Chatham County Hosp. Authority v. St. Joseph's Hosp., Inc.
| Decision Date | 21 March 1986 |
| Docket Number | Nos. 71277-71279,s. 71277-71279 |
| Citation | 178 Ga.App. 628,344 S.E.2d 463 |
| Parties | CHATHAM COUNTY HOSPITAL AUTHORITY & MEMORIAL MEDICAL CENTER, INC. v. ST. JOSEPH'S HOSPITAL, INC. et al. STATE HEALTH PLANNING AGENCY v. ST. JOSEPH'S HOSPITAL, INC. STATE HEALTH PLANNING AGENCY v. ST. JOSEPH'S HOSPITAL CENTER, INC. et al. |
| Court | Georgia Court of Appeals |
Randall L. Hughes, Kim H. Roeder, H. Worthington Lewis, Atlanta, for Chatham Co. Hosp. Authority & Memorial Medical Center, Inc.
John H. Parker, Jr., Atlanta, for St. Joseph's Hosp. Inc.
Michael J. Bowers, Atty. Gen., James P. Googe, Jr., Executive Asst. Atty. Gen., H. Perry Michael, First Asst. Atty. Gen., Carol A. Cosgrove, William C. Joy, Sr. Asst. Attys. Gen., Jeffrey C. Baxter, David C. Will, Asst. Attys. Gen., for State Health Planning Agency.
These appeals involve at bottom the Cardiac Surgery Rule (CSR), which was adopted by the State Health Planning Agency (agency) pursuant to its rule-making authority. OCGA § 31-6-21(b). The CSR provides: Rule 272-2-.09(13). We do not believe this rule requires a moratorium on considering applications for a certificate.
"The true genius of the law, whatever may be thought to the contrary, is to quibble as little as possible on words, and go directly to the substance." Humphrey v. Copeland 54 Ga. 543, 545 (1875). The uncluttered substance of these cases, despite almost 7,000 pages of combined appeals records, appears to be: (1) the State Health Planning Agency (agency) found the cardiac surgery rule placed no two-year moratorium upon applications but merely required a showing of need, which St. Joseph's Hospital failed to do; (2) the State Health Planning Review Board (board) affirmed the agency's denial of the application because it found that the cardiac surgery rule basically precluded applications for two years unless a party could convince the agency to change this particular rule, but it also advised that were there no such rule it would have reversed the agency's finding that no need was shown; (3) the superior court agreed with the agency's flexible interpretation of the cardiac surgery rule but with the board's advisory finding that need had been shown, although it also held that the rule actually was inapplicable because it was not in effect at the time St. Joseph's Hospital's application was filed.
It appears that the cardiac surgery rule, as correctly interpreted by the agency and superior court, actually is of little consequence in these cases. The net substance of the "approved" rule is that an applicant must show need for the additional services. There seems to be no dispute that in the alternate or advisory portion of the board's decision, which was approved by the superior court, the applicant had precisely that burden. In short, regardless of the superior court's or board's positions concerning the validity or applicability of any cardiac surgery rule, the fact remains that both tribunals required the applicant to show need. No sound reason exists for returning these cases to the board so that it may reconsider the matter now that it has been made aware of the rule that an applicant may be granted a certificate upon a successful showing of need, when the superior court and board in fact did what the rule required. The compliance with the dictates of the flexible cardiac surgery rule may have been inadvertent, but it was compliance nonetheless.
The record amply supports the superior court's and the board's finding that need for the additional services was shown. The board was the ultimate finder of fact, and the superior court and this court are bound by the any evidence rule to the board's finding that the need existed. Accordingly, the superior court's order directing the agency to issue the certificate, as well as its order validating the rule, are affirmed.
Judgments affirmed.
St. Joseph's Hospital applied to the agency for a certificate of need 1 to institute a new open heart surgery program at its facility in Savannah. The agency considered the application, took into account the existing services and current needs as demonstrated by the evidence, applied the CSR and statutory standards and Plan and its general rules, and denied the application because in its opinion a need for the proposed additional services had not been demonstrated. The agency issued its lengthy findings and conclusions and notified St. Joseph's that an appeal could be taken to the State Health Planning Review Board.
The appeal was taken. Memorial Medical Center, which is owned by Chatham County Hospital Authority, was interested because it was the only hospital currently providing open heart surgery in Savannah, so it intervened at the board stage pursuant to OCGA § 31-6-44(b). An extensive evidentiary hearing was conducted in accordance with OCGA § 31-6-44(c). The board issued its order in the alternative.
First, it interpreted the CSR to mean that the agency had expressed its determination, by way of the rule, that there were enough open heart surgery services available in Georgia and that this determination would be reevaluated in two years. This interpretation was deemed preclusive, or in effect a moratorium, which by way of the last clause of the CSR, could be changed by the agency if a need was shown that would cause it to change the CSR earlier. That is, the board considered the CSR as preventing the obtaining of a certificate of need unless someone convinced the agency that the determination should be changed before the two-year reevaluation. Thus it viewed the situation as a two-step one: if someone wanted to change the determination contained in the CSR, it would have to prompt the agency to change it. Then someone could apply for a certificate of need pursuant to a more friendly determination. The board was of the view that it had no authority to change the determination, and that it must apply this rule which it construed to set out the agency's "intent ... to limit open heart surgery in Georgia to the twelve hospitals that currently provide it." That being the case, and applying this interpretation of the CSR, the denial by the board which followed was inevitable.
Then the board embarked upon an alternative decision.
It said that since the meaning and validity of the CSR was then in litigation, it would also set forth a decision absent a consideration of the CSR, in case the rule was judicially deemed invalid. In doing so, it measured the application against the State Health Plan, its own newly fashioned criterion of "need in 1989," and cost control, one of the standards set out in the statute and the agency rules. OCGA §§ 31-6-1 and 31-6-42(a)(1); Rule 272-2-. 08(1)(b)(1). Based on these criteria, it found that the evidence supported a finding of a need for additional capacity for open heart surgery in Savannah in 1989. Thus, it concluded, if the CSR does not apply, (i.e., "but for" the rule) the application of St. Joseph's should be approved and a certificate of need issued. One member dissented from this alternate decision, being of the opinion that, assuming the non-application of the CSR, and taking into account the other criteria mentioned above, a need was not established.
These decisions were appealed to the superior court for judicial review, as provided by OCGA § 31-6-44(i), by St. Joseph's and by Chatham/Memorial, each challenging part of the decision. St. Joseph's had earlier also filed an action for declaratory judgment against the agency, seeking judicial invalidation of the CSR. Both of the appeals, and the suit for declaratory judgment, were consolidated for consideration by the superior court. Before it issued its order, the two Fulton County cases involving the CSR were dismissed by the Court of Appeals for lack of jurisdiction (see State Health Planning Review Bd. v. Piedmont Hosp., 173 Ga.App. 450, 326 S.E.2d 814 (1985)), and the superior court took note of it.
The court examined the CSR, the history of its making pursuant to OCGA § 31-6-21.1, and what it perceived to be the board's interpretation of it. The court found that the board gave a "preclusive interpretation" to the CSR and considered it as a "no need" and thus "conclusive determination" by the agency, creating an "irrebuttable presumption" against an applicant for a certificate of need. Such an interpretation, the court held, was erroneous for it would render the CSR invalid for a number of reasons: it would conflict with the purposes of the State Health Planning and Development statute and the state policy contained therein (OCGA Chapter 6); it would be inconsistent with the State Health Plan adopted pursuant to the statute; it would not conform to the statutory and general agency rule considerations to be given an application; it would completely eliminate board review and thus cut off its statutory function; it would "foredoom" an application to denial; it would not be in keeping with the apparent intention of the agency or the legislative committees involved in the making of the rule; and it would violate constitutional due process by depriving an applicant of a meaningful hearing.
The court then gave consideration to whether the CSR could be interpreted so as to be valid and concluded that it could and should be, upon the...
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