COBB HOSPITAL, INC. D/B/A WELLSTAR COBB HOSPITAL v. DEPARTMENT OF COMMUNITY HEALTH, 307 Ga. 578

DCH granted Emory University Hospital Smyrna a new certificate of need (CON) to renovate a hospital Emory acquired.
Wellstar (Cobb Hospital and Kennestone Hospital) appealed the CON to the CON Appeal Panel; the hearing officer refused to consider Wellstar’s challenges to the validity of Emory’s existing CON and excluded related evidence.
Wellstar appealed to the DCH Commissioner, raised a constitutional due process claim, and the Commissioner affirmed the hearing officer without ruling on the constitutional claim.
Wellstar sought judicial review in superior court; the trial court rejected Wellstar’s due process argument.
The Court of Appeals held Wellstar’s constitutional claim was not preserved for appellate review because no administrative official had ruled on it; the Georgia Supreme Court granted certiorari limited to that preservation issue, reversed that division of the Court of Appeals, and remanded for reconsideration of the constitutional claim.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether a constitutional due-process claim must be ruled on by an administrative decisionmaker to be preserved for appellate review	Wellstar: raising the claim during the administrative process and in the trial court suffices; agencies often cannot adjudicate constitutional questions	DCH/Emory: claim was not properly preserved because the administrative decisionmakers did not rule on it	Georgia Supreme Court: agencies are generally unable to decide constitutional claims; requiring an administrative ruling conflates preservation rules and is erroneous; reversed Court of Appeals on this point and remanded
Whether the Court of Appeals erred by conflating administrative preservation with the trial-court distinct ruling requirement	Wellstar: the Court of Appeals confused exhaustion/preservation before the trial court with the separate requirement that the trial court distinctly rule to preserve for appellate review	Court of Appeals/DCH: argued claim was not preserved for appellate review due to lack of ruling at administrative level	Court: the Court of Appeals erred by treating an administrative non‑ruling as fatal to appellate preservation; trial court’s distinct ruling is the relevant preservation step for appeals

Ga. Dept. of Human Svcs. v. Addison, 304 Ga. 425 (2018) (administrative agencies cannot declare statutes unconstitutional, but constitutional claims must be raised during administrative proceedings to exhaust remedies)
State Health Planning Agency v. Coastal Empire Rehab. Hosp., 261 Ga. 832 (1992) (constitutional claims may be raised in administrative proceedings and later reviewed by trial court)
Advanced Disposal Svcs. Middle Ga. v. Deep South Sanitation, 296 Ga. 103 (2014) (trial court must distinctly rule on constitutional claims to preserve them for appellate review)
East Ga. Land & Dev. Co. v. Baker, 286 Ga. 551 (2010) (clarifies preservation requirements for appellate review)
Singleton v. Dept. of Human Resources, 263 Ga. App. 653 (2003) (discusses requirement that constitutional claims be ruled on by courts for appellate review)
John Hardy Group, Inc. v. Cayo Largo Hotel Assoc., 286 Ga. App. 588 (2007) (addresses preservation and review of constitutional claims)