I N T H E SUPR EM E C O UR T O F M I SS I SS I PPI NO. 2 0 0 7 - S A- 0 0 0 3 5 - S CT M I SS I SS I PPI STATE DEPARTM

EN T OFH

EALTH AN D D ESOTO I

M AGI NG & DI

AGNO STICS, LLC
v. BAP TI S T M EM ORI AL HOS PI TAL -DES OTO, I

NC. d / b / a BAPTI ST M EM OR I AL H OSPI TAL-DESOTO A N D D ES O TO D IA GNO S T ICIM A G IN G, L L C

d /b /a CA RV EL I M AG I NG D A T E O F JU D G M E N T : 12/ 29/ 2006 TR I A L J U D G E: H O N
. PA TR I CI A D
. W I SE COURT F ROM W HI CH APP EAL ED: HI NDS COUNTY CHANCERY COURT A T T O R N E Y S F O R A P P E L L A N T S : D O N A L D E
. E IC H E R , III THOM AS L
. KI RKLAND, J R. AND Y LOW RY AL L I S ON C
. S I M P S ON ATTO RN EYS FOR A PP ELLEES : BA RRY K. CO CK RELL K A TH RY N RU SSELL G I LC H RI ST DA VI D W ELDO N D ON NELL NA TUR E OF THE C ASE: CI VI L - STATE BO AR DS A ND AG ENC I ES D I SPO SI T I O N : R E V E R SE D A N D R E N D E R E D - 06/ 19/ 2008 M OT I ON F OR RE HE AR I NG F I L E D: M ANDAT E I S S UE D: B E F O R E D I A Z, P . J. , D I C K I N SO N A N D R A N D O L P H , JJ. RAN DO LPH, J UST I CE, FOR TH E COU RT: ¶ 1
. D e S o to Im a g in g a n d D iag n o stic s, L L C (“ D e S o to ” ) e n te re d in to a n a g re e m e n t w ith A l l i ance I m agi ng ( “A l l i ance ”) f ort he pr ovi s i on of

m obi l e magnet i c r esonanc e i m agi ng ( “M R I ”) s ervices , cont i ngentupon D eSot o pr ocur i ng a C ert i f i cat e of N eed ( “C O N ”) f

r om th e M i s s i s s i p p i S t a t e De p a r t me n to f He a l t h ( “ M S DH” )
. De S o t o ’ s s u b s e q u e n t l y f i l e d CO N
a p p lica tio n w a s o p p o se d b y B a p tist M e m o ria l H o sp ital-D e S o to , In c . (“B a p tist”) a n d D e S o to

### 2

D i agnos t i c I m agi ng, LL C ( “C arvel ”)
. Fol l ow i ng a thr ee- day hear i ng, the hear i ng off i cer issued h i s “Propo sed F i nd i ng s of Factand C on cl usi on s of Law , ” fi nd i ng that D eS oto’s
a p p licati o n co m p li ed w ith the F iscal Y ea r 20 0 6 M issi ssipp i State H ea lth P lan’s (“ S tate H e a lth P lan ” ) “ G e n e ra l C e rtifica te o f N e e d P o licie s,” the S tate H e a lth P lan ’s “ C O N C riter ia and St andar ds fort he O f f er i ng of M R I S ervi ces , ” and the C O N R evi ew M anual ’ s “G ener al C ons i der at i ons , ” and r ecomm ended a ppr oval of D eSot o’ s appl i cat i on. ¶2. Soon t her eaf

t er , G i l m or e M emori al H os pi t al ( “G i l m or e”) , a hos pi t al on t he pr opos ed
m o b ile ro u te w h ich D e S o to w a s to jo in , term in a ted its M R I S e rv ice A g re e m e n t w ith A ll ianc e. B ap ti st an d C arv el th en fi led a “Jo int M o ti o n to R eo p en an d S u p p lem en t R ec o rd
a n d fo r R e c o n s id e ra tio n o f H e a ri n g O ff ic e r’ s F in d in g s o f F a c t a n d C o n c lu s io n s o f L a w ,” al l egi ng thatbeca us e of t hi s devel opm ent , the mobi l e r out e pr opos ed w oul d notm eet
r equi r ement s of

t he St at e H eal t h Pl an. A l l i ance s ubs equent l y at t es t ed thatal t er at i on of r out es
w as comm on and a m odi f i ed r out e w oul d s at i s f

y the St at e H eal t h Pl an’ s r equi r ement s . T he h ea ri n g o ffi ce r de n ied th e m o ti o n a n d re affirm ed the re co m m en d ati o n to g ran t D eS o to’s appl i cat i on. T he St at e H eal t h O f f i cersubs equent l y i s s ued a f i nal orde radopt i ng t he f i ndi ngs
an d rec o m m en d ati o n o f th e h ea ri n g o ffi ce r. ¶3. B apt i s tand C arvel fi l ed a “N ot i ce of A ppeal ” i n the C hance r y C our tof H i nds C ount y. F o ll o w ing he aring , th e ch an ce ry co u rti ssu ed an “O p inion an d O rde r” rev ersing the M S D H ’s
a p p rov al of D eS o to’s ap p li ca ti o n an d rem an d ing t o th e M S D H “w ith th e m an d ate th a t, i f [ D eSot o] w i s hes t o pr opos e a new M R I rout e, t hatnew rout e be subj ect ed t o a hea r i ng dur i ng the cour s e of

r evi ew atw hi ch i nt er es t ed part i es m ay oppos e ors uppor tt he new r out e. ” Fr om thatrul i ng pr ocee ds t hi s appea l f i l ed by D eSot o and the M S D H
. T he ce ntr al i s s ue f or

### Al l i anc e ’ s 1. 5 T e s l aMRIun i t a lr e a dyha d b e e n a

pp r ov e d b y theMS DH
. 1 

### Initially, the pr op os e d r ou t e w ou l d s e rvi c e “ G i l mor e thr ee da ys a w eek, [ M i s s i on] one 2 d a y a w e e k , a n d [D e S o to ] tw o d a y s a w e e k .” 

### The St at e He alth Pl an provide s, re garding th e “Ce rtif ic at e of Nee d Cri te ri a and 3 

### Standards f

or the Of fe ring of MRI Ser

vic es ,”that

“ [t ] he entit

y des iring t o off

er MRI s er vic es must d ocument th at theequi pment shall p erform a minimum of 1,700 proc eduresper y ear .

. . . This crit erion inc lude s both fi xed and mobile MRI equi pment .”StateHea lt

h Plan atXI47 (e mpha si s a dded) . Ac cording t o DeSot o’s appl ication, it “propose s to join an e xis ting mobi le MRIr out e , wh i c h i s a lr e a dype r f or m i ngov e r

1, 70 0 p r oc e dur e s annua l ly, 1, 440 pro cedures at Gilmo re in 20 04 an d 56 2 pro cedures at Missio n in20 04 .” Mo reov er, Smith te stif ie d that t he 1 ,4 4 0 p ro c e d u re s p e rf o rm e d a t G ilm o re th e p re v io u s y e a r w e re w ith a 1 .0 T es l a M R I uni tand that“w e w i l l actual l y be a bl e t o do m or e pat i ent s i n f ew erda ys . . . by u p g ra d in g to th e 1 .5 .” 

### DeSot o proje ct ed that it would us e the MRIunit

for “520 proce dure s in ye ar one, 650 in ye ar

two, and 780 in ye ar

three .”This proj ec ti on fa ct ore d in popul ation growth in De Soto County and thepurporte d suppor t of physi ci ans who did not

provi de 3 cons i der at i on i s nota s peci f i c r out e, butw hetherthe mi ni m um num berof pr ocedur es
r equi r ed by the St at e H eal t h Pl an t o obt ai n a C O N w oul d be metby t he new r out e. FACTS ¶ 4
. O n A u g u st 3 0 , 2 0 0 5 , G o rd o n S m ith , a re a sa les m a n a g e r fo r A lli a n c e , se n t a lette r to K evin B l ackw el l , presi den tand C E O of D eS oto, providi ng “w ri t t en n oti ce of [ A l l i ance’s] inten ti o n to p rov ide M R I serv ices tw o (2) da y s pe r w ee k at yo u r facil ity . . . . ” T h ere after, De S o t o f

i l e d a CON a p p l i c a t i o n wi t h th e M S DH f o rth e e s t a b l i s h me n to f mo b i l e M RI
se rv ice s in D e S o to C o u n ty . A c c o rd in g to D e S o to ’s a p p lica tio n , “[t]he p ro p o se d
. . . u n it i s a 1
. 5 T esla u n itthat c u rre n tl y serv es [G il m o re]
. . . in A m o ry a n d M issi o n P ri m ary C are C l i ni c [ ( “M i s s i on”) ]
. . . i n V i cks bur g on a mobi l e r out e. A l l i ance has conf i r m ed the equi pm ent ’ s exempt i on f ort he C O N pr oces s . [ ] [ D eSot o] w i l l s i m ply j oin thi s exi s t i ng 1
r out e. ” I n s uppor tof

t he appl i cat i on, D eSot o pr opos ed thatthe numberof pr ocedur es 2 pr ovi ded w oul d exce ed the r equi r ement s of the St at e H eal t h P l an, t hatD eSot o C ount y w as 3

### affidav its for fear o f repercussio ns fro m Baptist, as D eSo to’s submittedphysicianaffidav its

totaledon ly 3 72 annual p rojectedMRI pro cedure referrals. Th e app licationpro vid ed th at “sustain ed g row th has made DeS oto Countythe 3 5th 4 

### fastest gro win g co untyin th e natio n an d p laces DeS oto Co unty as M ississipp i’s 4thmost po pu lated co unty an d M ississipp i’s fastest gro win g co unty.” T h e sta ff a n a ly sis c laim e d th a t D e S o to ’s a p p lica tio n fa iled to m e e t eith e r th e S tate 5 H ea lth P lan N ee d C ri teri o n , C O N R ev iew M an u al G en era l C o n side rati o n 1 - S tat e H e a lth Pl an , CO N Revi e w M a nu a l G e ne r a l Cons i de r a t i on 4 - Eco no mi c V i a bi l i t y, CO N Revi ew M anual G ener al C ons i der at i on 5 - N eed f ort he Pr oj ect , o r C O N R evi ew M anual G ener al Co n s i d e r a t i o n 8 - Re l a t i o n s h i p t o Ex i s t i n g He a l t h Ca r e S y s t e m. 

### It is co nced ed by al l partie s that theSta ff Analysi s i s “ an inte rm edi at e s tep on the 6 

### way t o thef

i na ld e c i s i ono f

theS t at e H e a l th Of

f i c e r , ” and i s e nti t l e d t o no d e f

e r e nc e on app eal. 4 e x p e r i e n c i n g s i g n i f

i c a n tp o p u l a t i o n g r o wth , a n d t h a ta n a d v e r s e i mp a c to n o t h e rM RI 4 pr ovi der s i n t he G ener al H os pi t al Ser vi ce A r ea w as notant i ci pat ed. T he appl i cat i on added th a t “[t]h e a g re e m e n t w ith A lli a n c e is c o n tin g e n t u p o n th e g ra n tin g o f a [C O N ] pu rsu a n t to th is A p p lic a tio n .” ¶5
. O n N ovembe r 7, 20 05 , Sa m D a w ki ns , D i r e c t or of t he O f f i c e of H e a l t h Pol i cy and Pl anni ng f

orthe M SD H , r ece i ved l ett er s f r om Bapt i s ta nd Car vel oppos i ng t he appl i cat i on. T e n d a y s la te r, an M S D H sta ff a n a ly sis c o n c lu d e d th a t D e S o to ’s a p p lica tio n “ is n o t in
s ubs t ant i al compl i ance w i t h appl i cabl e cr i t er i a and st andar ds [ , ] ” and r ecomm ended 5 d isa p p ro v a l. 6 ¶ 6
. On De c e mb e r 5 , 2 0 0 5 , a “ Re q u e s t f o r P u b l i c He a r i n g Du r i n g t h e Co u r s e o f Re v i e w”
w as r ece i ved by t he M SD H f r om D eSot o, Car vel , a nd Bapt i s t . I n M ar ch 2006, a thr ee- day hear i ng w as he l d r egar di ng D eSot o’ s a ppl i cat i on. Tw el ve w i t nes s es t es t i f i ed, and tw entyfo u r e x h ib its w e re intro d u c e d into e v id e n c e . O n Ju ly 6 , 2 0 0 6 , the h e a rin g o ffic e r iss u e d h is

### Th e hearin g o fficer foundthat: 7 

### [t ] he num ber of s cans per for

me d by [Al li anc e] at Gilmore and [Mi ss ion] when com bine d exc ee d 1,700. As S mi th pointe d out, it is not unc omm on to a lt er routes o r lo se contracts. Wh ile this issu e do es beco me a bit co nv oluted, the fac t remains t

hat Alliancehas be en and continues to se rv e t hes e t wo fac ilities w i t h m o b i leM

RI s e rv i c e . . . . [

T ]h em o b i lero u tet

h a t in c lu d es[ G i l m o re ], [ Missi on] and [

DeSoto] wi ll

e asi lye xc ee d there quired 1, 700 proc eduresper ye ar . (Em phas is adde d). Regarding CON Revi ew ManualGene ra l Cons ide rati on 1 - St ate Health Plan, the 8 

### Hearin g O fficer found“th e [a]pp licationto be co nsistent withthe ap plicab le requ irements se t f orth in the StateHeal th Plan.” As to CON Revie w ManualGeneralConside rati on 4 - Eco no mic Viab ili ty , the h earing officer d eterminedthat “[t]here is substantial evid ence in the reco rd that, basedon the scans pro jected, th e [DeS oto ] project w ill be fin anciallyviab le.” Under CON Revi ew ManualGene ra l Cons ide rati on5 - Need f or the Proje ct , the he aring officer fo un d “th e service sp ecific needcriteria fo r the p rov isionof M RI serv ices is control ling,”but addedthat the s er vic e wi llme et

thenee ds of

DeSot o County’ s growing populati on as evi denc ed by the pos itivecommuni ty rea ction t o theappl ication. Final ly, regard ing CO N R eviewManual Gen eral C on sideratio n 8 - Relatio nsh ip to Ex istingHealth Care Sys te m, thehearing off ic er found: there cord con tains subs tanti alevi denc e that thi s proje ct

com pli es with the servicespe ci fi c c ri te ri a s et forth in theStateHea lt h Plan. Wi th t

hat determin ation , it seems th e ad d itionof an oth er MRI pro vid er in D eSo to Co unty w ill hav e little, if any , imp act o n the existin g pro vid ers. There wasno spe ci fic e videnc e f

rom e it her [ Bapti st ] or [ Carv el ] that the y wi ll suf fe r any sort o f ad verse imp act, fin an cial o r oth erw ise, from the a pp rova l of th is [ a] pplication . (Em phas is adde d). Baptis t e xpre ss ly s tipulate d at thehearing that i t wa s “ not c onte nd ing that th e pro

ject . . . will adverselyimpact [B aptist] from a fin ancial stan dp oint.” 5 “Pr opos ed Fi ndi ngs of

Factand C oncl us i ons of L aw , ” f i nd i ng t hatD eSot o’ s appl i cat i on
c o m p lied w ith th e S tate H e a lth P lan ’s “ G e n e ra l C e rtifica te o f N e e d P o licie s,” th e S tate He a l th P l a n ’ s “ CO N C r i t e r i a a n d S t a n d a r d s f o rt h e Of f e r i n g o f M RI S e rv i c e s , ” a n d t h e CO N 7 R ev iew M an u al’s “G en era l C o n side rati o n s. ” A cc o rdin g to the h ea ri n g o ffi ce r: 8

### 6

[u ]ltim a te ly
. . . the deter m i nat i on of need, def

i ned by the Stat e Heal th P l an as 1, 700 s cans pe ry ear, is contr ol l i ng . T h a t sa id , h o w e v e r, th is A p p lica tio n is tr ou bl e s ome i n s e ve r a l ways . The ro u te of w hi ch thi s new s ervi ce w i l l be a partis les s th a n c o n c re te . T h e p ro v id e r o f th e m o b ile u n it, [A lli a n c e ], is engage d i n contr actnegot i at i ons w i t h [ G i l m or e] and i s curr ent l y provi di ng service att hat l ocati on on a m on t h to m on t h b asi s. ( E m phas i s added)
. T her ef or e, as “the r ecor d cont ai ns s ubs t ant i al evi dence t hatt he pr opos ed
new s ervi ce w i l l j oi n a mobi l e r out e thatw i l l pr oduce i n exce s s of 1, 700 sca ns peryear , ” the hear i ng of

f i cerr ecomm ended appr oval of D eSot o’ s appl i cat i on. ¶7. O n J ul y 14, 2006, M on t e B ost w ick, C E O o f G i l m ore, sent a lett ert o A l l i ance p ro v id ing that “[t ] h is l ett er is t o serv e a s o u r 30
- da y no t i c e t o t e r m i na t e the M RI Se r v i ce A gr eem ent

betw een [

A l l i ance] and [G i lm or e]
. ” ( E m phas i s added)
. O n Jul y 24, 2006, B apt i s tand C arvel fi l ed a “ J oi ntM ot i on t o R eopen a nd Suppl ementR ecor d and f or R econs i der at i on of

H ear i ng O f

f i cer ’ s Fi ndi ngs of

Fa c ta nd Conc l us i on s of Law, ” a r gu i ng that

“ [o ]ne
. . . issu [e] in th e h e a rin g w a s w h e th e r th e p ro p o se d M R I ro u te w o u ld p e rfo rm in
e x c e ss o f 1 ,7 0 0 M R I p ro c e d u re s p e r y e a r. In li g h t of this rec e n t de v e lo p m e n t, . . . th e m o b ile
r out e w i l l notm eett hatSt at e H eal t h Pl an r equi r ement . ” A s s uch, t he mot i on r eques t ed that thi s new evi dence be adm i t t ed i nt o t he r ecor d and consi der ed by t he hea r i ng of f i cer“i n or der fo r a tru e , a c c u ra te a n d c o m p le te e v a lu a tio n o f th is a p p lic a tio n to b e m a d e b y th e [M S D H ].” ¶8. I n r es pons e, an af f i davi t of C i ndy Sm i t h, D i r ect or of O per at i on s for A l l i ance, w as pr es ent ed att es t i ng t hat“[ i ] n t he m obi l e M R I i ndus t r y i ti s comm on f orm obi l e M R I r out es to b e a lte re d a n d /o r f

o r c o n tr a c ts fo r m o b ile M R I s e rv ic e s t o b e a m e n d e d o r c a n c e lle d .” Sm i th s t at ed D eSot o w oul d be s hi f t ed t o a r out e i ncl udi ng Sw eetw at erH os pi t al A s s oci at i on (“ S w e e tw a ter ” ) in S w e e tw a ter , T e n n e ss e e , an d M a c o n G e n e ra l H o sp ital (“ M a c o n ” ) in

### In its resp on se, DeS oto add ed th at, inclu din g its projectedprocedures, the M RI unit 9 

### would pe rf

orm 2,843 MRIproc edur es in t he f ir st year. The he aring of

fi ce r s tate d: 10 

### anytime during the h earing pro cess the ap p li cant w ou ld h ave th e right to change the propose d rout e both a s an am endm ent to t he a ppli cati on or a s ne w evi denc e at t

he he aring, espe ci al ly c onsi dering t he f ac t t hat therout e c hange was due t o thefa ct

that t he t er mination of th e c ontrac t by Gi lm oreocc urr ed without t he a ppar ent involvem ent

of [ DeSot o] . Thefact th at thechange happe ned during the per fe ct window of

timebetwee n theHearing Off ic er ’s re comme ndation and thedeci si on of theStateHea lt h Off ic er is ir re le vant , but rathe r pe rha

ps j ust circ ums tanti altiming, be ca use had t he CON be en issue d thechangein routewould not havebee n a changein scope under the Certi ficate of Nee d Manual, re vi

si on 2000. Under t

hisanaly sis of the probable c hangesin mobi leMRI routes t hat happe n as a matte r of

cour seand bus inessprac ti c e, [

MS DH ] wo ul d ass e rt that

no c ha ngein t

hemo bi leMRI route woul

d be a c hange in sc ope and woul d onlybe material

from the st andpoint of thestaf f at [ MSDH] if thechange would result in t he c ri te ria for ne e d u nd e r t heSt ateHe alt h P lan no t

being sati

s f i e d, a f ac t t ha t [ MS DH ] ass ertsisnot t

he c asein t

he f act s asprese nte d
. (Em phas is adde d). 7 L afayet t e, T enn essee, as the M R I uni tused o n thatro u te “ cu rr entl y si t s i dle tw o d ays a
w ee k
. ” S m ith av erred that the ro u te ch an g e w o u ld n o t a ffec t th e a p p rov al of D eS o to’s
a p p lica tio n , as S w e e tw a ter a n d M a c o n h a d p e rfo rm e d 2 ,3 2 3 M R I p ro c e d u re s c o m b in e d in the p revi ou s tw el ve m on t hs. 9 ¶9. Fol l ow i ng a A ugus t 11, 2006, hear i ng, t he hear i ng of f i cer ent er ed hi s “Fi ndi ngs and C o n c lu sio n s o n M o tio n to R e -O p e n R e c o rd ,” c o n c lu d in g th a t: [ t ] he [ M SD H ] is i n the bes tpos i t i on t o i nt er pr et t he stat ut es and r egulat i ons tha ti tenforces o n a d ail y ba sis. A ccordingly, I concu r w i th the [ M SD H ’s ] anal ys is of this m at t er . I f

i nd thatthe hea r i ng of

f i cerdoes r et ai n j ur i s di ct i on o v e r t h e d is p o s itio n o f t h is m o tio n . W h ile th e re m ig h t be , a s th e C o n tes ta n ts s ugges t , an occas i on w her e the r ecord m ightbe r eopene d, this is noti tf orthe r e a s o n s s e to u tb

y th e [ MS DH] .[ ] T

he m oti on of

the C on t estan t

s is theref

ore 10 d e n ied . A s a re su lt, th e h e a rin go ffi c e r’s re c o m m e n da tio n to th e S ta te He a lth

### In so find ing , the ch ancerycourt focu sed upo n th e fact that: 11 

### [t ] he s ugges ti on that [ Gilmore] or [ Mis si on] might be convinc ed to take f

ewe r days of s er

vic e wa s pure s pec ulati on, and no evide ncewas pre se nte d to show that Gilmore or

[Mi ss ion] would a cc ept

re duce d days of c overageon theMRI rout e. Additiona lly, the rewas no spe ci fi c and subs tanti alevi denc e t o suppor t thethe ory that

“ope rati onalef

fi ci enc y” c ould m aketherout e wor kabl e. 8 O f f i cerrem ai ns unchanged
. T o e ns ur e a compl et e r ecor d, how ever , I bel i eve it a p p ro p ri a te to a p p e n d a ll p le a d in g s re la tin g to th e C o n te s ta n t’ s m o tio n . . .

. The appended docum entat i on shal lbe i n t he f or m of pr of f er ed i nf or m at i on notacce pt ed as evi dence
. (E m p h a sis a d d e d ). O n A u g u st 3 1 , 2 0 0 6 , a le tter f ro m th e S tate H e a lth O ffic e r to D e S o to
co n sti tuted a fina l ord er a d o p ti n g the f in d in g s a n d rec o m m en d ati o n o f th e h ea ri n g o ffi ce r,
con cl ud i ng t hat D eS o to’ s appli cat i on w as “i n sub st anti al com pli ance w i t h the [ M S D H ’s ] adopt ed Pl ans , c r i t er i a, a nd s t andar ds
. ” Bapt i s ta nd Car vel then f i l ed t hei r“ N ot i ce of A p p e a l” o f th e M S D H ’s f in a l o rd e r in th e c h a n c e ry c o u rt. ¶10. Fol l ow i ng a hear i ng, t he chanc ery cour t , i n i t s “O pi ni on and O r der , ” concl uded “that th e M S D H e rr e d in its d e c is io n to a p p ro v e th e C O N a p p lic a tio n s u b m itte d b y [D e S o to ]. S pecif i cal l y, t he M S D H ’s decis i on w as arbitrary and capri ci ou s and co ntr ary t o the m anif est
e v id e n c e in th e c a s e a s to th e m o b ile ro u te th a t w a s p r o p o s e d b y [ D e S o to Im a g in g ].” 11 M o re o v e r, th e c h a n c e ry c o u rt fo u n d th a t: th e M S D H c o m m itt e d re v e rsib le e rro r in its h a n d lin g o f th e m a tter r a ise d p o sthear i ng by [ B apt i s t ] and [ C arvel ]
. A tt he l eas t , t he pos t - hear i ng m ot i on f i l ed by [ B apt i s t ] and [ C arvel ] s houl d have r equi red [ D eS ot o] t o f i l e a ne w ap p li ca ti o n , p rop o sin g a n ew rou te w h ich s ati sfi ed the S tat e H ea lth P lan’s requi rem ents . T he cha ncery cour tconcl uded thatt he f ai l ur e t o do s o vi ol at ed “f undament al not i ons of

due pr oces s , as w el l as the r equi r ement s of the C O N s t atut es t hemsel ves [ , ] ” i n that“no af f ect ed

### Th e ord er of the chance ry court has been stayeduntil the man date o f this C ourt is 12 

### is sue d. 9 party . . . ha s ha d an oppor tuni t y t o cont es tthi s new pr opos al
. ” The chanc ery cour tr ever s ed the M SD H ’ s appr oval of D eSot o’ s appl i cat i on and r emanded t o t he M SD H “w i t h the
m andat e that , i f

[ D eSot o] w i s hes t o pr opos e a ne w M R I r out e, thatnew r out e be s ubj ect ed to a H ea ri n g D u ri n g the C o u rse o f R ev iew at w h ich in terested p arti es m ay o p p o se o r sup p o rt th e n e w ro u te .” D e S o to a n d th e M S D H th e n fi le d a “ N o tic e o f A p p e a l.” 12 I S S UES ¶1 1
. T h is C o u rtw il l con side r: (1 ) W h e th e r th e M S D H h a d su b sta n tial e v id e n c e u p o n w h ich to b a se its f i ndi ng t hatD eS oto sat i s f i ed the St at e H eal t h Pl an’ s “C O N C r i t er i a and St andar ds f

ort he O f f er i ng of M R I Ser vi ces , ” t he St at e H eal t h Pl an’ s “G ener al C er t i f i cat e of N eed Pol i ci es , ” and the C O N R evi ew M anual ’ s “G ener al C o n s id e ra tio n s .” (2) W h ethe r th e M S D H co m m itted re v ers ible erro r i n ap p rov ing D eS o to’s appl i cat i on af

t era new r out e w as s ubs t i tut ed f ol l ow i ng t he r ecomm ended a p p ro v a l o f th e h e a rin g o ffic e r b u t b e fo re th e fin a l o rd e r o f th e S tate H e a lth O ffi ce r. A N A L Y S IS I. W h eth er th e M S D H h a d su b stan ti a l evid en ce u p o n w h ich to b a se its f i ndi ng t hat DeSot o s at i s f i e d t he St at e H e al t h Pl an’ s “CO N C r i t e r i a a nd S tan d a rd s for the O fferin g of M R I S er v ices,” th e S tate H e a lth P lan ’s “ G en er a l C er ti fi ca te o f N ee d P o li cies,” a n d th e C O N R ev iew M a n u a l’ s “ G e n e r a l C o n s id e r a ti o n s .” ¶12. “O n a ppeal , t his C ou rtcon du ct s a de no vo revi ew of t he ch ancel l or ’ s act i on,
cons tr ai ned by the s ame f ami l i ars t andar d of

r evi ew underw hi ch he ope r at ed. ” Miss . S ta te

### “Subs tanti ale vide ncem eans more than a s cinti ll a or a s uspi ci on.” Miss. State

Dep’t 13 

### of Heal th v . Nat che z Cmt y. Hosp. , 7 43 S o. 2d9 73 , 9 77 (M iss. 1 99 9). Seeals o Falc o Lime v. Ma yor & Ald

ermen of V

icksb urg , 836 So. 2d 711, 721 (Mi ss . 2002) (quoting Johnson v. Fer guson , 4 35 So. 2d 1191, 1195 ( Mis s. 1983) ( ci tati on omitt ed) ) ( “[ w] e c onsi der the subs tanti ale vide ncerequire me nt to have be en m et when the r ec ord includes ‘s uch r el evant evid ence as reaso nab le min ds might accep t as ad equ ate to supp ort a co nclu sion ,’ wh ich mu st be ‘ more than a

me re‘s cinti ll a’ of e vide nce .’ ”)
. 10 D ep’t of Healt h v. Miss. B ap tist

Med. Ctr. , 663 So. 2d 563, 574 (M i s s . 1995) ( ci t i ng Miss. S tate D ep’t

of Hea lt

h v . S ou th w est

Miss. R eg’l

Med. Ctr. , 58 0 S o. 2d 12 38 , 12 40 (M i ss. 19 91 ))
. T he fi nal or der of the S t at e H eal t h O ff i cer r egardi ng a C O N app l i cat i on i s:
s ubj ectt o j udi ci al r evi ew , butthatr evi ew i s l i m i t ed by s t atut e, w hi ch pr ovi des in p a rt: T h e o rd e r sh a ll n o t b e v a c a ted o r se t as id e , e ith e r in w h o le o r in p a rt , e x c e p t f

o r e rr o r s o f

la w , unl es s the cour tf i nds thatthe or derof

the [ M SD H ] is nots uppor t ed by s ubs tant i al evi dence , [ ] is contr ar

y to the m ani

f es tw ei ghtof the ev i dence , 13 is i n exce s s of

the s tat ut or

y author i t

y orj ur is di ct i on of

the [ M SD H ] , o r vi olat es any ve s t ed cons t i t ut i onalr ight s of any par t y i nvolved i n the appeal
. . . . J a c k so n H

M A , In c . v. Miss . S ta te D e p ’t o f He a lth , 822 So. 2d 968, 970 (M i s s . 2005) ( quot i ng M i s s . C ode A nn. § 41- 7- 201( 2) ( f ) ) ( emphasi s added)
. A “ pr es um pt i on of val i di ty”
a tta c h e s to th e M S D H ’s d e c is io n , Miss. B ap tist Med. Ctr. , 6 6 3 S o . 2d at 57 9 , an d this C o u rt i s l i m i t ed t o “r evi ew i ng t he l ow erco urt ’s d eci s i on t o det erm i ne w hethert he r ecor d can
s uppor tthi s fi ndi ng. T hi s C our tm ay nots ubs t i tut e i t s ow n j udgm entf ort hatof t he age ncy
w hi ch r ender ed the deci s i on, normay w e r e- w ei gh t he f act s of t he ca s e. ” P u b. E m

ployees’ R et . Sys . v. D is hm on , 797 So. 2d 888, 892 ( M i s s . 2001) ( ci t i ng Miss. P u b . S erv . Co m m ’n
v. Mer chant

s T r uck L ine, I

nc. , 598 So. 2d 778, 782 ( M i s s . 1992) )
. “Thi s dut y of def er ence der i ves f r om ourr eal i zat i on t hatt he eve r yday expe r i ence of the adm i ni s t r at i ve agenc y gi ves

### 11

i tf ami l i ar i t y w i t h t he part i cul ar i t i es and nuances of the pr obl ems com m i t t ed t o i t s car e w hi ch
no c ou r tc a n ho pe t o r e pl i cat e. ” D u n n v. Miss . S ta te D e p ’t o f He a lth , 708 So. 2d 67, 72 ( M i s s . 1998) ( quot i ng G il l v. Mis s . D ep’ t

of W ildli f e Conse r vati on , 574 So. 2d 586, 593 ( M i s s . 1990) )
. H ow ever , def er ence i s by no m eans a “rubbers t amp. ” Mis s . B aptis t Med. Ctr. , 663 So. 2d at579 ( quot i ng Mis s . State B d. of Nurs ing v. W

il s on , 624 So. 2d 485, 489 ( M i s s. 1 99 3))
. “[ W ] her e an a dm i ni s t r at i ve age ncy err s as a mat t erof l aw , cour t s of compet entj ur i s di ct i on s houl d nothes i t at e t o i nt ervene. ” G ra n t Ctr. H o sp ., In c . v. He a lth G r oup of Jacks on, I

nc. , 5 2 8 S o . 2 d 8 0 4 , 8 0 8 (M iss. 1 9 8 8 ). ¶13. A C O N m us tbe obt ai ned by the pr opos ed pr ovi derof M R I s ervi ces “ i f

t hos e s ervi ces have notbeen pr ovi ded on a r egul arbas i s . . . w i t hi n the per i od of t w el ve ( 12) m onths pr i or t o the t i m e s uch s ervi ces w oul d be of f er ed. ” M i s s . C ode A nn. § 41- 7- 191( 1) ( d) ( xi i ) ( R ev. 2005)
. “[ T [ he [ M SD H ] i s char ged w i t h r evi ew i ng appl i cat i ons f or[ C O N ’ s ] , i n acc or dance
w ith th e h e a lth c a re p o licie s a n d p rio rities o f th is S tate . In an eff o rt t o h a v e u n ifo rm ity in its d e c isio n s, the leg isla tu re p ro m u lg a ted b y sta tu te th a t th e se p o licie s b e se t fo rth a n n u a lly in the St at e H eal t h Pl an. ” S t. D o m in ic- J a c k so n Me m ’l Ho sp . v. Miss . S ta te D e p ’t o f He a lth , 728 So. 2d 81, 83 ( M i s s . 1998) ( ci t i ng M i s s . C od e A nn . § 41- 7- 173( s ) )
. R egar di ng t he “C O N C r i t er i a and St andar ds f ort he A cqui s i t i on orO t herw i s e C ontr ol of M R I E qui pm ent and / or the O ff

eri ng of M R I Servi ces, ” t he S t at e H eal t h P l an p rovi des: [t] h e [M S D H ] w ill rev iew ap p lica tio n s fo r a [C O N ] .
. . u n d e r th e a p p lica b le s t atut ory r equi r ement s of Sect i ons 41- 7- 173, 41- 7- 191, and 41- 7- 193, M is s is s ip p i C o d e o f 1 9 7 2 , a s a m e n d e d
. The [ M SD H ] w i l lal

s o r evi ew ap pli cat i ons f

or[C O N

] accordi ng t o the gene r alcr i t er i a l is t ed i n the Mississi pp i C ert i f i cate of N eed R evi ew Man ua l; al lad op t ed rules , proced ures, and plans of

the [ M SD H ] ; and t he s

peci f i c cr i t er i a and s tandar ds l is t ed below .

### Dawkins dire ct ed the s ta ff ana lys is and t es ti fi ed at t he he aring. 14 

### Th is preferen ce, ho wev er, do es no t alte r the requirement that “th e app licant mu st 15 

### me et theappl ic abl e CON c ri te ri a and st andards provi ded her ein and the ge neralcrit eria and stand ards co ntain ed inthe currentlyapp rov ed M ississ ip p i [C ON ] ReviewManual.” S tate Hea lt h Plan at XI- 45. Th e State H ealth P lan also no tes that “ [ o] ptimu m u ti li

zation o f a singleMRI 16 

### ma chine range s be twe en 2, 000 and 2, 500 proce dure s pe r ye ar .”Stat e He alth Pl an at XI -14 (e mpha si s a dded)
. Dawkins a dmi tt ed that the2,000- 2,500 optim

um util iz ation f

igure i s not a CO N requirement. 12 St at e H eal t h Pl an atX I
- 46 ( emphasi s added)
. In i t s r evi ew , t he M SD H “i nt ends t o appr ove an appl i cat i on f

orC O N i f i tsubst ant i al l y compl i es w i t h t he pr oj ect ed nee d and w i t h t he appl i cabl e cr i t er i a and s t andar ds pr es ent ed i n t hi s Pl an . . . . ” St at e H eal t h Pl an atI
- 2.

A
. “ C O N

C ri t eri a a ndStanda rds f or the O f f eri ngof M

R I Servi ces” ¶14. B l ackw el l t es t i f

i ed, and D aw ki ns conce ded, thatthe pol i cy of t he M SD H i s t o “gi ve 14 pr ef er ence t o t hos e appl i cant s pr opos i ng t o ent eri nt o j oi ntventur es ut i l i zi ng m obi l e and/ or
s har ed equi pm ent . ” St at e H eal t h Pl an atX I
- 45. A s t o t he s ervi ce- s peci f i c nee d cr i t er i on 15 fort he o ff

eri ng of M R I s ervi ces, t he S t at e H eal t h P l an p rovi des: [ t ] he ent i t y des i r i ng t o of

f erM R I s er vi ces m us tdocum ent thatthe equi

pm ent s hal lperf

or m a m i ni m um of

1, 700 pr ocedur es peryear .[ ] . . . This cr i t er i on 16 i ncl udes both f

i xed and m obi l e M

R I equi pm ent . Appl i cant

s f ornon- hos

pi talbas ed M

R I f aci l i t i es m ay s ubm i taf

f i davi t s f r om r ef er r i ng phys i ci ans i n l i eu of the es t i m at i on m ethodol ogy r equi r ed f or hos pi talbas ed f

aci l i t i es . M R I pr ocedur es pr oj ect ed i n af f i davi t s s hal l be bas ed o n ac tual M R I pro ce d u res refe rred d u ri n g the y ea r. I tis r ecogni

z ed thata par t i cularM R I uni tm ay be ut i l ized by m or e than one pr ovi derof

M R I s er vi ces ; s om e of

w hich m ay be locat ed out s i de of Mis s is s i ppi
. I n s uch cas es al lexis t i ng orpr opos ed pr ovi ders of M R I s er vi ces m u st jo in tly m e e t th e re q u ire d se rv ice v o lu m e o

f 1 ,7 0 0 p ro c e d u re s a n n u a lly
. I f th e M RI u n i ti n q u e s t i o n i s p r e s e n t l y ut i l i z e d b y o t h e rp r o v i d e r s o f M RI

### In h is review , of “ev ery S taff An alysis fro m 20 03 thro ug h F ebru aryo f 20 06 [,]” 17 

### NoelFal ls , a cc ept ed a s an expe rt on theCON proce ss , te stif ie d that “ [m ] any . . . a

ppli cati ons haveno aff

idavit s. Many . . . ha d no le tt er s of suppor t. They ha d proj ec ti ons . . . provi ded bythe ap plicant that w ere no t qu estion ed inthe S taff Rep ort.” 13 services , t he actual num ber of procedu res perf orm ed b y them du ri ng the m ost recent12 -m on t h p eri od m ay b e used inst ead o f the form ula pr oject i on s. S ta te H e a lth P la n a t X I- 4 7 (e m p h a s is a d d e d ). 

### Th e hearin g o fficer foundthat: [t ] he numbe r of s cans pe rf orm ed by [ All iance ] at

Gilmore and [Mi ss ion] when com bine d exc ee d 1,700. As Sm it h point ed out , it is not unc omm on to a lt er routes or lo se contracts. Wh ile this issu e d o es beco me a bit co nv oluted, the fac t remains that

Allianc e hasbee n and continues to se rv e t hes e t wo fac ilities w i t h m o b i leM

RI s e rv i c e . . . . [

T ]h em o b i lero u tet

h a t in c lu d es[ G i l m o re ], [ Missi on] and [

DeSoto] wi ll

e asi lye xc ee d there quired 1, 700 proc eduresper ye ar . (Em phas is adde d). This conc lus ion wa s a dopte d by theStateHea lt h Off ic er . ¶1 5
. D eS o to init ial ly p rese n ted e v iden ce th at A ll ianc e’s 1
. 5 T esla M R I un itw o u ld p erfo rm
m or e tha n 1, 70 0 pr oc e du r e s a nn ua l l y a mong G i l mor e , M i s s i on , a nd DeSot o, b a s e d on t he p roc ed u res p erfo rm ed at G il m o re an d M issi o n i n th e m o st rec en t tw elve -m o n th p e rio d in
c o n ju n c tio n w ith p roje c tio n s fo r D e S o to . See S tate H e a lth P lan a t X I- 4 7 . S p e c ifica lly , in 2 0 0 4 , 1 , 4 4 0 M R I pro ce d u res w ere p erfo rm ed at G il m o re a n d 5 6 2 M R I pro ce d u re s w ere per f or m ed atM i s s i on. A ddi t i onal l y, D eSot o pr es ent ed phys i ci an af f i davi t s , i n compl i ance
w i th t he S t at e H eal t h P l an, accoun t i ng f or 372 add i t i on al proj ect ed M R I ref err al s. 17 F urtherm ore, F al l s, al so accep t ed as an exp erti n h eal t hcare pl ann i ng and syst em s anal ysi s, t es t i f i ed thatD eSot o’ s appl i cat i on “compl i ed .
. . w i t h al l of t he r equi r ed cri t er i a and
s t andar ds [
. ] ” H e adde d t hati n hi s r evi ew of pr i ors t af

f a nal ys es , D eSot o’ s appl i cat i on “w as the onl y m obi l e M R I appl i cat i on re comm ended f ordeni al by t he st af

f si nce 2003.
. . . [ I ] tw as

### At the tim e of both t he he aring and theis suanceof the He aring Of fi ce r’ s “ Propos ed 18 

### Findings of Fac t and Conclusi ons of Law, ” Gilmore and All iancerem ained under contra ct via an MRISer

vic e Agr ee me nt. As De Soto and t he MSDH point out , “ [t ] her e wa s no rec ord evi denc e that

Gilm oreor Mi ss ion woul d not ac cept t hat ar rangem ent , and thus it

was specu lative at b est that entities alreadyd oin g bu siness withA lliance wo uldcease to d o so .” 14 t he o nl y . . . a pp l i c a t i on i n w hi c h t hi s p a r t i c ul a rmetho d of a pp l yi ng the 1 , 70 0 a nd 2, 500
num ber s w a s a pp l i e d
. . . . ” Ed W i t e k, a c c e pt e d a s a n e xp e r ti n he a l t h pl a nn i ng and heal thcar e f

i nance , conce ded thatD eSot o “ca n s how t hatt he r out e of t he magnethas 1, 700
orm or e pr ocedur es peryearand meetthatdef i ni t i on . . . . ” Fi nal l y, Sm i t h t es t i f i ed that “[ t ] her e’ s not hi ng I know aboutatt hi s poi ntt hatpr ecl udes ” the v i abi l i t y of t he G i l m or eM i s s i on- D eSot o r out e. A l l i ance w as s t i l l unde rc ont r actw i t h G i l m or e and M i s s i on atthe 18 t i m e of the hea r i ng, and Sm i t h t es t i fi ed t hatt he pr opos ed s chedul e w as f eas i bl e gi ven the
u p g ra d e d p o w e r o f th e 1 .5 T e sla M R I u n it. ¶16. A ppl yi ng the “pr es um pt i on of va l i di t y” t o the M SD H ’ s deci s i on, Mis s . B aptis t Med. Ctr. , 663 So. 2d at579, t hi s C ou rtco ncl udes t hats ubs t ant i al evi dence , i
. e. , “more t han a
s ci nt i l l a ora s us pi ci on[ , ] ” N atchezCm t

y. Hos p. , 74 3 S o . 2d at 97 7 , is prese n t i n the re co rd to su p p o rt th e fin d in g tha t th e n u m b e r o f p ro c e d u re s e x c e e d e d th e re q u ire m e n ts o f th e S tate H eal th Pl an. T her ef

or e, D eSot o compl i ed w i t h t he “CO N C ri t er i a and St andar ds f ort he O f f er i ng of M R I Ser vi ces . ” See D is hm on , 797 So. 2d at892; St at e H eal t h Pl an atI
- 2, X I
- 47.

B
. “ G eneral C ert i

f i cate of N eed P oli ci es” ¶17. T he St at e H eal t h Pl an s t at es t he f ol l ow i ng “G ener al C ert i f i cat e of N eed Pol i ci es ”: T o p re v e n t u n n e c e s s a ry d u p lic a tio n o f h e a lth re s o u rc e s [.] T o p ro v id e c o s t c o n ta in m e n t[.]

### 15 T o im p ro v e th e h e a lth o f M is s is s ip p i r e s id e n ts [.] T o i ncr eas e the ac ces s i bi l i t y, acc ept abi l i t y, cont i nui t y, and q u a lity o f h e a lth s e rv ic e s [.] W h il e all of th e stated p u rpo ses o f hea lth plan n ing an d he alth reg u lat o ry a c tiv itie s a re im p o rt a n t, cos tcontai nm ent and the pr eve nt i on of

unnece s sary dupl i cat i on o

f h eal th r es our ces ar e the pr i m ar y pur pos es and s hal lbe gi ven pri m ary em

ph asis i n the [C O N

] process . St at e H eal t h P l an atI
- 2 ( emphasi s added)
. T he hea r i ng of f i cerf ound t hatgi ven “the demands a nd gr ow t h of t he popul at i on i n D eSot o C ount y, the change s i n M R I t echnol ogy, and the gr ow i ng m edi cal comm uni t y i n t he ar ea[ , ] ” al ong w i t h “s ubs t ant i al evi dence t hatt he pr opos ed s ervi ce w i l l pr om ot e and pr ovi de ac ces s i bi l i t y, acc ept abi l i t y, and cont i nui t y and q u ali ty o f he alth se rvice s fo r the res iden ts of D eS o to C o u n ty a n d M issi ssipp i[ , ] ” D eS o to’s
a p p lica tio n w a s “ su p p o rte d b y su b sta n tial e v id e n c e d e m o n stra ti n g c o m p lian c e w ith th e g o a ls
o f th e P lan.” T h is co n clus ion w as a d o p ted b y the S tat e H ea lth O ffi ce r. ¶ 1 8
. D e S o to p re se n ted e v id e n c e th a t D e S o to C o u n ty w a s th e fa s te s t- g ro w in g c o u n ty in M i s s i s s i ppi and the thi r t y- f i f t h f as t es t - gr ow i ng county i n the U ni t ed St at es . A ddi t i onal l y,
n u m e ro u s q u a lified in d iv id u a ls te stifie d a t th e h e a rin g a s to the im p a c t o f p o p u latio n g ro w th on heal thcar e pr ovi s i on. Fur t herm or e, F al l s provi ded expertt es t i m ony t hatt hi s popul at i on gr ow th m i t i gat ed any a dver s e i m pactupon exi s t i ng provi der s as “bas ed on the gr ow i ng i nci dence r at e . . . of

M R I s , coupl ed w i t h the expl os i ve popul at i on gr ow t h i n D eSot o C ount y, ther e’ s goi ng to be plent y of vol um e f

ort he exi s t i ng uni t s . . . . ” A ccor di ng t o Fal l s , t he ad d it ion al m o b il e M R I service w o u ld “im p rov e ac ce ssibil ity an d av ail ab il ity o f he alth ca re
s ervi ce t o t he r es i dent s of M i s s i s s i ppi [
. ] ” Thi s evi dence support s t he f i ndi ng thatt he p o p u lat ion g row th in D eS o to C o u n ty h as c rea ted a n ee d fo r ad d it ion al M R I se rvice s tow ard

### 16

the e n d of i m p rov ing th e h ea lth of M issi ssipp i reside n ts. O f add it ion al i m p o rt , ex p ert t es t i m ony i ndi cat ed thatD eSot o’ s pr opos ed pr ovi s i on of M R I servi ces coul d m eetthatneed in a m a n n e r w h ich w o u ld n o t in frin g e u p o n th e fin a n c ial v iab ili ty o f e x istin g p ro v id e rs, w h ile
s i m ul t aneous l y i ncr eas i ng acc es s i bi l i t y of M R I s ervi ces i n D eSot o C ount y. ¶19. A ppl yi ng t he “pr es um pt i on of va l i di t y” t o t he M SD H ’ s deci s i on, Mis s . B aptis t Med. Ctr. , 663 So. 2d at579, thi s C ou r tconcl udes t hats ubs t ant i al evi dence , i
. e. , “more t han a
s ci nt i l l a ora s us pi ci on[ , ] ” N atc he zCm t

y. Hos p. , 7 43 So. 2d at977, s uppor t ed the f i ndi ng thatD eSot o’ s appl i cat i on s at i s f i ed the St at e H eal t h Pl an’s “G ener al C ert i f i cat e of N eed Pol i ci es . ” See D is hm on , 797 So. 2d at892. C
. “ G eneral C on si derati on s” ¶20. T he C O N R evi ew M anual cont ai ns “G ener al C ons i der at i ons , ” i ncl udi ng: [ p ] r o j e c t s wi l l b e r e v i e we d b y th e [ M S DH] a s d e e me d a p p r o p r i a t e . Re v i e w, e v a lu a tio n , an d d e ter m in a tio n o f w h e th e r a C O N is to b e iss u e d o r d e n ied w ill b e b a se d u p o n th e f

o llo w in g g e n e ra l co n sid e ra tio n s a n d a n y se rv ice sp e c ific cr i t er i a w hi ch ar e appl i cabl e t o t he pr oj ectundercons i der at i on. 1
. State Heal

th P lan : T he r el at i ons hi p of the heal t h s ervi ces bei ng r evi ew ed t o the appl i cabl e St at e H eal t h Pl an. * * * 4
. E c o n o m ic V

ia b ility : The i m m edi at e and l ong- t erm f i nanci al f

eas i bi l i t y of the pr opos al , as w el l as t he pr obabl e ef f ectof t he pr opos al on t he cos t s and char ges f orpr ovi di ng heal t h s ervi ces by the i ns t i tut i on ors ervi ce. Pr oj ect i ons s houl d be r eas onabl e and ba s ed upon gene r al l y acc ept ed ac count i ng proced ures. * * * 5
. N eed f orthe P r oject : O ne o r m ore of the fol l ow i ng i t em s m ay be con si dered i n d et erm i ning w hethera need forthe p roj ectexis t s:

### 17 a. T he nee d t hatt he po pu l at i on s erved ort o be s erved has f or th e s e rv ic e s p ro p o s e d to b e o ff e re d o r e x p a n d e d
. . . . c. T he curr entand proj ect ed ut i l i zat i on of l i ke f aci l i t i es or se rv ice s w ith in the p ro p o se d se rv ice are a w ill b e c o n sid e re d in determ i ning t he n eed for addit i on al faci l i t i es or services
. U nles s cl ear l y show n ot herw i s e, dat a w her e ava i l abl e f r om the D i vi s i on of Hea l t h Pl a nn i ng a nd Res ou r c e Deve l op ments ha l l be cons i der ed t o be the mostr el i abl e dat a ava i l abl e. d
. The pr obabl e ef

f ect of the prop os ed f

aci l i t y ors er vi ce on exist i ngf acil i t i es or ser vi ces provi ding si m i l ar ser vi ces to those pr opos ed w i l lbe cons i der ed
. W hen the s ervi ce a r ea of t he pr opos ed f

aci l i t y ors ervi ce ove r l aps the s ervi ce ar ea of an e x istin g fa c ili ty o r s e rv ice , th e n th e e ffe c t o n th e e x istin g fa c ili ty o r se rv ice m a y b e c o n sid e re d . T h e a p p lica n t o r in ter e ste d p a rty m us tcl ear l y pr es entt he met ho do l ogi es and as s um pt i ons upon w hi ch any p ropos ed pr oj ect ’ s i m pacton ut i l i zat i on i n af f ect ed f aci l i t i es ors ervi ces i s cal cul at ed. A l s o, t he appr opr i at e and ef f i ci entus e of

exi s t i ng f

aci l i t i es / s ervi ces m ay be c ons i der ed.
e. The c om m uni t y r eac t i on t o the f aci l i t y s houl d be cons i der ed. T he appl i cantm ay choose t o s ubm i tendor s ement s f r om c o m m u n ity o ffic ials a n d in d iv id u a ls e x p re ss in g th e ir re a c tio n to th e p ro p o s a l. . . . * * * 8
. R elati onshi

p to E xis ting Heal

th Car e Sys tem : T he r el at i ons hi p of the s ervi ces pr opos ed t o be pr ovi ded t o the exi s t i ng he al t h c ar e s ys t em of the ar ea i n w hi ch the s ervi ces ar e pr opos ed t o be pr ovi ded. C O N R ev iew M an u al at 57 -59 (em p h asis ad d ed ). Stat e H eal th P l an ¶ 2 1
. T h e H e a rin g O ffic e r fo u n d D e S o to ’s a p p lica tio n “ to b e c o n sis ten t w ith th e a p p lica b le
re q u ire m e n ts se t fo rth in th e S tate H e a lth P lan .” T h is fin d in g w a s a d o p ted b y th e S ta te H eal th O f

f i cer , w ho a dded t hatD eSot o’ s a ppl i cat i on w as “i n s ubs t ant i al compl i ance w i th t he [ M S DH’ s ] a d o p t e d P l a n s , c r i t e r i a , a n d s t a n d a r d s . ” T h e r e c o r d c l e a r l y r e v e a l s th a tth e M S DH

### 18

w a s p re s e n te d w ith su b s ta n tia l e v id e n c e to s u p p o rt th a t c o n c lu s io n . See Issu e I.( A
. ) supra . A ddi t i onal l y, an expe r tw i t nes s t es t i f i ed that“ther e w as a nee d f orthe pr opos ed s ervi ce a nd
e q u ip m e n t,” a n d th a t th e D e S o to a p p lica tio n “ c o m p lied
. . . w ith a ll o f th e re q u ire d c riter ia and s t andar ds
. ” A ppl yi ng t he “pres um pt i on of val i di t y” t o the M SD H ’ s deci s i on, Miss. B ap tist Med. Ctr. , 663 So. 2d at579, t hi s C our tconcl udes t hats ubs t ant i al e vi dence i s pr es ent i n the r ecor d t o s uppor tt he f i ndi ng thatD eSot o’ s appl i cat i on s at i s f i ed thi s “G ener al C ons i der at i on. ” See D is hm on , 797 So. 2d at892. E c o n o m ic V

ia b ili ty ¶22. T he hear i ng off

i cerw as pr es ent ed w i t h conf l i ct i ng expertt es t i m ony on t he s ubj ect of
econ om i c vi abil i t y. W hil e W i t ek assert ed thatD eS oto und ers t at ed it s annu al proj ect ed leas e
e x p e n se b y $ 1 7 8 ,0 0 0 , ren d e rin g th e o p e ra tio n u n p ro fitab le a fte r its firs t t w o y e a rs, F a lls
m i ni m i zed the s i gni f

i canc e of t hatal l eged mi s t ake, s t at i ng “w e’ r e qui bbl i ng overei ghtt ot al
s cans peryear , t o m ake thi s proj ect. . . fi nanci al l y f eas i bl e. ” U l t i m at el y, the hea r i ng of f i cer f ound “s ubs t ant i al evi dence i n t he r ecor d that , base d on t he s cans pr oj ect ed, t he [ D eSot o] p rojec t w il l be fina n ciall y v iable.” T h is f ind ing w as a d o p ted b y the S tat e H ea lth O ffi ce r. ¶23. C ar vel now argue s t hat “t he on l y procedur e number s w hi ch [ D eSot o] m ay even arg u ab ly rely o n to ca lculate the fi n an cia l feasib il ity o f th is [ a]pp li ca ti o n are the n u m b ers att ested t o i n th e att ac h ed affi d av it s of th e eig h t su p p o rt ing ph y sici an s. ” H o w ev er, th is C o u rt f i nds t hatt he M SD H w as pr es ent ed w i t h s ubs t ant i al evi dence , i
. e. , “more t han a s ci nt i l l a or
a s us pi ci on[ , ] ” N

atchezCm t

y. Hos p. , 7 4 3 S o . 2 d at 97 7 , that D eS o to’s p rojec ti o n s w ere
re a s o n a b le
. See f

oot not e 3 supra . A s th e M S D H ’ s d e c is io n is p re s u m e d v a lid , s ee Miss. B ap tist Med. Ctr. , 663 So. 2d at579, the pr es ence of c om pet i ng e xper topi ni ons on the i s s ue

### 19

of economi c vi abi l i t y l eads t hi s C our tt o concl ude t hatsubs t ant i al evi dence i s pre s enti n t he
r ecor d t o s uppor tt he f i nd i ng t hatD eSot o’ s appl i cat i on s at i s f i ed thi s “G ener al C ons i der at i on. ” See D is hm on , 797 So. 2d at892. N eed f orthe Proj ect ¶2 4. I n ass es s i ng t hi s “G ener al C on s i de r a t i on , ” the he a r i ng of f i c e rf ou nd “ t he s er vi ce
s peci f i c nee d cr i t er i a f

orthe pr ovi s i on of

M R I s ervi ces i s c ontr ol l i ng. ” The hear i ng of f i cer ad d ed that the D eS o to p rojec t w il l m ee t th e M R I s erv ice n ee d s o f D eS o to’s C o u n ty’s gr ow i ng popul at i on as evi dence d by t he posi t i ve comm uni t y r eac t i on t o the appl i cat i on att he h ea ri n g . T h is f

ind ing w as a d o p ted b y the S tat e H ea lth O ffi ce r. ¶25
. T h is “G eneral C on si derat i on ” provides that the li st ed it em s “ m ay b e co n side re d in det erm i ni ng w hethera nee d f ort he pr oj ectexi s t s . . . . ” C O N R evi ew M anu al at 57 (em p h asis ad d ed ). T h e u se o f th e p erm issi v e lan g u ag e “ m ay , ” a s o p p o sed to the m an d atory la n g u a g e “ s h a ll,” le a v e s th is c o n s id e ra tio n w ith in th e d is c re tio n o f t h e M S D H
. See H ill B ro s. Co n str. v. Miss. T ra n sp . Co m m ’n , 9 0 9 S o . 2 d 5 8 , 6 6 (M iss . 2 0 0 5 ). A c c o rd in g ly , this C o u rt g ra n ts d is c re tio n to th e M S D H , p re s u m e s th e v a lid ity o f i ts d e c is io n , s ee Miss. B ap tist Med. Ctr. , 663 So. 2d at579, a nd c oncl udes thats ubs t ant i al evi dence i s pr es enti n the r ecor d,
s ee Issu e I.( A
. ) an d I. (C
. )(Sta te H e a lth P lan) supra , to su p p o rtthe find ing that D eS o to’s appl i cat i on s at i s f

i ed thi s “G ener al C ons i der at i on. ” See D is hm on , 797 So. 2d at892. R elat i ons hi

p t o E xis t i ng Heal th C ar e Sys t em ¶2 6. T he hear i ng off i cerdet er m i ne d thi s “ G e ne r a l Cons i de r a t i on ” w a s f ul f i l l e d a s t he
s ervi ce- s peci f

i c nee d cr i t er i on of

t he St at e H eal t h Pl an w as s at i s f i ed and, ther ef

or e, “the addi t i on o f

a no t he rM RI p r ov i de ri n D e Sot o County w i l l h a ve l i t t l e , i f a ny , i m pacton t he

### 20

exi s t i ng pr ovi der s . ” I ti s i m por t antt o not e thatthe hea r i ng of f i cerf ound nei t herB apt i s tnor C a rv e l p ro v id e d “ sp e c ific e v id e n c e . . . tha t t h e y w ill s u ffe r a n y so rt o f a d v e rse im p a c t, f i nanci al orot herw i s e, fr om t he appr oval of thi s [ a] ppl i cat i on. ” B apt i s texpr es s l y s t i pul at ed th a t itw a s n o t as se rtin g a d v e rse fin a n c ial im p a c t. T h e se fin d in g s w e re a d o p ted b y th e S tate H ea lth O ffi ce r. A d d it ion all y , F all s p rov ided test im o n y th a t D eS o to C o u n ty w as “ u n d err epr es ent ed i n t he numberof M R I s one w oul d expectt o occuri n t he popul at i on[ , ] ” and the D eSot o pr oj ectw oul d notadver s el y i m pactotherM R I provi der s “bas ed on the gr ow i ng in c id e n c e ra te . . . or u se ra te o f M R Is, c o u p led w ith th e e x p lo siv e p o p u latio n g ro w th in D eSot o Coun t y . . . . ” A pp l yi ng t he “ pr e s umpt i on of va l i di t y” t o the M SD H ’ s de c i s i on, Miss. B ap tist

Med. Ctr. , 663 So. 2d at579, t hi s C our tconcl udes once aga i n thats ubs t ant i al evi dence i s pr es enti n t he r ecor d f orthe s epar at e f

i ndi ng t hatD eSot o’ s appl i cat i on s at i s f i ed thi s “G ener al C ons i der at i on. ” See D is hm on , 797 So. 2d at892. C oncl us i on ¶ 2 7
. In tota l, th is C o u rt fi n d s th a t s u b s ta n tia l e v id e n c e w a s o ff e re d th ro u g h o u t th is p r o c e e d i n g t o s u p p o r tt h e u l t i ma t e f i n d i n g t h a tDe S o t o ’ s a p p l i c a t i o n s a t i s f i e d t h e “ CO N C r i t er i a and St andar ds f ort he O f f er i ng of M R I S ervi ces , ” t he “G ener al C ert i f i cat e of N eed P o licie s,” a n d th e c o n tes ted “ G e n e ra l C o n sid e ra tio n s.” G iv e n th e M S D H ’s “ fa m ili a rity w ith the par t i cul ar i t i es and nuanc es of t he pr obl ems comm i t t ed t o i t s car e[ , ] ” D unn , 708 So. 2d at72, thi s Courtf

i nds thati ti s obl i gat ed t o de f ert o the M SD H ’ s j udgm enti n the abs ence of a b rea ch o f es tablishe d req u ir em en ts. A cc o rdin g ly, th is C o u rtco n clud es th at th e c h an ce ry
cour terr ed i n f

i ndi ng t he M SD H ’ s gr antof D eSot o’ s appl i cat i on w as “arbi t r ary and
c a p ri c io u s a n d c o n tr a ry to th e m a n if e s t e v id e n c e in th e c a s e . . . .”

### 21 II. W h eth er th e M S D H co m m it ted re v er sible e rr o r in a p p ro v ing D e S o to’s appl i cat i on af

t er a new route w as s ubst i t ut ed f ol l ow i ng t he rec om m ended a p p ro v a l of th e h ea rin g o ffi ce r b u t b efo re th e fin a l ord er o f the S tate H eal t h O f

f i cer . ¶ 2 8
. T h is C o u rt p re v io u sly h a s s tate d th a t: [a]d m in istra tiv e a g e n c ies a re a m b ig u o u s c re a tu re s b o rn o f n e c e ss ity , m ire d in th e te n s io n b e tw e e n p u b lic p o lic y a n d p e rs o n a l c la im s o f r ig h t. They purs ue p ra g m a tica lly th e p u b lic in ter e st b a la n c in gthe u til ita ria n (an d ex p e rtly d ivin e d ) ca lcu lu s o

f a g g re g a te n e t b e n e

fit a g a in st th e in d ivid u a l’s c la im to fa ir op po rt un i t y an d p rocess . T hey addr ess pr es s i ng ques t i ons of pol i t i cal economy and s ci ence w her e ther e ar e s el dom e as y ans w er s and al m os tnever o n ly tw o p o in ts o f v iew . O u r a d m in istra to rs a lso re g u late a n d fa c ili tate i ndi vi dual en t e rpr i s e w i t houtw hi ch the publ i c i nt er es tw i l l s ur el y s uf f er . H er e, a s w e ll, “ th e lif

e o f t h e la w h a s n o t b e e n lo g ic ; it h a s b e e n e x p e ri e n c e .” McG ow an v. Mis s . State O il & G as B d. , 6 0 4 S o . 2 d 3 1 2 , 3 1 5 -16 (M iss. 1 9 9 2 ) (“McG ow an II ”) ( ci t at i on s om i t t ed) ( em ph asi s added ). G i ven that s t atus: [ t ] hi s C our thas gener al l y acc or ded gr eat def er ence t o an adm i nis tr at i ve agency ’s cons tr uct i on of i t s ow n r ul es and r egulat i ons and the s tat ut es under whi c h i top e r at es . . . . T hi s C our thas not ed that“an a gency’ s i nt erpr et at i on of a r egul at i on i thas been a uthor i zed t o pr om ul gat e i s ent i t l ed t o gr eat def er ence and m ustbe u ph eld u nles s i tis so pl ainl y erroneo us or so i ncons is t ent

w i th ei therthe under l

yi ng r egulat i on ors tat ut e as to be ar bi tr ar y, capr i ci ous , an abus e of dis cr et i on orotherw is e noti n ac cor dance wi th l aw .” B u e lo w v. G lide w e ll , 757 So. 2d 216, 219 ( M i s s . 2000) ( quot i ng T ow erL oan of

Mis s . , I nc. v. Miss. S tate T

ax Co m m ’n , 6 6 2 S o . 2 d 1 0 7 7 , 1 0 8 1 (M iss
. 1 9 9 5 )) (e m p h a sis ad d e d ). “T h is duty of def ere nce de r i ves f

r om ourr eal i zat i on thatthe eve r yday expe r i ence of t he
a d mi n i s tr a t i v e a g e n c y g i v e s i tf a mi l i a r i ty wi t h th e p a r t i c u l a r i t i e s a n d n u a n c e s o f th e p r o b l e ms
com m i t t ed t o i t s car e w hi ch no courtcan hope t o r epl i cat e. ” D unn , 7 0 8 S o . 2 d a t 7 2
. See al s o I nt ’l B d. of T eam sters v. D ani el , 439 U
. S. 551, 566, 99 S. C t . 790, 58 L
. E d. 2d 808

### Missio n w as still un der co ntract fo r two years w ith “n o o ut clau se.” 19 

### 22 ( 1979) ( admi ni s t r at i ve age ncy def er ence “ i s a pr oductboth of a n a w ar enes s of

the pr act i cal expert ise w h ic h a n a g e n c y n o rm a lly d e v e lo p s , an d o f a w i l l i ng ness t o a ccord so m e m easure
o f f l ex i b i l i t y to s u c h a n a g e n c

y a s i te n c o u n t e rs n e w a n d u n f o r e s e e n p r o b l e ms o v e rt i me . ”) ( emphasi s a dded)
. A ne w a nd unf or es een pr obl em ar os e i n the cas e s ub j udi ce i n thatt he pr opos ed r out e w hi ch D eSot o w as t o j oi n w as r ender ed pr os pect i vel y i ns uf f i ci entt o pr oduce the m inim u m n u m b er o f ann u al pro ce d u res req u ir ed by th e S tat e H ea lth P lan b y G il m o re’s term ination o f i ts M R I S erv ice A g ree m en t w ith A ll ianc e , a fte r th e h ea ri n g o ffi ce r’s
r ecomm endat i on t o gr antD eSo t o’s a ppl i cat i on, butbef or e the St at e H eal t h O f f i cerrul ed ther eon. ¶29. T he hea r i ng of

f i cerw as aw ar e t hatA l l i ance w as re negot i at i ng t he t erm s of i t s contr act
w i th G i l m or e, w hi ch r ece nt l y had bee n acqui r ed by H eal t hcar e M anage m entA s s oci at es , and thatthei rcurr entpr opos al of thr ee days ( i ncl udi ng a Satur day) ha d notye tbeen a cce pt ed. 19 S m i th tes t i fi ed t hat A l l i ance w as “ o p e ra tin grig h t n o w w ith G ilm o re o n a m o n th -to -m o n th b a sis [,] ” fu rth e r n o tin g th a t “ [i] t’s a p o ss ib ili ty th a t w e c o u ld lo se a c o n tra c t a t a ny p o in t in t i me [,] ” b u t th a t “ [i

] f w e lose the G i lm ore con tract , w e ha ve m any, m any m ore con tract s .

. . and cus t om ers thatw e can put i n thos e places . ” ( E m phas i s added)
. T he hea r i ng of f i cer
w as w el l aw ar e that“[ t ] he r out e of w hi ch thi s new s ervi ce w i l l be a pa r ti s l es s t han
co n cre te[ , ] ” w h en h e re co m m en d ed ap p rov a l o f D eS o to’s ap p li ca ti o n . A ft er G il m o re ter m in a ted its M R I S e rv ice A g re e m e n t w ith A lli a n c e , a s u b se q u e n t h e a rin g w a s h e ld to
cons i derB apt i s tand C arve l ’ s “J oi ntM ot i on t o R eopen a nd Suppl ementR ecor d and f or R econs i der at i on of

H ear i ng O ff

i cer ’ s Fi ndi ngs of

Factand C oncl us i ons of L aw . ” The

### 23

h e a r i n g o f

f i c e rwa s a wa r e o f

S mi t h ’ s a f

f i d a v i t , wh i c h p r o v i d e d t h a t“ [ i ] n t h e mo b i l e M RI ind u stry i t is co m m o n for m o b il e M R I r o u tes t o be alt ere d an d /or f o r con tr ac ts fo r m o b ile M R I s ervi ces t o be amended orcance l l ed” a nd thatD eSot o w oul d be adde d t o a r out e w hi ch per f or m ed 2, 323 M R I pr ocedur es i n the pr evi ous tw el ve mont hs
. A f t erdue cons i der at i on, th e h e a ri n g o ffi ce r de n ied th e m o ti o n an d affirm ed h is r ec o m m en d ati o n to g ran t D eS o to’s
a p p lic a tio n . In s o fi n d in g , th e h e a ri n g o ff ic e r d e te rm in e d th a t if a C O N h a d b e e n is s u e d , a
c h a n g e d r o u t e wo u l d n o tc o n s t i tu t e a c h a n g e i n s c o p e u n d e rS e c t i o n 1 0 0
. 0 1 o f t h e CON R eview M anu al , as i tw as i m m at eri al given t he fr equ ency of chan ges in m ob i l e M R I r ou t es,
e sp e c ially w h e n c o m b in e d w ith th e n e e d re q u ire m e n t su ffic ien c y o f th e n e w ro u te. T h e S tate H eal th O f

f i ceradopt ed thi s f

i ndi ng. T he chanc ery cour tr ever s ed the M SD H ’ s deci s i on. T he chanc el l ors peci f

i cal l y concl uded that“f undament al not i ons of

d ue proces s , as w el l as t he
r equi r ement s of

t he C O N st atut es t hemsel ves [ , ] ” shoul d have r equi r ed D eSot o “t o fi l e a new
a p p lic a tio n , p ro p o s in g a n e w ro u te w h ic h s a tis fi e d th e S ta te H e a lth P la n ’s re q u ir e m e n ts .” ¶30. B apt i s tar gues t hatthe hear i ng of f i cer ’ s de ni al of

i t s mot i on t o r eopen a nd s uppl ement the r ecor d and ac companyi ng r ecomm endat i on t o gr antD eSot o’ s appl i cat i on, adopt ed by the St at e H eal t h O f

f i cer , c ont r avene d M i s s i s s i ppi Code A nnot at ed Sect i on 41- 7- 197( 2) i n that

“ a n y p e rso n a ff

e c ted b y th e p ro p o sa l b e in g re v iew e d ” w a s n o t g iv e n th e o p p o rtu n ity to “conduc tr eas onabl e ques t i oni ng of per s ons w ho m ake r el evantf actual al l egat i ons
conce rni ng t he pr opos al
. ” See M i s s . Code A nn. § 41- 7- 197( 2) ( R ev. 2005)
. A ddi t i onal l y,
o n a p p e a l, B a p tist an d C a rv e l in c o rp o ra ted a d u e -p ro c e ss a rg u m e n t in th a t: [ t ] h e n e w r o u t e p r o p o s e d b y [ De S o t o ] h a s n e v e rb e e n p a r to f a n y CO N appl i cat i on. I thas neve rbeen r evi ew ed by t he M SD H s t af f
. I thas neverbeen d isc lo se d to th e p u b lic. A ffe c ted p a rtie s h a v e n e v e r b e e n n o tified th a t th is

### Regarding noti ce , De Soto and theMSDH maint ain that “thenotic e is of thefa ct

of 20 

### the ap plicatio n itself, n ot o f everydetail th erein.” 24 pr opos ed r out e w as even be i ng cons i der ed by the M SD H
. [A ppel l ees ] have neverhad the oppor tuni t y t o chal l enge thi s r out e thr ough s ubpoenas of do cum ents an d qu est i on i ng o f w i t nesses. D espi t e all o f this , t he M S D H has, i n ef f ect , appr oved an appl i cat i on ba s ed on a n M R I r out e w hi ch has neverbeen s ubj ect ed t o admi ni s t r at i ve norpubl i c s crut i ny. T he cha ncery cour tagree d, r el yi ng upon the per cei ved appl i cabi l i t y of M i s s i s s i ppi C ode A nnot at ed Sect i on 41- 7- 197 and “f undament al not i ons of

due pr oces s , ” i n f

i nd i ng “the M S D H d id n o t ha v e the leg a l au th o rity
. . . to ap p ro v e a n e w p ro p o sa l fo r a n M R I se rv ice in a pos t - hear i ng af

f i davi tformat , w i t houtr equi r i ng t he appl i cantt o s ubm i ta f ul l , new
s u b s ta n tiv e a p p lic a tio n a n d s u b je c tin g th e n e w ro u te to p u b lic a n d re g u la to ry s c ru tin y .” ¶ 3 1
. D e S o to a n d th e M S D H re sp o n d th a t: [ n] ot hi ng change d i n [ D eSot o’ s ] appl i cat i on exce ptf orthe i dent i t i es of

the othert w o pr ovi der s on t he r out e. T he C O N l aw s r equi r e thata hea r i ng be a ff o rd e d to c h a lle n g e rs o f a C O N a p p lic a tio n o r a s ta ff a n a ly s is , and a hear i ng w as pr ovi ded
. T he l aw s do n o t r equi r e thatan appl i cat i on be r ej ect ed, ort hat a new hear i ng be hel d, i f any f act s i n the appl i cat i on change af t ert hat h e a ri n g .[ ]

20 A s t o due pr oces s , D eSot o and the M SD H ar gue: the [ M S D H ] m ade i t s pos i t i on know n, as r egar ds the negl i gi bl e ef f ectof the new r out e on [ D eS oto’ s ] C O N appl i cat i on, i n i t s m ot i on of A ugus t9, 2005. T he det ai l s of

t he new r out e had be en made avai l abl e t o the A ppel l ees even ear l i er , o n Jul y 26, w hen [ D eSot o] pr ovi ded the C i ndy Sm i t h af f i davi t . T he hear i ng of

f i cerhear d t he m ot i on on A ugus t11, 2005. T hus , A ppel l ees cannot m a in ta in th a t t h e y w e re n o t a ff o rd e d “ n o tic e , a n d a n o p p o rt u n ity to b e h e a rd .” U ndert he unus ual ci r cumst ance s , and gi ven the f l exi bi l i t y aff

or ded the [ M S D H ] , t hat s uff

i ced for due p rocess . D eSot o and the M SD H f ur t herar gue, “[ t ] hi s cas e involved an unus ual ci r cumst ance not f or es een by the C O N s t atut es orby the [ M SD H ’ s ] r egul at i ons . T her ef or e, i tw as exac t l y the

### 25

ki nd of cas e i n w hi ch t he [ M SD H ’ s ] exper t i s e shoul d have been af f or ded gr eatdef

er ence as i td e c i d e d h o w t o h a n d l e t h e s i tu a t i o n b e f o r e i t. . . . ” F i n a l l y , De S o t o a n d t h e M S DH
m a in tain th a t: 

### the chan cery court awardedrelief that th e Ap p ellees nev er sought from the [ MS DH ] . In th eir joint motio n to reop en the record , th e Ap pellees so ug ht on ly to s upple me nt t

he r ec ord wi th t

he fact of Gi lm ore ’s withdrawalfrom t he pro po sed ro ute, an d to seek th e rejectionof th e app licationonthat b asis. . . . [T] hey nev er

move d thehearing off

ic er or the [ MSDH] for

a ne w hearing. (Emp hasis added) . As suc h, De Soto and theMSDH argue t hat any a ppli ca bleri ght t o a hearing was wai ved. ¶ 3 2
. M iss iss ip p i C o d e A n n o tate d S e c tio n 4 1 -7 -1 9 7 p ro v id e s, in p e rtin e n t p a rt, th a t: (1) T h e [M S D H ] sh a ll a d o

p t a n d u til ize p ro c e d u re s fo r c o n d u c tin gc e rtifica te of ne ed r evi ew s . Such pr ocedur es s hal li ncl ude, i nt eral i a, the f ol l ow i ng : ( a) w ri tt en n o ti fi ca ti o n to the ap p li ca n t; (b) w ri tt en n o ti fi ca ti o n to h ea lth ca re f aci l i t i es i n t he s ame heal t h s ervi ce a r ea as t he pr opos ed s ervi ce; ( c) w r i t t en not i f i cat i on t o ot herper s ons w ho pr i ort o the r ece i ptof t he appl i cat i on have f i l e d a f o r ma l n o t i c e o f

i n t e n tt o p r o v i d e th e p r o p o s e d s e r v i c e i n th e s a me s ervi ce area; and ( d) not i f i cat i on t o m ember s of

the publ i c w ho r es i de i n t he s ervi ce ar ea w here the s ervi ce i s pr opos ed, w hi ch may be pr ovi ded thr ough new spapers or publi c i nform at i on chan nels
. ( 2)
. . . A ny s uch hea r i ng s hal l be conduc t ed by a he ar i ng of f i cerdes i gnat ed b y th e [M S D H ]. A t s u c h h e a ri n g , the hear i ng of f i cerand any pers on af

f ected by the proposalbei ng r evi ew ed m ay conduc tr eas onabl e ques t i oni ng of pers ons who m ake r el evant f actualal l egat i ons c oncerni ng the p roposal
. . . . A re c o rd o f th e h e a rin g sh a ll b e m a d e , w h ich sh a ll co n sis t o f a tra n sc rip t o f a ll t es t i m ony r ece i ved, al l document s and otherm at er i al i ntr oduced by a ny i nt er es t ed per s on, the s t af f r epor ta nd r ecomm endat i on and s uch otherm at er i al as the hea r i ng of

f i cercons i der s r el evant , i ncl udi ng hi s ow n r ecomm endat i on, w h ich h e sh a ll m a k e w ith in a re a s o n a b le p e rio d o f tim e a fte r th e h e a rin g is cl os ed and a f

t erhe has had an opportuni t y t o r evi ew , s tudy and anal yze the evi dence pr es ent ed dur i ng t he hea r i ng. T he com pl et ed r ecor d shal l be ce r t i f i ed to th e S tate H e a lth O ffic e r, w h o sh a ll co n sid e r o n ly th e re c o rd in m a k in g h is deci s i on, a nd s hal l notc ons i derany evi dence orm at er i al w hi ch i s noti ncl uded th e re in . A ll fin a l d e c isio n s re g a rd in g th e iss u a n c e o f a c e rtifica te o f n e e d sh a llA s t o route am end m ents , t he S t at e H eal t h P l an p rovi des: 21 [ a] n equi pm ent vendorw ho pr opos es t o add a he al t h car e f aci l i t y t o an exi s t i ng orpr opos ed r out e mustobt ai n an am endm ent t o t he or i gi nal C ert i f

i cat e of N eed bef or e pr ovi di ng s uch s ervi ce. A ddi t i onal l y, an equi pm ent vendorm ust info rm the [M S D H ] o f an y p rop o sed c h a n g es, i
. e. ad d it ion al he alth ca re f aci l i t i es orr oute devi at i ons f r om t hos e pr es ent ed i n the C ert i f i cat e of N eed appl i cat i on pr i ort o s uch cha nge. S tat e H ea lth P lan a t X I-45 (em p h asis ad d ed ). 

### Th is C ourt fin ds this p rov isioninap plicab le her e a s the “ equipme nt ve ndor”is All iance , not DeSot o. Fo r instan ce, “the f

ai l ur e of an agenc y t o f

ol l ow i t s ow n r egul at i ons i s notpers e a 22 deni al of pr ocedur al due pr oces s . ” W o o da rd v. L o s Fresn o s In dep . S ch . D ist . , 7 32 F
. 2d 

### 26 b e m a d e b y th e S tate H e a lth O ffic e r. T h e S tate H e a lth O ffic e r sh a ll m a k e h is w r i t t en f i ndi ngs and i s s ue hi s or deraf t err evi ew i ng s ai d r ecor d. M i s s . C ode A nn. § 41- 7- 197 ( R ev. 2005) ( emphasi s a dded)
. R egar di ng “ C hanges i n Scope
o f A p p ro v e d P rojec t,” th e C O N R e v iew M a n u a l sta tes , “[a ]pp lica n ts fo r a C O N sh o u ld
c lea rly u n d e rsta n d th a t if a n a p p ro v e d p rojec t is c h a n g e d su b sta n tially in sc o p e – in
c o n s tru c t i o n , s e r v i c e s , o rc a p i t a l e x p e n d i tu r e t h e e x i s t i n g CO N i s v o i d , a n d a n e w C ON appl i cat i on i s r equi r ed bef or e the pr oponentcan l aw f ul l y proceed f

ur t her
. ” C O N R evi ew M anual § 100. 01 at54. 21 ¶ 3 3
. “ D u e p ro c e ss a lw a y s sta n d s a s a c o n stitu tio n a lly g ro u n d e d p ro c e d u ra l sa fe ty n e t in adm i nis t r at i ve hea r i ngs . ” McG ow an II, 60 4 S o. 2d at31 8 (ci t at i on s om i t t ed). H ow ever, “[ t ] he due pr oces s cl aus es of ourcons t i tut i ons m us tnotbe cons t rued so as t o putt he s t at e and f eder al governm ent s i nt o a s t r ai ght
- j acke tand pr eventthem fr om adapt i ng l i f e t o t he cont i nuous change i n s oci al and ec onom i c condi t i ons . ” Mis s . P ow erCo. v. G oudy , 459 So. 2d 25 7, 27 3 ( M i s s . 19 84 ) ( H a w ki ns , J
. , s pe c i a l l y c on c urr i ng ) ( qu ot i ng A l br itton v. Cit

y of W inona , 181 M i s s . 75, 178 So. 799 ( 1938) )
. In t he adm i ni s t r at i ve s ett i ng, “mi ni m um 221243, 1245 ( 5 C i r . 1984) ( ci t i ng U ni ted States v. Cacer es , 440 U
. S. 741, 99 S. C t . 1465, 59 th L
. E d
. 2 d 7 3 3 (19 7 9 )). 

### 27 pr ocedur al due pr oces s . . . i s ( 1) not i ce, and ( 2) oppor tuni t y t o be hea r d. ” State O il & G as B d. v. McG ow an , 5 4 2 S o . 2 d 2 4 4 , 2 4 8 (M iss. 1 9 8 9 ) (“Mc G owan I ”) (cit ati o n s o m itted). ¶ 3 4
. T h e “ g re a t d e fe re n c e ” e x te n d e d to th e M S D H , B uelow , 7 5 7 S o . 2 d a t 2 1 9 , re a c h e s to th e “ n e w a n d u n fo re s e e n p ro b le m s ” it e n c o u n te rs o v e r t im e . D ani el , 4 3 9 U
. S
. at 56 6
. T h ere can be no l egi t i m at e di s put e thatt he pr ocedur es out l i ned i n M i s s i s s i ppi C ode A nnot at ed S e c tio n 4 1 -7 -1 9 7 (1 ) w e re sa tisfie d w ith res p e c t t o D e S o to ’s a p p lica tio n . F o llo w in g a ro u te change , w hi ch w as nota subs t ant i al change i n s cope a nd w hi ch w oul d have r equi r ed a ne w C O N appl i cat i on had C O N R e v iew M a n u a l § 1 0 0 .0 1 b e e n a p p lica b le, a h e a rin g w a s h e ld to
cons i derB apt i s tand C arvel ’ s “J oi ntM ot i on t o R eopen a nd Suppl ementR ecor d and for R e c o n s id e ra tio n o f H e a ri n g O ff ic e r’ s F in d in g s o f F a c t a n d C o n c lu s io n s o f L a w .” S ign if ican tl y , n o p arti es to th e p ro ce ed ing , n o h ea lth ca re fac il it ies i n the s am e h ea lth ca re
s ervi ce a r ea, and no other s or i gi nal l y not i ced, appea r ed t o r eques ta new hear i ng. ¶35. Pr ocedur al l y, t hi s C our tf i nds t hatgi ven the abs ence of a r eques tf

ora hea r i ng, t he due pr oces s cont ent i on of

B apt i s tand C arvel i s m uch ado ove rnothi ng, t he pr overbi al “r ed herr i ng. ” A ddr es s i ng t he due pr oces s ar gum ents ubs t ant i vel y, thi s C our tf i nds t he admi ni s tr at i ve pr ocedur al due pr oces s r equi r ement s of “( 1) not i ce, and ( 2) opportuni t y t o be hear d[ , ] ” Mc G owan I, 542 So. 2d at248, w er e s at i s f i ed. B apt i s tand C arvel w er e on not i ce of the new r out e. A m oti on hear i ng on B apt i s tand C arvel ’ s “J oi ntM ot i on t o R eopen a nd Suppl ementR ecor d and f orR econs i der at i on of

H ear i ng O f

f i cer ’ s Fi ndi ngs of

Factand C oncl us i ons of

L aw ” ac cor ded them due pr oces s . H ad any otheri ndi vi dual orent i t y ent i t l ed

### Had the e vide nceprof fe re d bee n adm itte d, the re sult would be thes am e. Ther ef ore , 23 

### eve n if the rewas er

ror , i t wa s harm le ss , a s the r es ult re mains unchanged. 28 t o not i ce s oughti nt erven t i on i n t he pr ocee di ng atany s t age c om pl ai ni ng a l ack of due process , t he cha ncel l orm i ghthave be en r equi r ed t o undert ake a s epar at e due pr ocess anal ys i s . H ow ever , no s uch cl ai m w as advanc ed. Fi nal l y, att he pos t - hear i ng m ot i on p ro c e e d in g , S m ith ’s s w o rn a ffi d av itp rov ided su b sta n tial e v id e n c e , i. e ., “ m o re th a n a sc in til la
ora s us pi ci on[ , ] ” N

atchezCm t

y. Hos p. , 743 So. 2d at977, t hata new r out e w oul d m eetthe
ne e d r e qu i r e ment s o f

the St a t e Hea l t h Pl a n. Thi s Courtf i nd s tha tthi s s w orn s t at ement of A l l i ance ’ s D i r ect orof

O per at i ons i s m or e than a mer e “f actual al l egat i on, ” ther eby r ender i ng the cont es t ed port i on of s ubs ect i on ( 2) i nappl i cabl e. T he i s s ue of i m po r tt o s at i s f

y t he
r equi r ement s of

the St at e H eal t h Pl an is n ott he s peci f i c r out e, butr athert he numberof pr ocedur es . W hethercons i der i ng evi dence bas ed upon the pr evi ous t w el ve-m ont h per i od (th e h isto ric a l n u m b e r o f p ro c e d u re s p e rfo rm e d ) o r th e p ro p o se d ro u te c h a n g e (th e fo rm u la p rojec tio n ), th e re su lt i s th e sa m e . T h e m in im u m n u m b e r o f p ro c e d u re s re q u ire d w a s m e t. 23 ¶36. W hi l e thi s C our tcomm ends t he cha ncel l or ’ s car eful ex am i nati on of al l i s s ues , the chanc el l ore r r on e ou s l y g r a nt e d r e l i e f w hi c h was no ts ou gh tby t he pa r t i e s t o the a ge ncy p ro c e e d in g , i. e ., a n e w h e a rin g . A d d iti o n a lly , th e ap p lica b le s tan d a rd o f re v iew re n d e rs th is a mat t erof

def er ence , notequi t y. A ccor di ngl y, thi s C ourtdef er s t o the j udgm ent of

t he M SD H
. T her ef

or e, t hi s C our tconcl udes thatthe cha ncery cour terr ed i n r emandi ng t o t he M S DH.

### 29 CO NC L US I ON ¶37. B as ed upon the af or ement i oned ana l ys i s , thi s C our tre ver s es t he C hance r y C our tof Hi n d s Co u n t y a n d a f

f i r ms t h e d e c i s i o n o f

th e M S DH i n g r a n t i n g th e CO N. ¶38. RE VE RS ED AND RE NDE RE D. S M I T H, C. J . , W AL L E R A ND DI AZ , P . J J . , E AS L E Y, CA RL S ON , DI CK I NS ON AN D LAM AR, J J . , CO NCU R. GR AVES, J . , DI S S ENTS W I THO UT S EPARATE W RI TT EN OP I NI ON.