MultiCare Health System v. Department of Health
MultiCare Health System v. Department of Health
Opinion of the Court
The question in this appeal is whether the “construction, development, or other establishment of a new health care facility” requires a Certificate of Need from the Department of Health (Department) when the new facility is to be operated under an existing license.
MultiCare is a Washington not-for-profit corporation. It operates Tacoma General Hospital and Allenmore Hospital in Pierce County. It is currently licensed for a total of 521 beds.
MultiCare wants to construct a new facility in King County. It proposes to operate that facility under its existing license, moving 80 of its 521 beds from Tacoma to the new location.
In May 2000, MultiCare asked the Department to determine that MultiCare did not have to obtain a Certificate of Need before constructing its new facility.
(1) The department is authorized and directed to implement the certificate of need program in this state pursuant to the provisions of this chapter.
(2) There shall be a state certificate of need program which is administered consistent with the requirements of federal law as necessary to the receipt of federal funds by the state.
(3) No person shall engage in any undertaking which is subject to certificate of need review under subsection (4) of this section without first having received from the department either a certificate of need or an exception granted in accordance with this chapter.
(4) The following shall be subject to certificate of need review under this chapter:
(a) The construction, development, or other establishment of a new health care facility; . . .
Under RCW 70.38.025(6), “ ‘[hjealth care facility’ means hospices, hospice care centers, hospitals, psychiatric hospitals, nursing homes, kidney disease treatment centers, ambulatory surgical facilities, and home health agencies .. . .” Under RCW 70.38.025(15), “ ‘[hjospital’ means any health care institution which is required to qualify for a license under [former] RCW 70.41.020(2) [(1991)]; or as a psychiatric hospital under chapter 71.12 RCW.”
Against this statutory backdrop, MultiCare asserts that it is not required to obtain a Certificate of Need. Citing and relying on WAC 246-320-085,
In our opinion, MultiCare’s argument is logically flawed. That a facility need not apply for a new license does not mean that it need not qualify for a license, and the applicable statutes require exactly that. RCW 70.41.110 provides that a license “shall be issued only for the premises and persons named in the application,” and that a license shall not “be transferable or assignable except with the written approval of the department.” (Emphasis added.) This statute requires that when an operator like MultiCare wants to bring new premises under an existing license, it must obtain a license — albeit an amended one — that includes the new premises.
Furthermore, RCW 70.41.110 provides that “no license . . . shall exceed thirty-six months in duration.” Thus, even if MultiCare’s new premises did not have to be licensed now — which they do — they would have to be licensed within three years; they would have to “qualify for a license” then if not now; and they are both a “hospital” and a “health care facility” within the meaning of RCW 70.38.025(15) and RCW 70.38.105(4)(a), respectively.
Nothing in the statutes or regulations contravenes these conclusions. RCW 70.41.120 states that “[a]ny licensee or applicant desiring to make alterations or additions to its facilities or to construct new facilities shall. . . comply with the regulations prescribed by the department.” WAC 246--320-085 states only that the department “may issue” a
We do not hold that an operator like MultiCare is required (or not required) to amend or renew its existing license before it can renovate or add to its existing premises. Because this case involves the establishment of new premises, not existing ones, we have not considered or addressed that question.
We reject MultiCare’s arguments that the Department has engaged in improper rule making and made inconsistent decisions on other projects. For the reasons already discussed, it is our opinion that the Department is adhering to the applicable statutes, at least in this case.
The parties’ remaining arguments lack merit or need not be reached. We deny MultiCare’s claim for reasonable attorney fees.
Affirmed.
Quinn-Brintnall, A.C.J., concurs.
See WAC 246-310-050.
WAC 246-320-085 provides:
The purpose of this section is to allow a single hospital license to cover more than one building.
The department may issue a single hospital license to include two or more buildings, provided:
(1) The applicant or hospital:
(a) Meets the licensure requirements of chapter 70.41 and this chapter; and
(b) Operates the multiple buildings as a single integrated system with:
(i) Governance by a single authority or body over all buildings or portions of buildings under the single license; and
(ii) A single medical staff for all hospital facilities under the single license;
*600 (2) The hospital arranges for safe, appropriate, and adequate transport of patients between buildings.
Br. of Appellant at 25.
Dissenting Opinion
(dissenting)
I respectfully dissent. Multicare Health System owns and operates two Tacoma hospitals under one license and plans to construct an inpatient/outpatient facility in south King County. Multicare would transfer 80 beds from its Tacoma hospitals’ bed capacity to the new, satellite facility and operate it under its existing hospital license, as part of a single integrated system. The Department of Health (Department) determined that Multicare’s new facility would require Certificate of Need (CN) review. Multicare appeals from summary judgment in favor of the Department.
I would hold that the Department’s statutes and regulations permit new buildings to be licensed under a hospital’s existing license without CN review if the buildings are operated as a single integrated system with uniform gover
Multicare, a Washington not-for-profit corporation, owns and operates two Tacoma hospitals, Tacoma General and Allenmore (TGAH). The Department issued TGAH a hospital license under chapter 70.41 RCW, permitting it to operate 521 total beds. In 1999, over 70,000 patients registered with, and more than 200,000 patients visited Multicare facilities in south King County. Also, Multicare employs approximately 75 physicians who provide primary care and specialty services in south King County facilities.
Multicare wants to construct an inpatient/outpatient facility (i.e., a hospital) in south King County and operate it under TGAH’s hospital license. TGAH would transfer 80 existing beds from the Tacoma hospitals to the new facility, leaving TGAH’s total licensed bed capacity unchanged. The new facility would be located in Auburn, 20 miles away from TGAH.
The issue before us is whether chapters 70.38 RCW and 246-320 WAC mandate a CN review when a hospital seeks to transfer existing beds to a new facility to be operated under the hospital’s existing license. We are not deciding whether there is a “need” and the issue is not the same as if the CN statute had been accessed to determine “need.” All parties acknowledge that multiple buildings can be operated under the same license; so the question becomes “is this one of those circumstances?”
I. CN Review
Under a provision of the CN statute, RCW 70.38.105(4)(a), the “construction, development, or other establishment of a new health care facility” requires CN review. (Emphasis added.) RCW 70.38.025(6) defines “[h]ealth care facility” to include “hospitals.”
“Hospital” means any institution, place, building, or agency which provides accommodations, facilities and services over a continuous period of twenty-four hours or more, for observation, diagnosis, or care, of two or more individuals not related to the operator who are suffering from illness, injury, deformity, or abnormality, or from any other condition for which obstetrical, medical, or surgical services would be appropriate for care or diagnosis.
Thus, under chapter 70.38 RCW, the construction of a hospital — any health care institution that must qualify for a hospital license under chapter 70.41 RCW — requires CN review. And under chapter 70.41 RCW, no person can establish a hospital, as defined by RCW 70.41.020, without a hospital license.
Under WAC 246-320-085, the Department may issue a single hospital license to cover multiple buildings. The regulation provides:
The purpose of this section is to allow a single hospital license to cover more than one building.
The department may issue a single hospital license to include two or more buildings, provided:
(1) The applicant or hospital:
*604 (a) Meets the licensure requirements of chapter 70.41 RCW and this chapter; and
(b) Operates the multiple buildings as a single integrated system with:
(1) Governance by a single authority or body over all buildings or portions of buildings under the single license; and
(ii) A single medical staff for all hospital facilities under the single license;
(2) The hospital arranges for safe, appropriate, and adequate transport of patients between buildings.[7 ]
Thus, under WAC 246-320-085, a single hospital license may cover multiple buildings (i.e., hospitals) if the applicant meets the licensure requirements, operates the buildings as a single integrated system, and arranges for sufficient transport of patients between buildings. Indeed, Multicare operates its two Tacoma hospitals and its Covington, King County campus under a single hospital license.
Multicare contends that the Department made an error of law in concluding that the transfer of beds to the proposed inpatient/outpatient facility is subject to CN review. It argues that CN review is not required because TGAH seeks to operate the new facility as part of a single integrated system under its existing hospital license. Multicare reasons as follows: (1) the construction of a hospital (a “health care facility’)7
This requirement of compliance with chapter 70.41 RCW was the linchpin for the presiding officer’s decision. He reasoned that the proposed facility must first qualify for a license by itself before it could be added to TGAH’s license. In other words, before a hospital may be operated under an existing license, it must independently qualify for a license. That is, whenever a hospital is established, it must qualify for a license, regardless of whether it will be operated under an existing license. Consequently, because all hospitals must qualify for a license, all hospitals must also undergo CN review.
The presiding officer’s position was not sound. First, it would render useless the WAC that permits the operation of two buildings and even two hospitals under one license. Requiring a separate license and CN whenever there is new construction would be wasteful and useless. The operation of two or more buildings under one license is permitted under the WAC, which has not been challenged.
Second, any currently licensed hospital may “construct new facilities” under the hospital licensing statute and may amend its license to include the new facilities. RCW 70.41.120. Though a hospital must comply with licensing regulations any time it undertakes “new construction,” including “[a]Iterations to an existing hospital,”
Third, to understand how WAC 246-320-085 operates, it is instructive to examine its predecessor, former WAC 246-318-017(4) (1999). Before March 10, 1999, separate hospital buildings could be operated under a single license only if the buildings were located within 10 miles of one another: “Hospital buildings included under one license shall not be located more than ten surface miles apart.”
Accordingly, the presiding officer erred in granting summary judgment in favor of the Department. I would reverse and hold that Multicare need not obtain a Certificate of Need for its satellite facility.
Finally, Multicare argues that it is entitled to its attorney fees and costs on appeal, should this court reverse.
I would reverse.
Review denied at 151 Wn.2d 1023 (2004).
RCW 70.38.025(6) provides in relevant part, “ ‘Health care facility* means hospices, hospice care centers, hospitals, psychiatric hospitals, nursing homes,
Recodified as RCW 70.41.020(4) (2002) by Laws of 2002, ch. 116, § 2.
RCW 70.41.090(1) provides in relevant part:
No person or governmental unit of the state of Washington, acting separately or jointly with any other person or governmental unit, shall establish, maintain, or conduct a hospital in this state, or use the word “hospital” to describe or identify an institution, without a license under this chapter ....
(Emphasis added.)
WAC 246-320-085 (emphasis added).
RCW 70.38.105(4)(a).
RCW 70.38.025(15).
WAC 246-320-085.
WAC 246-320-500, -010(64).
WAC 246-320-500.
WAC 246-320-010(7)(a), (64).
WAC 246-320-505(2).
Former WAC 246-318-017(4) (1992).
See RCW 4.84.340(5), .350(1).
Case-law data current through December 31, 2025. Source: CourtListener bulk data.