MRI Associates, Inc. v. Department of Public Health
MRI Associates, Inc. v. Department of Public Health
Opinion of the Court
Following denial of their requests for approval to transfer the sites of their respective clinic operations, the plain
Background. Greater Boston
In 2002, Cooley Dickinson Hospital and Brockton Hospital sought, and obtained, permission from the department to purchase MRI equipment and provide MRI services under 105 Code Mass. Regs. § 100.308 (1994). That regulation allows for a discretionary and temporary exemption from the requirement, otherwise applicable to purchases of new MRI equipment and providing MRI services, to obtain a determination of need. See
After notice and hearing, the department (through its commissioner and public health council) denied the clinics’ transfer requests. In the case of Greater Boston, the department found that the proposed transfer failed to satisfy the requirement under § 100.720(I)(2) that it significantly increase access to service at
The plaintiffs filed a complaint in the Superior Court, challenging the department’s denials pursuant to G. L. c. 30A, § 14, and requested a declaratory judgment that the department’s denials were in excess of its authority.
Discussion. The plaintiffs challenge the department’s actions on two distinct levels. First, they contend that the department is without statutory authority to deny, based on determination of need, a request to transfer a facility that does not provide ambulatory surgery.
We begin by reviewing the statutory scheme. “General Laws
The plaintiffs’ argument that the department is without authority to perform a needs analysis of their transfer requests would fundamentally undermine the purposes of the determination of need statute. It would derogate significantly from the purpose of the statute to encourage appropriate allocation of resources for health care purposes if, following licensure of a facility for service of a particular type in a particular location and based on a determination of need for that service in that location, the license holder were then free to transfer the facility to any other location, without regard to the need for service in either the new or former location. Particularly under the highly deferential standard of review we apply to the interpretation of a statute developed by the administrative agency charged with its enforcement, see Falmouth v. Civil Serv. Commn., 447 Mass. 814, 821-822 (2006), we are not persuaded that the department acted
The plaintiffs separately contend that, even if the department in theory has the statutory authority to adopt regulations which apply a needs analysis to transfer requests, the regulations the department in fact adopted do not have that effect. As the motion judge observed, however, the contention is simply incorrect: 105 Code Mass. Regs. § 100.720(G) (2001) expressly requires the department to conduct a needs analysis of any facility transfer request. Section 100.720(G) provides as follows:
“Except as provided in 105 CMR 100.720(H) and 100.720(1), the Department shall grant a request for transfer of site or change in location unless it finds that transfer of the project or facility to the site proposed would likely violate the objectives of the determination of need process stated at 105 CMR 100.532. The Department may approve the request subject to reasonable conditions related to the proposed transfer of site or change in location” (emphasis added).
The plaintiffs suggest that the “except” phrase appearing at the beginning of § 100.720(G) excludes from the operation of that section any transfer request governed by 105 Code Mass. Regs. § 100.720(H) (2001) (which applies to any project ap
Moreover, considered in the context of the over-all statutory purposes and objectives, we think it reasonable and permissible for the department to construe the requirement, under § 100.720(I)(2), that any transfer “significantly increase access to the service for the population residing in cities and towns of the new site, and . . . not result in a corresponding decrease in access to the service at the original site,” in a manner consistent with the determination of need analysis performed incident to original licensure. As we have previously observed, a contrary conclusion would derogate from the purposes of G. L. c. 111, § 25F, by allowing services approved and licensed based on a determination of need for the service at a particular location to relocate without regard to the need for the service at the proposed new location, or any adverse impact on services available at the originally approved location.
Having established the department’s statutory authority to adopt regulations applying a needs analysis to transfer requests, and that its regulations carry out that authority, we are satisfied
As to the separate request by WMMRS under § 100.720(I)(1), however, we conclude that the department’s decision must be vacated. In considering WMMRS’s request, the department treated its service area as Chicopee, the location of another fixed-site MRI clinic operated by WMMRS. However, WMMRS proposed to transfer its former Northampton facility, and not its Chicopee facility, and was entitled to have its transfer request considered on the basis of the historical patient data it submitted from its Northampton operations. Because the department did not conduct an analysis of WMMRS’s transfer request under § 100.720(I)(1) with reference to the Northampton facility that was the subject of WMMRS’s transfer request, we vacate that portion of the judgment and direct that the judgment be modified to remand the matter to the department for further proceedings on WMMRS’s request under § 100.720(I)(1).
Conclusion. So much of the judgment as affirms the department’s decisions to deny the clinics’ transfer requests pursuant to § 100.720(I)(2) is affirmed. So much of the judgment as affirms the department’s decision to deny WMMRS’s transfer request pursuant to § 100.720(I)(1) is vacated, and the judgment shall be modified to remand the matter to the department for further proceedings on WMMRS’s transfer request under § 100.720(I)(1) consistent with this opinion.
So ordered.
For convenience we shall refer to Greater Boston and WMMRS together in this opinion as the “clinics.”
MRI Associates, Inc., is the general partner of Greater Boston.
The three hospitals, Cooley Dickinson Hospital (in Northampton), Franklin Medical Center (in Greenfield), and Wing Hospital (in Palmer), were joint licensees with WMMRS.
Section 100.720(I) provides in relevant part:
“With respect to a facility duly licensed pursuant to M.G.L. c. 111, §§ 51 through 53 or M.G.L. c. 111B, §§ 6, 6A, or 6B, a request for a transfer of site under 100 CMR 100.720 shall be approved if the Department determines that no substantial change in service or substantial capital expenditure will result and one or the following applies:
“(1) The proposed transfer will not substantially change the population served by the facility, defined as the population residing in the cities and towns whose patients when ranked ordinally contribute cumulatively 75% of the facility’s total discharges; provided that the transfer of site request shall not be approved if the proposed site of the transfer is a city or town that ranks higher on the 75% discharge list of another facility that provides the same services than it does on the 75% list of the facility proposing the transfer, unless there has been demonstration that the proposed transfer will not result in the duplication of services; or;
“(2) The proposed transfer will significantly increase access to the service for the population residing in cities and towns of the new site, and will not result in a corresponding decrease in access to the service at the original site.”
The plaintiffs also sought a declaration that the department may not consider exceptions pursuant to 105 Code Mass. Regs. § 100.308 in its determination whether to grant a transfer of site request. This count was dismissed by stipulation of the parties.
General Laws c. 111, § 51, explicitly requires a determination of need analysis for the transfer of any facility that provides ambulatory surgery. Though the department’s decisions reference that statute, for the reasons discussed below we agree with the judge that G. L. c. 111, § 25C, authorizes a determination of need analysis in the circumstances of the present case as well.
We also note that the department’s rulemaking authority was subject to some degree of legislative oversight. Following the directive to promulgate regulations, G. L. c. 111, § 25F, contains the following proviso: “provided, however, that no new promulgated rule or regulation shall take effect before the thirtieth day next following the date which [sic] a copy of the rule or regulation shall have been filed with the joint committee on health care of the general court.” G. L. c. 111, § 25F, inserted by St. 1977, c. 945, § 5. “The Legislature does not ordinarily display this level of interest in administrative regulations. The fact that the Legislature has done so here strongly indicates that it anticipates that the regulations will be substantive, and wishes to be in a position quickly to alter anything it deems inconsistent with desirable regulatory policy regarding the subject matter.” Postal Community Credit Union v. Commissioner of Banks, 61 Mass. App. Ct. 563, 571-572 (2004). That the Legislature did not act to challenge the department’s regulations lends weight to the conclusion that the department acted within its delegated authority in promulgating them. See ibid. See also Carleton v. Commonwealth, 447 Mass. 791, 804, 808-810 & n.26 (2006); Pulsone v. Public Employee Retirement Admin. Commn., 60 Mass. App. Ct. 791, 796-797 (2004).
The plaintiffs’ proffered interpretation would render § 100.720(G) superfluous, since its provisions would apply independently to no class of facilities. Following oral argument before this court, the plaintiffs submitted a letter pursuant to Mass.R.A.P. 16(1), as amended, 386 Mass. 1247 (1982), in which they suggested that § 100.720(H) and § 100.720(1) applied only where no “substantial change in service” or “substantial capital expenditure” is involved, leaving open the possibility that § 100.720(G) would hold independent force with respect to transfer requests in which either a substantial change in service or a substantial capital expenditure is involved. However, the references in the two sections to a substantial change in service or a substantial capital expenditure do not define the scope of coverage of each section, but instead establish the conditions required for approval of a request falling within the scope of each section. As the scope of the two sections, taken together, is comprehensive (in that one covers unlicensed facilities and the other covers licensed facilities), the plaintiffs’ suggestion that § 100.720(G) does not apply to requests under either section, and applies only to requests to which neither section applies, is unpersuasive.
Reference
- Full Case Name
- MRI Associates, Inc. & others v. Department of Public Health
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- 2 cases
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- Published