Hospital of St. Raphael v. Commission on Hospitals and Health Care
| Decision Date | 11 November 1980 |
| Citation | 438 A.2d 103,182 Conn. 314 |
| Court | Connecticut Supreme Court |
| Parties | HOSPITAL OF ST. RAPHAEL v. COMMISSION ON HOSPITALS AND HEALTH CARE. |
Jane S. Scholl, Asst. Atty. Gen., with whom were Richard J. Lynch, Asst. Atty. Gen., and, on the brief, Carl R. Ajello, Atty. Gen., and Bernard F. McGovern, Jr., Asst. Atty. Gen., for appellant (defendant).
William J. Doyle, New Haven, with whom were J. Michael Eisner and Judy A. Rabkin, New Haven, for appellee (plaintiff).
Before BOGDANSKI, PETERS, PARSKEY, SHEA and DALY, JJ.
This appeal concerns a request by the Hospital of St. Raphael, a general teaching hospital located in New Haven, to purchase a computerized tomographic total body scanner. Because the scanner's cost exceeded $100,000, approval of this request by the commission on hospitals and health care (commission) was required by General Statutes § 19-73m. The commission denied the request, citing both a present excess capacity for computerized tomographic (CT) scanning in the region and the duplication of services which would ensue if the proposed project were approved. See General Statutes § 19-73k. The hospital appealed 1 this decision to the Superior Court, which reversed, holding that the commission's decision was clearly erroneous in view of the reliable, probative and substantial evidence on the whole record; see General Statutes § 4-183g (5); because no workable CT scanner owned by an institution under the commission's control was available for use by the New Haven community. We granted the commission's petition for certification and we reverse.
A CT scanner is a diagnostic device which combines x-ray equipment with a computer and a television monitor to produce images of cross sections of the human body. In documenting its need for the scanner, the hospital contended before the commission that approximately 2000 patients per year potentially could benefit from receiving a CT scan at St. Raphael's. Other evidence, however, indicated that fewer than 100 patients were actually transferred to another facility to receive scans. Thirty-five patients could not be moved due to acute head trauma. The balance of the hospital's projected yearly use of the scanner was to be the result of scans performed on patients with intracranial lesions, lymphoma, jaundice and abdominal masses and CT scans performed as an alternative in some cases in which isotopic brain scans are currently performed.
In addition to this evidence of need, the commission also heard evidence of the present scanning capacity provided by CT scanners in other facilities in the New Haven area. Yale-New Haven Hospital presently has two CT scanners. One is not functional except for occasional emergency use, although Yale-New Haven is planning to submit a proposal to update this scanner. The other scanner is not owned by Yale-New Haven, but is presently on loan from the manufacturer primarily for research purposes. Because this scanner is the only one at Yale-New Haven Hospital in good working condition, it is presently being used clinically. A third CT scanner in the region is operated by a private group of radiological physicians, Temple Radiology Group. This scanner is currently operating at approximately one-third of its capacity. It could be used for over 2000 additional scans per year, although its maximum utilization is inhibited because not every health insurance carrier reimburses patients for scans performed at this facility. On the basis of this evidence concerning regional CT scanning capacity, the commission denied St. Raphael's request for the purchase of a CT scanner.
In reversing the commission's decision, the court below focused primarily on the fact that the use of the scanner operated by the private radiological group was outside the commission's jurisdiction. Because the commission could not regulate the extent of the availability of this scanner, the court disregarded it for purposes of ascertaining regional capacity. The court similarly disregarded both scanners at Yale-New Haven, one because it was not working and the other because Yale-New Haven did not own it. Concluding that no workable scanner was owned by an institution under the control of the commission, the court held that the commission's decision denying the St. Raphael request was clearly erroneous.
The commission is charged by law with the responsibility for approving capital expenditures of $100,000 or more by health care facilities or institutions. General Statutes § 19-73m. Hospitals are specifically included within the meaning of health care facilities or institutions. General Statutes § 19-73b. In reviewing a request for such a capital expenditure, the commission is directed to "consider such request in relation to the community or regional need for such capital program, the possible effect on the operating costs of the health care facility or institution, the recommendations of the Health Systems Agency regarding such proposal, and such other relevant factors as the commission deems necessary." General Statutes § 19-73m. In addition, the commission is directed to consider the effectiveness of the facility's delivery of health care services, the quality of available health care and the duplication of service by institutions and facilities in the area served. General Statutes § 19-73k. In its consideration of the foregoing factors in this case the commission concluded that the region had excess capacity and the proposed services would duplicate services provided by the health care facilities which in the aggregate are operating at less than full capacity.
In reviewing the action of an administrative agency the trial court must accept the evidence presented to such agency uncoated by any judicial gloss. Williams v. Liquor Control Commission, 175 Conn. 409, 414, 399 A.2d 834 (1978).
The trial court recognized that in reviewing the commission's action it was precluded from substituting its judgment for that of the commission as to the weight of the evidence on questions of fact. General Statutes § 4-183(g). Rather than challenge directly the commission's factual conclusion of...
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