Opinion ID: 2132355
Heading Depth: 1
Heading Rank: 2

Heading: Calculating Bed Need.

Text: The plaintiffs argue that, because the department failed to follow its own regulations in determining bed need, the Health Facilities Appeals Board erred in affirming the department's grant of a determination of need for 977 hospital beds. It contends that the department used the wrong figures for two components of the bed need calculation: the population projection for Boston, and bed utilization or use rate data. Title 105 Code Mass. Regs. § 100.535 (1986) provided: For the purposes of determinations of need under 105 CMR 100.533 ..., the population of the applicable service area shall be projected for an appropriate year by using the most recent edition of the `Department of Public Health, Population Projections' and `Department of Public Health Population Projections Methodology and Handbook for Users.' The department used these sources for the projected 1990 population of every community within the hospital's service area except Boston. The department's failure to use the required source to project the population of Boston is fatal to the department's determination, the plaintiffs contend. The record contains a letter to a determination of need program analyst from the department's division of health statistics and research, dated September 11, 1986, as follows: As we discussed in June of this year, the official Department of Public Health projections for 1990 do not accurately reflect the 1982 and 1984 census statistics for Boston. Facts that have occurred since the 1980 census (upon which the DPH projections were based) indicate that population projections now in force for Boston are too low. Therefore I advised you that the Department's revision of the Boston population projections would be expected to be comparable to the Boston Redevelopment Authority number of 579,468 for the Boston [population] in 1990. Final population projections for Boston by the Department will not be available until 1987, but in the interim, use of the 579,468 1990 Boston population number is a more reasonable forecast than the 497,600 figure listed currently in the Department's official projections. The department staff summary states that, because the department's projections for Boston's 1990 population were found to underestimate the city's growth, a projection from the Boston Redevelopment Authority was used instead. According to the summary, [t]he Department is in the process of revising population projections for 1990 for the entire state. Eventually these numbers will incorporate the Massachusetts Institute for Social and Economic Research (MISER) projections for 1990. Staff consulted with the Department's statisticians who indicated that the BRA projection of 579,468 for the City of Boston for 1990 is within the upper limit of the MISER projection of 580,000. Title 105 Code Mass. Regs. § 100.536 (1986) authorized the department to accept as supporting documentation any statistical or other factual material containing reliable data. The Department will take official notice of vital statistics and other demographic data ... compiled by its staff. Of course, as the plaintiff's point out, population projections, while they may at least be partially based on statistics, are not themselves statistics. Title 105 Code Mass. Regs. § 100.536 does not by itself authorize the department to employ population projections supplied by another agency. Nevertheless, in view of the purposes of the determination of need statute, and the manifest necessity to the accomplishment of those purposes that the department have reasonable flexibility in construing and applying its regulations, we conclude that the department was not bound by 105 Code Mass. Regs. § 100.535 to use population projections it knew were inaccurate. Nor was the department bound to delay the determination of need process until after new editions of Department of Public Health, Populations Projections and Department of Public Health Population Projections Methodology and Handbook for Users were published. In the circumstances, the department's use of the Boston Redevelopment Authority projections was reasonable and consistent with its statutory charge. The plaintiffs also argue that the department improperly departed from its calculations of bed need in computing the bed utilization or use rate. Although a new 1984 use-rate figure had been calculated, the department used 1982 figures, ultimately accounting for a determination of need of one hundred more beds than would have been approved using the 1984 figure. Bed use rate is a component of bed need calculations which the department adopts and applies to applications filed during a fixed period. The department periodically changes the use rate to be applied in reviewing applications submitted after a prescribed subsequent date. Under 105 Code Mass. Regs. § 100.540(B) (1986), and G.L.c. 111, § 25C, an applicant is entitled to have its application based on the criteria in effect on the date of filing of the application unless waived by the applicant. On August 9, 1983, the department adopted the 1982 figures to be set for applications filed between August 9, 1983, and January, 1986. The hospital filed its application on September 13, 1985, and was thus entitled to utilize the 1982 figures. Because the hospital did not waive its right under the statute and the regulation to have the 1982 use-rate data applied, it was the only rate which the department properly could apply. Moreover, in contrast to the population figures for Boston, the department had no evidence that the 1982 use rate figures were in any way unreliable. We conclude, therefore, that the department did not err in applying the 1982 use rate, and that the Health Facilities Appeals Board's affirmance of that procedure was correct.