COURT OF APPEALS OF VIRGINIA

Present: Chief Judge F itzpatrick, Judges Benton and Bumgardner Argued at Richmond, Virginia

HEALTH SYSTEMS AGENCY OF NORTHERN VIRGINIA, INC. OPINION BY v. Record No. 2669-04-4 J UDGE JAMES W. BENTON, JR. DECEMBER 28, 2005 ROBERT B. STROUBE, M.D., M.P.H., STATE HEALTH COMMISSIONER, NORTHERN VIRGINIA COMMUNITY HOSPITAL, L.L. C., LOUDOUN HOSPITAL CENTER, AND I NOVA HEALTH CARE SERVICES d/b/a INOVA FAIR OAKS HOSPITAL

FROM THE CIRCUIT C OURT OF LOUDOUN COUNTY Theodore J. Markow , Judge Designate K. Stewart Evans, Jr. (Pepper Ha milton LLP, on brief), for appellant. Matthew M. Cobb, Assistant At torney General (Judith Williams Jagdmann, Attorney General; Davi d E. Johnson, Deputy Attorney General; Jane D. Hickey, Senior Assistant Attorney General, on brief), for appellee Robert B. Stroube, M.D., M.P.H., State Health Commissioner. Jeannie A. Adams (Thomas F. Hancock, III; Hancock, Daniel, Johnson & Nagle, P.C., on brief), for appellee Northern Virginia Community Hospital, L.L.C. (Virginia H. Hackney; Mark S. Hedberg; W. Taylor Reveley, IV; Woodrow W. Turner, Jr.; Hunton & Williams, LLP, on brief), for appellee Loudoun Hospital Center . Appellee Loudoun Hospital Center submitting on brief. No brief or argument for appellee Inova Health Care Services, d/b/a Inova Fair Oaks Hospital.

The trial judge ruled that Health Systems Ag ency of Northern Virginia, a regional health planning agency that was a party to an admi nistrative proceeding under Article 1.1 of Title 32.1,- 2 - did not have standing to appeal the State Health Commissioner’s decision approving a hospital’s application for a certificate of public need. Health Systems Ag ency contends the trial judge erred in dismissing its petition for appeal. We affirm the trial judge’s standing decision and the order dismissing Health Systems’ petition.

I. As a prelude to considering the circumstan ces of this case, we review the statutory administrative structure that governs applications for certificates of public need for medical care

facilities. These statutes also illuminate the re lationship between the State Department of Health and regional health planning agencies, which is ge rmane to the standing issue we must consider. As a part of the comprehensive scheme for health care planning in Virginia, the General Assembly provided for health planning and resource development. See Code §§ 32.1-122.01 to 32.1-122.08. The General Assembly authorized the State Board of Health to develop a State

Health Plan with the assistan ce of regional health planning agencies. Code §§ 32.1-122.03 to 32.1-122.05. These health planning agencies were cr eated “[f]or the purpose of representing the interests of health planning regions and perfor ming health planning activ ities at the regional level.” Code § 32.1-122.05(A). Among the statutor ily required functions of health planning agencies is reviewing applications for certificates of public need for medi cal care facilities. Code § 32.1-102.6(B). 1

1 Health planning agencies also perform functi ons outside of the admi nistrative review of certificate of public need applications. See Code §§ 32.1-122.04, 32.1-122.05, 32.1-122.07. In developing a rural health plan, the Commissioner may seek assistance from the health planning agency. Code § 32.1-122.07(D). Buyers of certa in medical equipment must register such purchases with the Commissioner and the releva nt health planning agency. Code § 32.1-102.1:1. Health planning agencies ai d the Board of Health by: (i) conducting data colle ction, research and analyses as required by the Board; (ii) preparing reports and studies in consultation and cooperation with the Board; (iii ) reviewing and commenting on the components of the State Health Plan; (iv) conducting needs- 3 - As a medical care facility, a hospital must obtain a certificate of public need before undertaking a project enumerated in Code § 32.1-102.1. For example, a hospital must obtain a certificate of public need to esta blish a medical facility, increase the number of beds or operating rooms in an existing facility, relocate beds ( unless for nursing home care), add a new nursing home service to an existing facili ty, add certain clinical services such as psychiatric service or open heart surgery, convert existing beds to reha bilitation or psychiatri c beds, newly acquire certain medical equipment, or spend $5 million or more. Code §§ 32.1-102.1, 32.1-102.3. To apply for a certificate of public need, a hos pital must file a completed application with both the Department and the appropriate regional health planning agency. Code § 32.1-102.6(A). The hospital must send the appli cation by certified mail or delivery service with a return receipt requested, or deliver it “by hand” to obtain a signed receipt. Id. Within ten days of the application’ s receipt, the Department and the he alth planning agency shall notify the hospital whether the application is complete or more information is needed. Id. The health planning agency reviews the hospi tal’s application within sixty days of the start of the review cycle esta blished by the Department. C ode § 32.1-102.6(B). The health planning agency must hold a public hearing on each application and publish notice for that hearing. Id. The health planning agency is also re quired to notify local governments in the health care planning region of the impending hear ing and to consider th e comments of those governing bodies. Id. The health planning agency must c onsider all public comments it receives and give the applying hospital an opportunity to respond to any co mments that its staff has made

assessments as appropriate and serv ing as a technical resource to the Board; (v) identifying gaps in services, inappropriate use of services or resources and assess ing the accessibility of critical services; . . . and . . . conducting su ch other functions as directed by the regional health planning board. Code § 32.1-122.05(D).- 4 - about the proposal. Id. Within ten days of finishing its re view, the health planning agency must submit its recommendations concerning the application to the Department. Id. If it has not finished its review within the statutorily designa ted period, the Department must deem the health planning agency’s lack of response to be a recommended approval of the project. Id. The Department must begin its applicati on review simultaneously with the health planning agency’s review. Code § 32.1-102.6(D) . Although the Department has a Division of Certificate of Public Need that analyzes and i ssues reports on applicatio ns, the statute does not

reference the Division or its function. Id. Instead, the statute provides generally that the

Commissioner “shall make determin ations in accordance with the Administrative Process Act.”

Id.

To facilitate the Commissioner’s determin ation, the Department shall convene an informal fact-finding confer ence if “necessary.” Id. The Department’s guidelines provide that the Department will conduct an informal fact-fi nding conference if the Divi sion of Certificate of Public Need has recommended denial of the appli cation, if a regional heal th planning agency has recommended denial of the application, or if a person has challenged the application by seeking to show good cause as provided in Code § 32.1- 102.6(G). The General Assembly designated that the parties to the case before the Commissi oner “shall include only th e applicant, any person showing good cause, any third-party payor providing h ealth care insurance or prepaid coverage . . . or the health planning agency if its r ecommendation was to deny th e application.” Code § 32.1-102.6(D). 2

2 The statute was amended in 2005 to read as follows: Further, if an informal fact-findi ng conference is determined to be necessary by the Department or is requested by a person seeking good cause standing, the parties to the case shall include only the applicant, any person showing good cause, any third-party payor- 5 - Following this procedure, the Commissioner reviews the applicati on and may only issue a certificate if the applicant has demonstrated a public need for the project. Code § 32.1-102.3(A). The Commissioner has the discretion to approve all or part of an application, but the Commissioner’s decision to approve the issuance of a certificat e of need must be

consistent with the State Medical Facilities Plan, with limited statut ory exceptions. Id. In considering an application, the Commissioner is required to evaluate tw enty factors, including “[t]he recommendation and the reasons therefor of the appropriate hea lth planning agency.” Code § 32.1-102.3(B)(1). During the administrative proceeding, only the applicant has the authority to extend any of the time periods. Code § 32.1-102.6(I). If the Commissioner does not make a determination within forty-five days of the close of the re cord, the Commissioner must notify the applicants and anyone seeking to show good cause that th e application “shall be deemed approved 25 calendar days after expiration of such 45-calen dar-day period,” unle ss the hearing officer conducting the fact-finding conf erence permits the Commissi oner to rule within the twenty-five-day grace period. Code § 32.1-102.6(E)(6 ). If the Commissioner does not act after forty-five days, any competing applicant may petition for immediate injunctive relief, naming “as respondents the Commissioner and all par ties to the case.” Code § 32.1-102.6(E)(8). Otherwise, after seventy days of the closing of the record, if the Commissioner has not made a determination whether a public need exists, th e application will be deemed approved and the “certificate shall be granted.” Code § 32.1-102.6(E)(7). A “deemed approval” is to be construed

providing health care insurance . . . and the relevant health planning agency. Thus, the regional health planning agency now ha s standing as a party to the administrative proceeding regardless of its recommendation.- 6 - as a case decision and “subject to judicial review on appeal as the Commissioner’s case decision.” Code § 32.1-102.6(F).

II. In 2002, in accordance with these statutor y provisions, Northern Virginia Community Hospital, L.L.C. filed with the State Department of Health and the Health Systems Agency of Northern Virginia, the regional health planning ag ency, an application for a certificate of public

need. See Code §§ 32.1-102.3 and 32.1-102.6. The applicat ion proposed to replace two of its existing hospitals (one in Arli ngton County and one in Fairfax County) with a new one hundred and eighty bed hospital (Broadlands Medical Ce nter) in Loudoun County. At the same time, three other hospitals in the northern Virginia regional area filed applications for certificates of public need for hospital projects . Loudoun Hospital Center proposed to add space for thirty-two beds in its hospital in Loudoun County. Inova Health Care Services sought to add forty beds at Inova Fair Oaks Hospital in Fairfax County. Potomoc Hospital proposed to rebuild the medical-surgical area at its hospita l and to add thirty beds. During the administrative review, Health Systems Agency recommended to the Department that it deny the application from Co mmunity Hospital and appr ove the applications from the three other hospitals. See Code § 32.1-102.6(B). Th e Division of Certificate of Public Need recommended approval of only the Potomoc Hospital application. At the conclusion of these reviews, the Commissioner approved only th e application from Potomoc Hospital, ruling that a public need did not ex ist for the projects proposed by Community Hospital, Loudoun Hospital, and Inova Hospital. Community Hospita l appealed the Commissioner’s denial of its application to the circuit court. Neithe r Inova Hospital nor Lo udoun Hospital appealed. While its appeal was pending in the circuit court, Community Hospital filed another certificate of public need app lication with the Department and Health Systems Agency,- 7 - proposing a modified Broadlands Medical Center (Broadlands II). In response to Community Hospital’s modified application, both Inova Hospital and Loudoun Hospital filed modified applications proposing competing projects at their hospitals. Th e appeal currently before us

arises from this second round of administrative proceedings. Upon receipt of the modified applications, the Department and Health Systems Agency began their statutory administrative functions. Th e Division of Certificate of Public Need and Health Systems Agency reviewed all three applic ations. As required by statute, Health Systems Agency held public hearings on the proposed proj ects. At least one local governing body, the board of supervisors of Arlington County, informed Health Systems Agency of its objections to the Broadlands II project. Health Systems Agency’s staff issued a report noting that current bed capacity already met the needs of the region and concluding that none of the three proposals were in the regional public’s interest. The repor t also indicated that the same conditions that resulted in denial of the app lications in the first administrative proceedings still existed. Following the public hearing and the staff report, the board of directors of Health Systems Agency recommended that the Comm issioner deny all three projects.

Two weeks later the Division of Certificate of Public Need issued its report, noting that the Broadlands II “project is not consistent with many of the applicable provisions of the State Medical Facilities Plan.” Its staff report al so recommended denial of all three competing applications. Following these reports, the Department conve ned an informal fact-finding conference. The entities designated by Code § 32.1-102.6(D) as parties to the case participated in the informal fact-finding conference: the applicants (Community Hospital, Loudoun Hospital, and Inova Hospital) and the regional h ealth planning agency (Health Sy stems Agency). The director

of the Division of Certificate of Public Need al so participated in the conference. Based upon the- 8 - informal conference and his review of the exte nsive administrative record, the hearing officer issued his reports recommending approval of Community Hospital’s application subject to conditions, approval of Inova Hospital’s applicat ion subject to conditions , and denial of Loudoun Hospital’s applications. The Commissioner acce pted the recommendations of the hearing officer, denying the Loudoun Hospital applicat ion and conditionally approving the Inova Hospital and Community Hospital applications. Health Systems Agency filed a petition fo r appeal in the circuit court, naming the Commissioner, Loudoun Hospital, Community Hospital, and Inova Hospital as respondents. It

contended that the Commissione r’s decision approving Community Hospital’s application for a certificate of public need for Broadlands II wa s “unlawful.” Loudoun Hospital filed a separate appeal of the Commissioner’s decision on a ll three applications. The Commissioner and Community Hospital filed demurrers and motions to dismiss Health Systems Agency’s appeal, arguing that it did not have the statutory authority to appeal the Commissioner’s decision. The trial judge sustained the demurrers and granted the motions to dismiss the petition for appeal. Relying upon Virginia Beach Beautificati on Commission v. Board of Zoning Appeals , 231 Va. 415, 344 S.E.2d 899 (1986), the judge ruled that Health Systems Agency “is not a party aggrieved and therefore lacks standing to appeal the Commissioner’s decision.” Health Systems Agency appeals this ruling.

III. Health Systems Agency contends it has stan ding to appeal the Comm issioner’s grant of a certificate of public need because it has a “sta tutorily mandated interest in preventing the Commissioner from arbitrarily ex ercising his powers” and because its appeal is necessary to fulfill its legislatively mandated duties. Loudoun Hospital supports the position advanced by Health Systems Agency. The Commissioner a nd Community Hospital contend, however, that- 9 - Health Systems Agency is not “aggrieved” by th e grant of the certificat e of public need and argue that Health Systems Agency acts only in a representative capacity during the administrative process to assist the Board of Health. The Comm issioner further contends that, because Health Systems Agency was a respondentin Loudoun Hospital’s appeal to the circuit court, any decision favorable to Health Systems Agency in this appeal would be an advisory opinion. As a general proposition, the Administrativ e Process Act governs the appeals process for administrative decisions, unless the agency’s basi c law provides otherwise. Kenley v. Newport News Gen. & Non-Sectarian Hosp. Ass’n , 227 Va. 39, 46, 314 S.E.2d 52, 56 (1984); Va. Bd. of Med. v. Va. Physical Therapy Ass’n , 13 Va. App. 458, 465, 413 S.E.2d 59, 63-64 (1991). Because the statutes governing certificates of public need generally are silent regarding procedures for judicial review of the Co mmissioner’s case decisions, we look to the

Administrative Process Act. Under the Ac t, “[a]ny person affected by and claiming the unlawfulness of any regulation, or party aggr ieved by and claiming unlawfulness of a case decision . . . shall have a right to the direct review thereof by . . . court action.” Code § 2.2-4026;

see also Kenley , 227 Va. at 46, 314 S.E.2d at 56. Thus, Health Systems Agency can appeal the Commissioner’s grant of a certificate of public need if (1) that acti on was a case decision, (2) Health Systems Agency was a named party in the administrative proceeding, and (3) the decision aggrieved Health Systems Agency. See Strawbridge v. County of Chesterfield , 23 Va. App. 493, 498, 477 S.E.2d 789, 792 (1996). All the parties to this app eal agree that the Commissione r’s decision was a case decision, that Health Systems Agency was a named party in the administrative proceedings, and that the determinative issue in this case is whether Health Systems Agency is “aggrieved.” The parties also agree that the Supreme Court’s decisions in Virginia Beach Beautification Commission , 231- 10 - Va. 415, 344 S.E.2d 899, and Board of Supervisor s of Fairfax County v. Board of Zoning Appeals , 268 Va. 441, 604 S.E.2d 7 (2004), provide guidance in determining who is “aggrieved.” In Virginia Beach Beautification Commission , a non-stock corporation of individuals and organizations that had the goal of maintaining Virg inia Beach as “one of the most beautiful cities in the state” sought to challeng e the board of zoning appeals grant of a zoning variance to a hotel. 231 Va. at 418, 344 S.E.2d at 902. The Supr eme Court noted that the civic entity owned no property, paid no city taxes, and sought “to advance some percei ved public right or to redress some anticipated public injury when the only wr ong . . . suffered [was] in common with other persons similarly situated.” Id. at 419, 344 S.E.2d at 902. Upholdi ng the trial judge’s denial of standing, the Supreme Court held that “[t]he wo rd ‘aggrieved’ in a statute contemplates a substantial grievance and means a denial of some personal or prope rty right, legal or equitable, or imposition of a burden or obligation upon the pe titioner different from that suffered by the public generally.” Id. at 419-20, 344 S.E.2d at 902-03. Thus, this voluntary civic organization, which had a mere intangible connection to the zoni ng decision, did not have an interest damaged by the decision to allow a variance from the heig ht and setback requireme nts the city’s zoning ordinance imposed for freestanding signs. Id. at 420, 344 S.E.2d at 903. By contrast, in Board of Supervisors of Fairfax County , the Supreme Court held that the board of supervisors had standing to appeal a decision by the board of zoning appeals granting a residential property owner a variance from a county zoning ordinance. 268 Va. at 446, 604

S.E.2d at 9. The Court held that the board of s upervisors had a statutorily recognized “interest in the proper and uniform application of its zoning ordinances” and a governmental need to “ensure compliance with its legislative enactments , including its zoning ordinance[s].” Id. These governmental functions sufficiently established “an immediate and substant ial interest in this- 11 - litigation.” Id. at 450, 604 S.E.2d at 11. Thus, the Ge neral Assembly’s statutory grant of authority to governing bodies informed, in part , the Supreme Court’s st anding decision. See id. In both cases, the Supreme Court referred to an established meaning of “aggrieved” as the guiding principle for its decision. “The term ‘aggrieved’ has a settled meaning in Virginia when it becomes necessary to determine who is a proper party to seek court relief from an adverse decisi on. In order for a petitioner to be ‘aggrieved,’ it must affirmativ ely appear that such person had some direct interest in the subjec t matter of the proceeding that he seeks to attack. [Nicholas v. Lawrence , 161 Va. 589, 592, 171 S.E. 673, 674 (1933)]. The petitioner ‘must show that he has an immediate, pecuniary and substantial interest in the litigation, and not a remote or indirect interest.’ [Id. at 593, 171 S.E. at 674]. Thus, it is not sufficient that the sole interest of the petitioner is to advance some perceived public right or to redress some anticipated public injury when the only wrong he has suffered is in common with other persons similarly situat ed. The word ‘aggrieved’ in a statute contemplates a substantial grievance and means a denial of some personal or property right, le gal or equitable, or imposition of a burden or obligation upon the pe titioner different from that suffered by the public generally. [Insurance Ass’n v. Commonwealth , 201 Va. 249, 253, 110 S.E.2d 223, 226 (1959)].” Board of Supervisors of Fairfax County , 268 Va. at 449-50, 604 S.E.2d at 11 (quoting Va. Beach

Beautification Comm’n , 231 Va. at 419-20, 344 S.E.2d at 902-03). Therefore, we too apply these principles as a guide to analyzi ng the issue of standing in this case. 3 Without any reference to Board of Supervisors of Fairfax County , the trial judge found that Health Systems Agency’s sole interest in the proceeding was “represe ntational, [which] is only an indirect interest.” Based on this finding, he ruled that Health Systems Agency’s interest did not meet the standards for an aggrieved part y. Health Systems Agen cy contends the trial

3 We recognize that the Court in Boar d of Supervisors of Fairfax County did not apply each factor encompassed by the meaning of “aggrieved.” See 268 Va. at 454-60, 604 S.E.2d at 13-17 (Kinser, J., dissenting) (noting that the majo rity fails to apply each factor of the definition when holding that the board of supervisors was “aggrieved”). Th e Court held, however, that at a minimum a necessary factor was a showing of “an immediate and substantial interest in the litigation.” Id. at 450, 604 S.E.2d at 11.- 12 - judge erred because it has a statutorily recognized “i nterest that arises out of legislated purposes

and/or duties” that constitutes a direct and substa ntial interest in the lit igation. Thus, it argues Board of Supervisors of Fairfax County controls the decision on its standing. The Commissioner contends that the trial j udge ruled correctly because the Board of

Health and the Commissioner are the entities manda ted by statute to protect the public health.

See Code § 32.1-2 (providing that “the State Board of Health and the State Health Commissioner, assisted by the St ate Department of Health, sh all administer and provide a comprehensive program of preventive, curative, re storative, and environmen t health services”). Consequently, the Commissioner argues, regional health planning agencies act solely in a representative capacity similar to the non-stock corporation in Virginia Beach Beautification

Commission

. We recognize that the General Assembly crea ted health planning agencies to serve as a significant aid to the development of health pr ograms and planning for Virginia. This is an important distinction between H ealth Systems Agency and voluntar y civic organizations such as the one discussed in Virginia Beach Beautification Commission . The duties of “representing the interests of health planning regions and perfor ming health planning activ ities at the regional level” are significant in Virgin ia’s comprehensive health car e planning. Code § 32.1-122.05(A). Yet, health planning agencies’ primary responsibilitie s arise out of “assist[ing] the Board of Health.” Code § 32.1-122.05(D). They do so by: (i) conducting data colle ction, research and analyses as required by the Board; (ii) preparing reports and studies in consultation and cooperation with the Board; (iii ) reviewing and commenting on the components of the State Health Plan; (iv) conducting needs assessments as appropriate and serv ing as a technical resource to the Board; (v) identifying gaps in services, inappropriate use of services or resources and a ssessing accessibility of critical services; (vi) reviewing applicatio ns for certificates of public need and making recommendations to the Department thereon as- 13 - provided in § 32.1-102.6; and (vii) conducting such other functions as directed by the regional health planning board.

Id. These responsibilities and other duties of regional health planning agencies are of an advisory nature. The statutes create a scheme in which the Bo ard of Health, Department of Health, Commissioner, and health planning agenci es work together to accomplish the same end of promoting the public’s health care interest. Th e statutory scheme does not suggest that health planning agencies need to be able to appeal the Commissioner’s decisions with which they disagree in order to fulfill thei r legislated purposes and functions. At the administrative proceedings in this case, Health Systems Agency recommended that the Commissioner deny all the applications. This recommendation was made after a thorough review of the documents and following considera tion of the comments received from the public and the local governing bodies. A ccepting as true Health Systems Agency’s claim in its petition for appeal that the Commissioner’s approval of Community Hospital’s application violated the State Medical Facilities Plan and was “unlawful, ” we cannot conclude, as the Supreme Court did in Board of Supervisors of Fairfax County , that Health Systems Agency has an immediate and

substantial interest in the li tigation. The Commissioner did no t vitiate any governmental or statutory authority of Health Systems Agency by not following its recommendation. Health Systems Agency performed its statutory role and made its recommendations. Unlike the appellant in Board of Supervisors of Fairfax County , Health Systems Agency does not point to any statute granting the “broad power to institute actions in its own name.” 268 Va. at 446, 604 S.E.2d at 9. In Pearsall v. The Virginia Racing Commission , 26 Va. App. 376, 494 S.E.2d 879 (1998), we noted that the Supreme Court has held that “‘[a]n individual or entity does not acquire standing to sue in a representa tive capacity by asserting the rights of another, unless authorized by statute to do so.’” Id. at 382, 494 S.E.2d at 882 (quoting W.S. Carnes, Inc.- 14 - v. Bd. of Supervisors , 252 Va. 377, 383, 478 S.E.2d 295, 300 (1996)). As we further noted in

Pearsall , the absence of statutory au thorization has added signifi cance when the suit is brought against a state agency because we are required to “construe the Commonwe alth’s waiver of its sovereign immunity narrowly.” 26 Va. App. at 383, 494 S.E.2d at 883. The statutes concerning certificates of public need do not define the class of persons who may appeal the Commissioner’s decision. The statutes only address litigation in two circumstances. One statute provides that, if the Commissioner issues a certificate for only a portion of a project, “any appeal may be limited to the part of the decision with which the appellant disagrees without affecting the remainde r of the decision.” Code § 32.1-102.3(A) (emphasis added). The statute doe s not otherwise describe who ma y appeal. In another section, the statute provides for health planning agency in volvement in a certificate of public need case at

the circuit court level: when the Commissi oner has overly delayed on making a decision, a competing applicant can petition for injuncti ve relief and name “as respondents the Commissioner and all parties to the case.” C ode § 32.1-102.6(E)(8). In that circumstance, the health planning agency is a party to the cas e only “if its recommenda tion was to deny the application.” Code § 32.1-102.6(D). 4 The legislature could have expanded health pl anning agencies’ powers to sue or be sued

but did not do so. 5 The legislature chose not to delin eate further health planning agency participation outside of the Commissioner’s revi ew process. We believe this omission is

4 In accordance with the statute as now wr itten, the health planning agency must be named as a respondent in all cases where an ap plicant seeks injunctive relief after delay.

5 At least one other jurisdiction authorizes its comparable entity to appeal the Department of Health’s decision concerning a certificate of need. See , e.g. , D.C. Code § 44-413 (providing that the final decision of the Depa rtment of Health concerning cer tificates of public need may be appealed by the Statewide H ealth Coordinating Council to the Office of Administrative Hearings).- 15 - significant and persuasive as to health planni ng agencies’ legislated purpose and functions. Simply put, the legislature creat ed regional health planning agen cies to give assistance and advice to the Department, but ga ve it no authorization to a ppeal from the Commissioner’s

decision. We conclude, therefore, that Health System s Agency has not demonstrated “a substantial grievance” or “an immediate and su bstantial interest in this liti gation” as required by Board of Supervisors of Fairfax County . 268 Va. at 450, 450, 604 S.E.2d at 11, 11. Consequently, Health Systems Agency is not “aggrieved” and does not have standing to appe al the Commissioner’s decision rejecting its recommendati on to deny a certificate of public need application. For these reasons, we affirm the decision of the circuit court.

Affirmed.