Decision 

Matter of: Carthage Area Hospital, Inc. 

File: B-402345 

Date: March 16, 2010 

John G. McGowan, Esq., Bond, Schoeneck & King, PLLC, for the protester. 

David B. Dempsey, Esq., and Megan Mocho Jeschke, Esq., Holland & Knight LLP, for 

Valor Healthcare, Inc., an intervenor. 

David W. Altieri, Esq., Department of Veterans Affairs, for the agency. 

Peter D. Verchinski, Esq., and Guy R. Pietrovito, Esq., Office of the General Counsel, 

GAO, participated in the preparation of the decision. 

DIGEST 

Selection of higher-rated, higher-priced proposal is unobjectionable where the 

selection official reasonably determined that awardee’s higher technical rating 

outweighed the protester’s lower price. 

DECISION 

Carthage Area Hospital, Inc., of Carthage, New York, protests the award of a 

contract to Valor Healthcare, Inc., of Washington, D.C., under request for proposals 

(RFP) No. VA-528-09-RP-0139, issued by the Department of Veterans Affairs (VA) for 

the operation of an outpatient clinic in the agency’s Veterans Integrated Service 

Network 2 (VISN 2) in upstate New York. Carthage, the incumbent contractor, 

challenges the agency’s evaluation and source selection decision. 

We deny the protest. 

BACKGROUND 

The RFP provided for the award of a fixed-price contract for the operation of a 

community-based outpatient clinic (CBOC) in Jefferson County, New York for a base 

year with 2 option years.1

 Award was to be made on a “best value” basis, considering 

 

(continued...) 

United States Government Accountability Office

Washington, DC 20548 

Comptroller General

of the United States

DOCUMENT FOR PUBLIC RELEASE

The decision issued on the date below was subject to a 

GAO Protective Order. This redacted version has been 

approved for public release. 

1

 The VA operates more than 800 CBOCs across the United States. The CBOCs, 

which are generally in more rural areas, provide the most common outpatient 
the following three evaluation factors (listed in descending order of importance): 

technical capabilities, past performance, and price. The technical capabilities 

evaluation factor included three subfactors, which were stated to be of equal weight: 

quality; management, experience and staffing; and geographic location. RFP at 91. 

Offerors were informed that the technical capabilities and past performance factors, 

when combined, were significantly more important than price.2

 Id.

Instructions for the preparation of proposals were provided for each evaluation 

factor and subfactor. For example, under the management, experience and staffing 

subfactor, offerors were to provide, among other things, a list of names of the 

qualified staff that the offeror intended to use (including detailed information such 

as certifications, licenses, and curriculum vitae) “and/or describe the mechanism” 

used to provide a qualified staff. Id. at 92-93. With respect to the geographic location 

subfactor, offerors were instructed to describe, among other things, the proposed 

facility’s access to public transportation, access to major highways, and how the 

facility’s geographic location will serve the anticipated clients. Id. at 94. 

The agency received three proposals, including Carthage’s and Valor’s.3

 Carthage’s 

and Valor’s proposals were included in the competitive range. Following 

discussions, the firms’ revised proposals were evaluated as follows:4 

 

(...continued) 

services, including health and wellness visits, without the need to visit the VA’s 

larger medical centers. See www1.va.gov/health/MedicalCenters.asp. 

2

 The RFP stated elsewhere that “the following [five] evaluation factors (listed in 

descending order of priority) shall be used to evaluate offers”: quality; management, 

experience and staffing; geographic location; past performance; and price. RFP at 

92-94. The agency’s source selection decision is based upon the evaluation scheme 

described in the body of this decision--that is, using a technical capabilities 

evaluation factor composed of three equally weighted subfactors. This inconsistency 

was not protested. 

3

 Carthage has been operating the clinic at issue here since 2003. Valor operates 

15 CBOCs for the VA, including 1 CBOC in the VISN 2 area. Agency Report (AR), 

Tab 6, Valor Proposal, at 6. 

4

 Proposals were assessed under the technical capabilities evaluation subfactors as 

excellent, good, satisfactory, marginal, or unsatisfactory. An excellent rating 

reflected a proposal that demonstrated an understanding of the requirements, an 

approach that significantly exceeded performance or capability standards, and had 

exceptional strengths that would significantly benefit the government. A good rating 

reflected a proposal that demonstrated an understanding of requirements, an 

approach that exceeded performance or capability standards, and had one or more 

strengths that would significantly benefit the government. A satisfactory rating 

(continued...) 

Page 2 B-402345 
Carthage Valor 

Technical Capabilities 

Quality Satisfactory Excellent 

Management, Experience & Staffing Good Excellent 

Geographic Location Satisfactory Excellent 

Past Performance Low Risk Low Risk 

Price $5,612,245 $6,292,800 

AR, Tab 11, Best Value Analysis. 

The evaluators’ adjectival ratings were supported by narrative discussions that 

identified each offeror’s respective strengths and weaknesses under each factor and 

subfactor. With regard to Carthage’s proposal, the evaluators noted the firm’s 

incumbent experience, and found strengths in the firm’s proposal under the 

management, experience and staffing evaluation subfactor because, among other 

things, award to Carthage would cause “minimal disturbance” to the patients 

assigned there. See AR, Tab 10, Evaluation Worksheets, at 10. The evaluators also 

noted a weakness in Carthage’s proposal, i.e. that the firm had proposed inadequate 

[DELETED], and that, despite discussions concerning this weakness, the VA “did not 

see where [DELETED] provided in their proposal will resolve this issue.” Id. The 

evaluators further noted weaknesses in Carthage’s proposal under the geographic 

location subfactor because the location of Carthage’s proposed clinic was “20 

minutes away from the largest [veteran] population in Jefferson County and [was] 

not in close proximity to any major highways.” Id. at 11. With respect to past 

performance, the evaluators found that the quality of Carthage’s past performance 

was satisfactory, and that the firm was “average in ranking amongst Syracuse CBOCs 

in regard to Quality, Satisfaction, and Performance.” Id. at 12. 

The excellent ratings assigned to Valor’s proposal under the technical capabilities 

subfactors reflected the evaluators’ judgment that the firm’s proposal contained a 

number of strengths and no weaknesses. Specifically, under the quality subfactor, 

the evaluators noted that the firm was accredited by The Joint Commission for its 

ambulatory health care,5

 had strong processes to [DELETED], and conducted 

monthly [DELETED]. Id. at 3. 

 

(...continued) 

reflected a proposal that demonstrated an acceptable understanding of 

requirements, an approach that met performance or capability standards, and had 

few or no strengths. See AR, Tab 9, Source Selection Plan, at 6. 

5

 The Joint Commission is an independent, not-for-profit national body that accredits 

health care organizations. See www.jointcommission.org/AboutUs. 

Page 3 B-402345 
Under the management, experience and staffing subfactor, the evaluators noted, 

among other things, Valor’s offer to provide [DELETED], a [DELETED], a 

[DELETED], a [DELETED] and a [DELETED]. The evaluators also cited the firm’s 

low turnover rate for primary care and mental health care providers, and “excellent 

provisions for provider absences.” Id. at 4. Under the geographic location subfactor, 

the evaluators cited Valor’s proposed location in Watertown, New York. The 

evaluators noted that this location was in “the center of Jefferson County” where 

most veterans reside, and was in close proximity to major highways. Id. at 5. With 

respect to Valor’s past performance, the evaluators noted: 

Valor Health Care operates the Dunkirk CBOC in VISN 2 . . . . VA 

staff that works with Valor stated that they have an excellent 

understanding of the needs of the VA patients and have a working 

knowledge of VA programs . . . . 

Additionally they stated that Valor provides excellent performance 

scores in all areas including Performance Measures, Access, and 

Patient Satisfaction. This is reiterated in the VISN 2 CBOC 

dashboard [rankings] as Dunkirk has been rated 1st or 2nd for the past 

three years.6

Id. at 6. 

The final evaluation results were provided to the source selection authority (SSA), 

who compared the strengths and weaknesses assessed in the proposals and 

determined that Valor’s technical superiority outweighed Carthage’s price advantage. 

Specifically, the SSA noted that Valor’s proposed clinic was “closest to the largest 

group of veterans,” when compared to the location of Carthage’s proposed clinic; 

offered the greatest opportunity for future growth; and offered easy access given its 

location “right off [Interstate] 81.” AR, Tab 11, Best Value Analysis, at 3. The SSA 

also stated that the “compelling reason” for selecting Valor’s proposal was the quality 

of care the firm had provided at the Dunkirk CBOC. Id. The SSA noted, with respect 

to Valor’s higher price, that the firms’ proposed prices for the option years were very 

similar and that Valor’s higher price in the base year was “to be expected since this is 

a new clinic and Valor has the added expense of securing the space, buying furniture, 

and hiring staff.” Id. 

Award was made to Valor, and this protest followed. 

 

6

 The dashboard rankings monitor “quality,” “satisfaction,” and “access.” Protest 

exh. 2, at 2. 

Page 4 B-402345 
DISCUSSION 

Carthage objects to the agency’s assignment of an excellent rating to Valor’s 

proposal under the management, experience and staffing subfactor, complaining that 

Valor failed to adequately describe how it would provide qualified personnel. In this 

regard, Carthage contends that Valor’s plan to hire staff after contract award was 

inadequate because it did not address the difficulty of getting health care 

professionals to move to “a somewhat remote area,” or address limitations in the 

pool of potential employees in the local area.7 Protester’s Comments, app., at 2. 

In reviewing protests of alleged improper evaluations and source selection decisions, 

it is not our role to reevaluate submissions; rather, we will examine the record to 

determine whether the agency’s judgment was reasonable and in accord with the 

stated evaluation criteria and applicable procurement laws and regulations. Panacea 

Consulting, Inc., B-299307.4, B-299308.4, July 27, 2007, 2007 CPD ¶ 141 at 3. A 

protester’s mere disagreement with the agency’s judgment is not sufficient to 

establish that an agency acted unreasonably. Entz Aerodyne, Inc., B-293531, 

Mar. 9, 2004, 2004 CPD ¶ 70 at 3. 

Here, the record provides no basis to object to the agency’s assessment of the 

awardee’s proposal under the management, experience and staffing subfactor. This 

subfactor provided for the evaluation of more than the staff proposed by an offeror, 

or an offeror’s plan to provide staff; rather, offerors were informed that the agency 

would also assess the offeror’s scheduling methods, experience, planned 

organization, capability and plan to commence performance within required 

timeframes, proposed administrative support staff, average personnel turnover rate, 

and “detailed operational plan to include staffing for the first 90 days of clinic 

operation.” RFP at 92-94. The agency’s excellent rating assessment for Valor under 

this subfactor reflected the evaluated strengths for the firm’s proposed [DELETED], 

its low [DELETED], its “excellent provisions for [DELETED],” and its employment of 

[DELETED] and [DELETED]. AR, Tab 10, Proposal Evaluation Worksheets, at 4. 

 

7

 Carthage also complains that Valor did not provide curricula vitae, licenses, or 

certifications for its staff, which Carthage argues is required by the RFP. This 

interpretation of the solicitation is inconsistent, however, with its plain language 

which informed offerors that they could provide this information, but did not require 

it. To the extent that the protester believes that the RFP should have required 

offerors to identify qualified staff and establish their qualifications, this ground of 

protest concerns an alleged apparent solicitation impropriety that should have been 

filed before the closing date for receipt of proposals under our Bid Protest 

Regulations. 4 C.F.R. § 21.2(a)(1) (2009). 

Page 5 B-402345 
While the VA did not assess any strengths with respect to Valor’s proposed staffing 

planning, it found acceptable Valor’s mechanism for recruiting and hiring qualified 

staff. In this regard, the proposal stated 

[DELETED] 

See AR, Tab 6, Valor Technical Proposal, at 104. Valor further explained how it 

performs a comprehensive credentialing and background investigation on all 

candidates. Finally, Valor stated that “based on our history of successfully 

establishing fifteen (15) VA Community Based Outpatient Clinics, including the 

Dunkirk NY VA CBOC, in less than 45-60 days, [we have] learned that the best 

candidates are hired when we have actually won the award and are able to make an 

offer to the candidate for actual employment.” Id. at 101. 

Given Valor’s specific description of the mechanism it proposed for hiring its staff 

and other evaluated strengths in its proposal under the management, experience and 

staffing subfactor, we find nothing unreasonable about the agency’s evaluation of 

Valor’s proposal in this regard. 

Carthage also protests its own “good” rating under this subfactor, complaining that it 

should have received a higher rating because, as the incumbent, it “already had a 

complete, qualified staff in place and functioning,” while Valor merely proposed to 

hire staff. Protester’s Comments, app., at 4. 

Contrary to Carthage’s assertion, the evaluators acknowledged Carthage’s 

advantages as the incumbent contractor, noting that an award to Carthage offered 

minimal disruption to patients. AR, Tab 10, Proposal Evaluation Worksheet, at 10. 

Carthage’s lower evaluation rating under this subfactor reflected, however, the 

agency’s assignment of a weakness for failing to provide [DELETED], despite the 

agency’s discussions with the firm with respect to this concern. Id. In addition, the 

agency noted that Carthage had not provided [DELETED]. Id. As with the 

evaluation of Valor’s proposal under this subfactor, the VA’s evaluation of Carthage’s 

proposal was based upon more than the firm’s proposed staff (or mechanism to 

provide staff). Although Carthage disagrees with the agency’s rating, its 

disagreement does not show that the agency’s judgment was unreasonable. 

Carthage also protests the agency’s assessment, under the geographic location 

subfactor, that the location of Valor’s proposed clinic was more favorable than 

Carthage’s proposed location. As described above, the evaluators found that the 

proposed location of Valor’s clinic in Watertown merited an excellent rating since 

Watertown is where most veterans in Jefferson County reside, the proposed site was 

in the center of the county, and the site was “in close proximity to major highways,” 

Page 6 B-402345 
among other things.8

 Id. at 5. Carthage complains that Watertown’s veteran 

population comprises only 16 percent of the county’s overall veteran population, 

which, in Carthage’s view, indicates that the VA has overstated the convenience of 

having a clinic in Watertown. Carthage also contends that veterans could easily 

travel from Watertown to Carthage, and that the Carthage location better serves 

veterans who use local highways, rather than the interstate. 

We find no basis to disagree with the VA’s evaluation of the proposals under this 

evaluation subfactor. Here, the record supports the agency’s finding that Valor’s 

CBOC location in Watertown offers numerous strengths. For example, the record 

shows that the highest concentration of veterans living in Jackson County live in 

Watertown, and that the number of veterans living in Watertown greatly exceeds the 

number living in Carthage. See AR, Tab 11, Best Value Analysis, at 8. Although 

Carthage disagrees with the agency’s assessment of the relative merits of these 

proposed clinic locations, its disagreement does not show that the agency’s 

judgment in this regard was unreasonable. 

Carthage also protests the agency’s evaluation of Carthage’s past performance, 

complaining that the agency improperly applied the firm’s “Dashboard” rankings for 

its CBOC in the VISN 2 area to conclude that the protester’s performance had been 

average.9

 Specifically, Carthage contends that the agency failed to use the most 

recent dashboard ranking; that is, the protester complains that the agency used 

information in the system as of August 2009, but it ignored the higher ranking 

Carthage received in October 2009. The record shows that the agency completed its 

evaluation of the firms’ revised proposals before the issuance of the October 2009 

dashboard ranking. Therefore, we do not find that the agency erred in failing to 

consider the October 2009 information. See AR, Tab 10, Proposal Evaluation 

Worksheets, at 1, 7 (evaluation of Valor’s and Carthage’s revised proposals was 

completed by October 19, 2009). 

 

8

 In addition to the views of the evaluators, the SSA also noted that the veteran’s 

population in Watertown was three times larger than Carthage’s, that Watertown had 

the greatest potential to handle increases in veterans’ population, and that the 

interstate made travel to Watertown (especially in the winter months) easier for 

veterans. AR, Tab 11, Best Value Analysis, at 3. 

9

 Carthage also argues, for the first time in its comments, that the agency’s evaluation 

of Valor’s Dashboard ranking was unreasonable because Valor’s only CBOC in the 

VISN 2 areas was not sufficiently similar to the CBOC at issue in this protest. This 

protest ground is untimely. The record shows that Carthage was informed in its oral 

debriefing that the VA had considered the Dashboard rankings as part of its 

evaluation. See AR, Tab 12, Notice of Debriefing, Nov. 16, 2009. However, Carthage 

did not assert this ground of protest in its protest. 

Page 7 B-402345 
Carthage also protests that the agency’s evaluation of the awardee’s past 

performance failed to consider negative past performance information. Specifically, 

the protester notes that the VA’s Office of Inspector General (OIG) issued a report 

critical of certain aspects of Valor’s performance of the operation of a CBOC in 

Monaca, Pennsylvania. See VA OIG Report No. 09-01446-26, “Healthcare Inspection 

Community Based Outpatient Clinic Reviews.” Carthage contends that the VA 

“either was or should have been aware” of other allegations regarding Valor’s 

allegedly poor performance on CBOC contracts. In support of this allegation 

Carthage provides a copy of a letter from a United States Senator to the VA 

requesting that the agency examine complaints about two CBOCs operated by Valor 

in Texas. Carthage also provides a number of newspaper articles from papers in 

Pennsylvania and Texas, discussing the OIG report and the allegations of poor care 

in Texas CBOCs. 

Our Office has recognized that in certain limited circumstances an agency evaluating 

an offeror’s proposal has an obligation (as opposed to the discretion) to consider 

“outside information” bearing on the offeror’s proposal. International Bus. Sys., Inc., 

B-275554, Mar. 3, 1997, 97-1 CPD ¶ 114 at 5; G. Marine Diesel; Phillyship, B-232619, 

B-232619.2, Jan. 27, 1989, 89-1 CPD ¶ 90 at 4-5. Where we have charged an agency 

with responsibility for considering such outside information, the record has 

demonstrated that the information in question was “simply too close at hand to 

require offerors to shoulder the inequities that spring from an agency’s failure to 

obtain, and consider this information.” International Bus. Sys., Inc., supra; see GTS 

Duratek, Inc., B-280511.2, B-280511.3, Oct. 19, 1998, 98-2 CPD ¶ 130 at 14. 

Here, the record does not demonstrate that this information was “too close at hand” 

for the agency to ignore. Specifically, there has been no showing that the VA 

employees involved in the evaluation or source selection were aware or should have 

been aware of the OIG report, the Senator’s letter, or the articles in small 

newspapers located outside of New York State. Accordingly, we have no basis to 

conclude that the agency should have considered this information in its evaluation of 

Valor’s past performance. 

Finally, Carthage complains that the SSA’s source selection decision placed 

disproportionate weight on the geographic location subfactor.10 Specifically, 

Carthage argues that the SSA unreasonably concluded that Valor’s location 

 

10 Initially, Carthage alleged that Valor was provided with information regarding the 

VA’s preferences for the clinic (such as a preference to move the clinic to 

Watertown) that was not provided to all offerors. The VA responded to these 

allegations in its agency report, and Carthage’s comments provided no rebuttal to the 

agency’s position. Under these circumstances, we deem the issue to have been 

abandoned. Remington Arms Co., Inc., B-297374, B-297374.2, Jan. 12, 2006, 2006 CPD 

¶ 32 at 4 n.4. 

Page 8 B-402345 
Page 9 B-402345 

outweighed “not only Carthage’s superior staffing proposal, but also the fact that 

Carthage proposed to provide the services for $650,555.00 less than Valor.” 

Protester’s Comments, app., at 7. 

We find no basis to question the source selection decision in this regard. As 

discussed above, offerors were specifically informed that the agency would consider 

the offeror’s proposed clinic location, given that the RFP included a subfactor for 

“geographic location” requiring offerors to describe how their proposed location 

would “best serve the clients anticipated to use the program.” See RFP at 94. The 

SSA’s decision gave measured weight to the strengths assessed in Valor’s proposal 

for its proposed location in Watertown. In this regard, the selection decision also 

discusses both firms’ evaluated strengths and weaknesses. While Carthage disagrees 

with the significance assigned by the SSA to Valor’s proposed clinic location, this 

disagreement does not demonstrate that the SSA’s decision was unreasonable. 

The protest is denied. 

Lynn H. Gibson 

Acting General Counsel