Title: Ex parte Sacred Heart Health System, Inc. PETITION FOR WRIT OF CERTIORARI TO THE COURT OF CIVIL APPEALS (In re: Infirmary Health System and South Baldwin Regional Medical Center v. Sacred Heart Health System, Inc.)
Citation: N/A
Docket Number: 1091788
State: Alabama
Issuer: Alabama Supreme Court
Date: November 21, 2012

R e l : 11/21/2012 
N o t i c e : 
T h i s 
o p i n i o n i s s u b j e c t t o f o r m a l 
r e v i s i o n b e f o r e 
p u b l i c a t i o n i n 
t h e 
advance 
s h e e t s o f 
Southern Reporter. 
R e a d e r s a r e 
r e q u e s t e d t o n o t i f y t h e 
Reporter of 
Decisions, 
Alabama 
A p p e l l a t e 
C o u r t s , 
300 D e x t e r Avenue, Montgomery, Alabama 36104-3741 
((334) 
2 2 9 - 0 6 4 9 ) , o f 
any t y p o g r a p h i c a l o r o t h e r e r r o r s , i n 
o r d e r t h a t c o r r e c t i o n s may be made 
b e f o r e t h e 
o p i n i o n i s 
p r i n t e d i n 
Southern Reporter. 
SUPREME COURT OF ALABAMA 
OCTOBER TERM, 2012-2013 
1091788 
Ex parte Sacred Heart Health System, 
Inc. 
PETITION FOR WRIT OF CERTIORARI 
TO THE COURT OF CIVIL APPEALS 
(In r e : Infirmary Health System and South Baldwin Regional 
Medical Center 
v. 
Sacred Heart Health System, 
Inc.) 
(Montgomery C i r c u i t Court, CV-07-900905; 
Court of C i v i l Appeals, 2090239) 
On A p p l i c a t i o n f o r Rehearing 
1091788 
MAIN, J u s t i c e . 
The 
o p i n i o n of March 2, 
2012, 
i s withdrawn, 
and 
the 
f o l l o w i n g i s s u b s t i t u t e d 
t h e r e f o r . 
S a c r e d Heart H e a l t h System, I n c . 
("Sacred 
H e a r t " ) , the 
d e f e n d a n t i n a d e c l a r a t o r y - j u d g m e n t a c t i o n f i l e d by I n f i r m a r y 
H e a l t h 
System, 
I n c . 
("IHS"), 
and 
South 
B a l d w i n 
R e g i o n a l 
M e d i c a l C e n t e r ("South B a l d w i n " ) ,
1 a p p e a l e d t o t h i s C o u r t from 
one 
a s p e c t 
of a 
f i n a l judgment e n t e r e d by 
the Montgomery 
C i r c u i t C o u r t i n f a v o r of IHS 
and South B a l d w i n . 
IHS 
and 
South B a l d w i n c r o s s - a p p e a l e d from a n o t h e r a s p e c t o f the 
t r i a l 
c o u r t ' s judgment 
i n f a v o r 
of 
S a c r e d 
H e a r t . 
T h i s 
C o u r t 
t r a n s f e r r e d the a p p e a l and c r o s s - a p p e a l t o the C o u r t of 
C i v i l 
A p p e a l s ; t h a t c o u r t r e v e r s e d the judgment o f the t r i a l c o u r t . 
S a c r e d Heart H e a l t h Sys., I n c . v. I n f i r m a r y H e a l t h Sys., 
[Ms. 
2090239, September 24, 2010] 
So. 3d 
( A l a . C i v . App. 
2010). 
S a c r e d Heart then 
f i l e d 
a p e t i t i o n 
f o r 
c e r t i o r a r i 
r e v i e w w i t h t h i s C o u r t , which we g r a n t e d . 
We now r e v e r s e and 
remand. 
I . F a c t s and P r o c e d u r a l H i s t o r y 
1 I t i s u n c l e a r from the r e c o r d what t y p e o f e n t i t y 
South 
B a l d w i n i s . 
2 
1091788 
S a c r e d Heart i s 
an o u t - o f - s t a t e , c h a r i t a b l e , n o n p r o f i t 
c o r p o r a t i o n 
t h a t 
p r o v i d e s 
h e a l t h - c a r e 
s e r v i c e s 
i n t h e 
panhandle o f F l o r i d a and 
i n 
s o u t h e r n B a l d w i n County. 
S a c r e d 
Heart 
a l s o 
owns 
S a c r e d 
Heart 
M e d i c a l 
Group 
("SHMG"), 
c o n s i s t i n g o f 
143 m u l t i - s p e c i a l t y p h y s i c i a n s who p r a c t i c e 
i n 
the a r e a s e r v e d by S a c r e d H e a r t . SHMG i s 
n o t 
a s e p a r a t e 
l e g a l 
e n t i t y . 
A l l 
SHMG p h y s i c i a n s have u n i f o r m employment c o n t r a c t s 
w i t h SHMG; b i l l i n g 
f o r a l l p a t i e n t s i s c o n s o l i d a t e d and 
h a n d l e d by 
SHMG e m p l o y e e s ; t h i r d - p a r t y p r o v i d e r s c o n s i d e r SHMG 
a m e d i c a l 
g r o u p ; and i t s p h y s i c i a n s share t h e 
same 
b i l l i n g 
number. 
S i x SHMG p h y s i c i a n s p r a c t i c e i n 
s o u t h e r n B a l d w i n County. 
When t h e i r p r a c t i c e s i n c r e a s e d and i t 
was n o t f e a s i b l e t o 
expand 
t h e i r 
e x i s t i n g 
o f f i c e s , 
S a c r e d 
H e a r t 
e x e c u t e d a 
p r e c o n s t r u c t i o n c o n t r a c t w i t h C o l o n i a l P i n n a c l e MOB, LLC, t h e 
w h o l l y 
owned 
s u b s i d i a r y o f Johnson 
Development, LLC, a 
d e v e l o p e r and 
b u i l d e r o f m e d i c a l 
o f f i c e b u i l d i n g s t h r o u g h o u t 
Alabama (both e n t i t i e s a r e h e r e i n a f t e r r e f e r r e d t o 
j o i n t l y as 
"Johnson 
Development"). 
The c o n t r a c t 
d e a l t 
w i t h 
S a c r e d 
H e a r t ' s p r o p o s e d 
l e a s e o f a p o r t i o n o f a b u i l d i n g t o be 
c o n s t r u c t e d 
p r i m a r i l y f o r m e d i c a l 
purposes 
( h e r e i n a f t e r 
3 
1091788 
r e f e r r e d t o 
as " t h e m e d i c a l - b u i l d i n g p r o j e c t " ) . 
S a c r e d Heart 
has no ownership i n t e r e s t i n 
t h e 
m e d i c a l - b u i l d i n g p r o j e c t o r 
the 
l a n d on which t h e m e d i c a l - b u i l d i n g 
p r o j e c t i s l o c a t e d . 
Johnson Development's i n i t i a l p l a n s f o r 
t h e m e d i c a l - b u i l d i n g 
p r o j e c t c a l l e d f o r 
a 4 4 , 0 0 0 - s q u a r e - f o o t b u i l d i n g t h a t would 
i n c l u d e an o u t p a t i e n t 
s u r g e r y 
c e n t e r , 
m e d i c a l - o f f i c e 
s u i t e s 
f o r SHMG p h y s i c i a n s , 
t i m e - s h a r e space f o r 
use by non-SHMG 
p h y s i c i a n s , 
a 
d i a g n o s t i c 
c e n t e r , 
a 
l a b o r a t o r y , 
and a 
r e h a b i l i t a t i o n c e n t e r , a l l 
o f 
which would be l e a s e d t o v a r i o u s 
e n t i t i e s i n c l u d i n g S a c r e d H e a r t . 
S a c r e d Heart i n t e n d s f o r 
t h e 
SHMG p h y s i c i a n s p r a c t i c i n g i n 
t h e 
m e d i c a l - b u i l d i n g p r o j e c t t o 
p r o v i d e a f a m i l y p r a c t i c e , w a l k - i n 
c a r e , and l a b o r a t o r y and 
d i a g n o s t i c f a c i l i t i e s . 
S a c r e d Heart a l s o p l a n s t o r e c r u i t an 
o n c o l o g i s t t o o f f e r 
s e r v i c e s t o i n c l u d e mammography and 
CT 
scans who would have an o f f i c e and d i a g n o s t i c 
f a c i l i t i e s i n 
the m e d i c a l - b u i l d i n g 
p r o j e c t . 
Three SHMG p h y s i c i a n s a l r e a d y use 
t h e l e a s e d space i n t h e 
m e d i c a l - b u i l d i n g 
p r o j e c t as t h e i r p r i m a r y 
o f f i c e ; t h e r e i s 
space f o r e i g h t p h y s i c i a n s . The a r e a i n t e n d e d f o r t h e s u r g e r y 
c e n t e r was t o have been l e a s e d t o and o p e r a t e d by 
P l e a s u r e 
I s l a n d A m b u l a t o r y S u r g e r y C e n t e r , LLC, 
a group o f non-SHMG 
4 
1091788 
p h y s i c i a n s . 
P l e a s u r e I s l a n d a p p l i e d f o r a c e r t i f i c a t e o f 
need 
("CON") t o o p e r a t e t h e s u r g e r y c e n t e r , b u t 
t h e S t a t e 
H e a l t h 
P l a n n i n g 
and Development 
Agency 
("SHPDA") 
d e n i e d i t s 
a p p l i c a t i o n . 
The C o u r t o f C i v i l A p p e a l s a f f i r m e d , 
w i t h o u t 
o p i n i o n , 
t h e 
t r i a l 
c o u r t ' s 
judgment 
u p h o l d i n g 
SHPDA's 
d e c i s i o n . 
P l e a s u r e 
I s l a n d A m b u l a t o r y S u r g e r y C t r . , LLC 
v. 
 
S t a t e H e a l t h P l a n n i n g & Dev. Agency (No. 
2080953, A p r i l 16, 
2010), 82 So. 
3d 
17 ( A l a . C i v . App. 
2010) ( t a b l e ) . 
T h e r e f o r e , 
the 
m e d i c a l - b u i l d i n g 
p r o j e c t 
w i l l 
n o t c o n t a i n a 
s u r g e r y 
c e n t e r , n o r w i l l i t 
c o n t a i n a r e h a b i l i t a t i o n 
c e n t e r . The 
i n i t i a l p l a n t o l e a s e space f o r 
a r e h a b i l i t a t i o n c e n t e r was 
abandoned b e f o r e Johnson Development c o m p l e t e d t h e m e d i c a l -
b u i l d i n g p r o j e c t . 
The 
c o n t e s t e d 
i s s u e between t h e p a r t i e s i s 
whether t h e 
p o r t i o n o f t h e m e d i c a l - b u i l d i n g 
p r o j e c t 
S a c r e d 
Heart has 
l e a s e d f o r i t s B a l d w i n 
County p h y s i c i a n s t o use ("the 
SHMG 
l e a s e d space") i s 
s u b j e c t t o S a c r e d H e a r t ' s 
f i r s t o b t a i n i n g a 
CON from SHPDA.
2 
S e c t i o n 22-21-260 e t seq., A l a . Code 
1975, 
2 I n e x a m i n i n g t h e m e d i c a l - b u i l d i n g p r o j e c t as a whole, 
t h i s C o u r t does n o t 
r e f e r t o 
t h e 
e n t i r e b u i l d i n g c o n s t r u c t e d 
by Johnson Development, which c o n t a i n s space f o r m e d i c a l and 
n o n - m e d i c a l u s e s , b u t 
t o 
t h e 
p o r t i o n o f 
t h e 
b u i l d i n g l e a s e d by 
the 
s p e c i f i c 
p h y s i c i a n s ' 
p r a c t i c e 
s e e k i n g 
t o a p p l y t h e 
p h y s i c i a n ' s o f f i c e exemption t o 
t h e 
CON r e q u i r e m e n t . 
I n t h i s 
5 
1091788 
s e t s out t h e l a w c o n c e r n i n g t h e r e g u l a t i o n o f h e a l t h - c a r e 
f a c i l i t i e s . 
S e c t i o n 
22-21-265, A l a . 
Code 1975, r e q u i r e s 
t h a t any 
p e r s o n f u r n i s h i n g a "new i n s t i t u t i o n a l h e a l t h s e r v i c e " must 
f i r s t o b t a i n a CON from SHPDA: 
"(a) On o r a f t e r J u l y 30, 1979, 
no p e r s o n t o 
w h i c h t h i s a r t i c l e a p p l i e s s h a l l a c q u i r e , c o n s t r u c t , 
or o p e r a t e a new i n s t i t u t i o n a l 
h e a l t h s e r v i c e , as 
d e f i n e d i n t h i s 
a r t i c l e , o r f u r n i s h o r o f f e r , o r 
p u r p o r t 
t o f u r n i s h a new 
i n s t i t u t i o n a l 
h e a l t h 
s e r v i c e , as d e f i n e d i n t h i s 
a r t i c l e , o r make an 
arrangement o r 
commitment f o r f i n a n c i n g t h e o f f e r i n g 
of a new i n s t i t u t i o n a l 
h e a l t h s e r v i c e , u n l e s s t h e 
p e r s o n 
s h a l l 
f i r s t 
o b t a i n 
from 
t h e SHPDA a 
c e r t i f i c a t e o f need t h e r e f o r . ... 
" 
S e c t i o n 
22-21-263, 
A l a . Code 
1975, 
p r o h i b i t s 
i n s t i t u t i o n a l h e a l t h s e r v i c e s t h a t a r e 
i n c o n s i s t e n t w i t h 
t h e 
" S t a t e H e a l t h 
P l a n " :
3 
"(a) A l l 
new i n s t i t u t i o n a l h e a l t h s e r v i c e s which 
are s u b j e c t t o t h i s 
a r t i c l e and which a r e p r o p o s e d 
t o be o f f e r e d o r 
d e v e l o p e d w i t h i n t h e 
s t a t e s h a l l be 
s u b j e c t 
t o 
r e v i e w 
under 
t h i s 
a r t i c l e . 
No 
i n s t i t u t i o n a l h e a l t h s e r v i c e s w h i c h a r e s u b j e c t t o 
t h i s 
a r t i c l e 
s h a l l 
be 
p e r m i t t e d 
which a r e 
i n c o n s i s t e n t w i t h t h e S t a t e H e a l t h 
P l a n . 
F o r t h e 
case, we r e v i e w t h e 
SHMG l e a s e d space because t h a t i s 
t h e o n l y 
space t o 
be used by t h e 
SHMG p r a c t i c e . 
3The " S t a t e H e a l t h 
P l a n " i s 
d e f i n e d a t 
§ 22-21-260(13), 
A l a . Code 1975, 
as " [ a ] comprehensive p l a n w h i c h i s 
p r e p a r e d 
t r i e n n i a l l y and r e v i e w e d a t l e a s t 
a n n u a l l y and r e v i s e d as 
n e c e s s a r y 
" 
6 
1091788 
p u r p o s e s o f t h i s 
a r t i c l e , new i n s t i t u t i o n a l 
h e a l t h 
s e r v i c e s s h a l l i n c l u d e any o f t h e f o l l o w i n g : 
" ( 1 ) The 
c o n s t r u c t i o n , d e v e l o p m e n t , 
a c q u i s i t i o n t h r o u g h l e a s e o r p u r c h a s e , o r 
o t h e r 
e s t a b l i s h m e n t 
of a new h e a l t h 
care 
f a c i l i t y 
o r 
h e a l t h 
m a i n t e n a n c e 
o r g a n i z a t i o n . " 
The term " i n s t i t u t i o n a l h e a l t h s e r v i c e s " i s d e f i n e d a t § 
22-21-260(9), A l a . 
Code 1975, as " [ h ] e a l t h s e r v i c e s 
p r o v i d e d 
i n or t h r o u g h h e a l t h 
care 
f a c i l i t i e s o r h e a l t h maintenance 
o r g a n i z a t i o n s , i n c l u d i n g t h e e n t i t i e s i n 
o r t h r o u g h which such 
s e r v i c e s a r e p r o v i d e d . " 
The emphasized language i n § 22-21-260(8), A l a . Code 
1975, 
d e f i n i n g " h e a l t h s e r v i c e s , " p r o v i d e s an exemption f o r 
a 
p h y s i c i a n ' s p r a c t i c e : 
"(8) H e a l t h s e r v i c e s . C l i n i c a l l y r e l a t e d 
( i . e . , 
d i a g n o s t i c , c u r a t i v e , or r e h a b i l i t a t i v e ) 
s e r v i c e s , 
i n c l u d i n g 
a l c o h o l , drug abuse, and m e n t a l 
h e a l t h 
s e r v i c e s 
c u s t o m a r i l y 
f u r n i s h e d 
on 
e i t h e r 
i n - p a t i e n t 
or 
o u t - p a t i e n t 
b a s i s 
by 
h e a l t h 
an 
care 
f a c i l i t i e s , b u t not i n c l u d i n g t h e l a w f u l p r a c t i c e of  
any 
p r o f e s s i o n or v o c a t i o n 
c o n d u c t e d i n d e p e n d e n t l y  
of a h e a l t h 
care 
f a c i l i t y and i n a c c o r d a n c e 
w i t h 
 
a p p l i c a b l e l i c e n s i n g laws of t h i s s t a t e . " 
(Emphasis added.) 
S e c t i o n 22-21-2 
6 0 ( 6 ) , A l a . 
Code 1975, d e f i n e s a " h e a l t h 
care 
f a c i l i t y " as f o l l o w s : 
7 
1091788 
"(6) 
H e a l t h 
care 
f a c i l i t y . 
G e n e r a l 
and 
s p e c i a l i z e d 
h o s p i t a l s , 
i n c l u d i n g 
t u b e r c u l o s i s , 
p s y c h i a t r i c , 
l o n g - t e r m 
c a r e , 
and o t h e r 
t y p e s o f 
h o s p i t a l s , 
and 
r e l a t e d 
f a c i l i t i e s 
such 
as, 
l a b o r a t o r i e s , 
o u t - p a t i e n t 
c l i n i c s , 
and 
c e n t r a l 
s e r v i c e 
f a c i l i t i e s 
o p e r a t e d 
i n c o n n e c t i o n 
w i t h 
h o s p i t a l s ; s k i l l e d n u r s i n g 
f a c i l i t i e s ; 
i n t e r m e d i a t e 
care 
f a c i l i t i e s ; s k i l l e d o r i n t e r m e d i a t e 
care 
u n i t s 
o p e r a t e d i n v e t e r a n s ' 
n u r s i n g homes and 
v e t e r a n s ' 
homes 
... 
; 
r e h a b i l i t a t i o n 
c e n t e r s ; 
p u b l i c 
h e a l t h 
c e n t e r s ; 
f a c i l i t i e s 
f o r s u r g i c a l 
t r e a t m e n t 
o f 
p a t i e n t s 
n o t 
r e q u i r i n g 
h o s p i t a l i z a t i o n ; k i d n e y 
d i s e a s e 
t r e a t m e n t 
c e n t e r s 
... 
; community 
m e n t a l 
h e a l t h c e n t e r s and r e l a t e d f a c i l i t i e s ; a l c o h o l and 
drug 
abuse 
f a c i l i t i e s ; 
f a c i l i t i e s 
f o r t h e 
d e v e l o p m e n t a l l y d i s a b l e d ; h o s p i c e s e r v i c e p r o v i d e r s ; 
and 
home 
h e a l t h 
a g e n c i e s and h e a l t h 
maintenance 
o r g a n i z a t i o n s . 
The term h e a l t h care 
f a c i l i t y 
s h a l l 
 
not 
i n c l u d e t h e o f f i c e s o f p r i v a t e p h y s i c i a n s o r  
d e n t i s t s , whether f o r 
i n d i v i d u a l o r group p r a c t i c e s  
and r e g a r d l e s s o f ownership 
.." 
(Emphasis added.) 
The language emphasized above i s r e f e r r e d 
t o as t h e p h y s i c i a n ' s 
o f f i c e exemption ("the 
POE"). 
A f t e r S a c r e d H e a r t c o n t r a c t e d t o l e a s e a p o r t i o n o f 
t h e 
m e d i c a l - b u i l d i n g p r o j e c t , South B a l d w i n f i l e d a p e t i t i o n w i t h 
SHPDA i n w h i c h i t 
r e q u e s t e d t h a t SHPDA d e c l a r e 
t h a t 
S a c r e d 
H e a r t ' s p l a n s t o 
d e v e l o p t h e 
m e d i c a l - b u i l d i n g p r o j e c t r e q u i r e d 
t h a t S a c r e d H e a r t o b t a i n a CON from SHPDA. IHS i n t e r v e n e d i n 
s u p p o r t o f South B a l d w i n ' s p e t i t i o n . 
The a d m i n i s t r a t i v e law 
j u d g e a s s i g n e d t o hear t h e p e t i t i o n d e t e r m i n e d t h a t SHPDA d i d 
not 
have 
j u r i s d i c t i o n 
and remanded t h e p e t i t i o n 
t o t h e 
8 
1091788 
C e r t i f i c a t e o f Need Review B o a r d ("the 
CONRB"). 
When 
t h e 
p e t i t i o n was n o t r u l e d on w i t h i n 45 days, t h e p e t i t i o n was 
deemed d e n i e d p u r s u a n t t o 
§ 41-22-11, A l a . Code 1975. 
South 
B a l d w i n and 
IHS then f i l e d a p e t i t i o n f o r j u d i c i a l r e v i e w i n 
the Montgomery C i r c u i t C o u r t . 
The t r i a l c o u r t d e n i e d summary-
judgment motions f i l e d by the p a r t i e s and c o n s i d e r e d the case 
on a j o i n t s u b m i s s i o n o f 
t h e 
e v i d e n c e . 
The t r i a l c o u r t 
h e l d 
t h a t t h e 
SHMG l e a s e d space q u a l i f i e d f o r the POE a v a i l a b l e 
i n 
§ 22-21-260(6), A l a . Code 1975, and, 
t h e r e f o r e , t h a t t h e 
SHMG 
l e a s e d space was n o t a h e a l t h - c a r e 
f a c i l i t y 
r e q u i r i n g CON 
r e v i e w . 
South B a l d w i n and 
IHS f i l e d a postjudgment m o t i o n . 
The 
t r i a l 
c o u r t amended i t s judgment t o h o l d t h a t t h e 
SHMG 
l e a s e d space q u a l i f i e d f o r t h e 
POE o n l y as t o 
t h e 
t h r e e SHMG 
p h y s i c i a n s who had r e l o c a t e d t o 
t h e 
m e d i c a l - b u i l d i n g p r o j e c t 
from t h e i r s o u t h B a l d w i n County o f f i c e s . The t r i a l c o u r t a l s o 
h e l d t h a t a d d i n g a d d i t i o n a l p h y s i c i a n s o r 
p r o v i d i n g a d d i t i o n a l 
s e r v i c e s i n 
the m e d i c a l - b u i l d i n g p r o j e c t would r e q u i r e S a c r e d 
H e a r t t o o b t a i n a CON. 
On a p p e a l , t h e 
C o u r t o f C i v i l A p p e a l s r e v e r s e d the 
t r i a l 
c o u r t ' s judgment and remanded t h e case f o r 
t h e e n t r y o f a 
judgment d e c l a r i n g t h a t " t h e 
MOB [ m e d i c a l - o f f i c e - b u i l d i n g ] 
9 
1091788 
p r o j e c t , as d e v e l o p e d a whole," does not q u a l i f y f o r t h e 
POE 
and r e q u i r e s CON 
r e v i e w .
4 
So. 3d a t 
. 
The C o u r t o f 
C i v i l A p p e a l s a l s o d i r e c t e d the t r i a l c o u r t t o e n j o i n S a c r e d 
H e a r t 
from 
o f f e r i n g 
h e a l t h - c a r e s e r v i c e s 
i n the 
m e d i c a l -
b u i l d i n g p r o j e c t u n t i l i t s e c u r e s a 
CON. 
S a c r e d H e a r t f i l e d a p e t i t i o n f o r a w r i t of c e r t i o r a r i t o 
t h i s C o u r t and a s s e r t e d as a ground f o r r e v i e w t h a t t h i s case 
p r e s e n t s the f o l l o w i n g m a t e r i a l q u e s t i o n o f f i r s t i m p r e s s i o n : 
Whether the SHMG l e a s e d space and the h e a l t h - c a r e s e r v i c e s 
p r o p o s e d by S a c r e d H e a r t t o be o f f e r e d t h e r e i n q u a l i f y f o r the 
POE so t h a t S a c r e d H e a r t i s not r e q u i r e d t o s e c u r e a 
CON. 
I I . S t a n d a r d of Review 
"Our s t a n d a r d of r e v i e w of t h i s case i s governed 
by 
s t a t u t e . 
S e c t i o n 12-2-7(1), 
A l a . Code 
1975, 
s t a t e s : 
" ' [ I ] n d e c i d i n g a p p e a l s , no w e i g h t s h a l l be 
g i v e n the d e c i s i o n of the t r i a l j u d g e upon 
the f a c t s where the e v i d e n c e i s not t a k e n 
o r a l l y b e f o r e the j u d g e , but i n such cases 
the Supreme C o u r t s h a l l weigh the e v i d e n c e 
and g i v e judgment as i t deems j u s t . ' 
"In 
a case i n which a t r i a l c o u r t has not h e a r d 
l i v e 
t e s t i m o n y , 
t h i s 
C o u r t has h e l d t h a t 'a r e v i e w i n g 
c o u r t w i l l not a p p l y the p r e s u m p t i o n o f c o r r e c t n e s s 
4The C o u r t of C i v i l A p p e a l s ' o p i n i o n was a u t h o r e d by Judge 
Thomas. P r e s i d i n g Judge Thompson and Judge Bryan c o n c u r r e d i n 
the r e s u l t ; Judge P i t t m a n and Judge Moore d i s s e n t e d . 
10 
1091788 
t o a 
t r i a l 
c o u r t ' s 
f i n d i n g s of 
f a c t and 
t h a t 
the 
r e v i e w i n g 
c o u r t 
w i l l r e v i e w the e v i d e n c e de novo.' 
Eubanks v. H a l e , 752 
So. 
2d 1113, 
1122 
( A l a . 1999). 
Our 
s t a t u t o r y o b l i g a t i o n i n a case such as t h i s i s 
t o 
'weigh the 
e v i d e n c e and 
g i v e judgment as 
[we] 
deem[] 
j u s t . ' " 
B e n t l e y 
Sys., 
I n c . v. I n t e r g r a p h Corp., 922 
So. 
2d 61, 
70-71 
( A l a . 
2005). 
Moreover, we a l s o r e v i e w de novo a q u e s t i o n 
of 
law 
i n v o l v i n g s t a t u t o r y c o n s t r u c t i o n . 
W h i t e h u r s t v. Baker, 
959 
So. 
2d 69, 
70 
( A l a . 2006). 
I I I . 
A n a l y s i s 
S e c t i o n 
22-21-265, A l a . Code 
1975, 
r e q u i r e s 
t h a t 
the 
p r o v i d e r 
of any 
new 
i n s t i t u t i o n a l h e a l t h s e r v i c e must 
f i r s t 
o b t a i n a CON 
from SHPDA. 
By 
d e f i n i t i o n , t o be 
c o n s i d e r e d 
a 
new 
" i n s t i t u t i o n a l 
h e a l t h 
s e r v i c e , " 
the 
p r o v i d e r 
of 
the 
s e r v i c e must o f f e r " h e a l t h s e r v i c e s " i n or t h r o u g h a 
" h e a l t h 
care 
f a c i l i t y . " 
As d e f i n e d 
i n the a p p l i c a b l e s t a t u t e s , 
the 
terms 
" h e a l t h 
s e r v i c e s " 
and 
" h e a l t h 
care 
f a c i l i t y " 
b o t h 
i n c l u d e 
exemptions 
f o r 
a 
p h y s i c i a n ' s 
p r a c t i c e . 
" H e a l t h 
s e r v i c e s " 
do 
not 
i n c l u d e 
"the 
l a w f u l 
p r a c t i c e 
of 
any 
p r o f e s s i o n 
or v o c a t i o n 
c o n d u c t e d i n d e p e n d e n t l y of a 
h e a l t h 
care 
f a c i l i t y 
and 
i n a c c o r d a n c e w i t h 
a p p l i c a b l e 
l i c e n s i n g 
l a w s . " 
§ 22-21-260(8). 
A " h e a l t h 
care 
f a c i l i t y " does 
not 
i n c l u d e 
"the 
o f f i c e s 
of 
p r i v a t e 
p h y s i c i a n s 
or 
d e n t i s t s , 
11 
1091788 
whether 
f o r i n d i v i d u a l o r group p r a c t i c e s and r e g a r d l e s s o f 
o w n e r s h i p . " 
§ 22-21-260(6). 
The exemption f o r a p h y s i c i a n ' s p r a c t i c e c o n t a i n e d i n t h e 
d e f i n i t i o n 
o f h e a l t h 
s e r v i c e s 
i s b r o a d e r 
than t h e POE 
c o n t a i n e d i n 
t h e d e f i n i t i o n o f a h e a l t h - c a r e 
f a c i l i t y . 
I t 
exempts a p h y s i c i a n ' s 
p r a c t i c e o f h i s o r h e r p r o f e s s i o n so 
l o n g as i t 
i s conducted 
i n d e p e n d e n t l y o f a 
h e a l t h - c a r e 
f a c i l i t y . 
I f 
our i n q u i r y were l i m i t e d t o whether t h e 
SHMG 
p h y s i c i a n s whose o f f i c e s a r e 
l o c a t e d i n 
t h e m e d i c a l - b u i l d i n g 
p r o j e c t 
a r e engaged 
i n t h e l a w f u l 
p r a c t i c e 
o f 
t h e i r 
p r o f e s s i o n , 
t h e exemption 
i n t h e d e f i n i t i o n 
o f 
" h e a l t h 
s e r v i c e s " i n 
§ 22-21-260(8) would excuse S a c r e d Heart 
from 
o b t a i n i n g a CON f o r 
t h e SHMG l e a s e d 
space. 
However, t h e 
exemption i n § 22-21-260(8) a l s o r e q u i r e s t h a t the p r a c t i c e 
o f 
the 
p r o f e s s i o n a t i s s u e be c o n d u c t e d 
" i n d e p e n d e n t l y o f a 
h e a l t h c a r e f a c i l i t y , " so 
we must a l s o d e t e r m i n e whether t h e 
POE i n 
t h e d e f i n i t i o n o f " h e a l t h c a r e f a c i l i t y " i n 
§ 22-21-
260(6) 
f o r t h e " o f f i c e s 
o f p r i v a t e 
p h y s i c i a n s " 
e i t h e r 
i n d i v i d u a l l y 
o r i n a 
group 
p r a c t i c e , 
" r e g a r d l e s s 
o f 
o w n e r s h i p , " a p p l i e s t o 
t h e 
SHMG l e a s e d space. 
12 
1091788 
Our 
i n q u i r y 
i s g o v e r n e d by 
s e t t l e d 
p r i n c i p l e s o f 
s t a t u t o r y 
c o n s t r u c t i o n . 
"When i n t e r p r e t i n g a s t a t u t e , a c o u r t must 
f i r s t 
g i v e 
e f f e c t t o t h e i n t e n t o f t h e l e g i s l a t u r e . BP 
E x p l o r a t i o n & O i l , I n c . v. H o p k i n s , 678 
So. 
2d 
1052 
( A l a . 
1996). 
"'The 
fundamental 
r u l e o f s t a t u t o r y 
c o n s t r u c t i o n 
i s t h a t 
t h i s 
C o u r t i s 
t o 
a s c e r t a i n and e f f e c t u a t e t h e l e g i s l a t i v e 
i n t e n t as e x p r e s s e d i n 
t h e 
s t a t u t e . 
League 
 
of Women V o t e r s v. R e n f r o , 292 A l a . 
128, 
290 
So. 2d 
167 
(1974). 
I n 
t h i s 
a s c e r t a i n m e n t , we must l o o k t o 
t h e e n t i r e 
 
A c t i n s t e a d o f i s o l a t e d p h r a s e s o r c l a u s e s ; 
O p i n i o n o f 
t h e J u s t i c e s , 264 A l a . 176, 
85 
So. 2d 
391 (1956).' 
"Darks D a i r y , I n c . v. Alabama D a i r y Comm'n, 367 
So. 
2d 1378, 
1380 ( A l a . 1979) (emphasis added). 
To 
d i s c e r n t h e l e g i s l a t i v e i n t e n t , t h e 
C o u r t must 
f i r s t 
l o o k t o 
t h e 
language o f 
t h e s t a t u t e . 
I f , 
g i v i n g 
t h e 
s t a t u t o r y language i t s 
p l a i n and o r d i n a r y 
meaning, 
we c o n c l u d e t h a t t h e 
language i s 
unambiguous, t h e r e 
i s no room f o r j u d i c i a l 
c o n s t r u c t i o n . 
Ex p a r t e  
W a d d a i l , 827 So. 2d 789, 794 ( A l a . 2001) . 
I f 
a 
l i t e r a l 
c o n s t r u c t i o n 
would produce an a b s u r d and 
u n j u s t r e s u l t t h a t i s c l e a r l y i n c o n s i s t e n t w i t h t h e 
purpose 
and 
p o l i c y 
o f t h e 
s t a t u t e , 
such 
a 
c o n s t r u c t i o n i s 
t o 
be a v o i d e d . 
Ex p a r t e Meeks, 682 
So. 2d 423 ( A l a . 1996)." 
C i t y o f Bessemer v. M c C l a i n , 957 So. 
2d 1061, 1074-75 ( A l a . 
2006). 
"When a c o u r t c o n s t r u e s a s t a t u t e , '[w]ords used 
i n 
[the] 
s t a t u t e must be g i v e n t h e i r n a t u r a l , p l a i n , 
o r d i n a r y , 
and commonly u n d e r s t o o d meaning, and 
where p l a i n language 
i s 
13 
1091788 
used a c o u r t i s bound t o i n t e r p r e t t h a t language t o mean 
e x a c t l y what i t 
s a y s . ' " 
Ex p a r t e B e r r y h i l l , 801 So. 2d 7, 10 
( A l a . 2001) 
( q u o t i n g IMED Corp. v. Systems Eng'g 
A s s o c s . 
 
Corp. , 602 So. 2d 344, 346 
( A l a . 1 9 9 2 ) ) . 
As we have 
r e p e a t e d l y s t a t e d , t h e f u n c t i o n o f t h i s C o u r t i s 
" ' t o 
say what 
the law i s , 
n o t t o say what i t s h o u l d be.'" 
Ex 
p a r t e  
Achenbach, 783 So. 2d 4, 7 ( A l a . 2000) ( q u o t i n g DeKalb Cnty.  
LP Gas Co. v. Suburban Gas, I n c . , 
729 So. 2d 270, 276 ( A l a . 
1 9 9 8 ) ) . 
" ' " ' I t i s 
s e t t l e d t h a t c o u r t s s h o u l d g i v e g r e a t w e i g h t t o 
any r e a s o n a b l e c o n s t r u c t i o n o f 
a r e g u l a t o r y s t a t u t e adopted by 
the agency c h a r g e d w i t h t h e enforcement o f t h a t s t a t u t e . ' " ' " 
QCC, I n c . 
v. H a l l , 757 So. 2d 1115, 1119 ( A l a . 2000) 
( q u o t i n g 
N a t i o n s B a n k o f N o r t h C a r o l i n a , N.A. v. V a r i a b l e A n n u i t y 
L i f e 
 
I n s . Co., 513 U.S. 251, 256 (1995), q u o t i n g i n t u r n C l a r k e v.  
S e c u r i t i e s Indus. A s s ' n , 479 U.S. 388 (1987), q u o t i n g i n t u r n 
Investment Co. I n s t i t u t e v. Camp, 479 U.S. 388 (1971)). 
The 
CONRB has 
f o r m u l a t e d 
a 
f o u r - p a r t 
t e s t 
t h a t 
i t uses t o 
d e t e r m i n e whether t h e POE i s 
a p p l i c a b l e i n 
a g i v e n 
s i t u a t i o n . 
The t e s t was f i r s t s t a t e d i n 
CONRB A d m i n i s t r a t i v e R u l i n g Re:  
Heart-Lung A s s o c i a t e s o f A m e r i c a , P.C., DR-100 
(August 29, 
14 
1091788 
2001), a t 
p.3, 511, 
n.3, 
and r e s t a t e d i n 
CONRB A d m i n i s t r a t i v e 
R u l i n g Re: E a s t Alabama 
H e a l t h 
Care 
A u t h o r i t y d/b/a E a s t 
Alabama 
M e d i c a l 
C e n t e r 
v. 
I n s t i t u t e 
f o r 
Advanced 
C a r d i o v a s c u l a r Care & Community M e d i c a l Development, LLC, 
DR-
110 (May 
3, 2007), a t 
p.5 ("the Heart-Lung t e s t " ) . 
Under 
t h e 
Heart-Lung t e s t , t h e 
POE i s 
a p p l i c a b l e when i t 
i s 
shown: 
"1. 
That 
t h e p r o p o s e d 
s e r v i c e s 
a r e t o be 
p r o v i d e d , and r e l a t e d equipment used, e x c l u s i v e l y 
by 
the p h y s i c i a n s 
i d e n t i f i e d as owners o r employees o f 
the 
p h y s i c i a n s ' 
p r a c t i c e f o r t h e c a r e o f 
t h e i r 
p a t i e n t s . 
"2. 
That 
t h e p r o p o s e d 
s e r v i c e s 
a r e t o be 
p r o v i d e d , and r e l a t e d equipment used, a t 
t h e p r i m a r y 
o f f i c e o f such p h y s i c i a n s . 
"3. That a l l 
p a t i e n t b i l l i n g s 
r e l a t e d t o such 
s e r v i c e s a r e 
t h r o u g h , o r e x p r e s s l y on b e h a l f o f , t h e 
p h y s i c i a n s ' p r a c t i c e , and 
n o t 
on b e h a l f o f a t h i r d 
p a r t y . 
"4. That t h e equipment 
s h a l l n o t be used 
f o r 
i n p a t i e n t c a r e , n o r 
by, t h r o u g h o r on b e h a l f o f a 
h e a l t h c a r e 
f a c i l i t y . " 
S a c r e d H e a r t argues 
t h a t t h e s t a n d a r d a p p l i e d by 
t h e 
C o u r t o f C i v i l A p p e a l s t o d e t e r m i n e whether t h e 
SHMG 
l e a s e d 
space 
q u a l i f i e s f o r 
t h e POE i s a r b i t r a r y , s u b j e c t i v e , and 
unworkable and t h a t t h a t c o u r t 
e r r e d when i t 
h e l d t h a t t h e 
second f a c t o r o f 
t h e 
Heart-Lung t e s t had 
n o t 
been 
s a t i s f i e d . 
S a c r e d H e a r t f u r t h e r argues t h a t t h e i n j u n c t i o n d i r e c t e d t o 
be 
15 
1091788 
i s s u e d by t h e C o u r t o f C i v i l A p p e a l s was based p r i m a r i l y on 
t h a t c o u r t ' s 
a p p l i c a t i o n o f a s u b j e c t i v e and a r b i t r a r y 
t e s t 
t h a t t h i s C o u r t s h o u l d r e j e c t . 
The main o p i n i o n o f 
t h e C o u r t 
of 
C i v i l A p p e a l s s t a t e d t h a t t h e 
POE d i d 
n o t a p p l y 
because 
"the scope o f t h e 
MOB 
[ m e d i c a l - o f f i c e - b u i l d i n g ] p r o j e c t , as 
o r i g i n a l l y d e s i g n e d and d e v e l o p e d , r e a c h e s i n 
our minds t h e 
p o i n t 
r e f e r r e d t o by t h e CONRB i n DR-116, 'where an o u t ¬
p a t i e n t f a c i l i t y , even one d e v e l o p e d and 
owned by p h y s i c i a n s , 
goes beyond a common sense 
d e f i n i t i o n o f a 
" p h y s i c i a n ' s 
o f f i c e , " and i s s u b j e c t t o r e v i e w . ' " 
So. 3d a t 
. 
S a c r e d H e a r t contends t h a t t h i s s t a n d a r d does n o t 
p r o v i d e t h e 
c l a r i t y o r s p e c i f i c i t y n e c e s s a r y f o r p r e d i c t a b l e 
h e a l t h - c a r e 
p l a n n i n g and m a i n t a i n s t h a t i t 
s h o u l d be r e p l a c e d 
w i t h t h e 
Heart-Lung 
t e s t . 
S a c r e d Heart 
a l s o argues 
t h a t 
a l l f o u r 
f a c t o r s o f 
t h e 
Heart-Lung t e s t a r e 
met and t h a t t h e r e f o r e t h e 
POE i s 
a p p l i c a b l e t o 
t h e 
SHMG l e a s e d space. 
IHS and South B a l d w i n argue n o t o n l y t h a t t h e s t a t u t o r y 
r e q u i r e m e n t f o r CON r e v i e w a p p l i e s t o 
t h e o p e r a t i o n o f a new 
h e a l t h - c a r e 
f a c i l i t y , 
b u t a l s o 
t h a t t h e s t a t u t o r y scheme 
p r o h i b i t s d e v e l o p i n g , 
a c q u i r i n g , c o n s t r u c t i n g , o r o b t a i n i n g 
f i n a n c i n g f o r i n s t i t u t i o n a l 
h e a l t h 
s e r v i c e s 
w i t h o u t 
f i r s t 
16 
1091788 
o b t a i n i n g a CON. 
See § 22-21-2 
6 3 ( a ) , A l a . Code 1975. 
IHS 
argues i n i t s 
b r i e f t h a t , a c c o r d i n g t o § 22-21-2 
6 3 ( a ) , " S a c r e d 
H e a r t was o b l i g a t e d t o o b t a i n a CON p r i o r t o , and i n o r d e r 
t o , 
engage i n t h e c o n s t r u c t i o n , development or l e a s e o f the new 
h e a l t h c a r e 
f a c i l i t y . " 
IHS's b r i e f , a t 27. 
IHS m a i n t a i n s 
t h a t S a c r e d H e a r t " e x e c u t e d l e a s e s f o r f a c i l i t i e s c o m p r i s i n g 
a ' h e a l t h c a r e f a c i l i t y ' f o r which CON r e v i e w i s r e q u i r e d . " 
IHS's b r i e f , a t 28. 
South B a l d w i n argues i n i t s b r i e f 
t h a t 
" S a c r e d H e a r t , w i t h i t s 
t h r e e h o s p i t a l s and v a r i o u s o u t p a t i e n t 
c l i n i c s a l l o p e r a t i n g as a s i n g l e l e g a l e n t i t y , u n q u e s t i o n a b l y 
q u a l i f i e s as a ' h e a l t h c a r e f a c i l i t y ' under [the Heart-Lung 
t e s t ] . " 
South B a l d w i n ' s 
b r i e f , 
a t 28. 
T h e r e f o r e , South 
B a l d w i n a r g u e s , S a c r e d H e a r t cannot "exempt i t s e l f 
from t h e 
r e s t r i c t i o n s 
of 
t h e 
CON 
s t a t u t e 
s i m p l y 
by 
e m p l o y i n g 
p h y s i c i a n s . " 
I d . SHPDA adopted t h e Heart-Lung t e s t , IHS and 
South B a l d w i n say, t o a n a l y z e whether a p r o j e c t i s 
d e s i g n e d as 
the o f f i c e s of p r i v a t e p h y s i c i a n s or i s 
a h e a l t h - c a r e 
f a c i l i t y 
s u b j e c t t o CON r e v i e w . IHS and South B a l d w i n c o n t e n d t h a t t h e 
SHMG l e a s e d 
space 
t r i g g e r e d t h e CON 
r e q u i r e m e n t not 
o n l y 
because i t 
was d e s i g n e d as a new h e a l t h - c a r e 
f a c i l i t y , b u t 
a l s o 
because 
S a c r e d 
H e a r t 
p r o p o s e d 
new 
s e r v i c e s 
a t t h e 
17 
1091788 
f a c i l i t y t h a t i n d e p e n d e n t l y r e q u i r e CON r e v i e w . IHS 
and 
South 
B a l d w i n argue t h a t the SHMG l e a s e d space does not meet a l l t h e 
c r i t e r i a t o q u a l i f y f o r t h e 
POE and t h a t , t h e r e f o r e , 
S a c r e d 
H e a r t must o b t a i n a CON b e f o r e i t 
can 
use t h e 
SHMG 
l e a s e d 
space. 
T h i s C o u r t has r e v i e w e d the Heart-Lung t e s t and g i v e n i t 
g r e a t w e i g h t , has 
c o n s i d e r e d the problems w i t h the a p p l i c a t i o n 
of t h e 
t e s t t h a t have a r i s e n i n 
t h i s case, and 
has g i v e n t h e 
words i n the POE " t h e i r n a t u r a l , p l a i n , o r d i n a r y , and 
commonly 
u n d e r s t o o d meaning." 
IMED Corp., 602 So. 2d a t 346. We 
c o n c l u d e t h a t t h e 
Heart-Lung t e s t i s 
s u b s t a n t i a l l y sound 
b u t 
t h a t i t s h o u l d be m o d i f i e d t o 
be c o n s i s t e n t w i t h t h e 
purpose 
and p o l i c y o f t h e 
POE and 
t o r e f l e c t t h e l e g i s l a t i v e 
i n t e n t 
e x p r e s s e d i n § 22-21-260(6). We hereby adopt a m o d i f i e d 
f o u r -
p a r t t e s t
5 t o 
be used t o d e t e r m i n e whether a p r o p o s e d m e d i c a l 
5We have changed t h e 
p h r a s e "the p r i m a r y o f f i c e " t o "any 
o f f i c e " i n 
t h e second p a r t o f t h e t e s t and have s t r u c k t h e 
p h r a s e "and n o t 
on b e h a l f o f 
a t h i r d p a r t y " i n 
t h e 
t h i r d p a r t 
because o f a p o t e n t i a l c o n f l i c t w i t h p h r a s e " r e g a r d l e s s o f 
o w n e r s h i p " i n 
t h e s t a t u t o r y language o f t h e 
POE. Ex p a r t e  
McLeod, 718 So. 2d 682, 
690 ( A l a . 1997) ("An a d m i n i s t r a t i v e 
agency's 
i n t e r p r e t a t i o n o f a 
s t a t u t e 
w i l l 
n o t be 
g i v e n 
d e f e r e n c e i f i t i s c o n t r a r y t o 
the l e g i s l a t i v e i n t e n t . " ) . See 
a l s o Ex p a r t e Crestwood Hosp. & N u r s i n g Home, I n c . , 670 
So. 2d 
45, 47 ( A l a . 1995) ("It i s s e t t l e d law 
t h a t t h e p r o v i s i o n s o f 
a 
s t a t u t e 
w i l l 
p r e v a i l i n any case i n w h i c h 
t h e r e i s 
a 
c o n f l i c t between the s t a t u t e and 
a s t a t e agency r e g u l a t i o n . " ) . 
18 
1091788 
f a c i l i t y 
or 
p r o j e c t 
q u a l i f i e s 
f o r 
the 
POE 
( h e r e i n a f t e r 
r e f e r r e d t o as "the POE 
a p p l i c a t i o n 
t e s t " ) : 
(1) The 
p r o p o s e d s e r v i c e s are 
t o be 
p r o v i d e d , 
and 
r e l a t e d 
equipment 
used, 
e x c l u s i v e l y 
by 
the 
p h y s i c i a n s 
i d e n t i f i e d as owners or employees of 
the 
p h y s i c i a n s ' p r a c t i c e f o r the c a r e of t h e i r p a t i e n t s . 
(2) The 
p r o p o s e d s e r v i c e s are 
t o be 
p r o v i d e d , 
and 
r e l a t e d equipment used, a t any 
o f f i c e 
of 
such 
p h y s i c i a n s . 
(3) 
A l l 
p a t i e n t 
b i l l i n g s 
r e l a t e d 
t o 
such 
s e r v i c e s are t h r o u g h , or e x p r e s s l y on b e h a l f o f , 
the 
p h y s i c i a n s ' 
p r a c t i c e . 
(4) 
The 
equipment 
s h a l l 
not 
be 
used 
f o r 
i n p a t i e n t c a r e , 
nor by, 
t h r o u g h , or on b e h a l f 
of a 
h e a l t h - c a r e 
f a c i l i t y . 
The 
POE 
a p p l i c a t i o n 
t e s t 
i s 
p r o m u l g a t e d 
t o 
p r o v i d e 
c l a r i f i c a t i o n as t o the exemption from the CON 
r e v i e w p r o c e s s 
f o r 
the 
o f f i c e s of 
l i c e n s e d p h y s i c i a n s , 
d e n t i s t s , or group 
p r a c t i c e s and s h o u l d not be i n t e r p r e t e d as c i r c u m v e n t i n g 
the 
s t a t u t o r y language i n §§ 22-21-260(6), 22-21-260(8), 22-21¬
263, 
and 22-21-265, A l a . Code 1975, 
or o t h e r w i s e 
a p p l i c a b l e 
s t a t u t e s or a d m i n i s t r a t i v e r e g u l a t i o n s p u r s u a n t t o the 
" S t a t e 
H e a l t h 
P l a n . "
6 
The 
POE 
a p p l i c a t i o n 
t e s t 
w i l l 
p r o v i d e 
an 
o b j e c t i v e s t a n d a r d t h a t can be used t o d e t e r m i n e whether 
the 
6See s u p r a note 
3. 
19 
1091788 
POE 
a p p l i e s t o 
any m e d i c a l p r a c t i c e , whether t h e 
p r a c t i c e 
i s 
s o l o o r group, l a r g e o r s m a l l , s p e c i a l i z e d 
o r g e n e r a l . 
Such 
an o b j e c t i v e t e s t w i l l n o t o n l y p r o v i d e 
d i r e c t i o n t o SHPDA, 
the CONRB, and 
our c o u r t s , but w i l l a l s o p r o v i d e the c e r t a i n t y 
needed by d e v e l o p e r s o f 
m e d i c a l o f f i c e b u i l d i n g s i n t h i s S t a t e 
and i t s p h y s i c i a n s a t t i m e s when, f o r example, t h e y 
c o n s i d e r 
r e l o c a t i n g a p r a c t i c e , a d d i n g a new p h y s i c i a n o r s p e c i a l t y t o 
an e x i s t i n g p r a c t i c e , p u r c h a s i n g a p i e c e o f 
new equipment, o r 
o f f e r i n g a new s e r v i c e . 
As t o 
the SHMG l e a s e d space, t h e 
t r i a l c o u r t d i d not have 
b e f o r e i t the POE a p p l i c a t i o n t e s t we adopt today; t h e r e f o r e , 
we remand t h i s case t o 
t h e 
C o u r t o f C i v i l A p p e a l s f o r i t 
t o 
remand the case t o 
t h e 
t r i a l c o u r t f o r c o n s i d e r a t i o n i n l i g h t 
of the POE a p p l i c a t i o n t e s t , i n c l u d i n g 
any 
f u r t h e r p r o c e e d i n g s 
the 
t r i a l c o u r t deems n e c e s s a r y . 
Because we today adopt 
t h e 
POE 
a p p l i c a t i o n t e s t and remand t h e case, 
we 
p r e t e r m i t 
c o n s i d e r a t i o n o f 
t h e 
o t h e r arguments made by t h e p a r t i e s . 
IV. 
C o n c l u s i o n 
We r e v e r s e t h e 
judgment o f the C o u r t o f C i v i l A p p e a l s 
and 
remand t h i s case f o r 
t h a t c o u r t t o remand t h e case t o t h e 
t r i a l c o u r t f o r any 
f u r t h e r p r o c e e d i n g s 
i t 
deems n e c e s s a r y and 
f o r t h e t r i a l c o u r t t o a p p l y t h e 
POE a p p l i c a t i o n t e s t t o t h e 
SHMG l e a s e d space i n 
the m e d i c a l - b u i l d i n g p r o j e c t i n 
a manner 
c o n s i s t e n t w i t h t h i s o p i n i o n . 
20 
1091788 
APPLICATION GRANTED; 
OPINION OF M^ARCH 2, 2012, WITHDRAWN; 
OPINION SUBSTITUTED; REVERSED AND REMANDED WITH INSTRUCTIONS. 
Malone, C . J . , 
and W o o d a l l , 
S t u a r t , B o l i n , 
P a r k e r , * and 
Murdock, J J . , c o n c u r . 
Shaw, J . , c o n c u r s i n 
t h e r e s u l t . 
Wise, J . , r e c u s e s 
h e r s e l f . 
* A l t h o u g h J u s t i c e P a r k e r was n o t 
p r e s e n t a t o r a l argument 
i n 
t h i s case, he has l i s t e n e d t o t h e a u d i o t a p e o f t h e o r a l 
argument. 
21