Affinity Hospital, LLC, d/b/a Trinity Medical Center of Birmingham v. Brookwood Health Services, Inc., d/b/a Brookwood Medical Center, et al.

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REL: 08/09/2013 Notice: T h i s o p i n i o n i s s u b j e c t t o formal 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 R e p o r t e r . 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 R e p o r t e r o f D e c i s i o n s , Alabama A p p e l l a t e C o u r t s , 300 D e x t e r A v e n u e , M o n t g o m e r y , A l a b a m a 3 6 1 0 4 - 3 7 4 1 ((334) 2 2 9 - 0 6 4 9 ) , o f a n y 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 b e 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 R e p o r t e r . ALABAMA COURT OF CIVIL APPEALS SPECIAL TERM, 2013 2120090 A f f i n i t y H o s p i t a l , LLC, d/b/a T r i n i t y M e d i c a l Center o f Birmingham v. Brookwood H e a l t h S e r v i c e s , Inc., d/b/a Brookwood M e d i c a l Center, e t a l . Appeal from Montgomery C i r c u i t (CV-10-900053.80) Court DONALDSON, J u d g e . Affinity H o s p i t a l , LLC, Birmingham ( " T r i n i t y " ) , appeals d/b/a T r i n i t y M e d i c a l Center o f t h e j u d g m e n t o f t h e Montgomery 2120090 Circuit Court Planning Development Certificate Inc., upholding o f Need d/b/a construct a of the State ("SHPDA") ("CON") t o Medical freestanding 1 decision Agency Brookwood Shelby County. a to Brookwood Center emergency Health grant Health of Services, ("Brookwood"), department a to ("FED") i n This c o u r t has p r e v i o u s l y a d d r e s s e d t h i s case on t h e d i s c r e t e i s s u e w h e t h e r a l a c k o f n o t i c e v i t i a t e d t h e CON g r a n t e d b y SHPDA. Affinity After See B r o o k w o o d H e a l t h Servs., Inc. v. Hosp. , L L C , 101 So. 3d 1221 ( A l a . C i v . App. 2012) . this court, i n Brookwood, reversed the t r i a l court's judgment a n d remanded t h e a c t i o n , t h e t r i a l c o u r t a f f i r m e d t h e decision o f SHPDA t o a w a r d t h e CON t o Brookwood. r e a s o n s s t a t e d h e r e i n , we a f f i r m t h e t r i a l 1 Section court's For the judgment. 22-21-261, A l a . Code 1975, p r o v i d e s : "The Legislature of the State o f Alabama declares that i ti s the p u b l i c p o l i c y of the State o f A l a b a m a t h a t a c e r t i f i c a t e o f n e e d p r o g r a m be administered i n the s t a t e t o assure that only those h e a l t h c a r e s e r v i c e s a n d f a c i l i t i e s f o u n d t o be i n t h e p u b l i c i n t e r e s t s h a l l be o f f e r e d o r d e v e l o p e d i n the s t a t e . I t i s t h e purpose o f t h e L e g i s l a t u r e i n enacting t h i s a r t i c l e to prevent the construction of u n n e c e s s a r y and i n a p p r o p r i a t e h e a l t h care f a c i l i t i e s through a system o f mandatory reviews o f new i n s t i t u t i o n a l health s e r v i c e s , as t h e same a r e defined i n this a r t i c l e . " 2 2120090 F a c t s and P r o c e d u r a l H i s t o r y The facts, as p r e s e n t e d i n our p r i o r opinion, a r e as follows: "On June 23, 2008, B r o o k w o o d H e a l t h S e r v i c e s , I n c . , d/b/a B r o o k w o o d M e d i c a l C e n t e r ('Brookwood'), a p p l i e d t o t h e S t a t e H e a l t h P l a n n i n g and Development A g e n c y ('SHPDA') f o r a c e r t i f i c a t e o f n e e d ('CON') to build a freestanding emergency department ('FED'). A FED i s a f u l l y f u n c t i o n i n g e m e r g e n c y department s e p a r a t e l y l o c a t e d from i t s h o s p i t a l . C u r r e n t l y , t h e r e a r e no FEDs i n A l a b a m a . Brookwood owns a n d o p e r a t e s a h o s p i t a l l o c a t e d i n t h e C i t y o f Homewood, i n J e f f e r s o n C o u n t y . Brookwood's p r o p o s e d FED w o u l d be l o c a t e d n e a r Highway 280 i n S h e l b y C o u n t y , a p p r o x i m a t e l y e i g h t m i l e s f r o m Brookwood's hospital. "Two h o s p i t a l s l o c a t e d i n B i r m i n g h a m , A f f i n i t y Hospital, L L C , d/b/a T r i n i t y M e d i c a l C e n t e r o f Birmingham ( ' T r i n i t y ' ) , and S t . V i n c e n t ' s Health Systems, I n c . ('St. V i n c e n t ' s ' ) , i n t e r v e n e d i n o p p o s i t i o n t o Brookwood's CON a p p l i c a t i o n . Trinity and St. Vincent's requested a contested-case h e a r i n g , a n d SHPDA a p p o i n t e d an a d m i n i s t r a t i v e l a w judge ('the A L J ' ) t o c o n d u c t t h e c o n t e s t e d - c a s e hearing. Trinity moved the ALJ to dismiss Brookwood's a p p l i c a t i o n on t h e g r o u n d t h a t B r o o k w o o d had f a i l e d t o c o m p l y w i t h R u l e 410-1-7-.06(1)(a), A l a . Admin. Code (SHPDA) ('the p u b l i c a t i o n r u l e ' ) . At the time, the p u b l i c a t i o n r u l e provided, i n pertinent part: " ' W i t h i n t h i r t y (30) c a l e n d a r d a y s o f t h e filing [ o f t h e CON a p p l i c a t i o n ] , the applicant shall also provide proof of p u b l i c a t i o n of notice of the a p p l i c a t i o n f o r two c o n s e c u t i v e weeks i n a n e w s p a p e r o f general circulation in the area(s) a f f e c t e d , i n such s i z e and u s i n g such forms 3 2120090 as p r o v i d e d b y [ S H P D A ] . ' 1 "The A L J d e n i e d T r i n i t y ' s m o t i o n t o d i s m i s s Brookwood's CON a p p l i c a t i o n . The A L J s u b s e q u e n t l y held a contested-case hearing regarding the application. Following the hearing, the A L J issued a recommended o r d e r c o n c l u d i n g t h a t B r o o k w o o d s h o u l d be g r a n t e d t h e CON. SHPDA's C e r t i f i c a t e o f Need Review Board ('the CONRB') adopted the ALJ's recommended o r d e r a n d i s s u e d t h e CON t o Brookwood. " T r i n i t y appealed t o t h e Montgomery Circuit C o u r t , p u r s u a n t t o § 4 1 - 2 2 - 2 0 , A l a . Code 1 9 7 5 , a p a r t o f t h e Alabama A d m i n i s t r a t i v e P r o c e d u r e A c t , § 41-22-1 e t s e q . , A l a . Code 1975. S t . V i n c e n t ' s d i d not appeal. On a p p e a l , Trinity made various arguments c h a l l e n g i n g t h e m e r i t s o f t h e d e c i s i o n t o g r a n t t h e CON t o B r o o k w o o d . T r i n i t y a l s o argued t h a t Brookwood's CON a p p l i c a t i o n s h o u l d have been d i s m i s s e d f o r f a i l u r e t o comply w i t h t h e p u b l i c a t i o n rule. On June 3, 2 0 1 1 , t h e c i r c u i t c o u r t e n t e r e d a judgment r e v e r s i n g t h e CONRB's d e c i s i o n t o g r a n t B r o o k w o o d t h e CON on t h e g r o u n d t h a t B r o o k w o o d h a d f a i l e d t o comply w i t h t h e p u b l i c a t i o n r u l e . In i t s judgment, t h e c i r c u i t court concluded that the CONRB's d e c i s i o n was ' f a t a l l y f l a w e d ' b y Brookwood's noncompliance w i t h the p u b l i c a t i o n r u l e . C u r i o u s l y , the circuit c o u r t ' s judgment a l s o p u r p o r t e d t o ' a f f i r m ' the d e c i s i o n 'with respect t o the merits of the [ F E D ] p r o j e c t and t h e need f o r t h e [ F E D ] project.' However, t h e j u d g m e n t i n f a c t r e v e r s e d t h e CONRB's d e c i s i o n t o i s s u e t h e CON. Brookwood appealed t o t h i s court, pursuant t o § 41-22-20. Trinity filed a cross-appeal, challenging the c i r c u i t c o u r t ' s j u d g m e n t i n s o f a r as i t p u r p o r t e d t o a f f i r m t h e CONRB's d e c i s i o n ' w i t h r e s p e c t t o t h e merits.' T h i s c o u r t h e a r d o r a l a r g u m e n t s on J u l y 10, 2012. " T h i s r u l e was amended e f f e c t i v e S e p t e m b e r 23, 2011, t o remove t h e p u b l i c a t i o n r e q u i r e m e n t except f o r CON a p p l i c a t i o n s f o r d r u g - a b u s e c e n t e r s a n d 1 4 2120090 p s y c h i a t r i c beds. The a b o v e - q u o t e d v e r s i o n o f t h e publication rule i s the version applicable i n this case." Brookwood, 101 argument, this So. 3d court at 1222-23. "conclude[d] After that hearing Trinity was oral not p r e j u d i c e d b y Brookwood's n o n c o m p l i a n c e w i t h t h e p u b l i c a t i o n rule. was That i s , Brookwood's f a i l u r e t o comply w i t h h a r m l e s s e r r o r . " I d . a t 1228. T h e r e f o r e , the rule we r e v e r s e d t h e t r i a l c o u r t ' s judgment a n d remanded t h e c a s e f o r a d e c i s i o n on the merits. On remand, t h e t r i a l c o u r t a f f i r m e d t h e d e c i s i o n o f SHPDA to a w a r d t h e CON t o Brookwood. The t r i a l court's judgment does n o t i n c l u d e a n y s p e c i f i c f i n d i n g s o f f a c t o r c o n c l u s i o n s of law. An a d m i n i s t r a t i v e l a w j u d g e findings hearing o f f a c t on t h e i s s u e s referenced t h e CON. following the t o and c o n s i d e r e d extensive contested-case i n the p r i o r opinion of t h i s f i n d i n g s were p r e s e n t e d granted ("ALJ") made court. Those b y SHPDA b e f o r e i t As n o t e d i n o u r p r i o r o p i n i o n , T r i n i t y h a s a p p e a l e d SHPDA's d e c i s i o n t o a w a r d t h e CON t o B r o o k w o o d t o t h e trial Trinity court, filed affirming pursuant to § 41-22-20(b), a timely appeal of the t r i a l SHPDA's d e c i s i o n to grant 5 A l a . Code 1 9 7 5 . court's t h e CON judgment to this court 2120090 p u r s u a n t t o § 41-22-21, A l a . Code 1975, w h i c h has j u r i s d i c t i o n p u r s u a n t t o § 12-3-10, A l a . Code 1975. Standard of Review As we stated in Brookwood, "[t]his court reviews a c i r c u i t c o u r t ' s j u d g m e n t as t o an a g e n c y ' s d e c i s i o n w i t h o u t a p r e s u m p t i o n o f c o r r e c t n e s s b e c a u s e t h e c i r c u i t c o u r t i s i n no b e t t e r p o s i t i o n t o r e v i e w the agency's d e c i s i o n than i s t h i s court. C l a r k v. F a n c h e r , 662 So. 2d 258, 261 1994)." 101 So. 3d a t 1225. The s c o p e o f j u d i c i a l an o r d e r i s s u e d by SHPDA a w a r d i n g 2 2 - 2 0 ( k ) , A l a . Code ( A l a . C i v . App. a CON review of i s p r o v i d e d i n § 41- 1975: " E x c e p t where j u d i c i a l r e v i e w i s b y t r i a l de novo, t h e a g e n c y o r d e r s h a l l be t a k e n as p r i m a f a c i e j u s t a n d r e a s o n a b l e and t h e c o u r t s h a l l n o t s u b s t i t u t e i t s j u d g m e n t f o r t h a t o f t h e a g e n c y as t o t h e w e i g h t o f t h e e v i d e n c e on q u e s t i o n s o f f a c t , e x c e p t where o t h e r w i s e a u t h o r i z e d by s t a t u t e . The court may a f f i r m t h e a g e n c y a c t i o n o r remand t h e c a s e t o t h e a g e n c y f o r t a k i n g a d d i t i o n a l t e s t i m o n y and e v i d e n c e o r f o r f u r t h e r p r o c e e d i n g s . The c o u r t may r e v e r s e o r modify the d e c i s i o n or grant other a p p r o p r i a t e r e l i e f from the agency a c t i o n , e q u i t a b l e or l e g a l , i n c l u d i n g d e c l a r a t o r y r e l i e f , i f the court f i n d s t h a t t h e a g e n c y a c t i o n i s due t o be s e t a s i d e o r m o d i f i e d under standards s e t f o r t h i n appeal or r e v i e w s t a t u t e s a p p l i c a b l e t o t h a t agency or i f substantial r i g h t s o f t h e p e t i t i o n e r have been p r e j u d i c e d b e c a u s e t h e a g e n c y a c t i o n i s any one o r more o f t h e f o l l o w i n g : "(1) I n v i o l a t i o n o f c o n s t i t u t i o n a l o r s t a t u t o r y 6 2120090 provisions; " ( 2 ) In excess of the s t a t u t o r y a u t h o r i t y of the agency; " ( 3 ) I n v i o l a t i o n o f any p e r t i n e n t a g e n c y r u l e ; "(4) Made upon u n l a w f u l procedure; "(5) A f f e c t e d b y o t h e r e r r o r of law; "(6) C l e a r l y e r r o n e o u s i n v i e w o f t h e r e l i a b l e , p r o b a t i v e , and s u b s t a n t i a l e v i d e n c e on t h e w h o l e record; or "(7) U n r e a s o n a b l e , a r b i t r a r y , o r c a p r i c i o u s , o r c h a r a c t e r i z e d by an abuse o f d i s c r e t i o n o r a c l e a r l y unwarranted e x e r c i s e of d i s c r e t i o n . " Analysis T r i n i t y r a i s e s three t h e CON that i s s u e s on a p p e a l : t h a t t h e award i s not c o n s i s t e n t w i t h the State Health Brookwood's proposed FED lacks l i c e n s e d by t h e A l a b a m a D e p a r t m e n t the reviewing T r i n i t y ' s arguments, r e v e r s a l b a s e d on t h r e e provisions decision is of (k)(2)); (3) specifically, in excess that the of P u b l i c Health Rule (SHPDA)(subsection and 7 be ("ADPH"); that i t urges of § 41-22-20(k):that the authority violates 410-1-6-.05, (k)(3)); to appropriateness." i t appears statutory decision ("SHP"); potential and t h a t t h e p r o p o s e d FED l a c k s " l o c a t i o n a l In Plan of an Ala. that the (subsection agency rule, Admin. decision Code is 2120090 unreasonable, discretion arbitrary, (subsection (k)(7)). b e e n n a r r o w l y d e f i n e d by t h a t "the agency order reasonable and [that] judgment for that evidence on the the by Trinity's only first issue is not as fact, SHPDA's review not to declared substitute the except weight where least annually and Health Coordinating Health Planning Governor." provide § i s that with "a CON the SHP and the with SHP. r e v i s e d as can that The be SHP Several the CON is Ala. Code "[a] reviewed services w i l l for a l l residents s t a t u t e s , as w e l l as 8 of the State a p p r o v e d by 1975. The be at Statewide SHP the "shall resources available i n a manner w h i c h a s s u r e s c o n t i n u i t y o f reasonable costs, the issued the d e v e l o p m e n t o f h e a l t h p r o g r a m s and to assure that q u a l i t y h e a l t h accessible n e c e s s a r y by D e v e l o p m e n t A g e n c y , and 22-21-260(13), f o r the its of C o u n c i l , w i t h the a s s i s t a n c e of the and and otherwise c o m p r e h e n s i v e 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 at has 41-22-20(k). contention consistent scope of our shall agency of i f i t i s consistent" exceeds t a k e n as p r i m a f a c i e j u s t court the statute." § The or l e g i s l a t u r e , w h i c h has s h a l l be questions authorized of capricious, care, and at s t a t e . " Id. administrative regulations 2120090 adopted pursuant evaluate whether a proposed h e a l t h s e r v i c e i s c o n s i s t e n t the SHP b e f o r e to statutory authority, require SHPDA t o a CON c a n be i s s u e d : "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 e CON p r o c e s s ] s h a l l be p e r m i t t e d w h i c h a r e inconsistent with the State Health Plan." § 2 2 - 2 1 - 2 6 3 ( a ) , A l a . Code 1975. "The SHPDA, p u r s u a n t t o t h e p r o v i s i o n s o f S e c t i o n 22-21-274, s h a l l p r e s c r i b e b y r u l e s a n d r e g u l a t i o n s t h e c r i t e r i a and c l a r i f y i n g d e f i n i t i o n s f o r r e v i e w s c o v e r e d b y t h i s a r t i c l e . These c r i t e r i a s h a l l include at least the f o l l o w i n g : "(1) C o n s i s t e n c y w i t h t h e a p p r o p r i a t e S t a t e H e a l t h F a c i l i t y and s e r v i c e s p l a n s e f f e c t i v e a t t h e t i m e t h e a p p l i c a t i o n was r e c e i v e d by t h e S t a t e Agency, w h i c h s h a l l i n c l u d e the l a t e s t approved r e v i s i o n s of [ s p e c i f i e d ] plans." § 22-21-264, A l a . Code 1975. "The p r o p o s e d 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 h a l l be c o n s i s t e n t w i t h t h e a p p r o p r i a t e state health f a c i l i t y and s e r v i c e s p l a n s e f f e c t i v e a t t h e time t h e a p p l i c a t i o n was r e c e i v e d b y t h e s t a t e a g e n c y " R u l e 4 1 0 - 1 - 6 - . 0 2 ( 1 ) , A l a . Admin. Code (SHPDA). "Determination o f a s u b s t a n t i a l l y unmet public requirement f o r the proposed h e a l t h care f a c i l i t y , s e r v i c e , o r c a p i t a l e x p e n d i t u r e s h a l l be made b e f o r e approval may be granted. The n e e d shall be consistent with orderly planning within the state and community f o r f u r n i s h i n g c o m p r e h e n s i v e h e a l t h care." 9 with 2120090 Rule 410-1-6-.05(1), A l a . Admin. Code (SHPDA). A t t h e t i m e B r o o k w o o d a p p l i e d f o r t h e CON a n d t h r o u g h o u t the p r o c e e d i n g s below, manner. Trinity t h e SHP d i d n o t a d d r e s s FEDs i n any argues that SHPDA could n o t have found B r o o k w o o d ' s p r o p o s e d FED t o be c o n s i s t e n t w i t h t h e SHP b e c a u s e the SHP does alternatively, not that address SHPDA and was approve required of FEDs to find or, that the p r o p o s e d FED was i n c o n s i s t e n t w i t h t h e SHP b e c a u s e i t c o n t a i n s no m e n t i o n of that type of f a c i l i t y . Specifically, a r g u e s t h a t t h e SHP "does n o t a d d r e s s [ F E D s ] . CON f o r a FED, SHPDA a c t e d ' i n v i o l a t i o n Trinity By i s s u i n g a of [ t h e ] statutory p r o v i s i o n s ' r e q u i r i n g consistency with the State Health see, e.g., § granting 22-21-264." t h e FED CON authority and usurped Coordinating responsible include specific petitioning the role ("SHCC"), f o r promulgating be r e q u i r e d argues t o Brookwood Council c o n j u n c t i o n w i t h SHPDA. should Trinity that exceeded of SHPDA, i n i t s statutory the Statewide which amendments is to Plan, Health statutorily the SHP in I n sum, T r i n i t y a r g u e s t h a t B r o o k w o o d to petition mention t h e SHCC t o amend t h e SHP t o o f and a p p r o v a l f o r a CON r e g a r d i n g 10 i t s FED. f o r FEDs before 2120090 We are not d i r e c t e d affirmative duty on t o any a u t h o r i t y the part of that imposes Brookwood or any p e t i t i o n e r t o s e e k amendments t o t h e SHP t h r o u g h SHCC petitioning project f o r a CON. Rather, the determination i s "consistent" with t h e SHP is a an CON before whether a determination s t a t u t o r i l y c o m m i t t e d t o SHPDA b y § 22-21-264. The l e g i s l a t u r e c o u l d have r e q u i r e d an a p p l i c a n t t o p e t i t i o n SHCC t o d e t e r m i n e o f w h e t h e r a p r o j e c t i s c o n s i s t e n t w i t h t h e SHP b e f o r e to obtain before a CON, b u t i t d i d n o t do s o . the issue us i s n o t w h e t h e r SHPDA h a s u s u r p e d t h e r o l e o f SHCC o r obviated the purpose determinating that inconsistent with, or Therefore, seeking discretion. o f t h e SHP, a FED is b u t whether consistent SHPDA, i n with, t h e SHP, e x c e e d e d i t s s t a t u t o r y Trinity argues that because FEDs or not authority are not s p e c i f i c a l l y m e n t i o n e d i n t h e SHP, SHPDA c o u l d n o t p r o c e e d t o determine whether t h e proposed p r o j e c t i s c o n s i s t e n t w i t h the SHP. We h o l d t h a t t h e d e t e r m i n a t i o n of the consistency p r o p o s e d p r o j e c t w i t h t h e SHP i s a m a t t e r e n t r u s t e d The p e r t i n e n t whether a statutes specific do n o t c a l l service or a p p r o v e d i n t h e SHP, o n l y w h e t h e r 11 of a t o SHPDA. upon SHPDA t o d e t e r m i n e facility i s mentioned and such a s e r v i c e o r f a c i l i t y 2120090 is consistent with t h e SHP. Had t h e l e g i s l a t u r e w i s h e d t o i m p o s e s u c h a n a r r o w r e v i e w o f CON p e t i t i o n s , i t c o u l d done so. The Findings of record includes Facts and the d e t a i l e d Conclusions have "Recommended of Law" ("the r e c o m m e n d a t i o n " ) s u b m i t t e d b y t h e A L J t o SHPDA, w h i c h SHPDA's CON R e v i e w B o a r d ("CONRB") a d o p t e d i n g r a n t i n g t h e CON. The recommendation d i r e c t l y addresses the i s s u e o f t h e c o n s i s t e n c y of the proposed recommendation FED to states that the SHP. " t h e SHP Specifically, contains no the specific p r o v i s i o n o r n e e d m e t h o d o l o g y a p p l i c a b l e t o FEDs o r e m e r g e n c y services. contain I t i s e q u a l l y c l e a r , h o w e v e r , t h a t t h e SHP does n o t any p r o v i s i o n s w h i c h p r o h i b i t , r e s t r i c t or otherwise p l a c e any r e q u i r e m e n t s on FEDs o r e m e r g e n c y d e p a r t m e n t s . " The recommendation observes t h a t t h e p r o j e c t " i s n o t i n c o n s i s t e n t with the any p r o v i s i o n o f t h e SHP." terms multiple " i n c o n s i s t e n t " and " c o n s i s t e n t " concerns references a specifically the expert course of the proceedings, and by reference to d i c t i o n a r i e s , n o t e s t h e d i f f e r e n c e p r e s e n t when an application facility, The r e c o m m e n d a t i o n e x a m i n e s practice of SHPDA service or testimony offered during the and c i t e s i n handling 12 governed t o the p r i o r precedent petitions for similar 2120090 projects, such as a m b u l a t o r y campus h o s p i t a l s u r g i c a l c e n t e r s and o t h e r o f f - departments, CONs b e f o r e t h e i r d i r e c t as t o w h i c h inclusion SHPDA h a s g r a n t e d i n t h e SHP. The f i n d i n g s i n t h e r e c o m m e n d a t i o n r e l i e d upon b y SHPDA i n g r a n t i n g t h e FED CON t o Brookwood are based on the record d e m o n s t r a t e t h a t t h e CONRB c a r e f u l l y presented and c o n s i d e r e d whether t h e p r o p o s e d p r o j e c t was c o n s i s t e n t w i t h t h e SHP. o u r r e v i e w , as p r o v i d e d i n § 4 1 - 2 2 - 2 0 ( k ) , The s c o p e o f specifically states t h a t " t h e a g e n c y o r d e r s h a l l be t a k e n as p r i m a f a c i e j u s t and r e a s o n a b l e and t h e c o u r t s h a l l n o t s u b s t i t u t e i t s judgment f o r that o f t h e agency questions of as t o t h e w e i g h t fact, except statute." "'This substantial deference rules court where and of the evidence otherwise the t r i a l t o an a g e n c y ' s authorized court must interpretation on by give of i t s and r e g u l a t i o n s . " [ A ] n agency's i n t e r p r e t a t i o n of i t s own r e g u l a t i o n must s t a n d i f i t i s r e a s o n a b l e , e v e n t h o u g h i t may n o t a p p e a r as r e a s o n a b l e Fowler v. J o h n s o n , M o b i l e Cnty. as some o t h e r interpretation."'" 961 So. 2d 122, 130 ( A l a . 2006) (quoting P e r s . Bd. v . T i l l m a n , 751 So. 2d 517, 518 ( A l a . C i v . App. 1 9 9 9 ) ) . The f i n d i n g s a n d c o n c l u s i o n s a d o p t e d b y SHPDA a r e n o t u n r e a s o n a b l e , arbitrary, 13 capricious, o r beyond 2120090 the statutorily granted See § 41-22-20(k)(2), a u t h o r i t y a n d d i s c r e t i o n o f SHPDA. (3), and ( 7 ) . T r i n i t y n e x t a r g u e s t h a t SHPDA " c a n n o t i s s u e a CON f o r a health care facility facility without a showing c a n be l i c e n s e d " b y ADPH. administrative regulations proposed f a c i l i t y that the proposed S t a t u t o r y p r o v i s i o n s and require SHPDA to find that a h a s t h e " r e a s o n a b l e p o t e n t i a l ... t o meet licensure standards" before g r a n t i n g a CON. § 22-21-264(4)g, Ala. Code 1 9 7 5 ; s e e a l s o R u l e 4 1 0 - 1 - 6 - . 0 5 ( 1 ) ( g ) , A l a . Admin. Code (SHPDA). ADPH i s a s e p a r a t e a g e n c y . ADPH, n o t SHPDA, determines whether t o l i c e n s e a h e a l t h - c a r e FED. The p e r t i n e n t statute determine the "[r]easonable facility l i k e the and r e g u l a t i o n r e q u i r e SHPDA t o p o t e n t i a l , " not the c e r t a i n t y or e v e n p r o b a b i l i t y , t h a t a p r o p o s e d f a c i l i t y w i l l meet l i c e n s u r e standards. FED A t t h e t i m e B r o o k w o o d a p p l i e d f o r t h e CON f o r t h e and throughout the proceedings, ADPH had not r e g u l a t i o n s o r c r i t e r i a f o r l i c e n s i n g FED f a c i l i t i e s . a r g u e s t h a t SHPDA c o u l d n o t have d e t e r m i n e d t h a t FED issued Trinity Brookwood's h a d t h e " r e a s o n a b l e p o t e n t i a l " t o meet l i c e n s u r e s t a n d a r d s unless such standards were i n place. Trinity p o r t i o n o f a l e t t e r from t h e deputy g e n e r a l 14 points counsel to a o f ADPH t o 2120090 Brookwood's c o u n s e l there that d a t e d A p r i l 24, 2009, w h i c h s t a t e s : " [ S ] o i s absolutely t h e [ADPH] intends emergency department current no m i s u n d e r s t a n d i n g , to require comment." advised any f r e e i s that p r o p o s e new r u l e s f o r h o s p i t a l - b a s e d which, be standing ... be l i c e n s e d b y t h e [ADPH]. t h i n k i n g b y [ADPH] s t a f f departments, that please of course, [it] will free standing would ... The be s u b j e c t need t o emergency to public The l e t t e r does n o t i n d i c a t e t h a t ADPH i n t e n d e d t o d e n y l i c e n s u r e t o t h e p r o p o s e d FED, s h o u l d t h e p r o j e c t come t o fruition. Rather, expectation ADPH i t suggests would that there use i t s e s t a b l i s h e d p r o m u l g a t e r u l e s t o meet t h e r e a l i t i e s This the correspondence notwithstanding, ALJ provided detailed potential-for-licensure and regulation with findings is a findings reasonable procedures o f t h e new facility. t h e recommendation from of fact the regarding requirement of the p e r t i n e n t respect to this particular FED. statute Those include: "147. The e v i d e n c e i n t h i s c a s e d e m o n s t r a t e d a r e a s o n a b l e p o t e n t i a l t h a t t h e [ p r o p o s e d FED] w i l l comply with a l l applicable licensure rules. Brookwood i s c u r r e n t l y a l i c e n s e d h o s p i t a l , and has b e e n l i c e n s e d s i n c e i t b e g a n o p e r a t i n g i n 1973, including for the provision of emergency services 15 to 2120090 "148. F u r t h e r , t h e r e a r e s e v e r a l d i f f e r e n t ways b y w h i c h ADPH c o u l d l i c e n s e t h e p r o p o s e d facility. F i r s t , t h e e v i d e n c e d e m o n s t r a t e s t h a t t h e 280 ER c a n be l i c e n s e d u n d e r B r o o k w o o d ' s h o s p i t a l l i c e n s e The [ p r o p o s e d FED] w i l l be an o f f - c a m p u s d e p a r t m e n t of Brookwood's main h o s p i t a l , o p e r a t i n g under t h e hospital's general license, j u s t l i k e St. Vincent's gastroenterology l a b a t One N i n e t e e n Health & Wellness. "149. S e c o n d , t h e [ p r o p o s e d FED] c o u l d be l i c e n s e d as a s e p a r a t e h o s p i t a l f a c i l i t y , y e t s t i l l operate as p a r t o f t h e h o s p i t a l a n d u n d e r t h e h o s p i t a l ' s management." See A l a . Admin. Code § 420-5-7. 0 2 ( 3 ) ( b ) ( ' A s e p a r a t e l i c e n s e s h a l l be r e q u i r e d f o r each facility when more t h a n one f a c i l i t y i s o p e r a t e d u n d e r t h e same management.') "150. I n t h a t r e g a r d , B r o o k w o o d h a s met w i t h t h e ADPH on s e v e r a l o c c a s i o n s t o d i s c u s s t h e o p e r a t i o n o f t h e [ p r o p o s e d FED] a n d t h e l i c e n s u r e o f FEDs. The ADPH i s p r e s e n t l y e n g a g e d i n t h e p r o c e s s o f d r a f t i n g l i c e n s u r e r u l e s f o r FEDs, a n d t h e s e r u l e s a r e e x p e c t e d t o be i n p l a c e b y t h e t i m e B r o o k w o o d ' s requested CON i s granted and t h e f a c i l i t y i s c o n s t r u c t e d and o p e r a t i o n a l " ( C i t a t i o n s o m i t t e d . ) Those f i n d i n g s a r e e n t i t l e d t o deference and t h i s c o u r t i s n o t a u t h o r i z e d t o s u b s t i t u t e i t s j u d g m e n t as t o t h e f i n d i n g s o f SHPDA on t h i s i s s u e . See § 4 1 - 2 2 - 2 0 ( k ) ( " t h e c o u r t s h a l l not s u b s t i t u t e i t s judgment f o r t h a t of t h e agency as t o t h e w e i g h t o f t h e e v i d e n c e on q u e s t i o n s where o t h e r w i s e Finally, of f a c t , except a u t h o r i z e d by s t a t u t e " ) . Trinity argues that Brookwood demonstrate " l o c a t i o n a l appropriateness" 16 failed to o f i t s p r o p o s e d FED 2120090 b e c a u s e B r o o k w o o d "has no purchase the r e a l p r o p e r t y located." The 2 regulation arrangement which w i l l where i t i n d i c a t e d t h e FED applicable require that allow statute SHPDA consider and i t to w o u l d be administrative "[e]vidence of the l o c a t i o n a l a p p r o p r i a t e n e s s of the proposed f a c i l i t y or s e r v i c e s u c h as local transportation zoning, Ala. Code 1 9 7 5 ; Code (SHPDA). proof of accessibility, environmental See The ownership health, manpower etc." § availability, 22-21-264(4)f, a l s o R u l e 4 1 0 - 1 - 6 - . 0 5 ( 1 ) ( f ) , A l a . Admin. s t a t u t e and or the right r e g u l a t i o n do n o t to acquire property require at a p a r t i c u l a r l o c a t i o n , only proof of l o c a t i o n a l a p p r o p r i a t e n e s s of the proposed f a c i l i t y . The detailed supporting the factual analysis ALJ's recommendation p r o v i d e the appropriateness a of location, including: "19. A l t h o u g h t h e s e r v i c e a r e a i s h e a v i l y p o p u l a t e d , p a r t i c u l a r l y the n o r t h w e s t e r n p o r t i o n of the s e r v i c e a r e a , t h e r e a r e p r e s e n t l y no ER s e r v i c e s i n t h i s a r e a . A r e a r e s i d e n t s n e e d i n g ER s e r v i c e s must t r a v e l t h e U.S. H i g h w a y 280 c o r r i d o r ('280 Corridor') to Brookwood, the c l o s e s t ER services provider D u r i n g r a r e t i m e s o f l i g h t t r a f f i c , g o o d w e a t h e r and A t the o r a l argument of t h i s case, Brookwood a g r e e d t h a t t h e CON i s v a l i d o n l y f o r t h e s p e c i f i c l o c a t i o n c o n t a i n e d i n the a p p l i c a t i o n i t s u b m i t t e d , i . e . , the i n t e r s e c t i o n of H i g h w a y 280 and 119 i n S h e l b y C o u n t y . Any o t h e r l o c a t i o n would, according to the p a r t i e s , r e q u i r e a s e p a r a t e CON p r o c e s s t o be i n i t i a t e d . 2 17 2120090 no a c c i d e n t s , t h e d r i v i n g t i m e down 280 f r o m Highway 199, the location of the [proposed FED], to B r o o k w o o d i s a t b e s t 20 m i n u t e s . ... I n o r d i n a r y t r a f f i c , t h e d r i v e t i m e i s a t l e a s t 30 m i n u t e s o r more, and, i n h e a v y t r a f f i c , can be an h o u r . Bad w e a t h e r o r an a c c i d e n t can b r i n g t r a f f i c t o a h a l t . " 2 0 . A c c o r d i n g l y , a r e a r e s i d e n t s a r e i n n e e d o f more r e a d i l y a v a i l a b l e ER s e r v i c e s . ... M o s t i m p o r t a n t l y , e v e r y y e a r v i c t i m s o f h e a r t a t t a c k s , s t r o k e s and other emergencies s u f f e r w o r s e outcomes due to d e l a y s i n o b t a i n i n g ER s e r v i c e s up t o and i n c l u d i n g d e a t h , b e c a u s e t h e y c o u l d n o t g e t t o B r o o k w o o d ' s ER i n t i m e . T h u s , f o r some, B r o o k w o o d ' s [ p r o p o s e d F E D ] t r u l y w i l l be a m a t t e r o f l i f e and d e a t h . "25. When p a t i e n t s p r e s e n t t o t h e [ p r o p o s e d FED], t h e y w i l l be s e e n and e v a l u a t e d a t l e a s t 30 m i n u t e s s o o n e r , and p r o b a b l y more, t h a n i f t h e y had t r a v e l e d down t h e 280 c o r r i d o r t o t h e B r o o k w o o d ER If a p a t i e n t needs f u r t h e r t r e a t m e n t i n t h e h o s p i t a l , s u c h as i n an o p e r a t i n g room, o r a c a t h l a b , t h e [ p r o p o s e d FED] p e r s o n n e l w i l l n o t i f y t h e h o s p i t a l i m m e d i a t e l y , so t h a t t h e o p e r a t i n g rooms o r c a t h l a b s can be r e a d i e d , and any n e c e s s a r y p h y s i c i a n s o r a f t e r h o u r s c a l l teams a s s e m b l e d , w h i l e t h e p a t i e n t i s en r o u t e f r o m t h e [ p r o p o s e d FED] v i a ambulance t o t h e h o s p i t a l , t h e r e b y s a v i n g v a l u a b l e t i m e . ... " "33. C u r r e n t l y t h e r e a r e s e r i o u s p r o b l e m s w i t h a c c e s s t o ER s e r v i c e s f o r h e a r t a t t a c k v i c t i m s i n the 280 service area. Once a p e r s o n leaves B i r m i n g h a m t r a v e l i n g s o u t h e a s t on U.S. 280, t h e r e a r e no ER s e r v i c e s a v a i l a b l e u n t i l C o o s a V a l l e y Medical Center ('Coosa Valley') in Sylacauga, A l a b a m a , o v e r 40 m i l e s away. ... " 18 2120090 "39. The e v i d e n c e was c o n c l u s i v e t h a t t h e [ p r o p o s e d FED] w i l l g r e a t l y improve emergency s e r v i c e s f o r h e a r t a t t a c k v i c t i m s , a n d w i l l s a v e l i v e s . ... " Therefore, Trinity h a s n o t shown that SHPDA exceeded i t s s t a t u t o r y a u t h o r i t y b y g r a n t i n g t h e CON o r t h a t i t r e n d e r e d an unreasonable, arbitrary, or capricious decision in that regard. Conclusion It was determine SHP, within whether the d i s c r e t i o n the proposed afforded t o SHPDA FED was c o n s i s t e n t whether i t had t h e reasonable with the p o t e n t i a l t o be l i c e n s e d , and w h e t h e r t h e p r o p o s e d l o c a t i o n was a p p r o p r i a t e . the required evidence d e f e r e n t i a l standard i s insufficient authority, arbitrary, decision. § Applying t o SHPDA's d e c i s i o n , t h e t o show that SHPDA exceeded i t s v i o l a t e d a n y r u l e s , o r r e n d e r e d an u n r e a s o n a b l e , or determinations Applying to capricious i n favor 41-22-20(k), Therefore, decision o f Brookwood we have by and a g a i n s t no b a s i s we a f f i r m t h e t r i a l a f f i r m i n g SHPDA's g r a n t making those Trinity. to reverse court's judgment o f t h e FED CON t o B r o o k w o o d . AFFIRMED. Thompson, P . J . , and P i t t m a n , J., concur. Thomas, J . , c o n c u r s i n t h e r e s u l t , with w r i t i n g . Moore, J . , c o n c u r s i n t h e r e s u l t , w i t h o u t w r i t i n g . 19 that 2120090 THOMAS, J u d g e , c o n c u r r i n g Although I agree i n the result. that t h e judgment o f t h e Montgomery C i r c u i t C o u r t a f f i r m i n g t h e award by t h e S t a t e H e a l t h and Development Agency Need R e v i e w B o a r d to Center of Services, ("Brookwood") department ("SHPDA") t h r o u g h t h e C e r t i f i c a t e o f ("CONRB") o f a C e r t i f i c a t e Brookwood H e a l t h Inc., to construct ("FED") s h o u l d t h e arguments asserted o f Need ("CON") d/b/a B r o o k w o o d a freestanding be a f f i r m e d , a result, Trinity's emergency b y A f f i n i t y H o s p i t a l , L L C , d/b/a differently. I must c o n c u r i n t h e r e s u l t . first and statutory-construction arguably, Medical I w o u l d a p p r o a c h two T r i n i t y M e d i c a l Center o f Birmingham ( " T r i n i t y " ) , As Planning cannot, argue main argument principles. that Trinity i s premised does on n o t , and, SHPDA i s n o t endowed w i t h t h e r i g h t , and indeed t h e duty, t o determine whether a p r o j e c t f o r w h i c h a CON i s s o u g h t i s 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 ("the SHP"). that the c r i t e r i a applications See A l a . Code 1975, § 2 2 - 2 1 - 2 6 4 ( 1 ) a t o be utilized f o r CONs s h o u l d by SHPDA in the time t h e a p p l i c a t i o n was include the l a t e s t (providing reviewing include "[c]onsistency with the a p p r o p r i a t e S t a t e H e a l t h F a c i l i t y and s e r v i c e s p l a n s at Plan received effective ... , w h i c h shall approved r e v i s i o n s of [ s p e c i f i e d ] p l a n s , " i n c l u d i n g t h e S H P ) . What T r i n i t y does a r g u e i s t h a t SHPDA's 20 2120090 review o f whether a project i s consistent with t h e SHP i s l i m i t e d t o d e t e r m i n i n g whether the proposed p r o j e c t an e x p r e s s p r o v i s i o n i n t h e [ S H P ] . " 10. Trinity different contends terms that "track[s] T r i n i t y ' s r e p l y b r i e f , p. t h e l e g i s l a t u r e ' s use o f the "consistent" and " i n c o n s i s t e n t " i n various s t a t u t e s g o v e r n i n g SHPDA r e v i e w , s e e , e . g . , A l a . Code 1975, § 22-21-266(1) proposed and § ( p r o h i b i t i n g the issuance facility or service 22-21-263(a) services "which permitted), that no inconsistent meanings; Trinity construction that relies requires CON with" unless with the on the health [SHP]" have a t h e SHP), institutional i s m e a n i n g f u l and t h a t t h e terms different statutory i s "consistent (stating are of a are distinctly principle of us t o presume t h a t t h e use o f d i f f e r e n t t e r m s b y t h e l e g i s l a t u r e i n t h e same s t a t u t e implies that redundant. 975 t h e terms have d i f f e r e n t meanings and a r e n o t See S u r t e e s v . V F J V e n t u r e s , I n c . , ( A l a . C i v . App. 2008) 8 So. 3d 950, ("The c o u r t s must presume t h a t the l e g i s l a t u r e intended t h a t e a c h w o r d o f [a] s t a t u t e ... have e f f e c t , a n d we must a l s o presume t h a t t h e l e g i s l a t u r e d i d n o t include meaningless language redundancies "inconsistent" means " c o n t r a d i c t i n g an e x p r e s s p r o v i s i o n i n I am n o t c o n v i n c e d . 21 specifically the Trinity [SHP]." suggests in statute."). the further or that 2120090 The terms forms o f the the or of "not." the antonym us "inconsistent" of the "consistent," p r i n c i p l e s of t o assume t h a t the are created in this statutory l e g i s l a t u r e used the meanings of those A m b u l a t o r y S u r g e r y C t r . , LLC A g e n c y , 38 So. 3d 739, 742 terms. v. State ( A l a . C i v . App. and The defined commonly Planning Island & Dev. 2008) ( q u o t i n g Bean D r e d g i n g , L.L.C. v. A l a b a m a Dep't o f Revenue, 855 (Ala. 2003)). means redundant Pleasure Health the terms i t must a l s o c o n s t r u e t h o s e t e r m s t h a t a r e n o t understood two construction by t h e l e g i s l a t u r e by u s i n g t h e p l a i n , o r d i n a r y , 517 by context, e m p l o y e d i n t h e s t a t u t e d e l i b e r a t e l y and d i d n o t use t e r m s , we but That i s , " i n c o n s i s t e n t " i s p r e f i x " i n , " which, Although require and word " c o n s i s t e n t . " opposite addition "consistent" dictionary definition So. of 2d 513, "consistent" i s "marked by harmony, r e g u l a r i t y , o r s t e a d y c o n t i n u i t y : f r e e from v a r i a t i o n or compatible." ( 1 1 t h ed. with contradiction" Merriam-Webster's 2003) " I n c o n s i s t e n t " another elements." fact or I d . a t 631. Collegiate or whether that i s the subject of the SHP whether a CON is as by agreement: Dictionary "not "containing Thus, when t h e SHPDA c o n s i d e r i t "marked i s defined claim" that or or compatible incompatible l e g i s l a t u r e required a proposed service or facility application i s consistent inconsistent 22 2 66 with the SHP, with i t 2120090 required t h e same a n a l y s i s . whether the service or The q u e s t i o n facility a p p l i c a t i o n i s compatible with SHPDA must a s k i s proposed in or incompatible with the CON t h e SHP. Nothing i n t h e language o f t h e s e v e r a l s t a t u t e s i n d i c a t e s that SHPDA may addresses the application. the approve a service or CON only i f t h e SHP facility proposed directly i n the T h a t i s , b a s e d on t h e l a n g u a g e u s e d i n some o f s t a t u t e s , i t does n o t a p p e a r t h a t SHPDA may a p p r o v e those proposed s e r v i c e s or f a c i l i t i e s provision CON i n t h e SHP"; instead that only " t r a c k an e x p r e s s the language used by t h e l e g i s l a t u r e p e r m i t s SHPDA t o d e t e r m i n e t h a t a p r o p o s e d s e r v i c e or facility i s consistent w i t h t h e SHP. Likewise, with a l t h o u g h t h e l a n g u a g e i n some o f t h e statutes p r o h i b i t s the approval service or language facility requires t h e SHP i f i t i s c o m p a t i b l e o f a CON when t h e p r o p o s e d i s inconsistent SHPDA t o determine service or f a c i l i t y i s incompatible confine i t s review t o determining or f a c i l i t y with t h e SHP, whether that the proposed w i t h t h e SHP a n d does n o t whether a proposed service " c o n f l i c t s w i t h an e x p r e s s p r o v i s i o n i n t h e SHP." Because t h e terms "consistent" and " i n c o n s i s t e n t " a r e u n d e f i n e d i n t h e s t a t u t e s , I r e a d t h e s t a t u t e s t o a l l o w SHPDA to determine whether a compatible or incompatible proposed service w i t h t h e SHP. 23 or facility is No l a n g u a g e u s e d i n 2120090 t h e s t a t u t e s l e a d s me t o t h e c o n c l u s i o n different meanings than t h e i r plain, t h a t t h o s e t e r m s have ordinary, a n d commonly u n d e r s t o o d meanings. I cannot read i n t o the s t a t u t e s that or are not there construe t h e terms used words by t h e l e g i s l a t u r e as n a r r o w l y as T r i n i t y w o u l d have us do. Furthermore, consider regarding the requirement the " l o c a t i o n a l appropriateness" that SHPDA of the proposed f a c i l i t y , § 2 2 - 2 1 - 2 6 4 ( 4 ) f , T r i n i t y a r g u e s t h a t SHPDA c o u l d n o t have d e t e r m i n e d s u c h a p p r o p r i a t e n e s s the h e a r i n g b e f o r e proof that the hearing because, a t the time o f o f f i c e r , B r o o k w o o d d i d n o t have i t had t h e r i g h t t o acquire the property location i t had proposed question t h a t B r o o k w o o d c o u l d n o t have p u r c h a s e d t h e p r o p e r t y without running (SHPDA), acquiring, before r. afoul t o b u i l d t h e FED. at the o f § 22-21-265 410-1-2-.19, constructing, which and A l a . prohibit or operating I t i s without an Admin. Code entity from a new h e a l t h r e c e i v i n g a CON; " a c q u i s i t i o n " i s d e f i n e d service i n § 22-21- 2 6 0 ( 1 ) as " [ o ] b t a i n i n g t h e l e g a l e q u i t a b l e t i t l e t o a f r e e h o l d or leasehold estate or otherwise obtaining the s u b s t a n t i a l b e n e f i t o f such t i t l e s o r e s t a t e s , whether by p u r c h a s e , loan or suffrage, g i f t , devise, legacy, settlement lease, of a trust o r means w h a t e v e r , a n d s h a l l i n c l u d e a n y a c t o f a c q u i s i t i o n . " See L l o y d N o l a n d Found., I n c . v. C i t y o f F a i r f i e l d 24 Healthcare 2120090 A u t h . , 837 So. 2d 253, 264 ( A l a . 2002) (considering a similar argument r e l a t i n g t o w h e t h e r an e n t i t y h a d s t a n d i n g t o s e e k a CON when i t d i d n o t have sought that acquire CON). title legal Because a party to the property c o n s t r u c t a new h e a l t h - c a r e title t o beds f o r which i t seeking upon which f a c i l i t y before a CON cannot i t intends to r e c e i v i n g a CON, t h e d e c i s i o n t h a t a l o c a t i o n i s a p p r o p r i a t e i s o f t e n b a s e d on information regarding a l w a y s be t h e f i n a l Trinity argues a tentative location, which may n o t location of the project. that Brookwood could have continued i n e f f e c t an o p t i o n t o p u r c h a s e t h e p r o p e r t y , w h i c h i t h a d h e l d through a development agency, b e f o r e before the hearing o f f i c e r . the date of the hearing I t i s not w i t h i n our province t o q u e s t i o n t h e b u s i n e s s d e c i s i o n s made b y B r o o k w o o d . presented evidence could secure other indicating that i t f e l t the property o r i g i n a l l y nearby property. hearing o f f i c e r , Based confident that i t planned f o rthe s i t e or on t h e e v i d e n c e the hearing o f f i c e r Brookwood before the a n d SHPDA c o n c l u d e d that t h e l o c a t i o n B r o o k w o o d p r o p o s e d i s an a p p r o p r i a t e l o c a t i o n f o r the proposed FED. I agree that the evidence supports that the location i t originally determination. If proposed Brookwood cannot as a s i t e secure f o r t h e FED, i t may 25 seek review of a 2120090 p r o p o s e d p r o j e c t m o d i f i c a t i o n u n d e r A l a . Admin Code r . 410-1-10-.03(1) (b), w h i c h p r o v i d e s that i n order change has in a project after a CON been a p p l i c a t i o n must be made i n w r i t i n g t o SHPDA. approval all t o make a secured, A party an seeking o f a change i n a p r o j e c t i s r e q u i r e d t o c e r t i f y parties provided (SHPDA), i n the underlying CON proceeding n o t i c e o f t h e change a p p l i c a t i o n . have that been Id. According to t h e r u l e , a p r o p o s e d change must be r e v i e w e d , d e p e n d i n g on t h e l e v e l o f t h e change, b y t h e e x e c u t i v e t h e f u l l CONRB. d i r e c t o r o f SHPDA o r b y A l a . Admin. Code (SHPDA), r . 4 1 0 - 1 - 1 0 - . 0 3 ( 2 ) . Thus, i f t h e FED p r o j e c t must be r e l o c a t e d , B r o o k w o o d , as i t a d m i t t e d a t o r a l a r g u m e n t , must s e e k a p p r o v a l f r o m SHPDA o f t h a t change t o t h e p r o j e c t . In conclusion, I conclude that t h e language of the r e l e v a n t s t a t u t e s p e r m i t s SHPDA t o c o n s i d e r w h e t h e r a p r o p o s e d project i s compatible with does n o t l i m i t the h e a l t h t h e SHP. of or incompatible SHPDA t o g r a n t i n g service or f a c i l i t y with a CON f o r a p r o j e c t o n l y i f i s s p e c i f i c a l l y referenced i n I also conclude that the l o c a t i o n a l the proposed t h e SHP a n d FED was p r o p e r l y considered appropriateness and found t o e x i s t , d e s p i t e t h e f a c t t h a t B r o o k w o o d does n o t have t h e r i g h t to the property the a t the exact l o c a t i o n i t proposed t o construct FED. A c c o r d i n g l y , I concur 26 i n t h e r e s u l t o f t h e main 2120090 opinion. 27

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