Title: In re Professional Nurses Service, Inc.

State: vermont

Issuer: Vermont Supreme Court

Document:

IN_RE_PROFESSIONAL_NURSES_SERV.94-456; 164 Vt 529; 671 A.2d 1289

[Filed 12-Jan-1996]

  NOTICE:  This opinion is subject to motions for reargument under V.R.A.P.
  40 as well as formal revision before publication in the Vermont Reports. 
  Readers are requested to notify the Reporter of Decisions, Vermont Supreme
  Court, 109 State Street, Montpelier, Vermont 05609-0801 of any errors in
  order that corrections may be made before this opinion goes to press.


                                 No. 94-456


In re Professional Nurses Service, Inc.         Supreme Court

                                                 On Appeal from
                                                 Health Care Authority

                                                 October Term, 1995
             

Richard G. Brandenburg, Chair

       Philip H. White of Wilson & White, P.C., Montpelier, for
  appellants/cross-appellees Vermont Assembly of Home Health Agencies and its
  constituent members

       Charles F. Storrow of Kimbell & Storrow, Montpelier, for
  appellee/cross-appellant Professional Nurses Service, Inc.

       Robert A. Mello, South Burlington, for appellee Vermont Health Policy
  Council


PRESENT:  Allen, C.J., Gibson, Dooley, Morse and Johnson, JJ.


       GIBSON, J.   The Vermont Assembly of Home Health Agencies and its
  thirteen constituent members (Assembly) appeal the Vermont Health Care
  Authority's denial of their petition to revoke the Certificate of Need
  (CON) issued in 1980 to Professional Nurses Service, Inc. (PNS).  PNS
  cross-appeals the Authority's order requiring CON review of PNS's proposal
  for expanded services.  We affirm.

       Since 1979, "[n]o new institutional health service shall be offered or
  developed within this state by any person, without a determination of need
  and issuance of a certificate of need by the board . . . ."  18 V.S.A. §
  9434(a) (formerly 18 V.S.A. § 2403(a)).  In a February 1980 letter of
  intent to the State Health Planning and Development Agency (SHPDA), PNS
  proposed to "provid[e] the community of Burlington with an organized system
  of obtaining a Registered Nurse, a Licensed Practical Nurse or a nurse aide
  for private duty patients in the home, convalescent home or hospital," and
  to provide supplemental staffing for existing health care

 

  institutions.  In April 1980, PNS applied for a CON to provide such
  services in Chittenden County.  In an August 1980 addendum, PNS sought to
  expand its proposed service area to include "not only Chittenden County,
  but also the areas of St. Albans, and Barre/Montpelier." The Assembly was
  granted party status in the PNS CON proceeding in September 1980. Following
  a public hearing in November, the SHPDA on December 1, 1980 issued a CON to
  PNS.

       The 1980 CON authorized PNS to offer "private duty nursing,"
  "homemaking" and "supplemental staffing" services and did not restrict the
  scope of PNS's service area.  The CON defined "homemaking" to include
  various nursing services provided at a patient's home, but expressly
  excluded "monitoring vital signs, range of motion exercises, or supervision
  of medications."  The CON did not define "private duty nursing" or
  "supplemental staffing."

       In February 1992, PNS filed a letter of intent with the Commissioner
  of Health to offer "unrestricted" nurse aide services, including the
  monitoring of vital signs, range of motion exercises, and supervision of
  medication.  PNS argued that the proposed expansion of its CON did not
  amount to a "material change" requiring CON approval under 18 V.S.A. §
  9444.  In a March 1992 letter, the Commissioner of Health notified PNS that
  the Legislature had transferred jurisdiction over CON applications to the
  Health Care Authority Board.  See 18 V.S.A. §§ 9403(b), 9433(a).  PNS
  interpreted this reply as a determination that its proposal required CON
  review, and in April 1992, appealed this determination to the Chittenden
  Superior Court.  PNS also sought a declaration that the proposed expansion
  did not come within the Health Care Authority's CON jurisdiction.

       In June 1992, PNS applied to the Department of Health for a CON to
  allow it to offer the additional services it had proposed.  In December
  1992, the superior court determined that the jurisdictional question should
  be decided by the newly established Health Care Authority.  The Health Care
  Authority Board (Board) agreed to consider the jurisdictional issue once
  PNS completed its pending CON application.

 

       In January 1993, the Assembly filed with the Board a "Petition to
  Revoke and Thereafter Reinstate with Additional Conditions the Certificate
  of Need of Professional Nurses Service, Inc."  The Assembly alleged that
  PNS had unilaterally expanded its operation to include skilled nursing
  services offered on a statewide basis, and that PNS was therefore in
  substantial noncompliance with the 1980 CON.

       In February 1993, the Health Policy Council (Council) determined that
  PNS's application for a second CON was complete, and in March 1993, PNS
  filed a motion to dismiss the Assembly's petition.  The Board denied that
  motion, and held hearings on both the Assembly's petition and PNS's
  jurisdictional challenge on December 6-7, 1993.  The hearing officer
  submitted recommended findings and conclusions to the Board in April 1994.

       In response to PNS's jurisdictional challenge, the Board ruled that 18
  V.S.A. § 9434 required PNS to obtain CON approval before offering expanded
  home health services.  With respect to the Assembly's petition, the Board
  held that the 1980 CON was not meant to limit PNS in the types of skilled
  nursing services it could offer and that PNS's statewide expansion did not
  amount to substantial noncompliance with the 1980 authorization.  The Board
  also concluded that the Assembly was barred by laches from contesting PNS's
  geographical expansion.  On July 28, 1994, the Board reissued the 1980 CON
  with revisions.  The instant appeals followed.

       Our standard of review is limited in cases involving an administrative
  agency's interpretation of statutory provisions that are within its
  particular area of expertise.  Absent a clear and convincing showing to the
  contrary, decisions made within the expertise of an administrative agency
  are presumed correct, valid and reasonable.  In re UNUM Life Ins. Co., 162
  Vt. 201, 206,