97-003029CON Hospice Of North Central Florida, Inc., D/B/A Hospice Of North Central Florida vs. Medlink Management Services, Inc., D/B/A Ramadan Hand Institute/Lake Butler Hospital, And Agency For Health Care Administration
 Status: Closed
Recommended Order on Friday, October 10, 1997.


View Dockets  
Summary: Exemption from Certificate of Need review denied where applicant was "for-profit" licensee, operating under fictitious name as "rural hospital."

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8HOSPICE OF NORTH CENTRAL )

13FLORIDA, INC., d/b/a HOSPICE OF )

19NORTH CENTRAL FLORIDA, )

23)

24Petitioner, )

26)

27vs. ) Case No. 97-3029

32)

33AGENCY FOR HEALTH CARE )

38ADMINISTRATION and MEDLINK )

42MANAGEMENT SERVICES, INC., )

46d/b/a RAMADAN HAND INSTITUTE/ )

51LAKE BUTLER HOSPITAL, )

55)

56Respondents. )

58_________________________________)

59SUMMARY RECOMMENDED ORDER

62On July 10, 1997, Petitioner Hospice of North Central

71Florida, Inc. (HNCF) filed a "Motion for Summary Recommended

80Order Denying and Dismissing Medlink Management Services, Inc.,

88d/b/a Ramadan Hand Institute/Lake Butler's Request for

95Exemption." On August 18, 1997, Respondent Medlink filed a

"104Response to Petition for Formal Administrative Hearing," which

112admitted certain paragraphs of Hospice's initial Petition. Also

120on August 18, 1997, Medlink filed a Response to HNCF's Motion and

132a Memorandum of Law in opposition to the Motion. It attached

143documents relied upon by all parties.

149On August 21, 1997, Respondent Medlink filed its own "Motion

159for Summary Recommended Order Denying Petitioner's Motion for

167Summary Recommended Order and Dismissal, or in the Alternative,

176Abatement of Petitioner's Petition for Formal Administrative

183Hearing." This pleading adopted the facts, statement of the

192case, and arguments set forth in Medlink's prior Memorandum.

201Also on August 21, 1997, Medlink filed an Amended

210Memorandum.

211On August 28, 1997, HNCF filed a "Motion to Strike and in

223the Alternative Reply to Medlink's Response to Petition and Reply

233to Medlink's Response to Motion for Summary Recommended Order."

242On that date, HNCF also filed its "Response to Medlink's Motion

253for Summary Recommended Order."

257On September 2, 1997, oral argument was heard by telephonic

267conference call upon all pending matters. Oral stipulations were

276entered into by the parties both as to procedural matters and

287facts upon which the Motion(s) for Summary Recommended Order

296might be considered. The parties were granted seven days in

306which to submit copies of the applicable rules and any further

317written argument. The Motion to Abate was denied. The parties

327selected November 10, 1997, for formal hearing in Tallahassee in

337the event a Summary Recommended Order was not issued.

346On September 8, 1997, the Agency filed copies of Rules 59-

3571.022, 59C-1.005, and 60Q-2.016, Florida Administrative Code.

364On September 9, 1997, Medlink filed a "Response to North

374Central Florida's Motion to Strike and Response to Its Reply."

384On September 11, 1997, the Agency filed copies of Rules 58A-

3952.002, 58A-2.003, and 58A-2.004, Florida Administrative Code.

402On September 15, 1997, HNCF filed a Motion to Strike the

413September 9, 1997, Medlink Response.

418On September 23, 1997, Medlink filed a Response to HNCF's

428September 15, 1997, Motion to Strike.

434Most of the foregoing pleadings are not authorized by Rule

44460Q-2.016, Florida Administrative Code. Many are cumulative and

452take advantage of the undersigned's acquiescence in permitting

460further written argument after the September 2, 1997, oral

469argument. Even so, many are outside the parameters of the oral

480order given at that time. The only real issue raised herein is

492whether Petitioner or Respondent Medlink is entitled to a Summary

502Recommended Order in its favor upon undisputed facts. To that

512end, none of the pleadings is struck and all have been

523considered.

524UNDISPUTED FINDINGS OF FACT

5281. Hospice of North Central Florida, Inc., d/b/a Hospice

537of North Central Florida (HNCF) is an existing hospice care

547provider duly licensed to provide hospice services in the Agency

557for Health Care Administration's (AHCA's) Health Planning

564District 3A.

5662. On or about May 2, 1997, the Ramadan Hand

576Institute/Lake Butler Hospital filed a letter with AHCA

584requesting an exemption from Certificate of Need (CON) review to

594establish a hospice program in health planning District 3A. The

604basis of the exemption request was the alleged rural hospital

614status of the Ramadan Hand Institute/Lake Butler Hospital.

6223. HNCF's substantial interests will be substantially

629affected by AHCA's decision to exempt Medlink's proposed hospice

638from CON review and any future decision to issue a license to

650Medlink Management Service d/b/a Ramadan Hand Institute/Lake

657Butler Hospital to operate a hospice in Health Planning District

6673A.

6684. AHCA did not request any further information prior to

678acting on the request. Neither did AHCA check out the

688applicant's corporate status as a rural hospital.

6955. AHCA's licensure files show that the Ramadan Hand

704Institute/Lake Butler Hospital is not a corporate entity, but the

714fictitious name registered to the facility's actual licensee,

722Medlink Management Services, Inc.

7266. According to the Florida Secretary of State's records,

735Medlink Management Services, Inc., the licensee of Ramadan Hand

744Institute/Lake Butler Hospital, is a "for profit" corporation.

752This is consistent with the information provided by Medlink to

762AHCA in its most recent Hospital Licensure Application, and is

772not disputed.

7747. The Ramadan Hand Institute/Lake Butler Hospital is a

"783rural hospital" as that term is defined under Section 395.602,

793Florida Statutes.

7958. This instant case was styled as set out above only by

807agreement or acquiescence of the parties, and the Respondents do

817not dispute the immediately preceding Finding of Fact.

8259. On or about May 17, 1997, AHCA responded to the letter

837request, authorizing a CON exemption for a Medicare-certified

845hospice program to the Ramadan Hand Institute/Lake Butler

853Hospital.

85410. Medlink Management Services, Inc. d/b/a Ramadan Hand

862Institute/Lake Butler Hospital has not made application for

870licensure to operate a hospice.

87511. Medlink represents that it intends to establish a non-

885profit operational entity to operate its rural hospital hospice

894and to thereafter become licensed as a hospice. However, these

904processes have not been initiated, and all parties concede that

914there is no statutory or rule requirement that, or any existing

925administrative mechanism in place whereby, any existing hospice

933licensee (including but not limited to HNCF) will be notified or

944provided an opportunity to participate in another licensee's

952application process. Therefore, this instant "exemption"

958proceeding, or a CON review, are the only windows of opportunity

969for HNCF to assert its substantial interests.

976CONCLUSIONS OF LAW

97912. The Division of Administrative Hearings has

986jurisdiction over the parties and subject matter of this cause,

996pursuant to Section 120.57(1), Florida Statutes.

100213. Medlink has acknowledged that in order for Medlink to

1012comply with Chapter 400, Florida Statutes, and the regulations

1021implementing the licensure requirements of Rule 58A-2.003 and

102958A-2.004, Florida Administrative Code, it is necessary for the

1038corporate health care provider to create a separate and distinct

1048non-profit corporation to make application as a licensee, 1 but

1058that it would be "legally impracticable, if not impermissible,

1067for an established corporate health care provider to become the

1077actual licensee of a hospice." It further asserted, however,

1086that Medlink has three options: (a) to submit an application

1096through an autonomous non-profit entity created to provide

1104hospice services, (b) convert to a non-profit entity, if

1113necessary, or (c) seek, with the help of its local delegation, to

1125introduce legislation to correct the alleged inconsistencies and

1133ambiguities in Chapters 395, 400, and 408, Florida Statutes.

1142Medlink further moved for abatement until it could address the

1152issues legislatively, and abatement was orally denied on

1160September 2, 1997. Likewise, all Medlink's suggestions that, for

1169the foregoing reasons, the issue herein is not ripe for

1179adjudication are not persuasive. See University Community

1186Hospital v. Department of Health and Rehabilitative Services , 555

1195So. 2d 922 (Fla. 1st DCA 1990); Baptist Hospital, Inc. v.

1206Department of Health and Rehabilitative Services , 500 So. 2d 620

1216(Fla. 1st DCA 1986); South Broward Hospital District v.

1225Department of Health and Rehabilitative Services , 385 So. 2d 1094

1235(Fla. 4th DCA 1980). See also Friends of the Hatchineha v.

1246Department of Environmental Regulation , 580 So. 2d 267 (Fla. 1st

1256DCA 1991), and Town of Palm Beach v. Department of Natural

1267Resources , 577 So. 2d 1383 (Fla. 1st DCA 1991).

127614. This case may be disposed of by Summary Recommended

1286Order as a matter of law, and, in fact, must be, because there

1299will be no notice to HNCF of intended agency action when, and if,

1312Medlink applies for its own license. Section 408.042, Florida

1321Statutes, does not address transfer of an exemption from CON

1331review, as suggested by Medlink, so as to provide a new window

1343for challenge to a later-created entity. There is no clear

1353authority to show that an exemption from CON Review granted to a

1365rural hospital can be subsequently transferred to an affiliated

1374entity either existing or yet to be formed. See Rule 59C-1.005,

1385Florida Administrative Code. However, there is authority to

1393support the proposition that failure to identify the license

1402holder as the applicant for a health care project is a fatal

1414defect, requiring dismissal of a CON application. See Brookwood.

1423Jackson County Convalescent Center v. Department of Health and

1432Rehabilitative Services , 591 So. 2d 1085 (Fla. 1st DCA 1992).

144215. The Ramadan Hand Institute/Lake Butler Hospital filed

1450a letter with the Agency requesting an exemption from CON review

1461to establish a hospice program in Health Planning District 3A.

1471The basis of the exemption request is the alleged rural hospital

1482status of the Ramadan Hand Institute/Lake Butler Hospital.

149016. Section 408.036(3)(h), Florida Statutes, provides in

1497pertinent part:

1499(3) EXEMPTIONS. -- Upon request, supported

1505by such documentations as the department may

1512require, the department shall grant an

1518exemption from the provisions of subsection

1524(1):

1525* * *

1528For hospice or home health services provided

1535by a rural hospital, as defined in s.

1543395.602, . . .

154717. The Ramadan Hand Institute/Lake Butler Hospital is not

1556a corporate entity, but the fictitious name registered to the

1566facility's actual licensee, Medlink Management Services, Inc.

157318. Medlink Management Services, Inc., the licensee of

1581Ramadan Hand Institute/Lake Butler Hospital, is a Florida "for

1590profit" corporation.

159219. Section 400.601(3), Florida Statutes, defines the term

"1600hospice" to mean, ". . . a centrally administered corporation

1610not for profit , as defined in chapter 617, providing a continuum

1621of palliative and supportive care for the terminally ill patient

1631and his or her family." (emphasis supplied) See also Rule 58A-

16422.004, Florida Administrative Code, which provides that a license

1651shall be issued to any "not-for-profit" agency which otherwise

1660meets the licensure requirements. Because Medlink is a

"1668for-profit" corporation, it cannot, as a matter of law, be

1678licensed as a hospice.

168220. The exemption afforded rural hospitals found in

1690Section 408.036(3)(h), Florida Statutes, does not exempt a

1698licensee from the requirements of Section 400.601, Florida

1706Statutes. Because Medlink, as a "for-profit" corporation, fails

1714to meet this mandatory statutory requirement, the act of issuing

1724a letter of exemption to Ramadan Hand Institute/Lake Butler

1733Hospital is an unauthorized exercise of Agency discretion,

1741inconsistent with the Agency rules, and in violation of the

1751statute. The Agency should have denied the exemption request and

1761required the Applicant to submit to the CON Review procedure.

1771RECOMMENDATION

1772Upon the foregoing findings of fact and conclusions of law,

1782it is

1784RECOMMENDED that the Agency for Health Care Administration

1792enter a Final Order denying the request for exemption from

1802Certificate of Need Review.

1806RECOMMENDED this 10th day of October, 1997, at Tallahassee,

1815Leon County, Florida.

1818___________________________ ________

1820ELLA JANE P. DAVIS

1824Administrative Law Judge

1827Division of Administrative Hearings

1831The DeSoto Building

18341230 Apalachee Parkway

1837Tallahassee, Florida 32399-3060

1840(904) 488-9675 SUNCOM 278-9675

1844Fax Filing (904) 921-6847

1848Filed with the Clerk of the

1854Division of Administrative Hearings

1858this 10th day of October, 1997.

1864ENDNOTE

18651 Cf - Contrariwise, HNCF contended that AHCA has never

1875interpreted Section 408.610, Florida Statutes, to require that a

1884hospice be established as a separate legal entity from an

1894existing health care provider and has interpreted the statute to

1904allow an existing not for profit provider to operate a hospice

1915within its existing corporate structure.

1920COPIES FURNISHED:

1922Pamela B. Howard

1925Post Office Box 748

1929Lake Butler, Florida 32054

1933Richard Ellis, Esquire

1936Agency for Health

1939Care Administration

1941Building 3, Suite 3431

19452727 Mahan Drive

1948Tallahassee, Florida 32308

1951R. Terry Rigsby, Esquire

1955Blank, Rigsby & Meenan

1959204 South Monroe Street

1963Tallahassee, Florida 32301

1966Douglas M. Cook, Director

1970Agency for Health Care Administration

19752727 Mahan Drive

1978Tallahassee, Florida 32308

1981Jerome W. Hoffman, General Counsel

1986Agency of Health Care Administration

19912727 Mahan Drive

1994Tallahassee, Florida 32308

1997NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

2003All parties have the right to submit written exceptions within 15

2014days from the date of this Recommended Order. Any exceptions to

2025this Recommended Order should be filed with the agency that will

2036issue the final order in this case.

2043STATE OF FLORIDA

2046DIVISION OF ADMINISTRATIVE HEARINGS

2050HOSPICE OF NORTH CENTRAL )

2055FLORIDA, INC., d/b/a HOSPICE OF )

2061NORTH CENTRAL FLORIDA, )

2065)

2066Petitioner, )

2068)

2069vs. ) Case No. 97-3029

2074)

2075AGENCY FOR HEALTH CARE )

2080ADMINISTRATION and MEDLINK )

2084MANAGEMENT SERVICES, INC., )

2088d/b/a RAMADAN HAND INSTITUTE/ )

2093LAKE BUTLER HOSPITAL, )

2097)

2098Respondents. )

2100_________________________________)

2101CORRECTED SUMMARY RECOMMENDED ORDER

2105This cause came on for consideration upon MEDLINK's Motion

2114for Extension of Time in Which to File Exceptions, received by

2125the undersigned on November 18, 1997.

2131Although the undersigned is without jurisdiction to grant

2139such a motion once a Recommended Order is entered, the motion

2150correctly points out a serious scrivener's error in the Summary

2160Recommended Order entered herein on October 10, 1997. That

2169error, which is the failure to "copy" MEDLINK's counsel with the

2180Summary Recommended Order, occurred in the office of the

2189undersigned and clearly affects due process in this cause.

2198Such a situation is exactly the type of inadvertent error

2208addressed by Rule 60Q-2.032, Florida Administrative Code. That

2216rule provides that at any time on her own motion, the undersigned

2228may enter a corrected order.

2233Therefore, pursuant to Rule 60Q-2.032(2), Florida

2239Administrative Code, this Corrected Summary Recommended Order is

2247entered to correct the "copies list" to include MEDLINK's counsel

2257and to provide a copy of the decision herein to such counsel. In

2270so doing, the time for filing exceptions is automatically

2279adjusted 15 days from instant date.

2285On July 10, 1997, Petitioner Hospice of North Central

2294Florida, Inc. (HNCF) filed a "Motion for Summary Recommended

2303Order Denying and Dismissing Medlink Management Services, Inc.,

2311d/b/a Ramadan Hand Institute/Lake Butler's Request for

2318Exemption." On August 18, 1997, Respondent Medlink filed a

"2327Response to Petition for Formal Administrative Hearing," which

2335admitted certain paragraphs of Hospice's initial Petition. Also

2343on August 18, 1997, Medlink filed a Response to HNCF's Motion and

2355a Memorandum of Law in opposition to the Motion. It attached

2366documents relied upon by all parties.

2372On August 21, 1997, Respondent Medlink filed its own "Motion

2382for Summary Recommended Order Denying Petitioner's Motion for

2390Summary Recommended Order and Dismissal, or in the Alternative,

2399Abatement of Petitioner's Petition for Formal Administrative

2406Hearing." This pleading adopted the facts, statement of the

2415case, and arguments set forth in Medlink's prior Memorandum.

2424Also on August 21, 1997, Medlink filed an Amended

2433Memorandum.

2434On August 28, 1997, HNCF filed a "Motion to Strike and in

2446the Alternative Reply to Medlink's Response to Petition and Reply

2456to Medlink's Response to Motion for Summary Recommended Order."

2465On that date, HNCF also filed its "Response to Medlink's Motion

2476for Summary Recommended Order."

2480On September 2, 1997, oral argument was heard by telephonic

2490conference call upon all pending matters. Oral stipulations were

2499entered into by the parties both as to procedural matters and

2510facts upon which the Motion(s) for Summary Recommended Order

2519might be considered. The parties were granted seven days in

2529which to submit copies of the applicable rules and any further

2540written argument. The Motion to Abate was denied. The parties

2550selected November 10, 1997, for formal hearing in Tallahassee in

2560the event a Summary Recommended Order was not issued.

2569On September 8, 1997, the Agency filed copies of Rules 59-

25801.022, 59C-1.005, and 60Q-2.016, Florida Administrative Code.

2587On September 9, 1997, Medlink filed a "Response to North

2597Central Florida's Motion to Strike and Response to Its Reply."

2607On September 11, 1997, the Agency filed copies of Rules 58A-

26182.002, 58A-2.003, and 58A-2.004, Florida Administrative Code.

2625On September 15, 1997, HNCF filed a Motion to Strike the

2636September 9, 1997, Medlink Response.

2641On September 23, 1997, Medlink filed a Response to HNCF's

2651September 15, 1997, Motion to Strike.

2657Most of the foregoing pleadings are not authorized by Rule

266760Q-2.016, Florida Administrative Code. Many are cumulative and

2675take advantage of the undersigned's acquiescence in permitting

2683further written argument after the September 2, 1997, oral

2692argument. Even so, many are outside the parameters of the oral

2703order given at that time. The only real issue raised herein is

2715whether Petitioner or Respondent Medlink is entitled to a Summary

2725Recommended Order in its favor upon undisputed facts. To that

2735end, none of the pleadings is struck and all have been

2746considered.

2747UNDISPUTED FINDINGS OF FACT

27511. Hospice of North Central Florida, Inc., d/b/a Hospice

2760of North Central Florida (HNCF) is an existing hospice care

2770provider duly licensed to provide hospice services in the Agency

2780for Health Care Administration's (AHCA's) Health Planning

2787District 3A.

27892. On or about May 2, 1997, the Ramadan Hand

2799Institute/Lake Butler Hospital filed a letter with AHCA

2807requesting an exemption from Certificate of Need (CON) review to

2817establish a hospice program in health planning District 3A. The

2827basis of the exemption request was the alleged rural hospital

2837status of the Ramadan Hand Institute/Lake Butler Hospital.

28453. HNCF's substantial interests will be substantially

2852affected by AHCA's decision to exempt Medlink's proposed hospice

2861from CON review and any future decision to issue a license to

2873Medlink Management Service d/b/a Ramadan Hand Institute/Lake

2880Butler Hospital to operate a hospice in Health Planning District

28903A.

28914. AHCA did not request any further information prior to

2901acting on the request. Neither did AHCA check out the

2911applicant's corporate status as a rural hospital.

29185. AHCA's licensure files show that the Ramadan Hand

2927Institute/Lake Butler Hospital is not a corporate entity, but the

2937fictitious name registered to the facility's actual licensee,

2945Medlink Management Services, Inc.

29496. According to the Florida Secretary of State's records,

2958Medlink Management Services, Inc., the licensee of Ramadan Hand

2967Institute/Lake Butler Hospital, is a "for profit" corporation.

2975This is consistent with the information provided by Medlink to

2985AHCA in its most recent Hospital Licensure Application, and is

2995not disputed.

29977. The Ramadan Hand Institute/Lake Butler Hospital is a

"3006rural hospital" as that term is defined under Section 395.602,

3016Florida Statutes.

30188. This instant case was styled as set out above only by

3030agreement or acquiescence of the parties, and the Respondents do

3040not dispute the immediately preceding Finding of Fact.

30489. On or about May 17, 1997, AHCA responded to the letter

3060request, authorizing a CON exemption for a Medicare-certified

3068hospice program to the Ramadan Hand Institute/Lake Butler

3076Hospital.

307710. Medlink Management Services, Inc. d/b/a Ramadan Hand

3085Institute/Lake Butler Hospital has not made application for

3093licensure to operate a hospice.

309811. Medlink represents that it intends to establish a non-

3108profit operational entity to operate its rural hospital hospice

3117and to thereafter become licensed as a hospice. However, these

3127processes have not been initiated, and all parties concede that

3137there is no statutory or rule requirement that, or any existing

3148administrative mechanism in place whereby, any existing hospice

3156licensee (including but not limited to HNCF) will be notified or

3167provided an opportunity to participate in another licensee's

3175application process. Therefore, this instant "exemption"

3181proceeding, or a CON review, are the only windows of opportunity

3192for HNCF to assert its substantial interests.

3199CONCLUSIONS OF LAW

320212. The Division of Administrative Hearings has

3209jurisdiction over the parties and subject matter of this cause,

3219pursuant to Section 120.57(1), Florida Statutes.

322513. Medlink has acknowledged that in order for Medlink to

3235comply with Chapter 400, Florida Statutes, and the regulations

3244implementing the licensure requirements of Rule 58A-2.003 and

325258A-2.004, Florida Administrative Code, it is necessary for the

3261corporate health care provider to create a separate and distinct

3271non-profit corporation to make application as a licensee, 1 but

3281that it would be "legally impracticable, if not impermissible,

3290for an established corporate health care provider to become the

3300actual licensee of a hospice." It further asserted, however,

3309that Medlink has three options: (a) to submit an application

3319through an autonomous non-profit entity created to provide

3327hospice services, (b) convert to a non-profit entity, if

3336necessary, or (c) seek, with the help of its local delegation, to

3348introduce legislation to correct the alleged inconsistencies and

3356ambiguities in Chapters 395, 400, and 408, Florida Statutes.

3365Medlink further moved for abatement until it could address the

3375issues legislatively, and abatement was orally denied on

3383September 2, 1997. Likewise, all Medlink's suggestions that, for

3392the foregoing reasons, the issue herein is not ripe for

3402adjudication are not persuasive. See University Community

3409Hospital v. Department of Health and Rehabilitative Services , 555

3418So. 2d 922 (Fla. 1st DCA 1990); Baptist Hospital, Inc. v.

3429Department of Health and Rehabilitative Services , 500 So. 2d 620

3439(Fla. 1st DCA 1986); South Broward Hospital District v.

3448Department of Health and Rehabilitative Services , 385 So. 2d 1094

3458(Fla. 4th DCA 1980). See also Friends of the Hatchineha v.

3469Department of Environmental Regulation , 580 So. 2d 267 (Fla. 1st

3479DCA 1991), and Town of Palm Beach v. Department of Natural

3490Resources , 577 So. 2d 1383 (Fla. 1st DCA 1991).

349914. This case may be disposed of by Summary Recommended

3509Order as a matter of law, and, in fact, must be, because there

3522will be no notice to HNCF of intended agency action when, and if,

3535Medlink applies for its own license. Section 408.042, Florida

3544Statutes, does not address transfer of an exemption from CON

3554review, as suggested by Medlink, so as to provide a new window

3566for challenge to a later-created entity. There is no clear

3576authority to show that an exemption from CON Review granted to a

3588rural hospital can be subsequently transferred to an affiliated

3597entity either existing or yet to be formed. See Rule 59C-1.005,

3608Florida Administrative Code. However, there is authority to

3616support the proposition that failure to identify the license

3625holder as the applicant for a health care project is a fatal

3637defect, requiring dismissal of a CON application. See Brookwood.

3646Jackson County Convalescent Center v. Department of Health and

3655Rehabilitative Services , 591 So. 2d 1085 (Fla. 1st DCA 1992).

366515. The Ramadan Hand Institute/Lake Butler Hospital filed

3673a letter with the Agency requesting an exemption from CON review

3684to establish a hospice program in Health Planning District 3A.

3694The basis of the exemption request is the alleged rural hospital

3705status of the Ramadan Hand Institute/Lake Butler Hospital.

371316. Section 408.036(3)(h), Florida Statutes, provides in

3720pertinent part:

3722(3) EXEMPTIONS. -- Upon request, supported

3728by such documentations as the department may

3735require, the department shall grant an

3741exemption from the provisions of subsection

3747(1):

3748* * *

3751For hospice or home health services provided

3758by a rural hospital, as defined in s.

3766395.602, . . .

377017. The Ramadan Hand Institute/Lake Butler Hospital is not

3779a corporate entity, but the fictitious name registered to the

3789facility's actual licensee, Medlink Management Services, Inc.

379618. Medlink Management Services, Inc., the licensee of

3804Ramadan Hand Institute/Lake Butler Hospital, is a Florida "for

3813profit" corporation.

381519. Section 400.601(3), Florida Statutes, defines the term

"3823hospice" to mean, ". . . a centrally administered corporation

3833not for profit , as defined in chapter 617, providing a continuum

3844of palliative and supportive care for the terminally ill patient

3854and his or her family." (emphasis supplied) See also Rule 58A-

38652.004, Florida Administrative Code, which provides that a license

3874shall be issued to any "not-for-profit" agency which otherwise

3883meets the licensure requirements. Because Medlink is a "for-

3892profit" corporation, it cannot, as a matter of law, be licensed

3903as a hospice.

390620. The exemption afforded rural hospitals found in

3914Section 408.036(3)(h), Florida Statutes, does not exempt a

3922licensee from the requirements of Section 400.601, Florida

3930Statutes. Because Medlink, as a "for-profit" corporation, fails

3938to meet this mandatory statutory requirement, the act of issuing

3948a letter of exemption to Ramadan Hand Institute/Lake Butler

3957Hospital is an unauthorized exercise of Agency discretion,

3965inconsistent with the Agency rules, and in violation of the

3975statute. The Agency should have denied the exemption request and

3985required the Applicant to submit to the CON Review procedure.

3995RECOMMENDATION

3996Upon the foregoing findings of fact and conclusions of law,

4006it is

4008RECOMMENDED that the Agency for Health Care Administration

4016enter a Final Order denying the request for exemption from

4026Certificate of Need Review.

4030RECOMMENDED this 18th day of November, 1997, at Tallahassee,

4039Leon County, Florida.

4042___________________________________

4043ELLA JANE P. DAVIS

4047Administrative Law Judge

4050Division of Administrative Hearings

4054The DeSoto Building

40571230 Apalachee Parkway

4060Tallahassee, Florida 32399-3060

4063(904) 488-9675 SUNCOM 278-9675

4067Fax Filing (904) 921-6847

4071Filed with the Clerk of the

4077Division of Administrative Hearings

4081this 18th day of November, 1997.

4087ENDNOTE

40881 Cf - Contrariwise, HNCF contended that AHCA has never

4098interpreted Section 408.610, Florida Statutes, to require that a

4107hospice be established as a separate legal entity from an

4117existing health care provider and has interpreted the statute to

4127allow an existing not for profit provider to operate a hospice

4138within its existing corporate structure.

4143COPIES FURNISHED:

4145Pamela B. Howard

4148Post Office Box 748

4152Lake Butler, Florida 32054

4156Herbert M. Webb, Esquire

41604400 Northwest 23rd Avenue, Suite E

4166Gainesville, Florida 32606

4169Richard Ellis, Esquire

4172Agency for Health

4175Care Administration

4177Building 3, Suite 3431

41812727 Mahan Drive

4184Tallahassee, Florida 32308

4187R. Terry Rigsby, Esquire

4191Blank, Rigsby & Meenan

4195204 South Monroe Street

4199Tallahassee, Florida 32301

4202Douglas M. Cook, Director

4206Agency for Health Care Administration

42112727 Mahan Drive

4214Tallahassee, Florida 32308

4217Jerome W. Hoffman, General Counsel

4222Agency of Health Care Administration

42272727 Mahan Drive

4230Tallahassee, Florida 32308

4233NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

4239All parties have the right to submit written exceptions within 15

4250days from the date of this Recommended Order. Any exceptions to

4261this Recommended Order should be filed with the agency that will

4272issue the final order in this case.

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Date
Proceedings
Date: 12/11/1997
Proceedings: Final Order filed.
PDF:
Date: 12/10/1997
Proceedings: Agency Final Order
PDF:
Date: 12/10/1997
Proceedings: Recommended Order
Date: 11/18/1997
Proceedings: Corrected Summary Recommended Order sent out. (providing Medlink`s counsel of the decision.)
Date: 11/17/1997
Proceedings: (From H. Webb) Motion for Extension of Time in Which to File Exceptions filed.
PDF:
Date: 10/10/1997
Proceedings: Summary Recommended Order sent out. CASE CLOSED.
Date: 09/23/1997
Proceedings: (From H. Webb) Response to Hospice of North Central Florida`s Motion to Strike filed.
Date: 09/15/1997
Proceedings: Hospice of North Central Florida`s Motion to Strike filed.
Date: 09/11/1997
Proceedings: (AHCA) Notice of Filing; Rules 58A-2.002, 58A-2.003, and 58A-2.004, FAC filed.
Date: 09/09/1997
Proceedings: (Respondent) Response to North Central Florida`s Motion to Strike and Response to Its Reply (filed via facsimile).
Date: 09/08/1997
Proceedings: (AHCA) Notice of Filing; Rules 59-1.002, 59C-I.002, 59C-I.005, and 60Q-2.0I6, FAC filed.
Date: 08/28/1997
Proceedings: HNCF`s Response to Medlink`s Motion for Summary Recommended Order filed.
Date: 08/28/1997
Proceedings: Hospice of North Central Florida`s Motion to Strike and in the Alternative Reply to Medlink`s Response to Petition and Reply to Medlink`s Response to Motion for Summary Recommended Order filed.
Date: 08/21/1997
Proceedings: (Petitioner) Amended Notice of Hearing filed.
Date: 08/21/1997
Proceedings: Plaintiff`s Amended Memorandum of Law in Opposition to Hospice of North Central Florida, Inc.`s Motion for Summary Recommended Order filed.
Date: 08/21/1997
Proceedings: Respondent`s Motion for Summary Recommended Order Denying Petitioner`s Motion for Summary Recommended Order and Dismissal or in the Alternative, Abatement of Petitioner`s Petition for Formal Administrative Hearing filed.
Date: 08/18/1997
Proceedings: (From H. Webb) Response to Hospice of North Central Florida, Inc.`s Motion for Summary Recommended Order Denying and Dismissing Medlink Management Services, Inc. d/b/a Ramadan Hand Institute/Lake Butler`s Request for Exemption filed.
Date: 08/18/1997
Proceedings: (From H. Webb) Memorandum of Law in Opposition to Hospice of North Central Florida, Inc.`s Motion for Summary Recommended Order; Response to Petition for Formal Administrative Hearing filed.
Date: 08/14/1997
Proceedings: (Petitioner) Notice of Hearing (8/26/97; 1:30 p.m.; Tallahassee) filed.
Date: 07/10/1997
Proceedings: Hospice of North Central Florida, Inc.`s Motion for Summary Recommended Order Denying and Dismissing Medlink Management Services, Inc. d/b/a Ramadan Hand Institute/Lake Butler`s Request for Exemption filed.
Date: 07/09/1997
Proceedings: Notification Card sent out.
Date: 07/03/1997
Proceedings: Notice; Petition for Formal Administrative Hearing (w/exhibit A-D) filed.

Case Information

Judge:
ELLA JANE P. DAVIS
Date Filed:
07/03/1997
Date Assignment:
07/09/1997
Last Docket Entry:
12/11/1997
Location:
Gainesville, Florida
District:
Northern
Agency:
ADOPTED IN TOTO
Suffix:
CON
 

Related DOAH Cases(s) (1):

Related Florida Statute(s) (5):

Related Florida Rule(s) (3):