The Medical Center of Central Georgia, Inc. v. Hospital Authority of Monroe CountyThe Medical Center of Central Georgia, Inc. v. Hospital Authority of Monroe County
Case Information
*1 FOURTH DIVISION ELLINGTON, P. J., BRANCH and MERCIER, JJ.
NOTICE: Motions for reconsideration m us t be physically re ceived in our clerk’s office within ten days of the date of decision to be deemed timely filed.
http://www.gaappeals.us/rules
March 7, 2017 In the Court of Appeals of Georgia
A16A1557. THE MEDICAL CENTER OF CENTRAL GEORGIA,
INC. v. HOSPITAL AUTHORITY OF MONROE COUNTY A16A1558. GEORGIA DEPARTMENT OF COMMUNITY
HEALTH v. HOSPITAL AUTHORITY OF MONROE COUNTY.
M ERCIER , Judge.
In these related discretionary appeals, the Medical Center of Central Georgia, Inc. (“MCCG”) and the Georgia Department of Community Health (the “Department”) (collectively, “Appellants”) appeal the judgment of the Superior Court of Monroe County (the “Superior Court”) reversing the Department’s grant of a lеtter of non- reviewability (“LNR”) to MCCG for the acquisition of diagnostic equipment to be installed in a medical office building.
1. As a threshold matter, we address the Department’s Motion to Vacate Judgment Under Review and Remand For Dismissal in Case No. A16A1558. Appellee, the Hospital Authority of Monroe County (d/b/a/ Monroe County Hospital) (“MCH”), filed in both cases a supplemental brief stating that “MCH and MCCG have negotiated a business and clinical affiliation that would include shared use of the imaging center at the core of this appeal. MCH and MCCG reached an agreement . . . that will, when finally executed, resolve the matter at issue in this appeal.” Thus, MCH stated that it “will no longer defend the Superior Court Order overturning the [Department’s] decision.” The supplemental briefs were submitted concurrently with motions to withdraw MCH’s requests for oral argument in thesе cases.
The Department contends that its appeal from the Superior Court’s judgment
is thereby rendered moot, but because the mootness was created by circumstances
outside of the Department’s control, we should vacate the judgment and remand the
cases. See
Pimper v. State
, 274 Ga. 624, 626-627 (555 SE2d 459) (2001);
Babies
Right Start v. Ga. Dept. of Pub. Health
,
Contrary to the Department’s contention, a ruling by this Court in this case
would not constitute an advisory opinion or a determination of only abstract questions.
*3
MCH’s briefs indicate that there is an
anticipated
resolution of the issues between
MCH and MCCG, but the record does not demonstrate that a final resolution has been
achieved, or that the Superior Court’s reversal of the Department’s grant of the LNR
to MCCG has been rendered moot from the perspective of MCCG. See
In re
M.D.H.
,
MCCG contends that the Superior Court erred in (1) determining that the
Department’s interpretation of the phrase “offered in a hospital” violates the
“equipment threshold” provision in
2. The Department is authorized to administer Georgia’s certificate of need
(“CON”) program, codified at
MCCG is a not-for-profit hospital, and its main cаmpus is located in Macon,
Bibb County, Georgia. MCH is a political subdivision of the State of Georgia,
*5
organized under the Georgia Hospital Authorities Law,
MCCG’s LNR request was based on
[t]he purchase or lease by or on behalf of a health care facility or a diagnostic, treatment, or rehabilitation center of diagnostic or therapeutic equipment with a value in excess of $1 million [adjusted annually based on the consumer price index]; provided, however, that diagnostic or other imaging services that are not offered in a hospital or in the offices of an individual private physician or single group practice of physicians exclusively for use on patients of that physician or group practice shall be deemed to be a new institutional health service regardless of the cost *6 of equipment; and provided, further, that this shall not include build out costs, as defined by the department, but shall include all functionally related equipment, software, and any warranty and services contract costs for the first five years.
MCH filed a written objection to MCCG’s LNR request, arguing that the
diagnostic equipment would not be offered in a hospital, and that even if the purchases
were for hospital-based equipment, they would exceed the capital expenditure
threshold under
The Department granted the LNR to MCCG, finding that the equipment was for
use “in a hospital.” It found that mammography and x-ray equipment were not subject
to CON review or the diagnostic imaging equipment threshold, and that the CT
scanner and related costs were below the then-current equipment threshold of
*7
$1,126,874 for diagnostic imaging services offered in a hospital. Further, the
Department found that the costs of the medical office building were not simultaneоusly
developed and associated with the purchase of the equipment, based on MCCG
having “confirmed” that the costs associated with the building were incurred
approximately three years prior, citing Ga. Comp. R. & Regs., r. 111-2-2-.01 (8) (a),
(b) (which provides that activities, services, expenditures and items are associated and
simultaneously developed or planned if they occur within a six-month period), and
noting that pursuant to
MCH requested a fair hearing under the Georgia Administrative Procedure Act (“APA”). MCCG moved for summary adjudication. A hearing was held on September 4, 2014. The Department-appointed hearing officer granted summary adjudication to MCCG on November 5, 2014, concluding that there wаs no genuine dispute of material fact as to the issue of whether the proposed equipment purchase was for use in a hospital and that the value of the equipment was below the equipment threshold. In addition to the statutory and regulatory grounds cited in the LNR, the hearing officer noted that the medical office building was not purchased or renovated by MCCG and *8 the costs associated with it should not be included in the equipment threshold calculation.
MCH requested a review of the hearing officer’s decision by the Department’s
Commissioner. On December 30, 2014, the Commissioner issued a final decision
affirming the hearing officer’s decision and the grant of the LNR (the “Final
Decision”). MCH then filed a petition for judicial review in the Superior Court of
Monroe County, contending that the Department’s interpretation of the statutory
phrase “offered in a hospital” in
3. We agree with Appellants that the Superior Court erred in determining that the
Department’s interpretation of the phrase “offered in a hospital” violates the equipment
threshold provision in
The Georgia APA,
The court shall not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact. The court may affirm the decision of the agency or remand the case for further proceedings. The court may reverse or modify the decision if substаntial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions, or decisions are: (1) In violation of constitutional or statutory provisions; (2) In excess of the statutory authority of the agency; (3) Made upon unlawful procedure; (4) Affected by other error of law; (5) Clearly erroneous in view of the reliable, probative, and substantial evidence on thе whole record; or (6) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.
While reviewing courts defer to agency interpretations of the statutes they are charged with administering, that deference applies only as far as the agency interpretation is consistent with the statute. Administrative agencies may not change a statute by interpretation, or establish different standards within a statute that are not established by a legislative body. [The Department] is authorized only to adopt and implement rules sufficient to administer the Act’s provisions, including the CON program. The judicial branch determines independently whether the agency’s interpretation correctly reflects the plain language of the statute and comports with the legislative intent. If reviewing courts find that [the Department] has acted within the authority granted the agency by statute, they defer to [the Department’s] interpretation and application of the CON statute and the rules and regulations it has enacted to fulfill the function given it by the legislative branch.
Palmyra Park Hosp. v. Phoebe Sumter Med. Center
,
The Superior Court found that the Department’s interpretation of the phrase “in
a hospital” in
When we consider the meaning of a statute, we must presume that the General Assembly meant what it said and said what it meant. To that end, we must afford the statutory text its “plain and ordinary meaning,” we must view thе statutory text in the context in which it appears, and we must read the statutory text in its most natural and reasonable way, as an ordinary speaker of the English language would.
Deal v. Coleman , 294 Ga. 170, 172 (1) (a) (751 SE2d 337) (2013) (citations and punctuation omitted). The Superior Court acknowledged this principle, but found that “[n]o ordinary understanding of this term would include services offered in a medical mall nearly 25 miles from the sponsoring hospital.” The Superior Court’s interpretation is contrary to the definition given by the legislature to the term “hospital;” the latter defines “hospital” as:
an institution which is primarily engaged in providing to inpatients, by or under the supervision of physicians, diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled or sick persons or rehabilitation services for the rehabilitation of injured, disabled, оr sick persons. Such term includes public, private, psychiatric, rehabilitative, geriatric, osteopathic, and other specialty hospitals. (Emphasis supplied).
We disagree with MCH and the Supеrior Court that the use of the phrase “ part of a hospital” elsewhere in the Health Planning Act requires that the phrase “ in a hospital” be interpreted to include a geographical limitation. MCH points to Ga. Comp. R. & Regs., r. 111-2-2-.40, regarding ambulatory surgery service, as an example, and the Superior Court referenced that rule as a comparison as well. This rule provides that if the ambulatory surgery service is оr will be provided as “part of a hospital,” the hospital’s provision of such service is not subject to CON review; it further provides that such services are always considered to be “part of a hospital” if 1) the service is located within the hospital, or 2) if the service is located in a building on the hospital’s primary campus and that building, or relevant portion thereof, is included in the hospital’s permit; and thе Department will make determinations of *13 reviewability on a case-by-case basis in other situations involving hospitals. Ga. Comp. R. & Regs., r. 111-2-2-.40 (1). MCH contends, and the Superior Court held, that the Department’s interpretation of “in a hospital” is inconsistent with this rule because if “hospital” includes an entire institution, without geographical limits, then the second part of the definition of “part of a hospital” in this rule would be unnecеssary.
It is true that we must “avoid constructions that make some language mere
surplusage or meaningless,” construe a statute “in relation to other statutes of which
it is a part,” and construe together and harmonize “all statutes relating to the same
subject-matter” wherever possible.
Aimwell, Inc. v. McLendon Enterprises, Inc.
, 318
Ga. App. 394, 397 (1) (
MCH contends that an institution-wide interpretation of “in a hospital” is contrary to the importance of geography in the context of the Health Planning Act and *14 the Department’s rules, citing several examples throughout the Health Planning Act and the related Department rules in which the scope of CONs or exceptions thereto are geographically limited. However, no such restriction or condition was provided in the portion of the equipment threshold provision at issue here, and we can assume that the legislature would have provided suсh a restriction or condition if it intended to do so, as it did elsewhere in the statute. See Deal , supra.
The Superior Court erred in holding that the Department’s interpretation of the
phrase “offered in a hospital” is contrary to the equipment threshold provision in
4. We agree with the Department and with MCCG that the Superior Court
exceeded its jurisdiction in ordering the Department to investigatе certain expenditures
related to the purchase and renovation of the medical office complex. Whether the
*15
Superior Court had jurisdiction to do so is a question of law that we review de novo.
Walker v. DOT
,
Ga. Comp. R. & Regs., r. 111-2-2.10 (6) authorizes a party who opposes the
Department’s determination approving a request for an exemption to obtain “judicial
review of a final decision in the same mаnner and under the same provisions as in
Here, the Superior Court stated:
Having concluded that the [d]iagnostic [e]quipment should have
undergone CON review, this [c]ourt turns its attention to the Monroe
Regional Medical Complex as a whole. MCH does not сontend in this
appeal that MCCG’s past spending on the Monroe Regional Medical
Mall Complex was reviewable as part of the instant LNR application, but
rather that its opposition to the LNR put [the Department] on notice of
spending that likely would have required a CON under
By the Superior Court’s own description, this issue was outside thе scope of its
review of the Department’s Final Decision regarding the grant of the LNR for specific
equipment, and MCH cites no authority for a superior court to order the Department
to conduct investigations. The Department has the
authority
to make public or private
investigations or examinations to determine whether the provisions of Chapter 6 of
Title 31 have been violated, and interested persons may bring an action for injunctive
relief to enforce the provisions of the chapter.
Having reversed the Superior Court’s judgment which (a) reversed the Final Decision as to the grant of the LNR, and (b) ordered the Department to conduct an investigation, we need not address the Appellants’ remaining contentions.
Judgments reversed. Ellington, P. J., and Branch, J., concur .
Notes
[1] “Institution” is pertinently defined as “an established organization or corporation (as a bank or university) especially of a public character.” https://www.merriam-webster.com/dictionary/institution. Other definitions include “a significant practice, relationship, or organization in a society or culture”; “something or someone firmly associated with a place or thing;” and “a facility or establishment in which people (such as the sick or needy) live and receive care typically in a confined setting and often without individual consent.” Id.