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  "name": "DIMENSIONS MEDICAL CENTER, LTD., et al., Plaintiffs-Appellees, v. SUBURBAN ENDOSCOPY CENTER et al., Defendants (Illinois Health Facilities Planning Board et al., Defendants-Appellants)",
  "name_abbreviation": "Dimensions Medical Center, Ltd. v. Suburban Endoscopy Center",
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    "parties": [
      "DIMENSIONS MEDICAL CENTER, LTD., et al., Plaintiffs-Appellees, v. SUBURBAN ENDOSCOPY CENTER et al., Defendants (Illinois Health Facilities Planning Board et al., Defendants-Appellants)."
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    "opinions": [
      {
        "text": "JUSTICE HOURIHANE\ndelivered the opinion of the court:\nIn February 1996, Suburban Endoscopy Center received approval from the Illinois Health Facilities Planning Board (the Planning Board) to begin operation of an ambulatory surgical treatment center, in Mount Prospect, dedicated solely to gastroenterological procedures. Plaintiffs Dimensions Medical Center, Ltd., Access Center for Health, Ltd., and Access Health Center, Ltd., filed a timely complaint for administrative review in the circuit court challenging the Planning Board\u2019s approval. Following a hearing, the circuit court reversed the decision of the Planning Board. On appeal, defendants Illinois Health Facilities Planning Board, John Lumpkin, M.D., Director, and Illinois Department of Public Health (the Department) contend that (1) plaintiffs lacked standing to challenge the Planning Board\u2019s approval and (2) the circuit court erred in finding that the aforementioned approval was against the manifest weight of the evidence. For the reasons that follow, we reverse.\nBACKGROUND\nIn 1995, Suburban applied to the Planning Board for approval to begin operation of an ambulatory surgical treatment center, in Mount Prospect, dedicated solely to gastroenterological procedures. Pursuant to section 8 of the Illinois Health Facilities Planning Act (Act) (20 ILCS 3960/8 (West 1996)), Suburban\u2019s application was reviewed by the Illinois Department of Public Health. As a part of that review, a public hearing was conducted on the advisability of such a treatment center. A representative of plaintiffs attended that hearing and objected to defendant\u2019s application on several grounds. Among the objections advanced was the failure of Suburban\u2019s application to adequately address certain of the \u201cnecessary criteria\u201d used in reviewing such applications, as set forth within the Illinois Health Care Facilities Plan (Plan) (77 Ill. Adm. Code \u00a7 1110.10 et seq. (1996)). Also advanced was the fact that an underutilization of current health-care facilities existed within the relevant planning area. Plaintiffs\u2019 representative further argued that any additional ambulatory surgical treatment centers would have a \u201cdistinct negative impact\u201d upon plaintiffs, as potential patients will be drawn from their facilities \u201cwhich already provide the services.\u201d Specifically, plaintiffs\u2019 representative argued that \u201cDimensions Medical Center provides a full range of out-patient surgical procedures, including [ejndoscopy.\u201d\nSeveral prior Department reports, in which similar applications were deemed inadvisable due to the underutilization of existing area health-care facilities, were also proffered by plaintiffs\u2019 representative during the hearing. One such report concerned an application of Access Center for Health, Ltd., and Access Health Center, Ltd., for approval to expand the surgical procedures offered in their single-specialty treatment center. An endoscopy procedure was among the surgical procedures for which approval was requested.\nDr. David Sales and Ira Rogal also testified at the public hearing; Dr. Sales, in his capacity as Suburban\u2019s medical director, and Rogal, as a consultant. Dr. Sales stated that approval for Suburban\u2019s proposed treatment center \u201cwill offer significant patient advantages,\u201d including specialization, state-of-the-art equipment, increased \u201copportunities for cross[-]education and specialized quality assurance\u201d as well as substantially lower costs.\nRogal briefly described Suburban\u2019s proposed treatment center, stating that it was intended to be \u201ca single specialty ambulatory surgical treatment center\u201d with two procedure rooms, in which only gastroenterology procedures would be performed. Rogal further stated that Suburban\u2019s impact upon other area hospitals and ambulatory surgical treatment centers would be \u201cminimal,\u201d while the total healthcare savings would be substantial.\nFollowing that hearing, the Department issued a report to the Planning Board regarding Suburban\u2019s application. That report found Suburban\u2019s application was not in conformance with three of the \u201cnecessary criteria\u201d outlined within the aforementioned Plan. Specifically, the Department found Suburban\u2019s application did not meet the requirements contained within sections 1110.230(e), (f) and 1110.1540(e) (77 111. Adm. Code \u00a7\u00a7 1110.230(e), (f), 1110.1540(e) (1996)), all of which related, in some manner, to the need for such a treatment center. Indeed, underlying each of those unsatisfactory assessments was the Department\u2019s finding that three area hospitals had \u201cunderutilized surgery suites.\u201d Also included with the Department\u2019s report were completed questionnaires used to survey 15 other area health-care facilities regarding their respective charges for certain surgical procedures. Those charges were compared with those proposed by Suburban. Such a questionnaire was sent to Dimensions, which returned it with a notation simply stating that \u201cDimensions Medical Center proposes to provide these and other endoscopy services to the patients of Suburban Endoscopy Center below their projected charges.\u201d However, because the Department needed specific charges from each area health-care facility, it consulted a prior application from Dimensions, in which the latter listed its charges for the relevant surgical procedures. Those charges were used by the Department within its report. No questionnaire was sent to Access Center for Health, Ltd., or Access Health Center, Ltd.\nSuburban\u2019s application was thereafter considered by the Planning Board in February 1996. Therein, the Planning Board was presented with the Department\u2019s report. It was also advised that none of the three aforementioned area hospitals objected to Suburban\u2019s proposed treatment center and that one was not, in fact, within the relevant planning area.\nRepresentatives of Suburban were also given the opportunity to address the Planning Board. Billie Paige, another consultant to Suburban, explained that the Department\u2019s finding of \u201cunderutilized surgery suites\u201d within the relevant planning area was \u201cflawed\u201d in that no distinction was made between endoscopy rooms and general surgery rooms. Rather, all rooms were considered together, which, according to Paige, inaccurately reflected the utilization rate of endoscopy rooms.\nDr. Sales also addressed the Planning Board and reiterated, by way of anecdotal information, that the Department\u2019s finding of \u201cunderutilized surgery suites\u201d was \u201cflawed.\u201d He also listed the additional benefits Suburban\u2019s proposed treatment center would offer, as he had at the public hearing, and further pledged to keep charges constant for the next two years.\nFollowing a series of questions from various members of the Planning Board, Suburban\u2019s application was approved.\nOn March 1, 1996, plaintiffs filed a complaint in administrative review, alleging, inter alia, that the Planning Board\u2019s approval was against the manifest weight of the evidence and that Suburban\u2019s application did not satisfy certain administrative criteria. On October 10, 1996, following a determination that plaintiffs had standing to challenge the Planning Board\u2019s approval, the circuit court reversed the decision of the Planning Board. The circuit court did so on the basis that Suburban\u2019s application failed to satisfy certain of the \u201cnecessary criteria\u201d set forth within the Plan. According to the circuit court, Suburban\u2019s application, in addition to the three unmet criteria enumerated within the Department\u2019s report, also failed to satisfy three other such criteria, specifically, sections 1110.230(a)(1), (d) and (e) (77 111. Adm. Code \u00a7\u00a7 1110.230(a)(1), (d), (e) (1996)). The circuit court also found that the Planning Board lacked sufficient evidence.\nDISCUSSION\nI\nDefendants first contend that the circuit court erred in determining that plaintiffs had standing to challenge the Planning Board\u2019s approval. According to defendants, plaintiffs lacked standing as the administrative record failed to establish that any of the three actually performed gastroenterological procedures. Plaintiffs respond that this contention has been waived by defendants\u2019 failure to raise it during the administrative proceedings and that, in any event, they have standing by virtue of their participation in the public hearing before the Department and because they were \u201cadversely affected\u201d by the Planning Board\u2019s approval.\nDefendants have not waived this contention. Simply stated, the defense that plaintiffs lacked standing to challenge the Planning Board\u2019s approval would not lie until plaintiffs, in fact, filed their complaint for administrative review in the circuit court. Indeed, raising such a defense prior to the commencement of the circuit court action would have been premature. See Velazquez v. Soliz, 141 Ill. App. 3d 1024, 1032, 490 N.E.2d 1346 (1986); Bronstein v. Kalcheim & Kalcheim, Ltd., 90 Ill. App. 3d 957, 959-60, 414 N.E.2d 96 (1980); North-town Bank v. Becker, 45 Ill. App. 2d 112, 126-27, 195 N.E.2d 404 (1964), aff\u2019d, 31 Ill. 2d 529, 202 N.E.2d 540 (1964).\nHere, the circuit court found that plaintiffs had standing to challenge the Planning Board\u2019s approval; Dimensions, pursuant to section 1180.40(e)(5) (77 Ill. Adm. Code \u00a7 1180.40(e)(5) (1996)), and Access Center for Health, Ltd., and Access Health Center, Ltd., pursuant to section 1180.40(e)(6) (77 Ill. Adm. Code \u00a7 1180.40(e)(6) (1996)). That determination, however, was in error, for sections 1180.40(e)(5) and (e)(6), properly considered, do not provide standing for plaintiffs to challenge the Planning Board\u2019s approval.\nSections 1180.40(e)(5) and (e)(6) define certain health-care facilities as \u201cadversely affected persons.\u201d 77 Ill. Adm. Code \u00a7\u00a7 1180.40(e)(5), (e)(6) (1996). But those sections do so within the context of limiting the number of participants to an administrative hearing following the denial of an application by the Planning Board. 77 Ill. Adm. Code \u00a7 1180.10 (1996). The application submitted by Suburban was approved. Accordingly, those sections have no relevance and thus fail to provide plaintiffs with standing to challenge the Planning Board\u2019s approval.\nNor does participation in the public hearing, alone, serve to establish such standing. See Citizens for the Preservation of Knox County, Inc. v. Department of Mines & Minerals, 149 Ill. App. 3d 261, 264, 500 N.E.2d 75 (1986); see also Kemp-Golden v. Department of Children & Family Services, 281 Ill. App. 3d 869, 876-77, 667 N.E.2d 688 (1996); Castleman v. Civil Service Comm\u2019n, 58 Ill. App. 2d 25, 32, 206 N.E.2d 514 (1965).\nInstead, only those persons \u201cadversely affected by a final decision of the [Planning] Board may have such a decision judicially reviewed.\u201d 20 ILCS 3960/11 (West 1996). In Condell Hospital v. Illinois Health Facilities Planning Board, 161 Ill. App. 3d 907, 515 N.E.2d 750 (1987), aff\u2019d, 124 Ill. 2d 341, 530 N.E.2d 217 (1988), this court held that a \u201ccompeting health care facility\u201d was an \u201cadversely affected\u201d person, and thus had standing to challenge a final decision of the Planning Board granting a permit for construction of a new hospital. 161 Ill. App. 3d at 933; see also Manor Healthcare Corp. v. Northwest Community Hospital, 129 Ill. App. 3d 291, 293-94, 472 N.E.2d 492 (1984). Accordingly, plaintiffs may be said to have standing to challenge the Planning Board\u2019s approval if, within the administrative record, they are shown to be \u201ccompeting health care facilities.\u201d\nNo serious contention may be maintained that either Access Center for Health, Ltd., or Access Health Center, Ltd., is a \u201ccompeting health care facility.\u201d Indeed, as the administrative record makes clear, neither has ever performed any gastroenterological procedures. Nor could they, for they jointly operate a single-specialty ambulatory surgical treatment center limited to pregnancy terminations. Access Center for Health, Ltd., and Access Health Center, Ltd., therefore, lacked standing to challenge the Planning Board\u2019s approval.\nThe same, however, cannot be said of Dimensions. Here, the administrative record makes clear that Dimensions, unlike Access Center for Health, Ltd., and Access Health Center, Ltd., is a multispecialty ambulatory surgical treatment center. In addition, the Department\u2019s report lists Dimensions as a provider of certain endoscopy procedures. Moreover, plaintiffs\u2019 representative testified during the public hearing that Dimensions \u201cprovides a full range of outpatient surgical procedures, including [e]ndoscopy.\u201d Dimensions is, therefore, a \u201ccompeting health care facility\u201d and, thus, duly entitled to challenge the Planning Board\u2019s approval.\nII\nNext, defendants contend that the circuit court erred in determining that the Planning Board\u2019s approval was against the manifest weight of the evidence.\nPursuant to section 3 \u2014 110 of the Code of Civil Procedure, \u201c[t]he findings and conclusions of the administrative agency on questions of fact shall be held to be prima facie true and correct\u201d on appeal. 735 ILCS 5/3 \u2014 110 (West 1996). In reviewing an administrative agency\u2019s decision, a court is to examine the record before it and determine whether that decision is against the manifest weight of the evidence. Schweig v. Schacht, 276 Ill. App. 3d 311, 315, 657 N.E.2d 1152 (1995); Hall v. Board of Education, 227 Ill. App. 3d 560, 574, 592 N.E.2d 245 (1992). If the administrative record contains any evidence that fairly supports an administrative agency\u2019s decision, that decision is not against the manifest weight of the evidence and must be sustained. Abrahamson v. Illinois Department of Professional Regulation, 153 Ill. 2d 76, 88, 568 N.E.2d 1319 (1992); Commonwealth Edison Co. v. Property Tax Appeal Board, 102 Ill. 2d 443, 467, 468 N.E.2d 948 (1984).\nOf the three additional \u201cnecessary criteria\u201d found unmet by the circuit court, two, sections 1110.230(a)(1) and (d) (77 Ill. Adm. Code \u00a7\u00a7 1110.230(a)(1), (d) (1996)), were amended during the pendency of this action. The circuit court, however, refused to apply sections 1110.230(a)(1) and (d), as amended. That was error.\nPursuant to First of America Trust Co. v. Armstead, 171 Ill. 2d 282, 664 N.E.2d 36 (1996), those intervening amendments were to have been applied unless to do so would have interfered with a \u201cvested right.\u201d 171 Ill. 2d at 290. Application of sections 1110.230(a)(1) and (d), as amended, would not have interfered with a \u201cvested right,\u201d for, at the time those amendments became effective, a final judgment had not yet been entered. Bates v. Board of Education, Allendale Community Consolidated School District, No. 17, 136 Ill. 2d 260, 269, 555 N.E.2d 1 (1990). As such, application of amended sections 1110.230(a)(1) and (d) was required.\nAs amended, section 1110.230(a)(1) required the following:\n\u201c(a) Location \u2014 Review Criterion.\n(1) The applicant must document that the primary purpose of the proposed project will be to provide care to the residents of the planning area in which the proposed project will be physically located. Documentation for existing facilities shall include patient origin information for all admissions for the last 12 months. Patient origin information must be presented by zip code and be based upon the patient\u2019s legal residence other than a health care facility for the last six months immediately prior to admission. For all other projects for which referrals are required to support the project, patient origin information for the referrals is required. Each referral letter must contain a certification by the health care worker physician that the representations contained therein are true and correct. A complete set of the referral letters with original notarized signatures must accompany the application for permit.\u201d 77 111. Adm. Code \u00a7 1110.230(a)(1) (1996).\nHere, several physician referral letters detailing the number of gastroenterological procedures performed by Suburban\u2019s principals were included as a part of Suburban\u2019s application. All of the \u201cpatient origin information\u201d therein was presented by zip code, and each letter was properly certified and notarized. As such, Suburban\u2019s application was in due conformance with the section 1110.230(a)(1), as amended.\nPrior to amendment, section 1110.230(d) required an applicant to document \u201can absence of two or more serious violations in each facility operated during the last five years.\u201d 77 111. Adm. Code \u00a7 1110.230(d) (1994). After amendment, section 1110.230(d) provided, in pertinent part, as follows:\n(d) Background of Applicant \u2014 Review Criterion.\n(1) The applicant shall demonstrate that it is fit, willing and able, and has the qualifications, background and character to adequately provide a proper standard of health care service for the community. In evaluating the fitness of the applicant, the State Board shall consider whether adverse action has been taken against the applicant, or against any health care facility owned or operated by the applicant, directly or indirectly, within three years preceding the filing of the application.\u201d (Emphasis in original.) 77 Ill. Adm. Code \u00a7 1110.230(d)(1) (1996).\nHere, a letter from Endoscopy Center Affiliates, Inc., Suburban\u2019s general partner, explained that \u201cno adverse action\u201d has ever been taken against North Shore Endoscopy Center, the only other healthcare facility owned and operated by Endoscopy Center Affiliates, Inc. As such, Suburban\u2019s application was in due conformance with section 1110.230(d), as amended.\nThe third of the three additional \u201cnecessary criteria\u201d found unmet by the circuit court, section 1110.230(e), concerned alternatives to the proposed project and required certain cost comparison documentation. Specifically, that section provided as follows:\n\u201c(e) Alternatives to the Proposed Project \u2014 Review Criterion.\nThe applicant must document that the proposed project is the most effective or least costly alternative. Documentation shall consist of a comparison of the proposed project to alternative options. Such a comparison must address issues of cost, patient access and financial benefits in both the short and long-term. Alternatives must include, but are not limited to[,J purchase of equipment, leasing or utilization (by contract or agreement) of other facilities, development of freestanding settings for service and alternate settings within the facility.\u201d 77 111. Adm. Code \u00a7 1110.230(e) (1996).\nAs a part of its application Suburban included a comparison between the proposed charge for its most expensive gastroenterological procedure and the highest and lowest corresponding charges of surrounding area health-care facilities. Suburban\u2019s proposed charge was, by far, the lowest. In addition to that information, the Planning Board also had before it completed questionnaires from other area healthcare facilities, each detailing the various gastroenterological procedure charges at those facilities. Suburban\u2019s proposed charges were still, by far, the lowest.\nThe circuit court found that evidence insufficient for purposes of determining Suburban\u2019s conformance with section 1110.230(e). It clearly was not.\nAs previously discussed, three other \u201cnecessary criteria\u201d were also found unmet by both the Department and the circuit court. Of those three, each related, in some manner, to the need for such a treatment center. First among that number, section 1110.230(e), concerned alternatives. 77 Ill. Adm. Code \u00a7 1110.230(e) (1996). According to the Department, Suburban failed to demonstrate that its proposed treatment center would increase consumer access to gastroenterological procedures in light of the underutilization of certain other health-care facilities. In fact, in the opinion of the Department, \u201cthe best alternative [was] to utilize existing resources.\u201d\nThe existence of such underutilized health-care facilities within the planning area also led the Department and circuit court to find deficiencies in two other \u201cnecessary criteria\u201d; one contained within section 1110.230(f) (77 Ill. Adm. Code \u00a7 1110.230(f) (1996)), and the other, in section 1110.1540(e) (77 111. Adm. Code \u00a7 1110.1540(e) (1996)). Specifically, the Department and the circuit court found that an underutilization of \u201csurgical suites\u201d at three hospitals within the planning area demonstrated a lack of need for such a treatment center.\nHowever, during the Planning Board meeting in February 1996, both Billie Page and Dr. Sales explained that the Department\u2019s finding of \u201cunderutilized surgical suites\u201d was \u201cflawed\u201d in that the report did not distinguish between endoscopy rooms and general surgical rooms. According to them, considering all rooms together understated the utilization rate of those dedicated solely to gastroenterological procedures. The Planning Board was also advised during that meeting that two of the aforementioned three hospitals did not object to Suburban\u2019s application and that the other was not, in fact, within the planning area.\nAs such, the record on appeal contains evidence that fairly supports the Planning Board\u2019s approval.\nMoreover, even assuming the Planning Board was not persuaded by such supplemental information, its approval still cannot be said to have been against the manifest weight of the evidence, for as section 1130.660 allows, \u201c[t]he failure of a project to meet one or more review criteria *** shall not prohibit the issuance of a permit.\u201d 77 Ill. Adm. Code \u00a7 1130.660 (1996). In Access Center for Health, Ltd. v. Illinois Health Facilities Planning Board, 283 Ill. App. 3d 227, 669 N.E.2d 668 (1996), this court held that an applicant\u2019s failure to comply with similar \u201cnecessaiy criteria\u201d could be excused by the Planning Board pursuant to section 1130.660. 283 Ill. App. 3d at 239. As such, it cannot now be said that the Planning Board\u2019s approval was against the manifest weight of the evidence.\nCONCLUSION\nFor the aforementioned reasons, the judgment of the circuit court is reversed\nReversed.\nHOFFMAN, EJ., and SOUTH, J., concur.\ndimensions relies upon Springwood Associates v. Health Facilities Planning Board, 269 Ill. App. 3d 944, 646 N.E.2d 1374 (1995), in support of its contention that Suburban failed to comply with the requirements of section 1110.230(a)(1). That reliance, however, is misplaced, for Springwood Associates predates the amendment to section 1110.230(a)(1). Indeed, that court applied the former version of that section. 269 Ill. App. 3d at 948-49. Spring-wood Associates is, therefore, inapposite.",
        "type": "majority",
        "author": "JUSTICE HOURIHANE"
      }
    ],
    "attorneys": [
      "James E. Ryan, Attorney General, of Chicago (Barbara A. Preiner, Solicitor General, and Karen J. Dimond, Assistant Attorney General, of counsel), for appellants.",
      "Andrew J. Creighton and Allyson Bouldon, both of Des Plaines, for appellees."
    ],
    "corrections": "",
    "head_matter": "DIMENSIONS MEDICAL CENTER, LTD., et al., Plaintiffs-Appellees, v. SUBURBAN ENDOSCOPY CENTER et al., Defendants (Illinois Health Facilities Planning Board et al., Defendants-Appellants).\nFirst District (5th Division)\nNo. 1\u201496\u20143919\nOpinion filed July 17, 1998.\nJames E. Ryan, Attorney General, of Chicago (Barbara A. Preiner, Solicitor General, and Karen J. Dimond, Assistant Attorney General, of counsel), for appellants.\nAndrew J. Creighton and Allyson Bouldon, both of Des Plaines, for appellees."
  },
  "file_name": "0093-01",
  "first_page_order": 113,
  "last_page_order": 123
}
