Ex Parte Beverly Enterprises-Alabama, Inc.
Ex Parte Beverly Enterprises-Alabama, Inc.
Opinion
The 1996 revision of the Alabama State Health Plan ("SHP") included the addition of 72 new skilled nursing facility beds in Baldwin County. This case concerns the applications of three competing entities to the State Health Planning and Development Agency ("SHPDA") for authorization to supply those beds. Living Centers, Inc., sought 37 of these beds. Beverly Enterprises-Alabama, Inc. ("Beverly"), and Mercy Medical ("Mercy") each sought all 72 beds. The Certificate of Need ("CON") Review Board examined all three applications. At the conclusion of a public hearing on these applications, the CON *Page 1191
Review Board awarded all 72 beds to Mercy. Beverly appealed to a Fair Hearing Officer ("FHO"). The FHO reversed the CON Review Board's ruling and remanded. Mercy appealed that ruling to the Baldwin County Circuit Court, which reversed the ruling of the FHO. Beverly appealed to the Court of Civil Appeals, which affirmed on June 9, 2000, without an opinion.Beverly Enters.-Alabama, Inc. v. Mercy Med. Corp. (No. 2990160),
Beverly had proposed, in its application, to combine the 72 new beds with 20 other beds from 2 of its existing nursing homes in Baldwin County, resulting in a new facility with a total of 92 beds. Beverly planned to offer a comprehensive range of services, including a designation of 20 beds for a Medicare-certified skilled-nursing unit and 16 beds for an Alzheimer's unit. (R. 11 and SHPDA AL-97012: p. 87.) Beverly projected a total cost of $6,640,820. Mercy proposed to construct a 72-bed facility that would have offered, in its words, "a basic level of care." (SHPDA AL-97015: p. 58.) Mercy projected a total cost of $5,242,961.
The Alabama Administrative Code prescribes 18 different standards for the CON Review Board to use when applicants are competing for available beds. See Ala. Admin. Code (State Health Planning and Development Agency), Rule
The FHO determined that the CON Review Board had based its decision on an arbitrary or capricious interpretation of four of the standards specified by Rule
Second, the CON Review Board favored Mercy's proposal for a narrower range of services over Beverly's proposal for a broader range of services. Rule
Third, Rule
"In addition, in its written ruling as to the application of Mercy Medical, the [CON Review] Board concluded that the `construction of an additional nursing home facility [by Mercy Medical] to care for those patients who require a lesser level of therapy would broaden the scope of healthcare services for residents of Baldwin County.' Ruling of [CON Review Board], Mercy Medical ¶ 9. (Emphasis added.) This finding constitutes a near verbatim lifting of the statement of Mercy Medical at page 4 of its application. However, Mercy Medical's application differs in one critical aspect[;] it merely asserts that the granting of its application would `broaden the scope of healthcare services that Mercy Medical can make available to the citizenry of Baldwin County.' Mercy Medical's application, p. 4 (Emphasis added.) To the extent that the [CON Review] Board, perhaps unwittingly, based its favorability finding for Mercy Medical on an institutional need as opposed to a `public requirement' or `community need', it acted inconsistent with prescribed standards. See generally CON Rules
410-1-6-.05 and410-1-6-.06 ."
(Report of the FHO, pp. 6-7.) (Emphasis original.) In this decision, the CON Review Board deviated from this fixed standard by favoring Mercy's plan for 72 beds at a "basic level of care" (SHPDA AL-97015: p. 87) over Beverly's proposal for *Page 1193
36 beds at a "basic level of care" and 36 beds dedicated to a Medicare-certified skilled-nursing unit and an Alzheimer's unit (R. 11 and SHPDA AL-97012: p. 87). This violated the fixed standard of Rule
Fourth, Rule
"Dr. Philpott: . . . Mercy Medical has proven to be a good provider. The problem — not that I want to speak against my own motion. The problem I have with my motion [to approve Mercy Medical] is it's very appealing to get rid of the [outdated beds and overcrowded wards] at the other facilities. But I have the same problem with what do you do with the other —
"Mr. Haughton: Right.
"Dr. Philpott: — thirty-five beds. And if you split those, you end up with Beverly only getting a fifty-five bed facility. And that just doesn't seem like the thing to do. That's why I make the motion for Mercy Medical."
(CON Review Board Transcript at p. 57, as quoted in Report of the FHO, pp. 10-11.) Dr. Philpott's confusion appeared to result from the misconception that if the CON Review Board awarded some beds to Beverly because of the positive impact that would have on Beverly's existing nursing homes, then the CON Review Board would also have to award some of these new 72 beds to Living Centers, because of the positive impact that would have on Living Centers existing nursing homes. This misconception, however, was not mandated by Rule
The FHO consequently concluded:
"[I]t is the opinion of the undersigned that the Rulings of the State Agency in the above-captioned matter were arbitrary or capricious. Certain justifications given either are not reasonable in that they are based on erroneous or arbitrary conclusions of fact or are not made based upon fixed standards as to which applications are to be measured. . . . It simply is the opinion of the undersigned that the Board, in reaching its decision, did not base that decision on applicable standards or justifiable factual conclusions. There is nothing in the record, however, to indicate that, once the Board corrects the errors in its factual conclusions and applies the fixed standards prescribed by the CON Rules, it cannot make an appropriate decision . . . . Therefore, the undersigned is given no option under the regulations other than to remand this case to the Board for further proceedings consistent with this Order."
(Report of the FHO, p. 13., R. 392.)
Mercy appealed the final decision of the FHO to the Baldwin County Circuit Court. That court reversed the FHO's order, entering the following on the case action summary:
"This Court finds that the FHO acted unreasonabl[y], arbitrar[ily], and capricious[ly] in his review. The Court reverses the final decision of the SHPDA and the ruling of the FHO dated 12-31-98. The Court reinstates the decision of the CON Board and finds that the record supports the CON Board's decision that Mercy Medical is the most appropriate applicant to be awarded the 72 skilled nursing home beds for Baldwin County."
(See Beverly's certiorari petition, Exhibit B.)
The Court of Civil Appeals affirmed the judgment of the circuit court, without an opinion. In its petition for certiorari review, Beverly claims that the holding of the Court of Civil Appeals conflicts with that ofForest Manor, Inc. v. State Health Planning Development Agency,
Alabama Medicaid Agency v. Beverly Enters.,"[As this court is required to do,] the circuit court . . . was required to look to the Commissioner's decision and the reasons she gave for denying reimbursement. Where such decision is shown to be arbitrary and capricious, no posthoc rationalizations or theories for denying reimbursement can correct it."
Forest Manor, 723 So.2d at 79 (emphasis added)."'[T]he decision of the fair hearing officer is the final decision of the Board.' Methodist Homes for the Aging Corp. v. Stewart,
594 So.2d 161 ,163 (Ala.Civ.App. 1992) (citing §22-21-275 (14), Ala. Code 1975); see also Ala. Admin. Code Rule410-1-8-.26 (`The decision of the [FHO] shall be considered the final decision of [SHPDA]'). Thus, it is the FHO's decision, and not the [CON Review Board's] decision, that is entitled to a presumption of correctness on appeal; thus, the pertinent question raised by Forest Manor's appeal is whether the FHO's order was `arbitrary, capricious, or fail[ed] to comply with applicable law.' [State Health Planning Res. Dev. Admin. v. Rivendell of Alabama, Inc.,469 So.2d 613 ,614 (Ala.Civ.App. 1985)]."
Just as the FHO is prohibited from substituting his or her judgment for that of the CON Review Board, the circuit court and the Court of Civil Appeals are likewise prohibited from substituting their judgments for that of the FHO. In Forest Manor, the main dispute centered on which entity was entitled to the presumption of correctness on appeal — the CON Review Board or the FHO. The Court of Civil Appeals properly resolved the dispute in that case in favor of the FHO:
Forest Manor, 723 So.2d at 80. See also, Ala. Administrative Code, Rule"Thus, because the FHO's order (and not the CONRB's order) is the final agency decision to which a presumption of correctness applies, we must determine whether his conclusions . . . were themselves `arbitrary, capricious, or [contrary to] applicable law.'"
We must conclude that in this present case the decision of the circuit court conflicted with Forest Manor, supra, because in this case the circuit court substituted its judgment for that of the FHO. The circuit court reinstated the CON Review Board's award, but only after reweighing the facts and holding that "Mercy Medical is the most appropriate applicant to be awarded the seventy-two skilled nursing home beds." This decision exceeded the scope of its review. Again, the FHO determined:
"[I]t is the opinion of the [FHO] that the Rulings of the State Agency in the above-captioned matter were arbitrary or capricious. Certain justifications given either are not reasonable in that they are based on erroneous or arbitrary conclusions of fact or are not made based upon fixed standards as to which applications are to be measured . . . . It simply is the opinion of the [FHO] that the Board, in reaching its decision, did not base that decision on applicable standards or justifiable factual conclusions."
(Report of the FHO, pp. 13, R. 392.)
According to the FHO, the four flawed facets of the CON Review Board's decision in favor of Mercy established that that decision was arbitrary and capricious. We fail to see how the circuit court could have determined that the FHO's decision was "arbitrary, capricious, or fail[ed] to comply with applicable law." Forest Manor, 723 So.2d at 79. We must conclude that the circuit court erred by not deferring to the decision of the FHO. Consistent with Forest Manor, supra, at 78, andMethodist Homes, supra, at 163, the FHO's conclusion was the final decision of the CON Review Board and was thus entitled to a presumption of correctness. Having correctly determined that the CON Review Board had breached its own standards, the FHO properly remanded this dispute to the CON Review Board. The circuit court erred by reversing this ruling of the FHO.
The judgment of the Court of Civil Appeals is therefore reversed, and this case is remanded for an order or proceedings consistent with this opinion.
REVERSED AND REMANDED.
Houston, See, Lyons, Brown, Johnstone, Harwood, Woodall, and Stuart, JJ., concur.
Reference
- Full Case Name
- Ex Parte Beverly Enterprises-Alabama, Inc. (Re: Beverly Enterprises-Alabama, Inc. v. Mercy Medical Corporation)
- Cited By
- 13 cases
- Status
- Published