2015
Proceedings: Notice of Serving Lifepath Hospice, Inc., Responses to West Florida Health, Inc., First Interrogatories filed.
PDF:
Date: 08/18/2015
Proceedings: Notice of Appearance (Michael Glazer) (filed in Case No. 15-002003CON).
PDF:
Date: 08/12/2015
Proceedings: Vitas Healthcare Corporation of Florida's Response to Gulfside Hospice & Pasco Palliative Care, Inc.'s First Request for Production filed.
PDF:
Date: 08/07/2015
Proceedings: Gulfsides Notice of Service of Discovery Responses and Objections filed.
PDF:
Date: 08/07/2015
Proceedings: Vitas Responses to West Floridas First Request for Production filed.
PDF:
Date: 08/07/2015
Proceedings: Vitas Response to Seasons Second Request for Production filed.
PDF:
Date: 08/07/2015
Proceedings: Vitas Response to Seasons First Request for Production filed.
PDF:
Date: 08/07/2015
Proceedings: Notice of Service of Vitas Responses to West Floridas First Interrogatories filed.
PDF:
Date: 08/07/2015
Proceedings: Notice of Service of Vitas Responses to Seasons Second Interrogatories filed.
PDF:
Date: 08/07/2015
Proceedings: Notice of Service of Vitas Responses to Seasons First Interrogatories filed.
PDF:
Date: 08/07/2015
Proceedings: Seasons Notice of Service of Answers to First Interrogatories from Vitas filed.
PDF:
Date: 08/07/2015
Proceedings: Seasons Response to First Request for Production from Vitas filed.
PDF:
Date: 08/07/2015
Proceedings: Seasons Notice of Service of Answers to First Interrogatories from West Florida filed.
PDF:
Date: 08/07/2015
Proceedings: Seasons Response to First Request for Production from West Florida filed.
PDF:
Date: 08/07/2015
Proceedings: Seasons Response to First Request for Production from Gulfside filed.
PDF:
Date: 08/07/2015
Proceedings: West Florida Health, Inc.'s Response to Lifepath's, Seasons', VITAS' and Gulfside's First Request for Production of Documents and Gulfside's Second Request for Production of Documents filed.
PDF:
Date: 08/07/2015
Proceedings: West Florida Health, Inc.'s Notice of Service of Responses to Lifepaths, Seasons' and VITAS' First Interrogatories filed.
PDF:
Date: 07/22/2015
Proceedings: Gulfside's Second Request for Production to Seasons (filed in Case No. 15-002007CON).
PDF:
Date: 07/13/2015
Proceedings: Gulfside's Second Request for Production to West Florida Health (filed in Case No. 15-002008CON).
PDF:
Date: 07/13/2015
Proceedings: Gulfside's First Request for Production to VITAS (filed in Case No. 15-002008CON).
PDF:
Date: 07/13/2015
Proceedings: Gulfside's First Request for Production to Seasons (filed in Case No. 15-002008CON).
PDF:
Date: 07/13/2015
Proceedings: Gulfsides Second Request for Production to West Florida Health (filed in Case No. 15-002008CON).
PDF:
Date: 06/17/2015
Proceedings: Notice of Filing Joint Proposed Order of Pre-hearing Instructions filed.
PDF:
Date: 06/05/2015
Proceedings: Amended Notice of Hearing (hearing set for November 30 through December 4, 7 through 11 and 14 through 18, 2015; 9:00 a.m.; Tallahassee, FL; amended as to Dates).
Date: 06/05/2015
Proceedings: CASE STATUS: Pre-Hearing Conference Held.
PDF:
Date: 06/03/2015
Proceedings: Order Denying Continuance of Final Hearing.
PDF:
Date: 06/03/2015
Proceedings: (Respondents') Agreed Motion for Continuance filed.
PDF:
Date: 06/02/2015
Proceedings: Seasons Hospice and Palliative Care of Tampa, LLC's Notice of Service of First Interrogatories to Gulfside Hospice & Palliative Care, Inc. filed.
PDF:
Date: 06/02/2015
Proceedings: Seasons Hospice and Palliative Care of Tampa, LLC's First Request for Production to Gulfside Hospice & Palliative Care, Inc. filed.
PDF:
Date: 06/02/2015
Proceedings: Seasons Hospice and Palliative Care of Tampa, LLC's Second Request for Production to Vitas Healthcare Corporation of Florida filed.
PDF:
Date: 06/02/2015
Proceedings: Seasons Hospice & Palliative Care of Tampa's Notice of Service of Second Interrogatories to Vitas Healthcare Corporation of Florida filed.
PDF:
Date: 06/02/2015
Proceedings: Seasons Hospices Second Request for Produciton to Vitas filed.
PDF:
Date: 06/01/2015
Proceedings: West Florida Health, Inc.'s Response to Gulfside Hospice & Pasco Palliative Care, Inc.'s First Request for Production of Documents filed.
PDF:
Date: 06/01/2015
Proceedings: Seasons Hospice and Palliative Care of Tampa, LLC's First Request for Production to VITAS Healthcare Corporation of Florida filed.
PDF:
Date: 05/29/2015
Proceedings: Vitas Healthcare Corporation of Florida's First Request for Production of Documents to Gulfside Hospice & Pasco Palliative Care, Inc., filed.
PDF:
Date: 05/29/2015
Proceedings: Notice of Serving Vitas Healthcare Corporation of Florida's First Interrogatories to Gulfside Hospice & Pasco Palliative Care, Inc., filed.
PDF:
Date: 05/29/2015
Proceedings: Vitas Healthcare Corporation of Floridas First Request for Production of Documents to Seasons Hospice & Palliative Care of Tampa filed.
PDF:
Date: 05/29/2015
Proceedings: Notice of Serving Vitas Healthcare Corporation of Florida's First Interrogatories to Seasons Hospice & Palliative Care of Tampa, LLC filed.
PDF:
Date: 05/29/2015
Proceedings: Seasons Hospice & Palliative Care of Tampa's Notice of Service of First Interrogatories to Vitas Healthcare Corporation of Florida filed.
PDF:
Date: 05/13/2015
Proceedings: Notice of Serving West Florida Health, Inc. First Interrogatories to VITAS Healthcare Corporation of Florida Coast, Inc. filed.
PDF:
Date: 05/12/2015
Proceedings: Notice of Serving Vitas Healthcare Corporation of Florida's First Interrogatories to West Florida Health, Inc. filed.
PDF:
Date: 05/12/2015
Proceedings: West Florida Health, Inc.'s First Request for Production to Lifepath Hospice, Inc., filed.
PDF:
Date: 05/12/2015
Proceedings: West Florida Health, Inc.'s Notice of Service of its First Request for Production to Lifepath Hospice, Inc., filed.
PDF:
Date: 05/12/2015
Proceedings: Notice of Serving West Florida Health, Inc., First Interrogatories to Seasons Hospice and Palliative Care of Tampa, Inc., filed.
PDF:
Date: 05/12/2015
Proceedings: Notice of Serving West Florida Health, Inc., First Interrogatories to Lifepath Hospice, Inc. filed.
PDF:
Date: 05/07/2015
Proceedings: Order Granting Joint Motion to Amend Case Style and Remove Counsel from Service List.
PDF:
Date: 05/07/2015
Proceedings: West Florida Health, Inc.'s First Request for Production to Seasons Hospice & Palliative Care, Inc. filed.
PDF:
Date: 05/07/2015
Proceedings: West Florida Health, Inc.'s Notice of Service of its First Request for Production to Seasons Hospice & Palliative Care of Tampa, LLC filed.
PDF:
Date: 05/07/2015
Proceedings: West Florida Health, Inc.'s First Request for Production to VITAS Healthcare Corporation of Florida Coast, Inc. filed.
PDF:
Date: 05/07/2015
Proceedings: West Florida Health, Inc.'s Notice of Service of its First Request for Production to VITAS Healthcare Corporation of Florida filed.
PDF:
Date: 05/06/2015
Proceedings: Seasons Hospice and Palliative Care of Tampa, LLC's First Request for Produciton to West Florida Health, Inc filed.
PDF:
Date: 05/06/2015
Proceedings: Seasons Hospice & Palliative Care of Tampa's Notice of Service of First Interrogatories to West Florida Health, Inc filed.
PDF:
Date: 05/06/2015
Proceedings: West Florida Health, Inc.'s Notice of Service of its First Request for Production to Gulfside Hospice & Palliative Care, Inc. filed.
PDF:
Date: 05/06/2015
Proceedings: West Florida Health, Inc.'s First Request for Production to Gulfside Hospice & Palliative Care, Inc. filed.
PDF:
Date: 05/05/2015
Proceedings: LifePath Hospice, Inc.'s First Request for Production of Documents to West Florida Health, Inc., filed.
PDF:
Date: 05/05/2015
Proceedings: Notice of Serving LifePath Hospice, Inc., First Interrogatories to West Florida Health, Inc., filed.
PDF:
Date: 05/04/2015
Proceedings: Vitas Healthcare Corp. of Florida's First Request for Production of Documents to West Florida Health, Inc. filed.
PDF:
Date: 05/04/2015
Proceedings: Joint Motion to Amend Case Style and Remove Counsel from Service List filed.
PDF:
Date: 05/01/2015
Proceedings: Gulfside's Notice of Service of Its First Request For Production to West Florida Health, Inc. (filed in Case No. 15-002008CON).
PDF:
Date: 05/01/2015
Proceedings: Order of Consolidation (DOAH Case Nos. 15-2001CON, 15-2003CON, 15-2006CON, 15-2007CON, 15-2008CON).
PDF:
Date: 04/24/2015
Proceedings: Joint Response to Initial Order filed.
PDF:
Date: 04/14/2015
Proceedings: Amended Notice filed.
PDF:
Date: 04/14/2015
Proceedings: Initial Order.
PDF:
Date: 04/13/2015
Proceedings: Decisions on Batched Applications filed.
PDF:
Date: 04/13/2015
Proceedings: Petition Challenging Co-batched Applicants and Assertion of Right to a 60-Day Hearing filed.
PDF:
Date: 04/13/2015
Proceedings: Notice (of Agency referral) filed.

Case Information

Judge:
R. BRUCE MCKIBBEN
Date Filed:
04/13/2015
Date Assignment:
04/14/2015
Last Docket Entry:
05/18/2016
Location:
Tallahassee, Florida
District:
Northern
Agency:
Other
Suffix:
CON
 

Counsels

Related DOAH Cases(s) (1):

Related Florida Statute(s) (6):