Tulsa Area Hospital Council, Inc. v. Oral Roberts University

• Citation: 626 P.2d 316
• Decision Date: 24 March 1981
• Docket Number: No. 53059,53059
• Parties: TULSA AREA HOSPITAL COUNCIL, INC., an Oklahoma non-profit Corporation, Appellee, v. ORAL ROBERTS UNIVERSITY, Appellant, and Oklahoma Health Planning Commission, Appellant.
• Court: Oklahoma Supreme Court

Page 316

626 P.2d 316

1981 OK 29

TULSA AREA HOSPITAL COUNCIL, INC., an Oklahoma non-profit Corporation, Appellee, v. ORAL ROBERTS UNIVERSITY, Appellant and Oklahoma Health Planning Commission, Appellant.

No. 53059.

Supreme Court of Oklahoma.

March 24, 1981.

As Corrected March 25 and April 9, 1981.

Appeal from the District Court of Tulsa County; Ronald N. Ricketts, judge.

Appellants appeal from the order of the district court, remanding the cause to the Oklahoma Health Planning Commission for further consideration.

REVERSED.

Crowe, Dunlevy, Thweatt, Swinford, Johnson & Burdick by William G. Paul and Richard C. Ford, Oklahoma City, and Boone, Smith, Davis & Minter by L. K. Smith, Tulsa, for appellee.

Moyers, Martin, Conway, Santee & Imel by Jack H. Santee and James R. Miller, Tulsa, for appellant, Oral Roberts University.

Jan Eric Cartwright, Atty. Gen., of Oklahoma by Thomas H. Tucker, Gerald E. Kelley and Amalija J. Hodgins, Oklahoma City, for appellant, Oklahoma Health Planning Commission.

HODGES, Justice.

The Tulsa Area Hospital Council, Inc., an Oklahoma non-profit corporation, appealed to the District Court of Tulsa County from an order of the Oklahoma Health Planning Commission (OHPC). OHPC granted a certificate of need, pursuant to 63 O.S.Supp.1975 § 2651, ¹ to Oral Roberts University (ORU) for the construction of a 294-bed hospital in which holistic medicine would be practiced. The order granting the certificate to the City of Faith Hospital was vacated on appeal and the cause remanded to OHPC for further findings because the District Court found that the granting of the certificate was: 1) "clearly erroneous in view of the reliable material, probative and substantial evidence, and 2) in violation of the Establishment Clause of the First Amendment of the United States Constitution."

A dual regulatory system controls new hospital construction. No new institutional health services may be offered or developed unless a certificate of need is obtained from OHPC. This state agency is comprised of the department heads of the Oklahoma departments of Health, Mental Health and Human Services. ² Under the National Health Planning & Resources Development Act of 1974, the Secretary of Health & Welfare is empowered to withhold reimbursement under medicare, medicaid, and other federal health payments for that portion of patient charges reflecting expenses relating to new capital expenditures unless the state agency, i. e., OHPC, makes a favorable recommendation of the need for such expenditures. ³ OHPC has the statutory duty to assure the orderly development of health services and the responsibility for operating and implementing a state program of health planning and of administering all health planning functions. ⁴

Promptly upon the receipt of any certificate of need application, OHPC is required to thoroughly investigate the need of the proposed services. The investigation, pursuant to 63 O.S.Supp.1975 § 2652, must include:

(a) the adequacy of institutional health services in the locality,

(b) the availability of services which may serve as alternatives or substitutes,

(c) the adequacy of financial resources for the new services,

(d) the availability of sufficient manpower to properly staff and operate the proposed new services,

(e) the availability of both allopathic and osteopathic facilities and services to protect the freedom of patient choice in the locality, and

(f) any other matter which the Commission deems appropriate.

I

The stated avowed major purposes of the City of Faith Hospital are to provide: 1) unique health care delivery to meet the needs of an existing national constituency; 2) clinical medical education for doctors, nurses and health personnel, and 3) an accessible situs for clinical research. OHPC specifically found a constituent demand existed for a hospital facility to provide holistic treatment, a unique approach to the delivery of health care to the whole patient through ministry to the body, mind, and spirit. This treatment involves the incorporation of prayer and touching into standard and recognized medical procedures. Although the District Court did not disturb the validity of the finding, it held that the ground upon which OHPC decided constituent need was clearly erroneous. Because OHPC failed to determine the size and geographical source of the constituent demand in patient numbers, and to then measure that demand against the existing hospital beds in the Tulsa area in order to calculate the number of beds needed in Tulsa, the court found the granting of the certificate of need was not supported by substantial evidence.

The applicable statute, 63 O.S.Supp.1975 § 2652, supra, ⁵ lists several factors which must be investigated before a certificate of need may be granted. The number of beds is not a specific requirement, but an investigation of the adequacy of institutional health services in the locality is required. It is undisputed by the parties that there are no holistic institutional health services provided either in Tulsa or in the United States. A review of the daily hospital reports made by the major Tulsa hospitals, indicating the number of beds available, reflected that the Tulsa hospitals have average occupancy rates of 95.5%, 93.8%, 93.7%, 90.0%, and 72.9%.

Although two Tulsa County hospitals subsequently offered to permit the training of ORU medical students and to permit practice by holistic physicians, OHPC found this to be an unsatisfactory substitute or alternative because holistic medicine requires the presence of medical personnel acting together as a team in proximity with the patient. Existing hospitals are unwilling to allocate geographic units for the holistic treatment of patients or the education of medical personnel. The holistic concept of care involves a team effort in which a complete environment exists where each person in the health care delivery is dedicated to the same philosophy of healing. Existing hospitals, because of their architectural structure and of their unwillingness to allocate geographic units for holistic treatment of patients or the education of medical personnel, are unable to provide a health care facility in which this total team concept can be expedited. The element of proximity is of alleged critical importance. It is asserted that proximity promotes regular contact among those on the health care team and with the patient, increasing the opportunity to touch. It is alleged that the laying on of hands by touching the patient is a method of transferring concern and compassion. The court erred when it found that all that was needed to provide the prayer stream was unrestricted access of the prayer partner to the patient. This concept fails to recognize that the evidence presented was that holistic medicine as conceived by ORU requires a complete complement of health professionals dedicated to a team effort in a controlled atmosphere.

OHPC found that the existence of a constituency was apparent from the receipt of OHPC of approximately 400,000 handwritten letters from people who believed that their medical and physical needs cannot be met in other hospitals. The Cooper & Lybrand survey reported that 91.4% of the national constituency, if seriously ill, would consider coming to the City of Faith or bring members of their families. Analysis of the mail by the OHPC staff reflected that if the hospital were in existence over half of the beds would be occupied by presently ill letter writers. The National Health Planning and Resources Development Act of 1974, 42 U.S.C. § 300n-1(c)(7), provides that special consideration be given to facilities which fulfill special needs to individuals who do not reside in the area where the proposed health care is to be provided.

A survey of medical and nursing personnel revealed that there was enough manpower to operate and staff the proposed new services. Services requiring extreme outlays for expensive equipment such as CAT scanners and linear accelerators were planned to be delayed with utilization of present medical facilities until the significant need occurred. Neither burn nor obstetrical facilities were contemplated.

The statute also provides for consideration of the availability of both allopathic and osteopathic facilities to provide freedom of choice to the patient, and whether financial resources for the new services are adequate. It is apparent that OHPC had the authority to consider under (e) and (f) of the statute the possibility that the patients' freedom of choice might include holistic medicine, and that the special needs of a national constituency were relevant. The adequacy of funding was not disputed.

Great weight is to be accorded the expertise of an administrative agency, and a presumption of validity attaches to the exercise of expertise when the administrative agency is reviewed by the judiciary. A court of review may not substitute its own judgment for that of an agency, particularly in the area of expertise which the agency supervises. ⁶ The rationale for this rule is that courts do not possess the specialized knowledge, training, experience or competency to substitute opinions for the judgment of qualified experts. The legislature has recognized that the expertise in some cases of legislative authority is better left to those who have refined abilities in narrow areas, controlled only by general guidelines established by the legislature. ⁷ If the facts determined by the administrative agency are supported by substantial evidence, and the order is otherwise free of error, the decision of the agency must be affirmed. ⁸

To properly issue a certificate of need, OHPC must find, after its investigation, that the action proposed in the application is necessary and desirable in order to provide the required institutional health services in the area to be served; the proposed action can be economically accomplished and maintained; and that it will...