Iowa State Dept. of Health v. Hertko

Citation282 N.W.2d 744
Decision Date29 August 1979
Docket NumberNo. 62887,62887
PartiesIOWA STATE DEPARTMENT OF HEALTH and Norman Pawlewski, Commissioner, Appellants, Polk County ex rel. Dan L. Johnston, Intervenor-Appellant, v. Edward J. HERTKO, Ronald R. Grooters, Hooshang Soltanzadeh, M.D.'s, and Iowa Methodist Medical Center, Appellees. IOWA HEALTH SYSTEMS AGENCY, INC., Appellant, Polk County ex rel. Dan L. Johnston, Intervenor-Appellant, v. IOWA METHODIST MEDICAL CENTER, Appellee. Edward J. HERTKO, Ronald K. Grooters, Hooshang Soltanzadeh, M.D.'s and Iowa Methodist Medical Center, Appellees, v. HEALTH SYSTEMS AGENCY, INC., Iowa State Department of Health and Norman Pawlewski, Appellants.
CourtUnited States State Supreme Court of Iowa

Thomas J. Miller, Atty. Gen., Larry M. Blumberg, Fred M. Haskins and Sara K. Johnson, Asst. Attys. Gen., for appellants Iowa Department of Health and Norman Pawlewski.

Robert F. Holz, Jr. and Edwin N. McIntosh, of Thoma, Schoenthal, Davis, Hockenberg & Wine, Des Moines, for appellant Iowa Health Systems Agency, Inc.

Dan L. Johnston, Polk County Atty., and E. LaVon French, Asst. County Atty., for intervenor-appellant Polk County.

Edgar H. Bittle, of Belin, Harris, Helmick & Lovrien, Des Moines, for appellee Iowa Methodist Medical Center.

Michael H. Figenshaw and Marsha K. Ternus, of Bradshaw, Fowler, Proctor & Fairgrave, Des Moines, for appellees Edward J. Hertko, Ronald K. Grooters and Hooshang Soltanzadeh, M.D.'s.

Considered by REYNOLDSON, C. J., and LeGRAND, REES, McCORMICK and McGIVERIN, JJ.

McGIVERIN, Justice.

These three consolidated cases involve questions arising from attempted enforcement of the Iowa Certificate of Need Law, sections 135.61-.83, The Code 1979. Appellants Iowa State Department of Health (ISDH) and Iowa Health System Agency, Inc. (HSA) appeal from adverse trial court judgments in two injunction actions by which they sought to prevent performance of open heart surgery at Iowa Methodist Medical Center (Methodist) in Des Moines until Methodist complied with the Certificate of Need Law. ISDH and HSA also claim the court erred in ruling in a separate declaratory judgment action by Methodist and three of its doctors that the Certificate of Need Law requirements do not apply to performance of open heart surgery at Methodist. Intervenor-appellant Polk County appeals from dismissal of its petitions of intervention on the side of ISDH and HSA in the two injunction actions. We affirm in part, reverse in part and remand.

The following main issues are presented for our review by the parties:

1. Whether the court properly denied the temporary injunction sought by ISDH and HSA against open heart surgery at the hospital;

2. Whether the court erred in disposing of the three cases on their merits by ruling on motions of Methodist and its doctors without granting appellants a hearing on the motions or a trial;

3. Whether the court erred in dismissing Polk County's petitions for intervention in the two injunction actions; and

4. Whether the court erred in denying the motion by HSA for discovery from Methodist.

These cases arose as July 1, 1978, the effective date of the Iowa Certificate of Need Law, drew near.

The Preamble to the 1977 Iowa Acts, Chapter 75, stated the policy of sections 135.61-.83 is, Inter alia, to provide "necessary and adequate institutional health services to all the people of this state while avoiding unnecessary duplication of institutional health services and preventing or controlling increases in the cost of delivering these services."

Section 135.63(1) provided that a "new institutional health service" or "changed institutional health service" shall not be offered or developed in this state without proper application to the Iowa State Department of Health for and receipt of a certificate of need for such new service.

However, an institutional health facility, such as Methodist, would not need to obtain a certificate of need unless it was providing a new or changed institutional health service as defined in section 135.61(19)(e), which provides:

19. "New institutional health service" or "changed institutional health service" means any of the following:

e. Health services which are or will be offered in or through an institutional health facility or a health maintenance organization at a specific time but which were not offered on a regular basis in or through that institutional health facility or health maintenance organization within the twelve month period prior to that time.

In April 1978 Methodist advised ISDH of its intention to perform open heart surgery at its hospital. The question arose as to whether Methodist needed to apply to ISDH for a certificate of need before performing the surgery. ISDH is charged by the statutes with making a review and recommendation on each application for a new institutional health service to a five person state health facilities council, which makes the final decision on the application. Sections 135.62-.69, The Code 1979.

HSA is an Iowa non-profit corporation established pursuant to United States Public Law 93-641 (42 U.S.C. § 300L ). Among its duties in serving its health service area in Iowa is to restrain increases in the cost of providing health services and to prevent unnecessary duplication of health resources. HSA also makes recommendations to the ISDH as to whether a certificate of need should be granted to an applicant.

Sanctions for not complying with this law appear in section 135.73.

As July 1, 1978 approached, Methodist took the position it was not required to apply for a certificate of need. ISDH and HSA believed otherwise.

Within a one week period three suits were filed. On June 29, 1978 HSA petitioned for temporary and permanent injunctions to prevent Methodist from performing open heart surgeries until Methodist obtained a certificate of need. This petition was based on alternative grounds of promissory estoppel and the Certificate of Need Law. HSA alleged it was an "interested person" for the purposes of section 135.73(2).

On June 30 Doctors Hertko, Grooters and Soltanzadeh (Doctors) and Methodist filed a declaratory judgment petition at law against ISDH and HSA seeking a determination that the Certificate of Need Law had no application to open heart surgery performed at Methodist.

On July 5 ISDH filed a petition against the Doctors and Methodist seeking temporary and permanent injunctions against open heart surgery at Methodist until Methodist received a certificate of need.

On July 17, the three cases were consolidated by agreement of the parties and the court for determination of common issues. On that date hearing was held on the application by ISDH and HSA for temporary injunctions under the Iowa Certificate of Need Law. On July 18 the court denied the application.

On November 16 the court entered judgment against ISDH and HSA in all three cases. That ruling will be discussed later.

At present we will consider only the claim by ISDH and HSA that the temporary injunction should have been granted.

I. Was the temporary injunction properly denied? During the temporary injunction hearing the parties stipulated: That Doctors Grooters and Soltanzadeh performed open heart surgery at Methodist on June 19, 20, 21, 22, 26, 27, 28 and 29, 1978; that those doctors had been performing open heart surgery at Mercy Hospital in Des Moines for approximately the past eighteen months; and that no heart surgery was performed or offered at Methodist from at least July 1, 1977 to June 19, 1978. Correspondence stating the positions of the parties also was placed in the record.

Methodist had submitted and then withdrew an application for review of its open heart surgery program by ISDH. Methodist has not received a certificate of need for its program.

In seeking the temporary injunction ISDH and HSA relied on Iowa R.Civ.P. 321(c) which states a temporary injunction may be allowed in any case specially authorized by statute. They then point to section 135.73(2) which provides:

Any party offering or developing any new institutional health service or changed institutional health service without first obtaining a certificate of need therefor as required by this division may be temporarily or permanently restrained therefrom by any court of competent jurisdiction in any action brought by the state, any of its political subdivisions, or any other interested person.

The court denied the temporary injunction and stated the legal question presented is whether the performance of the eight open heart surgeries at Methodist in June of 1978 constituted a health service which was offered on a regular basis in or through Methodist within twelve months prior to July 1, 1978.

Relative to section 135.61(19)(e), the court defined "regular" as "recurring at fixed times", "periodic". It defined "within" as "inside the limits of." The court concluded that heart surgery was performed on a regular basis at Methodist within the twelve month period prior to July 1, 1978; therefore, open heart surgery is not a "new institutional health service"; the Certificate of Need Law does not apply to this surgery at Methodist; and there is no statutory basis for injunctive relief.

The count of the HSA petition seeking temporary and permanent injunctions based on promissory estoppel, claiming Methodist had promised in writing in 1975 to comply with established review procedures in the future, was excepted from the consolidation of cases and was not before the court at the temporary injunction hearing on July 17. We will give further attention to this count later.

The quest of ISDH and HSA for a temporary injunction is in equity and the scope of our review is de novo. Iowa R.App.P. 4.

In determining whether the court erred in refusing to grant a temporary injunction under section 135.73(2), several considerations are necessary. We first note the statute states that the court "may" grant a temporary restraint. There is no requirement that the court shall grant an...

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