Opinion ID: 1785185
Heading Depth: 2
Heading Rank: 4

Heading: Substantive Assignments of Error

Text: As pointed out by the Chancellor, appellant's contentions on the merits of this case when stripped to the bare essentials amount to an assertion that there is no evidence in the record to support the Commission's findings. Appellant has taken issue with each and every aspect of the handling of the subject application, both before the area-wide agency and before the Health Facilities Commission itself. A review of the record makes it readily apparent that there was conflicting evidence offered in the administrative hearings, and evidence from which diverse inferences and conclusions could be drawn. The Health Facilities Act, T.C.A. § 53-5411, contains the basis upon which a certificate of need may be issued and the criteria for certification of such need. It provides: (A) No certificate of need shall be issued unless the action proposed in the application for such certificate is necessary to provide required health care in the area to be served, can be economically accomplished and maintained, and will contribute to the orderly development of adequate and effective health care services. Criteria for certification of need shall be prescribed by rules and regulations of the commission which shall take into consideration: (1) the availability of facilities or services which may serve as alternatives or substitutes; (2) the need for such equipment and services in the area; (3) possible economies and improvement in services to be anticipated in the operation of joint central services; (4) the adequacy of financial resources and sources of present and future revenue; (5) the availability of sufficient manpower in the several professional disciplines required; and (6) such other factors as may be established or required by federal regulations. Despite appellant's sincere and thoughtful contentions to the contrary, we are of the opinion that there was substantial and material evidence offered on behalf of appellee with regard to each of the criteria, and that the Commission took all of these into consideration in reaching its decision. One of the principal insistences of appellant is that the Commission granted the certificate simply because some sixteen physicians, practicing various specialties, wished to locate in Wilson County and would do so only if the facility under consideration were authorized. We do not find this to be the primary or sole basis upon which the Commission reached its decision, although we do note that one of the criteria for certification of need specified in the statute is the availability of sufficient manpower in the several professional disciplines required... . Accordingly the availability of medical personnel was a legitimate factor for the Commission to consider. There is evidence in the record that a very large percentage of the citizens in the area to be serviced seek health care in Davidson County or in other areas, and this factor was given great weight, particularly by the area-wide agency in making its recommendation. Appellant contends that its general care hospital is more than adequate to meet the needs of the area to be served, and that secondary and tertiary health care are easily available in neighboring Davidson County, where Nashville affords some of the most advanced medical facilities in the Southeastern United States. There is substantial evidence, however, that the existing hospital has failed to attract needed medical personnel into the area, and that portions of Wilson County and other counties adjoining it to the east have been considered medically deprived for a long period of time, both from the standpoint of medical practitioners and of health care facilities. Wilson County is shown to be one of the most rapidly growing counties in the region. There are in the record conflicting projections as to present and future demands for hospital facilities in the area. None of these projections, or formulas, amounted to rules of the Health Facilities Commission within the meaning of the Administrative Procedures Act, in our opinion, and no one of them appears to have been given controlling weight by the Commission in its consideration of the evidence. Although appellant offered countervailing evidence as to the need for facilities, based upon what it characterizes as more recent data, it is clear from the record that there was material and substantial evidence before the Commission showing a future need of health care facilities which would justify the granting of the subject application. It is pointed out by appellant in its brief that the determinations to be made by administrative agencies, such as the Health Facilities Commission, are of a complex nature, involving the weighing and consideration of many conflicting factors and elements. The Health Facilities Act of 1973 represents an attempt on the part of the Tennessee General Assembly to regulate the construction and expansion of health care facilities, consonant with a number of federal statutes and policies on the subject. Appellant correctly points out that the task of the Commission is not unlike that of a public service commission regulating public utilities, both as to initial entry and certification and as to expansion of services. Public need under all of the circumstances is the ultimate consideration, and the legislation is designed to prevent costly, inefficient development or duplication of health care facilities. For a comprehensive review and evaluation of state statutes of this type, see Havighurst, Regulation of Health Facilities and Services by Certificate of Need, 59 Va.L.Rev. 1143 (1973). Certainly there was evidence offered on behalf of appellant at all stages of the proceedings which would have justified a decision in its favor, and a determination that the new facility was not needed in the proposed service area. This was by no means the only evidence in the record, however, and reviewing courts cannot reverse an agency merely because they might have decided the matter differently. Appellant is an existing and established hospital and clearly had an interest in opposing the application, particularly since it was just completing an expensive addition to its own facilities. The trier of fact was entitled to consider this in evaluating appellant's contentions. The decision which had to be reached in this case was basically one for determination by the administrative agencies charged with making it, on disputed evidence, representing divided community sentiments and opinions. We find no error, either substantive or procedural, which would warrant a reversal of the decision of the Commission. The judgment of the Chancery Court is affirmed and the cause is remanded to that Court for such further orders as may be necessary for implementation of its judgment. Costs are taxed to the appellant. COOPER, C.J., and FONES, HENRY and BROCK, JJ., concur.