Opinion ID: 1804083
Heading Depth: 1
Heading Rank: 5

Heading: Decision to Grant Certificate of Need.

Text: In reviewing the Council's decision to grant Coralville Manor's certificate of need, we must keep in mind that our review of the Council's decision is severely circumscribed. See On With Life, Inc. v. State Health Facilities Council, 532 N.W.2d 496, 497 (Iowa Ct.App.1995). We ordinarily defer to the expertise and experience of the agency, particularly in areas where the legislature has delegated considerable discretion to the agency. See S.E. Iowa Coop. Elec. Ass'n, 633 N.W.2d at 818; In re Certificate of Need Granted to the Harborage, 693 A.2d at 141. Thus, judgment calls are the province of the [agency] and not of the courts. Mercy Health Ctr., 360 N.W.2d at 809; accord On With Life, Inc., 532 N.W.2d at 497. The petitioning nursing facilities claim the Council ignored the requisite statutory criteria and placed undue emphasis on other irrelevant factors, such as fostering competition. Although the Council must consider the eighteen factors delineated in section 135.64(1) in evaluating an application, this list is not exhaustive. Mercy Health Ctr., 360 N.W.2d at 811; accord Hale, 438 A.2d at 233. The Council is authorized to consider any factors reasonably related to the purposes of the statute and the specific application. See Cathedral Rock of Granite City, Inc., 242 Ill.Dec. 158, 720 N.E.2d at 1124 (agency is free to use its expertise in determining what other considerations are relevant); Mercy Health Ctr., 360 N.W.2d at 811 (Council may consider other factors which directly bear on the factors listed in section 135.64(1)); Hale, 438 A.2d at 233 (may consider any factors rationally related to the statute's purpose). As mentioned, the legislature declared its objective in creating the Council was to provide orderly, economical, and adequate institutional health services that are accessible, both physically and economically, to all citizens of our state. See Mercy Health Ctr., 360 N.W.2d at 811. When considering the benefits of competition in the context of Coralville Manor's application, the Council was considering how competition would improve the quality and cost of health care to Johnson County's citizens. Thus, the Council properly considered competition in its evaluation of the application. Notwithstanding, we do not believe fostering competition was the sole or primary basis upon which the Council reached its decision. See Humana of Tennessee v. Tennessee Health Facilities Comm'n, 551 S.W.2d 664, 670 (Tenn.1977). Likewise, we find no merit to the argument that the Council ignored the statutory criteria of section 135.66. The review of the application was extremely thorough, and we are satisfied all of the issues raised by the affected persons were fully considered. See Nat'l Nephrology Foundation v. Dougherty, 138 N.J.Super. 470, 351 A.2d 392, 396 (App.Div.1976). The written decision and the recorded comments of the Council members at the public hearing reflect the Council's deliberate and detailed application of the criteria to Coralville Manor's application. See Cathedral Rock of Granite City, Inc., 242 Ill.Dec. 158, 720 N.E.2d at 1125 (record revealed agency fully considered the important aspects of the proposed project); On With Life, Inc., 532 N.W.2d at 497. The Council's written decision included the four mandatory findings and reasoned explanations for finding the presence of each factor in the application. Furthermore, the record contained sufficient evidence upon which the Council could have based its findings. See Cathedral Rock of Granite City, Inc., 242 Ill.Dec. 158, 720 N.E.2d at 1123. The state bed need formula projected a future need for 121 long-term care beds in Johnson County. The record indicated Johnson County is the fastest growing county in the state of Iowa. See Humana of Tennessee, 551 S.W.2d at 670 (record demonstrated that the county in which the proposed health facility would be located was one of the fastest growing counties in the region). Most importantly, the population for those sixty-five years and older in Johnson County had increased 74% since 1980, with no corresponding increase in the number of long-term care beds. Moreover, the occupancy rates of the seven county nursing facilities were consistently high. Additionally, no facility in the county had a CCDI unit, and the CCDI units in neighboring counties were either full and/or only accepted private pay patients. The only factor somewhat in dispute was the availability of adequate health personnel resources to staff the new facility. Although the representatives from neighboring facilities testified that Coralville Manor would be unable to fill its staffing requirements, both the owner of Coralville Manor and Coralville's economic developer countered that the staffing issues could be adequately resolved. However, the availability of resources was only one factor to consider, and the Council was not required to accept any parties' particular projection of future staffing difficulties. See Nat'l Nephrology Foundation, 351 A.2d at 396 (the fact that the agency did not give a factor the weight that a party would have preferred does not mean the agency ignored the appropriate criteria). In short, the Council was not convinced staffing shortages would be as detrimental to Coralville Manor's facility as the affected parties predicted at the hearing. See On With Life, Inc., 532 N.W.2d at 498. When examining the Council's decision in light of all of the evidence presented to the Council, we find the decision to grant the certificate was sufficiently supported by the record. See Dickinson County, 521 N.W.2d at 468. The Council's decision was not unreasonable, arbitrary, capricious, or without regard to the law. See Mercy Health Ctr., 360 N.W.2d at 812. Additionally, in making its determination, the Council adhered to the procedural requirements of section 135.66, and the general requirement imposed on agencies to act reasonably. Citizens' Aide/Ombudsman, 454 N.W.2d at 820; Farmers State Bank, 433 N.W.2d at 740; Polk County, 330 N.W.2d at 277.