Opinion ID: 1655620
Heading Depth: 2
Heading Rank: 1

Heading: is the methodology employed by the department in calculating out-of-state population for inclusion in rush's population base to determine need arbitrary and capricious?

Text: ¶ 4. A brief explanation of the factors to be considered in evaluating a proposal in a CON application will be discussed first. The main determination to be made is need, hence the title Certificate of Need. In this determination, the proposal must be consistent with the specifications and criteria established by the Department and in substantial compliance with the Mississippi State Health Plan (Plan). Miss.Code Ann. § 41-7-193 (2001). In our review, we will not determine whether there is an actual need for the Rush project. Instead, we will look to make sure there was substantial evidence to support the decision and that the decision was not arbitrary and capricious. ¶ 5. Mississippi is divided into seven planning areas. The Plan states that need shall be determined using designated planning areas (Cardiac Catheterization/Open-Heart Surgery Planning Areas (CC/OHSPAs)), 1999 Mississippi State Health Plan, IX-79, and a minimum population base of 100,000 per planning area is required, with exception. Id. at IX-77. If an applicant submits adequate documentation acceptable to the [Department], population outside the applicant's planning area will be considered in determining need. Id. at IX-76. The Plan does not specify how a population base is to be determined, so we must look to precedent. The Department uses market sharing as the method of determining a population base when service areas overlap. [1] ¶ 6. Rush included in its population base calculation the population of seven Mississippi counties, five of which are within its planning area, [2] and two Alabama counties. Rush used the market sharing methodology to calculate the population base from the counties outside its planning area. Jeff Anderson RMC acknowledges that the market sharing methodology is a proper tool, as recognized by this Court in HTI, and that out-of-state population can be considered in calculating a population base. HTI, 603 So.2d at 852. However, Jeff Anderson RMC argues that Rush did not submit adequate documentation to the Department to warrant consideration of out of area population, and therefore, the market sharing methodology was not properly applied. ¶ 7. Jeff Anderson RMC takes issue with the method of apportionment of counties not within the planning area as part of the population base. Jeff Anderson RMC distinguishes the HTI case and the case at bar based upon review of the Department's Staff Analysis in that case. Jeff Anderson RMC asserts that in HTI, Hinds County was within the applicant's service area but that it also had three other existing open heart service facilities. Instead of awarding the entire county population to the applicant as part of the population base, the Department gave only a percentage of the population toward the population base. The reasoning was that the discharges received by Hinds County amounted to only 1% of the total for Hinds County, and therefore, only this percentage was includable in the population base. ¶ 8. In light of this, Jeff Anderson RMC argues that the Department improperly gave Rush 100% of the population of the two Alabama counties noting that the definition of population base is that proportion of the population reasonably expected to be served by the facility proposing the new service. Id. Jeff Anderson RMC contends that this apportionment is mere speculation and is therefore, an arbitrary and capricious agency action. ¶ 9. While Jeff Anderson RMC's frustration is understandable, the issues before us are whether the order granting the CON was supported by substantial evidence and whether the methodology employed was arbitrary and capricious. We conclude that there was substantial evidence to support the final order and that the methodology employed was not arbitrary and capricious. Jeff Anderson RMC's points relate to a legislative process and would be more appropriately addressed by the Legislature. ¶ 10. We have noted that patient origin data from two-week sample periods is a sufficient method for determining service area and population base. Miss. State Dep't of Health v. Southwest Miss. Reg'l Med. Ctr., 580 So.2d 1238, 1240-41 (Miss. 1991). Therefore, Rush's four two-week patient origin studies constitute adequate documentation as required by the Plan to allow the use of population outside the planning area to be considered in the need analysis. Also, Rush provided statistical studies concerning Alabama patients which the Hearing Officer also considered. ¶ 11. Further, the market share methodology has been approved by this Court in many cases, most notably HTI and Delta Reg'l. It should also be noted that [t]he methodology used to determine or measure population base in any given case should not be carved in granite; instead some flexibility is required. It is prudent to utilize the methodology that will accommodate the various and sundry circumstances found in each individual case. The objective of it all, in the final analysis, is to determine need. HTI, 603 So.2d at 853. Even though the methodology employed in this case has been held valid in previous cases, it is not the only factor to be considered. As Rush points out, such factors as the number of cardiologists in an area can be considered in calculating a population base. This is especially poignant here since there is only one cardiologist serving the Meridian area through Jeff Anderson RMC. ¶ 12. Further, both parties offered extensive testimony and substantial evidence at the hearing. The record is voluminous. The Hearing Officer reviewed all materials before him and made extensive findings of fact and conclusions of law which were submitted to the State Health Officer with a recommendation for approval of the Rush CON. The chancery court reviewed the record and accordingly affirmed the Department's final order granting Rush the CON. We find no error in the chancery court's holding.