1. Hospitals and Other Medical Facilities--certificate of need--standard of review
The exclusion of the Certificate of Need Act from the standard of review in N.C.G.S §
150B-34(c), as well as the retention of the term "recommended decision, leaves undisturbed the
scope and standard of review under N.C.G.S. § 150B-51 for appellate review of DHHS action
under the CON Act.
2. Hospitals and Other Medical Facilities--certificate of need--review of ALJ
recommendation--new evidence
A DHHS decision upholding a settlement in a hospital certificate of need dispute was
remanded where DHHS heard new evidence after receiving the ALJ's recommended decision.
The consideration of new evidence clearly violated N.C.G.S. § 150B-51(a).
3. Hospitals and Other Medical Facilities--certificate of need dispute--settlement--
procedures
On remand, DHHS must follow the procedural safeguards for approval of applications and
for initial decisions when issuing a certificate of need pursuant to a settlement after a final agency
decision.
4. Administrative Law--final agency decision--finality
After an agency renders a final decision on the record before it, it is the province of the
judiciary to review asserted errors in the decision and not the province of the agency to consider
the matter further or anew. A final agency decision must be final in order to maintain procedural
consistency and coherence.
5. Hospitals and Other Medical Facilities--certificate of need--relocation of operating
rooms--grandfather clause
DHHS did not err in a certificate of need case by affirming an operating room settlement
where the relocation of operating rooms met the requirements of the grandfather clause in a
change in the certificate of need statutes. N.C.G.S. § 131E-176(16)u
6. Hospitals and Other Medical Facilities--certificate of need--PET settlement
DHHS exceeded its statutory authority in affirming a PET scanners regardless of whether
a certificate of need had been issued; however, the two hospitals could obtain PET scanners bysubmitting new applications in accordance with normal CON procedure (which they had done and
of which the Court of Appeals took judicial notice).
7. Administrative Law--final agency decision--rejection of ALJ findings--specific reason
not provided
In a disputed certificate of need case decided on other grounds, DHHS did not provide a
specific reason for rejection of ALJ findings as required by statute.
8. Hospitals and Other Medical Facilities--certificate of need--procedural
violations--hospital allowed to operate
A hospital that opened under a certificate of need settlement agreement improperly
approved after the final agency decision was allowed to continue operations pending remand
because closing the hospital would cause hardship to the community and because the parties had
acted in good faith.
Judge STEELMAN concurring in part and dissenting in part.
McGuire Woods, L.L.P., by C. Ralph Kinsey, Jr., William G.
Broaddus, and Smith Moore, L.L.P., by James G. Exum, Jr.,
Maureen Demarest Murray, and Susan M. Fradenburg, for
petitioner-appellant.
Attorney General Roy Cooper, by Special Deputy Attorney
General James A. Wellons, for respondent-appellees.
Nelson, Mullins, Riley & Scarborough, L.L.P., by Noah H.
Huffstetler, III, Denise M. Gunter, and Wallace C. Hollowell,
III, for respondent-intervenor-appellees.
CALABRIA, Judge.
Mooresville Hospital Management Associates, Inc., d/b/a Lake
Norman Regional Medical Center (Lake Norman) appeals a North
Carolina Department of Health and Human Services final agency
decision issued 20 March 2003 upholding two settlement agreements
between the North Carolina Department of Health and Human Services,Division of Facility Services, Certificate of Need Section (DHHS)
and Presbyterian Hospital (Presbyterian), Forsyth Medical Center
(Forsyth), and Novant Health, Inc. (Novant), Presbyterian and
Forsyth's parent company. We affirm in part, reverse in part, and
remand with instructions.
On 14 May 1999, Presbyterian submitted an application to DHHS
(the 1999 application) for a certificate of need (CON) to
construct a hospital (Presbyterian Hospital North) in Huntersville
(the hospital project or the project). On 28 October 1999, DHHS
denied the 1999 application. After an appeal to the Office of
Administrative Hearings (OAH), an Administrative Law Judge (ALJ)
entered a recommended decision to issue a CON to Presbyterian. On
13 October 2000, DHHS issued a final agency decision rejecting the
ALJ's recommended decision and denying the 1999 application.
Presbyterian appealed the final agency decision to this Court.
While that appeal was pending before this Court, Presbyterian
filed another CON application for the hospital project in September
of 2001 (the 2001 application). On 27 February 2002, DHHS denied
the 2001 application, and approximately one month later,
Presbyterian petitioned OAH to review the denial of the 2001
application. Presbyterian had two pending appeals at the same time:
(1) the 1999 application appeal, before this Court and (2) the 2001
application appeal, before OAH.
On 5 April 2002, the Chief of the CON Section, Lee B. Hoffman
(Hoffman), and the Director of the Division of Facility Services,
Robert J. Fitzgerald (Fitzgerald), met with representatives ofPresbyterian, Forsyth, and Novant. As a result of the meeting, the
parties agreed to negotiate eight outstanding disputes, which were
eventually reduced to two settlement agreements. Pertinent to this
appeal, the following three disputes were settled: (1) the
litigation surrounding Presbyterian's 1999 and 2001 applications,
which DHHS agreed to negotiate only if Presbyterian submitted
additional information on the hospital project (the hospital
settlement); (2) Presbyterian's September 2001 request for
approval, without a CON review, to relocate four operating rooms
from a downtown Charlotte facility to a new facility in south
Charlotte (the OR settlement); and (3) Presbyterian and Forsyth's
appeal to superior court concerning DHHS' denial of their October
2001 requests for approval, without a CON review, to replace
existing diagnostic health equipment at Presbyterian Hospital in
Charlotte and Forsyth Medical Center with a Positron Emission
Tomography Scanner (PET scanner) at each location (the PET
settlement) (collectively the settlements). Hoffman and a
Presbyterian representative reviewed the newly submitted information
regarding the hospital project. Although Hoffman disagreed with
Presbyterian's position that the newly submitted information
satisfied all the required statutory criteria for issuance of a CON,
Fitzgerald approved the hospital settlement along with the other two
settlements on 8 May 2002.
The hospital settlement, prompted by the newly submitted
information, provided for the immediate issuance of a CON for the
hospital project based on updates and amendments to the 1999application. In addition, the hospital settlement required
Presbyterian to dismiss the appeal pending before this Court
concerning the 1999 application, dismiss the contested case pending
before OAH concerning the 2001 application, and withdraw the 2001
application. The OR settlement approved, without a CON review,
Presbyterian's relocation of four operating rooms from a downtown
Charlotte facility to a new facility in south Charlotte. The PET
settlement stated Presbyterian and Forsyth could each acquire a PET
scanner on or after 1 July 2004 if (1) a CON had not been issued
to either hospital by that date and (2) Presbyterian and Forsyth
dismissed all pending litigation concerning acquisition of PET
scanners.
Throughout the 1999 and 2001 applications, Lake Norman Regional
Medical Center, located approximately eleven miles from the proposed
site of the hospital project, opposed issuance of a CON for the
project. Lake Norman was permitted to intervene in Presbyterian's
cases at OAH and also in the appeal to this Court concerning the
1999 application. After the 2001 application was withdrawn,
however, Lake Norman's opposition to the 2001 application was
rendered moot and could not be sustained.
From the time DHHS rendered a final agency decision denying the
1999 application, in Lake Norman's favor, until issuance of the CON
pursuant to the hospital settlement, DHHS did not provide Lake
Norman notice or an opportunity to be heard regarding the
settlement. Lake Norman did not learn of the settlements until 9
May 2002. On 24 May 2002, Lake Norman petitioned OAH for acontested case hearing concerning the propriety of the settlements.
Both Presbyterian and the Town of Huntersville were allowed to
intervene in support of issuance of the CON for the hospital
project. On 26 November 2002, an ALJ issued a recommended decision
granting summary judgment in favor of Lake Norman, setting aside the
settlements, and withdrawing the issued CON for the hospital
project. On 20 March 2003, DHHS entered a final agency decision
rejecting the ALJ's recommended decision, upholding the settlements,
and finding, inter alia, that the new information Presbyterian
submitted during negotiations regarding the hospital project was
sufficient to show the project's compliance with all the required
statutory review criteria. On 21 April 2003, Lake Norman appealed
DHHS' final decision to this Court. Presbyterian and the Town of
Huntersville were permitted to intervene in the appeal.
I. The Scope and Standard of Review applicable to the CON Act
[1] Before addressing the issues on appeal, we must consider
the effect of the 2000 amendments (effective 1 January 2001) to
Chapter 150B of the North Carolina General Statutes, the North
Carolina Administrative Procedure Act (the NCAPA), on the scope
and standard of review applicable to final agency decisions under
Article 9 of Chapter 131E of the North Carolina General Statutes
(the CON Act). Prior to the 2000 amendments, N.C. Gen. Stat. §
150B-51 (1999) controlled the scope and standard of review for all
final agency decisions made after a recommended decision by an ALJ.
Under N.C. Gen. Stat. § 150B-51 (1999):
(a) . . . In reviewing a final decision in a
contested case in which an [ALJ] made arecommended decision, the court shall make two
initial determinations. First, the court shall
determine whether the agency heard new evidence
after receiving the recommended decision. If
the court determines that the agency heard new
evidence, the court shall reverse the decision
or remand the case to the agency to enter a
decision in accordance with the evidence in the
official record. Second, if the agency did not
adopt the recommended decision, the court shall
determine whether the agency's decision states
the specific reasons why the agency did not
adopt the recommended decision. If the court
determines that the agency did not state
specific reasons why it did not adopt a
recommended decision, the court shall reverse
the decision or remand the case to the agency
to enter the specific reasons.
(b) . . . [T]he court reviewing a final
decision may affirm the decision of the agency
or remand the case for further proceedings. It
may also reverse or modify the agency's
decision if the substantial rights of the
petitioners may have been prejudiced because
the agency's findings, inferences, conclusions,
or decisions are:
(1) In violation of constitutional
provisions;
(2) In excess of the statutory authority
or jurisdiction of the agency;
(3) Made upon unlawful procedure;
(4) Affected by other error of law;
(5) Unsupported by substantial evidence
admissible under G.S. 150B-29(a),
150B-30, or 150B-31 in view of the
entire record as submitted; or
(6) Arbitrary or capricious.
(Emphasis added). On appeal, [w]here the appealing party alleges
that the agency made an error of law, seeking review under [N.C.
Gen. Stat. § 150B-51(b)] (1), (2), (3) or (4) [(1999)], the agency's
decision is reviewed de novo . . . . Burke Health Investors v.
N.C. Dep't of Hum. Res., 135 N.C. App. 568, 571, 522 S.E.2d 96, 98
(1999). Pursuant to the 2000 amendments to the NCAPA, N.C. Gen. Stat.
§ 150B-51 (2003) discards the term recommended decision in favor
of decision and retains the prior scope and standard of review
where the agency adopted the [ALJ's] decision but heightens the
scope and standard of review where the agency does not adopt the
[ALJ's] decision. N.C. Gen. Stat. § 150B-51(a1), (b), (c) (2003)
(emphasis added); Cape Med. Transp., Inc. v. N.C. Dep't of Health
& Human Servs., 162 N.C. App. 14, 21-22, 590 S.E.2d 8, 13-14 (2004).
Additionally, N.C. Gen. Stat. § 150B-36(b), (b1), (b2), and (b3)
(2003) require the agency to adopt in its final decision the
findings of fact and the decision of the [ALJ] unless the agency
demonstrates that [the findings of fact and decision are] clearly
contrary to the preponderance of the admissible evidence. (Emphasis
added).
Despite these amendments to the NCAPA, N.C. Gen. Stat. § 150B-
34(c) (2003) provides:
[I]n cases arising under [the CON Act], the
[ALJ] shall make a recommended decision . . .
that contains findings of fact and conclusions
of law. A final decision shall be made by the
agency in writing after review of the official
record [prepared by OAH] and shall include
findings of fact and conclusions of law. The
final agency decision shall recite and address
all of the facts set forth in the recommended
decision. For each finding of fact in the
recommended decision not adopted by the agency,
the agency shall state the specific reason,
based on the evidence, for not adopting the
findings of fact and the agency's findings
shall be supported by substantial evidence
admissible under G.S. 150B-29(a), 150B-30, or
150B-31. The provisions of G.S. 150B-36(b),
(b1), (b2), (b3), and (d), and G.S. 150B-51 do
not apply to cases decided under this
subsection.
(Emphasis added). We construe N.C. Gen. Stat. § 150B-34(c) (2003)'s
exclusion of the CON Act from the requirements of N.C. Gen. Stat.
§ 150B-36(b), (b1), (b2), (b3), and (d) (2003) and N.C. Gen. Stat.
§ 150B-51 (2003) as well as the retention of the term recommended
decision to leave undisturbed the scope and standard of review
applied under N.C. Gen. Stat. § 150B-51 (1999) for purposes of
appellate review of DHHS' action under the CON Act. Having set
forth the relevant standard of review, we now turn to the issues
presented on appeal.
II. Alleged Error under N.C. Gen. Stat. § 150B-51 (1999)
[2] Lake Norman asserts the settlement procedure used by DHHS
in reaching the hospital settlement violated the first prong of N.C.
Gen. Stat. § 150B-51(a) (1999). Specifically, Lake Norman argues
DHHS improperly considered new evidence in approving the hospital
settlement after receiving the ALJ's recommended decision concerning
the 1999 application. We agree.
As stated above, the first prong of N.C. Gen. Stat. § 150B-
51(a) (1999) requires a court reviewing a final agency decision to
reverse the decision or remand the case . . . [for entry of] a
decision in accordance with the evidence in the official record if
it determines that the agency heard new evidence [after receiving
an ALJ's recommended decision]. (Emphasis added). See generally,
N.C. Gen. Stat. § 150B-37 (1999); N.C. Gen. Stat. § 150B-37 (2003)
(providing that OAH shall prepare an official record in a contested
case and forward a copy of it with the ALJ's recommended decision
to the agency making the final decision). Here, after receiving theALJ's recommended decision concerning the 1999 application, DHHS
heard new evidence in approving the hospital settlement based on
updates to this application. Given the plain language and mandate
of the statute, we conclude DHHS' consideration of new evidence
clearly violated N.C. Gen. Stat. § 150B-51(a) (1999) and was
erroneous. Furthermore, based on this prohibited new evidence,
DHHS, in effect, rendered a second final agency decision regarding
the 1999 application through settlement countermanding its original
final agency decision. Accordingly, we reverse DHHS' final decision
upholding the hospital settlement.
III. Alleged Errors under the CON Act
[3] Lake Norman alternatively asserts the procedure used by
DHHS in approving the hospital settlement and issuing the CON for
the hospital project violated several provisions of the CON Act.
We agree.
Neither the CON Act nor case law addresses the procedure for
settlement of CON disputes after a final agency decision. In
determining the proper procedure, we must remember that, although
N.C. Gen. Stat. § 150B-22 (2003) establishes a state policy
directing agencies to settle disputes if possible, '[a]n
administrative agency is a creature of the statute creating it and
has only those powers expressly granted to it or those powers
included by necessary implication from the legislature grant of
authority.' Boston v. N.C. Private Protective Services Bd., 96 N.C.
App. 204, 207, 385 S.E.2d 148, 150-51 (1989) (quoting In re
Williams, 58 N.C. App. 273, 279, 293 S.E.2d 680, 685 (1982). Therefore, DHHS' ability to settle and, through settlement, to
exercise powers granted it by the legislature in the CON Act may not
supercede other express requirements and limitations placed upon its
exercise of those powers. Accordingly, we must interpret the CON
Act, looking to the language of the act and the intent of the
legislature, to discern the proper procedure for the settlement of
a CON dispute after a final agency decision. State ex rel. Cobey
v. Simpson, 333 N.C. 81, 90, 423 S.E.2d 759, 763 (1992) (stating the
fundamental task in statutory interpretation is to ascertain and
adhere to the intent of the legislature). We begin by reviewing
the relevant provisions of the CON Act.
The CON Act was intended to limit the construction of health
care facilities in this state to those that the public needs and
that can be operated efficiently and economically for their
benefit. In re Humana Hosp. Corp. v. N.C. Dept. of Human Resources,
81 N.C. App. 628, 632, 345 S.E.2d 235, 237 (1986); N.C. Gen. Stat.
§ 131E-175 (2003). To effectuate this purpose, the legislature
granted DHHS the authority to issue CONs only after a procedural
process consisting, in relevant part, of application, agency review,
administrative appeal, final agency decision, and judicial appeal.
Pursuant to the CON Act, if a proposed project requires a CON,
the proponent of the project must properly submit an application.
N.C. Gen. Stat. § 131E-178, 182 (2003). DHHS then reviews the
application for a period normally not to exceed ninety days to
determine whether a CON for the proposed project should issue. N.C.
Gen. Stat. § 131E-185(a1) (2003). As an initial matter, DHHSdetermines whether the applicant has complied with the statutory
criteria contained in N.C. Gen. Stat. § 131E-183(a) [(2003)] and
rules adopted by the agency [in N.C. Admin. Code tit. 10A, r.
14C.0100 through r. 14C.0502 (June 2004)]. Living Centers-
Southeast, Inc. v. N.C. Dep't of Health & Human Servs., 138 N.C.
App. 572, 575, 532 S.E.2d 192, 194 (2000). In rendering a decision,
DHHS is statutorily limited to approving, approving with conditions,
or denying the application. N.C. Gen. Stat. § 131E-186(a) (2003).
Once DHHS renders a decision . . . to issue, deny or withdraw
a certificate of need or exemption or to issue a certificate of need
pursuant to a settlement agreement with an applicant to the extent
permitted by law, affected persons are afforded thirty days in
which to petition OAH for a contested case hearing before an ALJ.
N.C. Gen. Stat. § 131E-188(a) (2003); N.C. Admin. Code tit. 10A, r.
14C.0208. If an affected person does not file a petition for a
contested case hearing after a decision to issue a CON, DHHS must
issue a CON within thirty-five days of the decision. N.C. Gen.
Stat. § 131E-187(a) (2003). If a petition is filed, N.C. Admin.
Code tit. 10A, r. 14C.0401(a), a rule promulgated by DHHS in
accordance with N.C. Gen. Stat. § 131E-187(a) and 188(a), provides
that a CON will not be issued. DHHS must stay issuance until the
official record is received following the contested case hearing;
whereupon DHHS must make its final agency decision within thirty
days and thereafter may issue the CON. N.C. Gen. Stat. § 131E-
188(a); N.C. Gen. Stat. § 131E-187(b) (2003). The statutory timeperiod for an affected person who was a party in a contested case
hearing [to appeal to the Court of Appeals is] . . . 30 days [from]
the receipt of the written notice of final decision . . . . N.C.
Gen. Stat. § 131E-188(b) (2003).
DHHS and Presbyterian, ostensibly, contend the procedural
process outlined in the CON Act does not apply to approvals of CON
settlements. However, N.C. Gen. Stat. § 131E-188(a) refers to
approval of a settlement as a decision [by DHHS]. . . to issue a
certificate of need pursuant to a settlement agreement . . . .
Therefore, we construe such an approval to occupy the same
procedural position as an initial decision to 'approve' [or]
'approve with conditions,' . . . an application under N.C. Gen.
Stat. § 131E-186(a). This also compels construing the settlement
agreement itself as being equivalent to a new application.
Therefore, it follows that all procedural safeguards applying to
application approval and initial decisions, as discussed above,
apply equally to approval of settlements.
Accordingly, prior to approving a settlement, DHHS must
determine that the project referenced in the settlement will be
consistent with or not in conflict with [the] criteria enumerated
under N.C. Gen. Stat. § 131E-183(a). After a decision to issue a
CON pursuant to a settlement, DHHS must wait thirty days before
issuing a CON so affected persons may request a contested case
hearing. N.C. Gen. Stat. § 131E-187(a), 188(a); N.C. Admin. Code
tit. 10A, r. 14C.0208. If a contested case hearing is requested,
DHHS may not issue a CON pursuant to the settlement unless thehearing has been withdrawn or the final agency decision has been
made following [receipt of the official record and an ALJ
recommended decision] . . ., and all applicable conditions of
approval that can be satisfied . . . have been met. N.C. Gen.
Stat. § 131E-187(b). See also N.C. Admin. Code tit. 10A, r.
14C.0401(a).
Applying this law to the facts in the instant case, several
procedural and statutory errors are immediately apparent. First,
Hoffman and a Presbyterian representative reviewed the newly
submitted evidence regarding the hospital project. Hoffman
disagreed with Presbyterian's position that the new evidence, in
fact, satisfied all the statutory criteria or that the criteria were
met by the hospital project, as referenced in the settlement, at the
time of approval. Furthermore, no evidence in the record suggests
Fitzgerald determined the new evidence satisfied the criteria or
that the hospital project, as referenced in the settlement, complied
before his approval of the hospital settlement. Nonetheless, DHHS
issued the CON in violation of N.C. Gen. Stat. § 131E-183(a).
Second, DHHS issued the CON immediately after approval of the
hospital settlement in violation of N.C. Gen. Stat. § 131E-188(a)
and its own agency rule, N.C. Admin. Code tit. 10A, r. 14C.0208,
promulgated in accordance with N.C. Gen. Stat. § 131E-188(a).
Affected parties were not permitted the required thirty day time
period to petition for a contested case hearing for the purpose of
substantively challenging the hospital settlement prior to issuance
of the CON. Third, even assuming arguendo DHHS determinedcompliance had been established, we would not be persuaded of the
propriety of the hospital settlement because affected parties
adverse to Presbyterian's position were excluded from presenting any
argument as to non-compliance prior to issuance of the CON. Cf.
Firefighters v. Cleveland, 478 U.S. 501, 529, 92 L. Ed. 2d 405, 428
(1986) (stating an intervenor is entitled to present evidence and
have its objections heard at the hearings on whether to approve a
consent decree . . . .); State ex rel. Util. Comm'n v. Carolina
Util. Customers Ass'n., 348 N.C. 452, 466, 500 S.E.2d 693, 703
(1998) (stating, in rate cases before the North Carolina Utilities
Commission, negotiation and settlement is subversive of due process
and the legislative authority delegated to the Commission if it
lacks representation of all the parties with a certified interest
in the outcome of the proceeding).
In analyzing the issues in the instant case, we deem it
appropriate to comment on our holding in Bio-Medical Applications
of N.C., Inc. v. N.C. Dep't of Hum. Res., 136 N.C. App. 103, 523
S.E.2d 677 (1999), which also addresses a settlement under the CON
Act. In that case, Bio-Medical asserted all the statutory criteria
were not met by a project approved pursuant to a settlement between
DHHS and Dialysis Care of North Carolina, which was entered into
after an initial DHHS decision to deny Dialysis Care's CON
application but prior to a final agency decision. Id., 136 N.C.
App. at 108-09, 523 S.E.2d at 680-81. Bio-Medical appealed both the
settlement between DHHS and Dialysis Care and DHHS' final decision
affirming issuance of the CON pursuant to the settlement. Id. ThisCourt held that DHHS erred by approving the settlement before
establishing that Dialysis Care's project complied with the
statutory criteria. Id. Nevertheless, because satisfactory
evidence of compliance was provided during the subsequent contested
case hearing, this Court upheld DHHS' final decision affirming
issuance of the CON under the settlement because any mistakes or
omissions under the settlement had been corrected, and there was
no prejudice to Bio-Medical. Id. Therefore, Bio-Medical
Applications reiterates that, in exercising its authority under the
CON Act, whether via normal application procedure or settlement,
DHHS remains obligated to ensure that a proposed project meets all
the statutory criteria before approving the issuance of a CON. Id.
In affirming DHHS' final decision, this Court noted the unusual
procedural posture of Bio-Medical Applications in that Bio-Medical
appealed only the settlement, which dealt solely with the criteria
left unresolved in the original review, and DHHS' final decision,
which corrected a failure to establish compliance at the time of
settlement approval. Id. We further note DHHS had not already
rendered a final agency decision on the official record when it
initially approved the settlement. Id. We do not deem it prudent
to expand the scope of Bio-Medical Applications to cases where, as
here, DHHS had rendered a final agency decision based on the
official record denying issuance of a CON before the settlement
negotiations occurred and before the settlement was approved.
[4] Furthermore, we must respectfully disagree with the dissent
in that neither the statutes nor case law cited by the dissent haveallowed an agency in North Carolina to effectively countermand its
original final agency decision with a different final agency
decision. Indeed, in order to maintain procedural consistency and
coherence, a final agency decision must have finality. After an
agency renders a final decision on the record before it, it is the
province of the judiciary to review asserted errors in the decision,
not the province of the agency to consider the matter further or
anew. Moreover, the dissent notes Lake Norman had a full and
complete opportunity to litigate and challenge the settlement
agreements[;] however, we note that prior to this review, a CON
had already issued.
In sum, we hold DHHS must adhere to the procedural safeguards
for application approval and initial decisions when issuing CONs
pursuant to settlements. Our holding ensures compliance with the
mandates of the CON Act as well as the dictates of this Court's
precedent, protects the rights of affected persons, and upholds the
CON Act's purpose to regulate health care facility construction for
the public benefit. Accordingly, on remand, DHHS must follow the
procedures outlined above in considering the hospital settlement
anew.
IV. The OR Settlement
[5] Lake Norman asserts DHHS erred in its final agency decision
by affirming the OR settlement. Specifically, Lake Norman argues
DHHS exceeded its authority in the OR settlement by permitting the
relocation of four operating rooms from a downtown Charlottefacility to a new facility in south Charlotte without a CON review.
We disagree.
Under N.C. Gen. Stat. § 131E-176(16)u (2003), a CON is required
to relocate an operating room or operating rooms . . . [to a
location] separated by more than a public right-of-way adjacent to
the grounds where the operating room is or operating rooms are
currently located. This requirement became effective 23 June 2001
but was subject to the following grandfather clause:
This act shall not apply to any project which
was not a new institutional health service as
defined in G.S. 131E-176(16) prior to the
effective date of this act and for which there
has been a capital expenditure exceeding fifty
thousand dollars ($50,000) or there was a
legally binding obligation for a capital
expenditure exceeding fifty thousand dollars
($50,000) in effect on or before the effective
date of this act and which was reasonably
expected to be completed by December 31, 2002.
Id. (Editor's Note) (quoting Act of June 13, 2001, ch. 242, sec. 5,
2001 N.C. Sess. Laws 640-41). Prior to 23 June 2001, the relocation
of operating rooms was not defined as a new institutional health
service requiring issuance of a CON. See N.C. Gen. Stat. § 131E-
176(16) (1999).
In the instant case, on or about 11 April 2001, Presbyterian
entered into a binding obligation with an architectural firm for
services relating to the relocation of the operating rooms for a fee
of ten percent of the construction cost. Estimated fees at that
time ranged from $110,000 to $130,000 and were subsequently
adjusted downward to $73,500 on 14 June 2001. Furthermore, at the
time of DHHS' approval of the OR settlement, the architect projectedmid-December 2002 as the completion date for the relocation.
Accordingly, Presbyterian's operating room relocation met the
requirements of the grandfather clause, and DHHS did not err in
its final decision by affirming the OR settlement.
V. The PET Settlement
[6] Lake Norman asserts DHHS erred in its final agency decision
by affirming the PET settlement. The settlement provided that DHHS
would permit both Presbyterian and Forsyth's acquisition of a PET
scanner on or after 1 July 2004 regardless of whether a CON had
been issued. To the extent the PET settlement forms the basis of
Presbyterian and Forsyth's acquisition of PET scanners or implies
permission to acquire a PET scanner irrespective of whether that
acquisition is consistent with the CON Act, we summarily agree that
DHHS exceeded its statutory authority and further analysis is
unnecessary.
Nevertheless, Presbyterian and Forsyth may obtain PET scanners
separate from the PET settlement by submitting new applications in
accordance with normal CON procedure. Pursuant to motions before
this Court, we take judicial notice that Presbyterian and Forsyth
have, in fact, submitted new CON applications for the acquisition
of PET scanners. See Utilities Comm. v. Southern Bell Telephone
Co., 289 N.C. 286, 288, 221 S.E.2d 322, 323 (1976) (observing that
appellate courts may utilize the device of judicial notice).
Nothing in the record before us indicates these new CON applications
or DHHS' treatment of them might be linked improperly to the PET
settlement. Accordingly, the proceedings associated with these newCON applications are not before this Court in this case, and we need
not consider them.
VI. Rejection of ALJ Findings of Fact in a Final Agency Decision
[7] In the interest of preventing future recurring error, we
address Lake Norman's assertion that DHHS' final decision violated
N.C. Gen. Stat. § 150B-34(c) by failing to provide a specific reason
for its rejection of certain findings of fact by the ALJ. Under
N.C. Gen. Stat. § 150B-34(c):
The final agency decision shall recite and
address all of the facts set forth in the
recommended decision. For each finding of fact
in the recommended decision not adopted by the
agency, the agency shall state the specific
reason, based on the evidence, for not adopting
the findings of fact and the agency's findings
shall be supported by substantial evidence
admissible under G.S. 150B-29(a), 150B-30, or
150B-31.
(Emphasis added).
DHHS' final decision adopted forty-nine of the ALJ's findings
of fact and rejected fifty-two. In twenty-five of the rejections,
DHHS did not provide a specific reason for the rejection as required
by N.C. Gen. Stat. § 150B-34(c). For example, the rejection of
finding of fact twelve stated, I reject Finding of Fact No. 12 on
the grounds that it mischaracterizes the Agency's actions. See
Fitzgerald Dep., Vol. I, pp. 40-42. While this rejection indicates
DHHS' determination that the finding was erroneous, no specific
reason was provided for this rejection in violation of N.C. Gen.
Stat. § 150B-34(c). The statutory requirement for providing a
specific reason both guards against arbitrary decisions by the
agency and facilitates meaningful appellate review, and we encourageDHHS to comply with the statutory requirements for rejecting
findings of fact in future final agency decisions.
VII. Conclusion
For the foregoing reasons, we reverse DHHS' final decision
concerning the hospital settlement and remand the case to DHHS with
instructions to: (1) withdraw the CON for the hospital project
issued pursuant to the settlement and (2) consider the hospital
settlement anew, adhering to the procedural safeguards applying to
an application approval and initial decision. Should a contested
case hearing occur after DHHS' decision concerning the hospital
settlement, we reiterate DHHS' duty to provide a specific reason for
each finding of fact rejected in its final agency decision. We
affirm DHHS' final decision concerning the OR settlement on the
basis of the grandfather clause applicable to N.C. Gen. Stat. §
131E-176(16)u. Any final agency decision based on the PET
settlement's implication of permission from DHHS to acquire a PET
scanner irrespective of whether that acquisition is consistent with
the CON Act must fail, but we express no opinion regarding
proceedings associated with independent CON applications.
[8] As a final matter, we note Presbyterian Hospital North
became fully operational during the pendency of this appeal. We are
faced, therefore, with balancing a strict application of the
provisions of the CON Act against maintaining health care services
currently provided by the operating hospital. It would be imprudent
to close the hospital due to procedural irregularities in light of
the hardship to the community. This is especially true in theinstant case because the new evidence submitted during negotiations
contains information relevant to a determination of compliance with
the required statutory criteria. Furthermore, after considering the
evidence in the record, as well as the parties' lack of guidance
from the statutes and from judicial precedent, it appears that DHHS
and Presbyterian proceeded in good faith, albeit erroneously, in
attempting to settle this matter after the original final agency
decision concerning the 1999 application. Now that this Court has
set forth the appropriate settlement procedure, the possibility of
such good faith attempts to settle by parties in future cases is
vitiated, and such considerations will not avail parties to whom a
CON has been issued in violation of these procedural safeguards.
In the instant case, however, Prebyterian Hospital North may
continue to operate (1) until the hospital settlement has upon
remand been considered anew by DHHS following the procedures
outlined above and (2) in the event a contested case hearing should
occur following DHHS' initial decision, until DHHS enters a final
agency decision.
Affirmed in part, reversed in part, and remanded with
instructions.
Judge McGEE concurs.
Judge STEELMAN concurs in part and dissents in part in a
separate opinion.
STEELMAN, Judge concurring in part and dissenting in part.
I concur in parts IV and V of the majority opinion, but must
respectfully dissent as to the balance of the opinion.
N.C. Gen. Stat. § 131E-188(a)(2004) provides that:
After a decision of the Department to issue,
deny or withdraw a certificate of need or
exemption or to issue a certificate of need
pursuant to a settlement agreement with an
applicant to the extent permitted by law, any
affected person, as defined in subsection (c)
of this section, shall be entitled to a
contested case hearing under Article 3 of
Chapter 150B of the General Statutes.
Pursuant to this provision and N.C. Gen. Stat. § 150B-22, the
Department of Health and Human services (DHHS) was permitted to
enter into settlement agreements with Presbyterian Hospital and
Forsyth Memorial Hospital. Following these settlements, Mooresville
Hospital initiated this contested case proceeding. Mooresville had
a full and complete opportunity to litigate and challenge the
settlement agreements. This procedure is clearly set forth in N.C.
Gen. Stat. § 131E-188. The additional procedural requirements set
forth in the majority opinion are not found in either Chapter 131E
or Chapter 150B.
I would also hold that the findings contained in the Final
Decision of DHHS are supported by the evidence, and petitioner can
show no prejudice. Bio-Medical Applications of N.C., Inc. v. North
Carolina Dep't of Human Resources, Div. of Facility Servs.,
Certificate of Need Section, 136 N.C. App. 103, 523 S.E.2d 677
(1999); Britthaven, Inc. v. North Carolina Dep't of Human Resources,
Div. of Facility Servs., 118 N.C. App. 379, 455 S.E.2d 455 (1995). Under the provisions of N.C. Gen. Stat. § 150B-34(c), DHHS was
required to state the specific reason, based on the evidence, for
not adopting the findings of fact of the Administrative Law Judge
(ALJ). This provision, applicable only to cases under Chapter 131E,
sets forth a lesser standard for final agency decisions than under
N.C. Gen. Stat. § 150B-36, for rejection of the findings of fact of
the ALJ. N.C. Gen. Stat. § 150B-36(b1) provides that in cases other
than Chapter 131E, the final agency decision:
shall set forth separately and in detail the
following:
(1) The reasons for not adopting the findings
of fact.
(2) The evidence in the record relied upon by
the agency in not adopting the finding of fact
contained in the administrative law judge's
decision.
I would hold that the specific reasons cited in the Final
Decision of DHHS for rejecting the findings of fact of the ALJ were
sufficient. The recommended decision of the ALJ was 39 pages long,
and contained 101 separate findings of fact. The final Decision of
DHHS was 103 pages long. Each rejected finding of the ALJ was set
out verbatim and the reason for the rejection stated. Some of the
reasons stated for rejection were lengthy and some were short. Some
of the reasons stated incorporated specific documents into the
decision. I would hold that the Final Decision complied with the
provisions of N.C. Gen. Stat. § 150B-34(c), which only require that
DHHS state the specific reason for rejection of the finding of fact
made by the ALJ. Finally, the majority opinion specifically authorizes
Presbyterian Hospital North to continue in operation without a CON
pending DHHS' reconsideration of this matter. The majority cites
no authority for this directive, and I know of none.
I would affirm the final agency decision in this matter.
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