As Florida lawmakers look at eliminating controversial regulations on building hospitals, a judge has sided with the HCA health-care chain in an industry battle about adding a hospital in Miami-Dade County.
Administrative Law Judge Robert Cohen, in an 80-page decision Thursday, said an HCA affiliate should receive what is known as a "certificate of need" to build the 80-bed Doral Medical Center. At the same time, Cohen recommended rejecting a certificate of need for a competing hospital that would be part of the Jackson Health System.
Cohen came to the opposite conclusion of the state Agency for Health Care Administration, which in December 2015 gave preliminary approval to the 100-bed Jackson Hospital West project and turned down Doral Medical Center. Adding to the battle, hospitals in the Tenet Healthcare System and Nicklaus Children's Hospital opposed both proposals.
"(Doral Medical Center) persuasively established need for its hospital, its ability to meet its financial projections, its community and physician support, and demonstrated, on balance, it better satisfied the statutory criteria than the (Jackson) proposal," Cohen wrote.
Under administrative law, Cohen's recommended order will go back to the Agency for Health Care Administration for a final decision.
The ruling came amid a high-profile legislative debate about the possibility of eliminating the certificate-of-need process for hospitals, nursing homes and hospice facilities. Under the regulatory process, the Agency for Health Care Administration must sign off before such facilities can be built — frequently leading to legal fights.
House leaders in recent years have sought to end certificates of need, saying the move would create greater competition in the health-care industry and more access to care. But supporters of the regulatory process argue, in part, that its elimination would lead to a proliferation of new hospitals in affluent areas that would draw insured patients away from established facilities.
Both of the proposed hospitals in Thursday's ruling would be built in Doral in western Miami-Dade County.
The Jackson Health System is a major provider of care to low-income residents. Cohen wrote that the Agency for Health Care Administration's preliminary approval of the Jackson Hospital West proposal was based on the system's provision of care to people in the Medicaid program and indigent patients.
"While (the Jackson system's) service to the county's underserved is vital to the health-care delivery system in Miami-Dade County, it is not a compelling enough reason, standing alone, to approve the (Jackson Hospital West) application over (Doral Medical Center's application)," Cohen wrote. "As noted by (Doral Medical Center) and the existing providers standing in opposition to the (Jackson) proposal, the Medicaid, indigent, and charity care provided by (the Jackson system) comes at a great cost to the taxpayers of Miami-Dade County. Pulling more of those dollars away from care of the underserved population to initiate a new facility in the county is not an efficient use of taxpayer dollars when (the Jackson system) has significant capacity at its other Miami-Dade County campuses."
Also, Cohen wrote that Doral Medical Center "clearly established a need for its hospital based on Doral's growing population and relative isolation from area providers."