96-001029CON
Bethesda Memorial Hospital, Inc. vs.
Agency For Health Care Administration
Status: Closed
Recommended Order on Tuesday, February 24, 1998.
Recommended Order on Tuesday, February 24, 1998.
1STATE OF FLORIDA
4DIVISION OF ADMINISTRATIVE HEARINGS
8BETHESDA MEMORIAL HOSPITAL, INC., )
13)
14Petitioner, )
16)
17vs. ) Case No. 96-1029
22)
23AGENCY FOR HEALTH CARE )
28ADMINISTRATION, )
30)
31Respondent. )
33__________________________________)
34RECOMMENDED ORDER
36Pursuant to notice, a formal hearing was held in this case
47on November 19 through 21, 1997, in Tallahassee, Florida, before
57J. D. Parrish, a designated Administrative Law Judge of the
67Division of Administrative Hearings.
71APPEARANCES
72For Petitioner: Kenneth F. Hoffman, Esquire
78M. Christopher Bryant, Esquire
82Oertel, Hoffman, Fernandez & Cole, P.A.
88Post Office Box 6507
92Tallahassee, Florida 32314-6507
95For Respondent: Richard A. Patterson, Esquire
101Agency for Health Care Administration
106Fort Knox Building 3
1102727 Mahan Drive, Suite 3407B
115Tallahassee, Florida 32308-5403
118STATEMENT OF THE ISSUES
122Whether the Petitioner, Bethesda Memorial Hospital, Inc.,
129(Bethesda) is entitled to a certificate of need (CON) in order to
141convert three general acute care beds for use as Level III
152neonatal intensive care unit (NICU) beds.
158PRELIMINARY STATEMENT
160This case began when Bethesda filed an application with the
170Agency for Health Care Administration (AHCA or Agency) for a CON
181to develop a three-bed Level III NICU. This CON was assigned
192number 8235. The proposed NICU was to be located at Bethesdas
203existing facility in Palm Beach County, Florida, the Agencys
212District 9. In its preliminary review of the request, the Agency
223denied the application, and the instant proceeding ensued as
232Bethesda timely filed a Petition for Formal Administrative
240Hearing.
241Prior to hearing, the parties filed a Prehearing Stipulation
250which outlined statutory and rule criteria which the applicant
259has met, or which are not at issue in this proceeding. More
271specifically, as stipulated, the following criteria are met, or
280are not at issue: Section 408.035(1)(a), ( c), (e), (f), (g),
291(h), (i), (j), (k), (m), (n), and (o), Florida Statutes; Section
302408.035(2)( c) and (e), Florida Statutes; Rule 59C-1.042(3)(e),
310(f), (g), (h), and (k), Florida Administrative Code; Rules 59C-
3201.042(4), (6), (8), (9), (10), (11), (12), and (13), Florida
330Administrative Code. Accordingly, the findings of fact herein
338address only those provisions which remain at issue.
346At the hearing, the parties offered witnesses and exhibits
355which are more particularly chronicled in the transcript of these
365proceedings. Such transcript was filed with the Division of
374Administrative Hearings on December 15, 1997. By stipulation,
382the parties agreed to file their Proposed Recommended Orders by
392January 14, 1998. Such proposals have been considered in the
402preparation of this order.
406Additionally, Petitioner filed as supplemental authority, a
413copy of a recent pleading from the appeal of DOAH Case No. 97-
4261161. Such document was filed on February 13, 1998, and, as it
438related to the issue of whether the Agency may deviate from its
450rule-mandated unit size, has been considered in the preparation
459of this order.
462On February 17, 1998, the Florida Statutory Teaching
470Hospital Council, Public Health Trust of Dade County, Florida, as
480Jackson Memorial Hospital, Miami Children's Hospital, and All
488Children's Hospital filed an Amicus Argument in response to the
498Proposed Recommended Order submitted by Bethesda. Such argument
506has not been considered. None of the hospitals named therein
516filed for, nor received, leave to file such Amicus Argument in
527the instant proceeding.
530FINDINGS OF FACT
5331. The Agency for Health Care Administration is the state
543agency charged with the responsibility of reviewing applications
551such as the one at issue in this proceeding.
5602. The parties have stipulated that whether or not the
570subject application should be approved must be decided upon a
580weighing and balancing of all pertinent statutory and rule
589criteria.
5903. Bethesdas letter of intent and application for CON were
600timely filed in an appropriate batching cycle.
6074. Bethesda is a 362-bed acute care hospital located in
617Boynton Beach, Palm Beach County, Florida. As such, it is
627located within the Agencys District 9.
6335. The approval of the CON at issue would allow Bethesda to
645convert three of its existing acute care beds to Level III NICU
657beds.
6586. This approval would expand Bethesdas existing NICU from
66712 beds, which are designated Level II NICU beds, to a total of
68015 beds for the combined NICU.
6867. Bethesda received a CON for its existing NICU in 1985.
697From its inception, the unit has been staffed and equipped for
708the highest level of NICU care and, in fact, performed Level III
720care until 1995 when the Agency ordered it to stop admitting
731babies of less than 1000 grams in weight.
7398. At the time of the original approval of the Bethesda
750NICU, the Agency did not distinguish between Level II and Level
761III NICU beds. Nevertheless, Bethesda staffed and equipped its
770unit based upon the highest level of care because of the
781population it has historically served.
7869. Later, as the Agency developed more distinct guidelines
795between Level II and Level III NICU beds (as well as a statewide
808bed-need methodology), Bethesda found it could not technically
816continue to do what it had historically done, i.e., serve a Level
828III newborn.
83010. Bethesda has historically served these Level III
838newborns because it is under contract with the Palm Beach County
849Public Health Unit (PHU) to care for indigent mothers and at-risk
860babies.
86111. This agreement to serve indigent mothers and at-risk
870babies has resulted in a significant number of babies being
880delivered at Bethesda requiring neonatal intensive care at all
889levels.
89012. Until 1989, Bethesda was the only hospital to provide
900obstetrical care in the southern portion of Palm Beach County,
910much less make exceptional provision for indigent birth mothers.
91913. As it developed, Bethesda provided quality obstetrical,
927pediatric, and neonatology services in an area of Palm Beach
937County where other providers were less than enthusiastic about
946the market.
94814. Except for St. Marys Hospital in the northern portion
958of the county, no other provider has extended services to the
969indigent as demonstrated by Bethesda.
97415. Moreover, Bethesda has offered to condition its CON
983approval on the provision that it render a minimum of 35 percent
995of the facilitys entire NICU patient days, including Level II
1005and Level III, to Medicaid/charity patients. Thus, a major
1014emphasis of this application is care for the indigent.
102316. Of all patients cared for in the south Palm Beach
1034County neonatal programs, ninety-nine percent are indigent.
1041While a provider may receive reimbursement for certain services
1050(from Medicaid or local health district funds), the patients
1059themselves (birth mothers and babies) are indigent.
106617. Additionally, one-third of the pregnancies processed
1073through the PHU are high-risk due to diabetes, infectious
1082diseases, or other complications.
108618. As a logical consequence of the complications with the
1096birth mother, the babies born through the PHU program tend to be
1108sicker than average.
111119. While Palm Beach County has demonstrated a remarkable
1120improvement in providing pre-natal care to birth mothers and
1129thereby improving at-risk results, Bethesda continues to play a
1138critical role in extending care to this needy population.
114720. Bethesda is the exclusive hospital used by the PHU in
1158south Palm Beach County. It is utilized because it is
1168geographically located near the patient population. Further,
1175Bethesdas reputation in this community makes it attractive to
1184those in need.
118721. Bethesda is engaged in a three-way partnership with St.
1197Mary's Hospital and the PHU to lower infant mortality in the
1208county. They have created an integrated care plan for south Palm
1219Beach County maternity patients. Bethesda, physicians in the
1227community (including obstetricians, gynecologists, neonatologists
1232and pediatricians), and the PHU have worked together for 11 years
1243to make sure that protocols are available so that pre-natal care
1254is available to all who need it. These parties work closely with
1266Healthy Mothers/Healthy Babies and other voluntary organizations
1273to bring patients to the PHU or to Bethesda.
128222. The PHU physicians and midwives deliver between 800 and
12921,000 babies a year. About 25 percent of these babies from the
1305southern portion of the county will require some kind of Level II
1317or Level III NICU care during their stay in the hospital. Thus,
1329200 to 250 babies needing NICU care come through the PHU each
1341year.
134223. It would also be expected that non-indigent mothers
1351from the southern portion of the county would deliver babies
1361requiring NICU care.
136424. Bethesda plans to open outlying health clinics to
1373enhance services offered to local communities within the Bethesda
1382zip codes. These programs or clinics are expected to result in
1393an estimated 20 percent increase in the volume of indigent
1403pregnant women served by Bethesda.
140825. The availability of services to the local communities
1417may also assist patients to keep their scheduled appointments.
1426There is a difference between the number of patients scheduled to
1437see PHU physicians and those who actually show up, due to the
1449inconvenience and financial burden of getting to the health unit.
1459Having the clinic locations readily available may alleviate the
1468inconveniences to the indigent mother.
147326. Under the present circumstances, when a Level III baby
1483is delivered at Bethesda it must be transferred to another
1493facility.
149427. These transfers create a major burden for the birth
1504mother. Remembering that the mother would not typically be
1513transferred with the child (and would not require the extended
1523stay some neonates demand), the issue of transportation for the
1533parent may be insurmountable.
153728. For example, in order to leave a convenient location to
1548visit once or twice a day, an indigent mother must arrange
1559transportation to and from the Level III facility where the baby
1570has been sent. This may entail additional expenses for the
1580parent such as lost wages or extending times for babysitters
1590watching other children in the home. These additional expenses
1599may be more than the indigent family can bear.
160829. The nearest Level III NICU provider to whom Bethesda
1618now transfers patients is St. Marys Hospital. This facility is,
1628by automobile, approximately 30-40 minutes from Bethesda
1635depending on traffic conditions. Bus transportation directly
1642connecting one site to the other, if it were available (which it
1654is not), would presumably take longer.
166030. Currently, even when it is determined that a maternity
1670patient should be sent to St. Mary's Hospital for pre-natal care,
1681the mothers are presenting for delivery at Bethesda. This occurs
1691because Bethesda is geographically located in the area where they
1701live. The baby is born at Bethesda and a decision must be made
1714how best to deal with the health issues of the child.
172531. Of the patients referred from Bethesda to St. Mary's
1735Hospital for pre-natal care, only 5 percent deliver at St.
1745Mary's. Ninety-five percent return to Bethesda for delivery even
1754though they were told to go to St. Mary's.
176332. The main reason for this failure of patients to follow
1774up at St. Mary's Hospital is the lack of affordable
1784transportation. Many indigent women do not have cars or access
1794to them. The existing facilities in Palm Beach County for Level
1805III care are not reasonably available, appropriate, or accessible
1814alternatives for these patients.
181833. AHCA District 9 has only three Level III NICU
1828providers. They are all in Palm Beach County, with St. Mary's
1839Hospital and Good Samaritan Hospital (now owned by the same
1849company) in the northern part of the county (West Palm Beach) and
1861West Boca in the southern part (Boca Raton).
186934. West Boca is not a reasonable alternative for the NICU
1880patient population served by Bethesda. West Boca does not serve
1890the lower income patients. In fact, West Boca transfers patients
1900without financial resources to Bethesda. West Boca transfers
1908indigent women in labor early enough so that COBRA regulations
1918are met. Pertinent to this case, historically, West Boca
1927transferred indigent Level III NICU patients to Bethesda until
19361994.
193735. During the last three years, Level III NICU utilization
1947at Good Samaritan and St. Mary's Hospital has averaged better
1957than 90 percent. To average 90 percent means that the beds are
1969often full or there are more patients than there are beds.
1980Accordingly, these providers are operating at what is essentially
1989capacity.
199036. It is, therefore, not surprising that St. Mary's
1999Hospital supports Bethesda's CON application in this proceeding.
2007No existing provider within District 9, including West Boca,
2016formally opposed the instant application.
202137. A primary service area is the area from which a
2032hospital draws the overwhelming majority of its patients for a
2042given service and is defined by zip code level information. The
2053primary service area of Bethesda for providing newborn and
2062neonatal services is wholly within what has been described in
2072this record as the southern portion of Palm Beach County.
208238. The primary service areas of West Boca and Bethesda for
2093newborn and neonatal services do not significantly overlap. In
2102fact, 40 percent to 45 percent of these services provided by West
2114Boca have been to residents of Broward County. In this regard,
2125West Boca's neonatal services compete more directly with those of
2135Broward General Hospital than Bethesda.
214039. Bethesda's NICU is currently staffed and equipped for
2149Level III services. From a medical standpoint, the CON proposal
2159will result in a quality 15-bed dual unit, which is very
2170efficient from the neonatologist's standpoint.
217540. The neonatologists staffing the Bethesda NICU are
2183associated with the same group serving St. Mary's Hospital and
2193Broward General Hospital, both Regional Perinatal Intensive Care
2201Centers (RPICC). This helps assure proficiency with large
2209volumes at more than one program.
221541. The nursing staff at Bethesda all have at least two
2226years of Level III experience, and no nurse is currently hired
2237for the NICU without that level of experience.
224542. From a neonatal nursing care standpoint, the addition
2254of the three Level III beds would result in quality, cost-
2265efficient care. The proposed combined unit would allow for
2274flexibility of making daily staff assignments and would enhance
2283care for the babies.
228743. The combined 15-bed NICU is large enough to provide
2297quality, cost-effective Level II and III care. Bethesda has the
2307physician staffing, nurse and therapist staffing, equipment,
2314facilities, and hospital services to provide proper quality
2322tertiary care for these newborns.
232744. Since 1993, Mease Hospital in Dunedin, Florida, has
2336operated a five-bed Level III NICU combined with a five-bed Level
2347II NICU in one room. It has proven to be a quality program with
2361a low mortality rate. The five-bed Level III NICU provides cost-
2372efficient care. There is no reason Bethesda cannot duplicate the
2382record Mease has demonstrated.
238645. High quality, neonatal intensive care may be easier to
2396achieve with Level II and III beds in the same room than with any
2410other configuration of beds.
241446. Bethesda will not be able to treat every sick baby. It
2426cannot care for babies requiring open heart surgery (Bethesda
2435does not have an open heart surgery program), for those needing
2446extra-corporeal membrane oxygenation (ECMO), nor those seeking
2453pediatric cardiac catheterization.
245647. None of the three existing Level III facilities in
2466District 9, however, has open heart surgery or ECMO available.
2476Like Bethesda they, too, must transfer out for these services.
248648. Fortunately, the Agency rule allows a provider to make
2496written arrangements with other Level III providers to provide
2505those services in the same or nearest service area. AHCA has
2516stipulated that Bethesda has the appropriate written transfer
2524agreements pursuant to Rule 59C-1.042(12), Florida Administrative
2531Code.
253249. For the number of babies to be served by Bethesda, the
2544ability to serve Level III babies will improve the quality of
2555care. There are medical risks in transferring babies from one
2565facility to another. When adequate staffing and facilities are
2574available at the hospital of birth, transferring the infant to
2584another provider may pose an unnecessary risk.
259150. The risks inherent in transfers do not always outweigh
2601the benefit. For example, transferring the child may delay
2610certain treatments such as use of "surfactants" which protect a
2620baby's lungs. Other risks such as those associated with
2629maintaining the infant's blood pressure or body temperature make
2638transfers difficult and, in some instances, medically
2645questionable.
264651. Bethesdas application for the instant CON meets the
2655applicable local and state health plans.
266152. Bethesda has an established record of providing quality
2670care and will be well able to provide quality of care for the
2683services allowed by the proposed addition of three Level III NICU
2694beds.
269553. It is unrealistic for Bethesda to refuse admission to
2705patients requiring Level III NICU services given the historical
2714and current patterns of births for this District.
272254. Bethesdas proposed addition of three Level III beds to
2732its NICU is financially feasible both in the short- and long-
2743term.
274455. Bethesdas Level III NICU beds will be programmatically
2753accessible to its patient population.
275856. Although 90 percent of the District 9 population is
2768within two hours ground travel time of an existing Level III NICU
2780bed, such accessibility does not consider the unique
2788characteristics of the indigent population the proposed beds at
2797Bethesda will serve. Moreover, the provider who would otherwise
2806serve the Level III patient under such scenario supports this
2816application.
281757. The existing facilities providing care to the indigent
2826population operate at capacity and are fully utilized. The only
2836facility not fully utilized (West Boca) has no significant
2845history of providing care to the Medicaid/indigent population.
285358. The proposed construction or renovation of the Bethesda
2862unit to accommodate fifteen NICU stations is reasonable. While
2871Bethesda will have to meet certain minimum licensing standards in
2881the configuration of the NICU, it is anticipated that such
2891standards will be met with little difficulty or significant
2900expense to Bethesda.
290359. The unchallenged fixed-need pool for the batching cycle
2912applicable to this case was one Level III bed.
292160. Bethesda has met all Agency requirements regarding
2929Emergency Transportation, Transfer Agreements, and Data
2937Reporting Requirements.
293961. The Agencys rule regarding minimum unit size for a
2949Level III NICU has not been met. However, this requirement has
2960not been adhered to by the Agency in several instances.
297062. In AHCA District 9, there are three hospitals with NICU
2981Level III programs. Not one of these programs has 15 beds. St.
2993Mary's Hospital (a RPICC) has ten beds, Good Samaritan has eight
3004beds, and West Boca has five beds. The quality of care at these
3017providers is presumably adequate despite the fact that they were
3027approved and licensed by the Agency with less than fifteen beds.
303863. Moreover, the Agency has never considered the 15-bed
3047minimum an absolute bar to the application for, or the review of,
3059lesser-numbered beds.
306164. In fact, the Agency approved new Level III NICU beds at
3073Mease Hospital (a five-bed unit), West Boca Hospital (a five-bed
3083unit), and Miami Baptist Hospital (a seven-bed unit) after the
3093rule was promulgated. Additionally, the total number of all NICU
3103beds at Mease and West Boca is less than fifteen.
311365. Thus, as stipulated in South Miami Hospital, Inc. v.
3123Agency for Health Care Administration , Case No. 97-04875,
3131currently pending before the First District Court of Appeal, the
3141Agency has consistently interpreted those unit size rule
3149provisions as permissive.
315266. Bethesda has presented not normal circumstances
3159supporting this CON application which are hereby accepted. Such
3168circumstances include: accessibility issues for indigent or
3175Medicaid mothers and babies; the lack of Level III beds in the
3187southern portion of the county where 60 percent of all resident
3198live births are delivered; the fact that approximately one-third
3207of the low birth weight mothers reside in the service area for
3219Bethesda yet the majority of the Level III beds are in the
3231northern portion of the county; and the fact that 30 percent of
3243Bethesdas patients are clients from the PHU.
325067. The average occupancy rate for Level III NICU beds for
3261the year applicable to this application was 80.9 percent. As a
3272result, the rule mandated minimum average occupancy rate has been
3282met.
3283CONCLUSIONS OF LAW
328668. The Division of Administrative Hearings has
3293jurisdiction over the parties to, and the subject matter of,
3303these proceedings.
330569. As the applicant, Bethesda has the burden of proof to
3316establish its entitlement to the CON sought. Boca Raton
3325Artificial Kidney Center, Inc. v. Department of HRS , 475 So. 2d
3336260 (Fla. 1st DCA 1985).
334170. More specifically, as stipulated by the parties,
3349Bethesda must establish, upon a weighing of all applicable and
3359statutory rule criteria, whether its application for a CON to
3369convert three general acute care beds for use as Level III NICU
3381beds should be approved.
338571. Having weighed such criteria, it is concluded Bethesda
3394has met its burden.
339872. Utilizing the methodology contained in Rule 59C-
34061.042(3)(e), Florida Administrative Code, there is insufficient
3413numeric need for the proposed beds sought by Bethesda. Under the
3424need methodology, only one Level III bed could be approved.
343473. Nevertheless, this applicant has demonstrated not
3441normal circumstances justifying the addition of three Level III
3450NICU beds.
345274. The applicant has demonstrated that, when reviewed in
3461the context of availability, quality of care, efficiency,
3469accessibility, past utilization, projected utilization, and the
3476adequacy of other providers to meet the needs for the service
3487district, this proposal will meet the not normal circumstances of
3497this district.
349975. Except as to the minimum size of the proposed Level III
3511NICU, this applicant has demonstrated compliance with the
3519applicable statutory or rule criteria. The rule criteria setting
3528forth a minimum size of 15 beds for a new Level III NICU cannot
3542be met.
354476. Rule 59C-1.042(5), Florida Administrative Code,
3550provides:
3551Minimum Unit Size. Hospitals proposing the
3557establishment of new Level III neonatal
3563intensive care services shall propose a Level
3570III neonatal intensive care unit of at least
357815 beds, and should have 15 or more Level II
3588neonatal intensive care unit beds. A
3594provider shall not normally be approved for
3601Level III neonatal intensive care services
3607only. Hospitals proposing the establishment
3612of new Level II neonatal intensive care
3619services only shall propose a Level II
3626neonatal intensive care unit with a minimum
3633of 10 beds. Hospitals under contract with
3640the Department of HRS' Children's Medical
3646Services Program for the provision of
3652regional perinatal intensive care center or
3658step-down neonatal special care unit care are
3665exempt from these requirements.
366977. Notwithstanding the clear language of this rule, the
3678Agency has allowed and granted applications for new Level III
3688NICU beds below the 15-bed minimum size. The instant application
3698must be reviewed in the same context given the Agencys decisions
3709wherein it has granted Level III NICU beds below the minimum
3720size. As such, it must be concluded the Agency has the authority
3732to grant approval of the instant application.
373978. Neither Mease Hospital nor West Boca will offer the
3749level of indigent care to which this applicant proposes to be
3760bound. Neither unit had more expertise nor quality of care than
3771that as demonstrated by Bethesda. Neither facility was
3779contractually obligated to provide services through a county-wide
3787network seeking to assure adequate medical accessibility for its
3796residents. Bethesdas application seeks to serve the population
3804needing its services most.
380879. NICU services are defined as a tertiary health service.
3818Section 408.032(20), Florida Statutes, provides:
3823(20) "Tertiary health service" means a health
3830service which, due to its high level of
3838intensity, complexity, specialized or limited
3843applicability, and cost, should be limited
3849to, and concentrated in, a limited number of
3857hospitals to ensure the quality,
3862availability, and cost-effectiveness of such
3867service. Examples of such service include,
3873but are not limited to, organ
3879transplantation, specialty burn units,
3883neonatal intensive care units, comprehensive
3888rehabilitation, and medical or surgical
3893services which are experimental or
3898developmental in nature to the extent that
3905the provision of such services is not yet
3913contemplated within the commonly accepted
3918course of diagnosis or treatment for the
3925condition addressed by a given service. The
3932agency shall establish by rule a list of all
3941tertiary health services.
394480. In this case, Bethesda has demonstrated there will be
3954sufficient volume and proper expertise to ensure quality of care
3964for the proposed Level III NICU beds. Moreover, the unit size
3975should be sufficient to promote quality care. The combined
3984fifteen-bed unit will perform with enhanced efficiency and
3992scheduling. All NICU babies should benefit from this approach.
4001In this instance, limiting these services to other providers will
4011serve no purpose.
401481. Having considered the evidence presented and the
4022argument of counsel, it is concluded Bethesda has demonstrated by
4032a preponderance of the competent, substantial evidence, that the
4041Agency should grant CON application Number 8235 and allow this
4051applicant to convert three general acute care beds to three Level
4062III NICU beds, so that its combined NICU will total 15 beds.
4074RECOMMENDATION
4075Based on the foregoing Findings of Fact and Conclusions of
4085Law, it is RECOMMENDED
4089That the Agency for Health Care Administration enter a final
4099order approving CON application Number 8235 with the condition
4108that Bethesda provide indigent/Medicaid care as proposed in the
4117application.
4118DONE AND ENTERED this 24th day of February, 1998, in
4128Tallahassee, Leon County, Florida.
4132___________________________________
4133J. D. PARRISH
4136Administrative Law Judge
4139Division of Administrative Hearings
4143The DeSoto Building
41461230 Apalachee Parkway
4149Tallahassee, Florida 32399-3060
4152(850) 488-9675 SUNCOM 278-9675
4156Fax Filing (850) 921-6847
4160Filed with the Clerk of the
4166Division of Administrative Hearings
4170this 24th day of February, 1998.
4176COPIES FURNISHED:
4178Sam Power, Agency Clerk
4182Agency for Health Care Administration
4187Fort Knox Building 3
41912727 Mahan Drive, Suite 3431
4196Tallahassee, Florida 32308-5403
4199Paul J. Martin, General Counsel
4204Agency for Health Care Administration
4209Fort Knox Building 3
42132727 Mahan Drive, Suite 3431
4218Tallahassee, Florida 32308-5403
4221Richard A. Patterson, Esquire
4225Agency for Health Care Administration
4230Fort Knox Building 3
42342727 Mahan Drive, Suite 3407B
4239Tallahassee, Florida 32308-5403
4242Kenneth F. Hoffman, Esquire
4246M. Christopher Bryant, Esquire
4250Oertel, Hoffman, Fernandez & Cole, P.A.
4256Post Office Box 6507
4260Tallahassee, Florida 32314-6507
4263NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
4269All parties have the right to submit written exceptions within 15
4280days from the date of this Recommended Order. Any exceptions to
4291this Recommended Order should be filed with the agency that will
4302issue the Final Order in this case.
- Date
- Proceedings
- Date: 01/19/1999
- Proceedings: Agency Final Order rec`d
- PDF:
- Date: 02/24/1998
- Proceedings: Recommended Order sent out. CASE CLOSED. Hearing held 11/19-21/97.
- Date: 02/17/1998
- Proceedings: Amicus Argument by Florida Statutory Teaching Hospital Council, Public Health Trust of Dade County, Florida as Jackson Memorial Hospital, Miami Children`s Hospital, and All Children`s Hospital filed.
- Date: 02/13/1998
- Proceedings: Letter to JDP from Kenneth Hoffman (RE: documents for official recognition/attached) (filed via facsimile).
- Date: 01/21/1998
- Proceedings: (Petitioner) Unopposed Motion for Leave to File Response to Proposed Conclusion of Law; Bethesda`s Response to Proposed Conclusion of Law filed.
- Date: 01/14/1998
- Proceedings: Respondent`s Proposed Recommended Order filed.
- Date: 01/14/1998
- Proceedings: Proposed Recommended Order of Bethesda Memorial Hospital, Inc. filed.
- Date: 12/23/1997
- Proceedings: Letter to JDP from Kenneth Hoffman (RE: filing date for PRO`s) filed.
- Date: 12/15/1997
- Proceedings: (4 Volumes) Transcript filed.
- Date: 11/19/1997
- Proceedings: CASE STATUS: Hearing Held.
- Date: 11/12/1997
- Proceedings: Bethesda`s Unopposed Motion For Leave To Present Telephonic Testimony Of Witnesses At Final Hearing filed.
- Date: 11/06/1997
- Proceedings: Order sent out. (Request for oral argument is denied; Motion for abeyance or consolidation is denied)
- Date: 11/06/1997
- Proceedings: (Signed by R. Patterson, K. Hoffman) Prehearing Stipulation filed.
- Date: 11/04/1997
- Proceedings: Letter to JDP from R. Patterson Re: No objection to two day Extension of Time for filing parties` prehearing stipulation filed.
- Date: 11/04/1997
- Proceedings: (Petitioner) Request for Oral Argument filed.
- Date: 11/04/1997
- Proceedings: (From K. Hoffman) Memorandum in Opposition to Motion for Abeyance or consolidation and Request for an Order Determining Bethesda`s Right to Hearing on Its CON Application filed.
- Date: 10/29/1997
- Proceedings: (Respondent) Motion for Abeyance or Consolidation filed.
- Date: 08/07/1997
- Proceedings: Notice of Hearing sent out. (hearing set for Nov. 19-21, 1997; 9:00am; Tallahassee)
- Date: 07/29/1997
- Proceedings: Petitioner`s Response to Order of Abeyance and Status Report filed.
- Date: 05/29/1997
- Proceedings: Order sent out. (case to remain in abeyance; parties to file available hearing dates by 7/29/97)
- Date: 05/27/1997
- Proceedings: Petitioner`s Consented Motion for Abeyance filed.
- Date: 05/16/1997
- Proceedings: Order sent out. (case to remain in abeyance; parties to file available hearing dates by 5/25/97)
- Date: 05/09/1997
- Proceedings: (Petitioner) Status Report filed.
- Date: 04/04/1997
- Proceedings: Order Extending Abeyance sent out. (abeyance is extending to 4/18/97)
- Date: 03/10/1997
- Proceedings: (Petitioner) Response to Order Extending Abeyance filed.
- Date: 02/24/1997
- Proceedings: Order Granting Request to Extend Abeyance sent out.
- Date: 02/07/1997
- Proceedings: Joint Status Report filed.
- Date: 12/02/1996
- Proceedings: Order Granting Motion for Continuance and Abeyance sent out. (Parties to file status report by 2/7/97)
- Date: 11/27/1996
- Proceedings: Petitioner`s Consented Motion for Continuance and Abeyance filed.
- Date: 10/18/1996
- Proceedings: Case No/s: 96-841, 96-1029 unconsolidated.
- Date: 03/13/1996
- Proceedings: Order Granting Consolidation sent out. (Consolidated cases are: 96-0841RX & 96-1029)
- Date: 03/13/1996
- Proceedings: Notice of Hearing sent out. (hearing set for July 24-26, 1996; 9:00am; Tallahassee)
- Date: 03/11/1996
- Proceedings: (From M. Bryant) Notice of Filing Motion to Consolidate; Joint Motion to Consolidate and Response to Order Requesting Hearing Dates filed.
- Date: 03/11/1996
- Proceedings: Joint Motion to Consolidate and Response to Order Requesting Hearing Dates (with DOAH Case No/s. 96-841RX, 96-1029) filed.
- Date: 03/11/1996
- Proceedings: (NME Hospitals, Inc. d/b/a West Boca Medical Center ("West Boca")) Petition to Intervene filed.
- Date: 03/05/1996
- Proceedings: Prehearing Order sent out.
- Date: 03/01/1996
- Proceedings: Notification card sent out.
- Date: 02/29/1996
- Proceedings: Notice; Petition For Formal Administrative Hearing filed.
Case Information
- Judge:
- J. D. PARRISH
- Date Filed:
- 02/29/1996
- Date Assignment:
- 03/13/1996
- Last Docket Entry:
- 01/19/1999
- Location:
- Tallahassee, Florida
- District:
- Northern
- Agency:
- ADOPTED IN PART OR MODIFIED
- Suffix:
- CON