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IN THE INTERMEDIATE COURT OF APPEALS OF WEST VIRGINIA

MINNIE HAMILTON HEALTH CARE CENTER, INC., d/b/a MINNIE 

HAMILTON HEALTH SYSTEM, 

Respondent Below, Petitioner 

vs.) No. 22-ICA-149 (CON File No. 21-5-12124-P)

HOSPITAL DEVELOPMENT CO., d/b/a ROANE GENERAL HOSPITAL,

Applicant Below, Respondent 

and

WEST VIRGINIA HEALTH CARE AUTHORITY, 

Respondent

MEMORANDUM DECISION

Minnie Hamilton Health Care Center, Inc. dba Minnie Hamilton Health System 

(“Minnie Hamilton”) appeals an April 29, 2022, West Virginia Health Care Authority (the 

“Authority”) decision granting Hospital Development Co. dba Roane General Hospital 

(“Roane General”) a Certificate of Need (“CON”) authorizing it to relocate a rural health 

clinic from its main campus to a new site in Arnoldsburg, Calhoun County, West Virginia.1

Respondents filed a timely response. Minnie Hamilton filed a reply. 

This Court has jurisdiction over this appeal pursuant to West Virginia Code § 51-

11-4 (2022). After considering the parties’ written and oral arguments, the record on 

appeal, and the applicable law, this Court finds no substantial question of law and no 

prejudicial error. For these reasons, a memorandum decision affirming the Authority’s 

order is appropriate under Rule 21 of the Rules of Appellate Procedure. 

Roane General is a hospital with its main campus located in Spencer, Roane County, 

West Virginia. In addition to hospital services, Roane General operates four rural health 

centers (“RHCs”), two located at the hospital’s main campus and two located off-campus. 

On July 30, 2021, Roane General completed an application for a CON, proposing a plan to 

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 Petitioner is represented by Robert L. Coffield, Esq. and Caleb P. Knight, Esq. 

Respondent Roane General is represented by Alaina N. Crislip, Esq. Respondent West 

Virginia Health Care Authority is represented by Katherine A. Campbell, Esq. 

FILED

March 9, 2023

released at 3:00 p.m.

EDYTHE NASH GAISER, CLERK

INTERMEDIATE COURT OF APPEALS

OF WEST VIRGINIA
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relocate one of the on-campus clinics to a site in Arnoldsburg, Calhoun County, West 

Virginia. The proposed relocation project would establish a new ambulatory care center 

with an expected capital expenditure of $439,720. In its application, Roane General’s stated 

objectives are to improve the ability of Arnoldsburg, Chloe, and Orma, West Virginia (the 

“service area”) residents to access primary care, cardiology, and general surgery services. 

On August 26, 2021, Minnie Hamilton requested an administrative hearing before 

the Authority to contest Roane General’s application. Minnie Hamilton operates a critical 

access hospital in Grantsville, Calhoun County, West Virginia, as well as a school-based 

clinic in Arnoldsburg.2

On December 1, 2021, Minnie Hamilton filed a motion to compel, requesting access 

to records relied upon by Roane General’s population methodology expert witness in 

preparing its CON. At a December 7, 2021, prehearing conference, the Authority denied 

the motion to compel; nevertheless, a number of records were disclosed by Roane General. 

The Authority held a public hearing on December 14, 2021, regarding Roane 

General’s CON application. Roane General and Minnie Hamilton presented documentary 

evidence and testimony. During the hearing, one of Roane General’s experts provided

testimony regarding the service area’s population, which encompasses multiple zip codes

in Calhoun County. Minnie Hamilton disputed the sufficiency of Roane General’s 

population calculations, arguing the calculations were based on flawed data.

Roane General also presented evidence of the service area’s need for additional 

primary care, cardiology, and general surgery services. Again, Minnie Hamilton disagreed, 

arguing that Roane General failed to adequately assess the number of providers in the 

service area and failed to account for Minnie Hamilton’s Grantsville hospital and other 

Calhoun County clinics. 

Additionally, Roane General provided financial projections to establish the 

proposed RHC’s financial viability and adequate staffing. However, Minnie Hamilton

argued that Roane General’s projections were based upon an inflated patient encounter rate

and that the proposed project would be financially unfeasible. Minnie Hamilton reasoned

that this alleged financial hardship would cause the project to fail to meet staffing 

requirements. 

On April 29, 2022, the Authority issued a written decision granting Roane General’s 

CON application, addressing each contested point in a detailed manner. The Authority’s 

decision adopted Roane General’s zip code population methodology as credible, finding

2 On September 13, 2021, Minnie Hamilton filed its own CON application to open 

a new primary care center in Arnoldsburg, which is still pending.
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that it rationally and objectively reflected the patient base for the proposed RHC. Further, 

the Authority found the service area had an unmet need for further health care providers, 

rejecting Minnie Hamilton’s arguments that Roane General failed to account for other 

providers within Calhoun County. The Authority determined that providers identified by 

Minnie Hamilton were properly excluded from Roane General’s calculations because they

were: (1) outside the service area; (2) not providing services to the general public; or (3) 

not an existing provider when the CON application was filed. Additionally, the Authority

concluded that Roane General’s financial projections were sufficient to establish financial 

viability and adequate staffing, dismissing Minnie Hamilton’s protests as speculative.

On May 25, 2022, Minnie Hamilton filed a request for review with the Office of 

Judges, which we consider in this appeal.3

“The specific standard of review both for the Office of Judges and, on appeal 

therefrom . . . is set forth in West Virginia Code § 29A-5-4(g).” Amedisys W. Va., LLC v. 

Pers. Touch Home Care of W. Va., Inc., 245 W. Va. 398, 407, 859 S.E.2d 341, 350 (2021). 

West Virginia Code § 29A-5-4(g) (2021) provides: 

The court may affirm the order or decision of the agency or remand the case 

for further proceedings. It shall reverse, vacate, or modify the order or 

decision of the agency if the substantial rights of the petitioner or petitioners 

have been prejudiced because the administrative findings, inferences, 

conclusions, decision, or order are:

(1) In violation of constitutional or statutory provisions;

(2) In excess of the statutory authority or jurisdiction of the agency;

(3) Made upon unlawful procedures;

(4) Affected by other error of law;

(5) Clearly wrong in view of the reliable, probative, and substantial evidence 

on the whole record; or

(6) Arbitrary or capricious or characterized by abuse of discretion or clearly 

unwarranted exercise of discretion.

Further, the factfinding determinations of an agency are entitled to deference unless clearly 

wrong.

[Where] an appellate court [is] charged with reviewing the decision of an 

administrative agency’s factfinder . . . the [appellate] court is required to 

3 This case is an appeal where the decision of the Authority was entered prior to 

June 30, 2022. However, because the Office of Judges did not decide this case prior to its 

dissolution on September 30, 2022, it was transferred to this Court for decision pursuant to 

West Virginia Code § 16-2D-16a(b) (2021). 
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accord deference to the hearing examiner’s findings of fact unless they are 

“[c]learly wrong in view of the reliable, probative, and substantial evidence 

on the whole record[.]” 

W. Va. State Police v. Walker, 246 W. Va. 77, __, 866 S.E.2d 142, 149 (2021) (quoting W. 

Va. Code § 29A-5-4(g)(5)); see also Syl. Pt. 1, Muscatell v. Cline, 196 W. Va. 588, 474 

S.E.2d 518, (1996). 

 The proposed relocation of Roane General’s RHC is subject to the Authority’s CON 

review process.4 See W. Va. Code § 16-2D-3(a)(1) (2017). A CON may be issued if the 

proposed service is “[f]ound to be needed; and . . . [c]onsistent with the state health plan, 

unless there are emergency circumstances that pose a threat to public health.” W. Va. Code 

§ 16-2D-12(a)(1)-(2) (2016). Different types of health services have different criteria that 

must be met, per the State Health Plan Standards, to qualify for a CON. See W. Va. Code 

§ 16-2D-12(g). In the instant case, Roane General’s proposed RHC is an ambulatory care 

center, so the Ambulatory Care Center Standards are at issue. 

The Standards require proposed ambulatory care facilities to demonstrate: (1) a 

methodology to calculate the service area’s unmet need for further medical providers, (2) 

that the proposed facility will not negatively impact other services or providers, (3) that the 

proposed services are the most cost effective alternative, (4) that the proposed services 

maintain compliance with applicable accreditation standards, (5) that the project is 

financially viable, (5) that the facility will be accessible to patients who lack adequate 

transportation, and (6) that less expensive alternatives to new construction have been 

considered.5

 

 In its brief, Minnie Hamilton presents two arguments; we will address each in turn. 

Minnie Hamilton contends that the Authority’s order was (1) insufficient in explaining the 

Authority’s reasoning for its conclusions regarding population calculations and financial 

viability of the project, and (2) erroneous because the population calculations used to 

support Roane General’s application were based upon questionable estimates. 

 

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 The Authority is named as a respondent in this matter and filed a brief. Because 

the Authority takes the same positions as Roane General on the issues, the Authority’s brief 

will not be discussed separately. 

5 See W. Va. Health Care Auth., CON Standards: Ambulatory Care Centers 

Standards, (Oct. 5, 1992), 

https://hca.wv.gov/certificateofneed/Documents/CON_Standards/Ambulatory_Care_Cent

ers_2_ASC.pdf. 
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West Virginia Code § 29A-5-3 (1964) requires that an agency in a contested case 

must articulate its findings and reasoning for review, providing in relevant part that:

Every final order or decision rendered by any agency in a contested case shall 

be in writing or stated in the record and shall be accompanied by findings of 

fact and conclusions of law. . . . Findings of fact, if set forth in statutory 

language, shall be accompanied by a concise and explicit statement of the 

underlying facts supporting the findings. 

The Supreme Court of Appeals of West Virginia has elaborated on the level of detail 

required in an agency’s decision:

[W]ith respect to decisions of administrative agencies following from 

findings of fact and conclusions of law proposed by opposing parties, . . . the 

agency must rule on the issues raised by the opposing parties with sufficient 

clarity to assure a reviewing court that all those findings have been 

considered and dealt with, not overlooked or concealed.

Muscatell, 196 W. Va. at 598, 474 S.E.2d at 528.

Upon review, we find that Minnie Hamilton’s argument disputing the sufficiency of 

the decision is unpersuasive. The Authority issued a detailed fifty-four page decision, 

setting out the parties’ opposing positions on each contested issue that substantively 

addressed Minnie Hamilton’s arguments at every turn. For example, in addressing the 

project’s financial outlook, Minnie Hamilton argued that Roane General’s similar clinics 

were operating significantly in the red, thus questioning the project’s financial feasibility.

In its decision, the Authority addressed the shortcomings of Minnie Hamilton’s position: 

[Minnie Hamilton] also appears to misunderstand the difference between 

RHC “collections” and “reimbursement,” and therefore, misapprehends a 

fundamental and critical distinction as it related to the project’s financial 

feasibility . . . [testimony explains] that these financial documents encompass

the margin based upon costs versus expenses, and not reimbursement versus 

expenses . . . the financial documents cited by Minnie Hamilton are not 

instructive as to the financial feasibility of the project, as they do not fairly 

and accurately depict the financial performance of [Roane General]’s 

[clinics]. (Emphasis added).

Subsequently, the Authority found, and we concur, that Roane General met its burden of 

demonstrating financial feasibility. 

Next, we find that the Authority, in its April 29, 2022, decision, sufficiently

addressed Minnie Hamilton’s concerns regarding the population methodology. The 
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Authority explicitly accepted Roane General’s use of zip code-specific population data as 

an interpretative tool to decipher the Authority-provided county-wide population data. The 

Authority reasoned:

The Authority rejects [Minnie Hamilton’s] inference that the application's 

population analysis is flawed because the zip code reference was not 

specifically identified as a source in the application. The zip code reference 

was utilized to break down the provided population data by zip code, since 

zip code-specific population percentages are not provided. . . . Thus, the 

existence/identity of [the] zip code reference, as well as the rationale for its 

use to interpolate the Authority provided population data, was fully 

established in the record for consideration.

Further, the Authority cited three past CON applications where it had approved the use of

zip code specific data, highlighting it as an accepted practice.6

We find that the Authority’s decision satisfies the requirements of West Virginia

Code § 29A-5-3, as it demonstrates consideration of each of the parties’ positions, the 

evidence, and sufficiently sets forth the reasoning and analysis underpinning the 

Authority’s conclusions. We find no error in the Authority’s April 29, 2022, decision. 

Accordingly, we affirm.

Affirmed.

ISSUED: March 9, 2023

CONCURRED IN BY:

Chief Judge Daniel W. Greear

Judge Thomas E. Scarr

Judge Charles O. Lorensen

6 Ancillary to this argument, Minnie Hamilton claims the Authority’s denial of its 

motion to compel left it unable to properly challenge Roane General’s population data. We 

disagree. The record reflects that Minnie Hamilton had an opportunity to cross examine

Roane General’s expert at the hearing and to present its own evidence. In addition, we 

conclude that, because the remaining evidence was “independently sufficient” to support 

the findings of fact, any technical evidentiary or discovery error by the Authority was 

harmless. See Stephens v. Rakes, 235 W. Va. 555, 573, 775 S.E.2d 107, 125 (2015) (quoting 

McDougal v. McCammon, 193 W.Va. 229, 239, 455 S.E.2d 788, 798 (1995)) (explaining 

that an evidentiary error is harmless if there is a separate evidentiary basis to support the 

verdict, so long as the verdict was not substantially influenced by the error).