K.M. v. Dept. of Health
237 So. 3d 1084
| Fla. Dist. Ct. App. | 2017Background
- DOH issued a Notice of Proposed Rule to repeal Fla. Admin. Code R. 64C-4.003, which incorporated CMS Pediatric Cardiac Facilities Standards and reporting requirements for CMS-approved pediatric cardiac facilities.
- K.M., a CMS beneficiary with a serious heart condition who will likely need future pediatric cardiac services, filed a petition challenging the proposed repeal as an invalid exercise of delegated authority, arguing repeal would reduce quality of care.
- At hearing K.M. presented testimony from two pediatric cardiac experts (Drs. St. Petery and Gessner) about the Rule’s quality-assurance role; Dr. Gessner testified repeal posed a risk of program deterioration but also acknowledged he did not expect providers to lower standards simply because the Rule was repealed.
- The ALJ found K.M. failed to prove the repeal would have a real or immediate effect on care quality, concluded K.M. lacked standing under § 120.56(1)(a), and dismissed the petition for lack of jurisdiction.
- The district court majority affirmed, holding K.M.’s asserted future injury was speculative and insufficient to show she would be "substantially affected;" a dissent argued the unrebutted expert testimony made a reasonable showing of prospective harm and thus conferred standing.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does K.M. have standing under § 120.56(1)(a) to challenge DOH’s proposed repeal of the Rule? | Repeal will undermine the CMS quality-assurance process, increasing risk of diminished care for K.M., a CMS beneficiary who will need future pediatric cardiac services. | Repeal does not on its face remove quality care; any injury is speculative and not a real or immediate injury in fact. | No. K.M. failed to show a real and immediate injury; testimony was speculative and did not establish she would be "substantially affected." |
| Was the ALJ’s jurisdiction properly dismissed based on lack of standing? | K.M. met the threshold by showing a reasonable likelihood of increased morbidity/mortality risk via unrebutted expert testimony. | The ALJ correctly dismissed for lack of jurisdiction because standing was not proved. | Yes. The appellate court affirmed dismissal for lack of jurisdiction; merits were not reached. |
Key Cases Cited
- NAACP, Inc. v. Fla. Bd. of Regents, 863 So. 2d 294 (Fla. 2003) (organization had standing to challenge proposed rule eliminating affirmative-action benefit)
- Peace River/Manasota Reg’l Water Supply Auth. v. IMC Phosphates Co., 18 So. 3d 1079 (Fla. 2d DCA 2009) (petitioner with legal water-right interest had standing to challenge nearby mining permit)
- Jacoby v. Fla. Bd. of Med., 917 So. 2d 358 (Fla. 1st DCA 2005) (defines “substantially affected” as real and immediate injury plus zone-of-interest test)
- Office of Ins. Regulation & Fin. Servs. Comm’n v. Secure Enters., LLC, 124 So. 3d 332 (Fla. 1st DCA 2013) (standing is a question of law reviewed de novo; speculative injury insufficient)