The hospital also offered extensive testimony from the nursing director of the intermediate unit and from a physician. The physician had admitted numerous patients to both the intermediate unit and the special care units and was a member of the hospital's critical care committee overseeing its special units. They offered uncontradicted testimony that the intermediate unit, while it may have originally been planned as a "stepdown" unit offering convalescent care, served primarily as an overflow unit for the recognized special care units. These witnesses testified that there was no significant difference between the intermediate unit and the recognized special care units in intensity of care, nurse training and skills, equipment availability or other important factors. The Board made no credibility findings against these witnesses but apparently disregarded their testimony.
There is no substantial evidence to support the finding that the intermediate care unit served in fact as a stepdown unit. The Board relied on the fact that approximately 40 per cent of the admissions to the intermediate unit were from the recognized special care units. This was said to support the contention that it served as a stepdown unit. This statistic alone proves little in the face of the other evidence showing that patients in the intermediate unit were subject to continuous monitoring and in other respects received the requisite "extraordinary, concentrated and continuous" care.
Finally, the Board concluded that the hospital had failed to show that it had written guidelines for the unit for the fiscal years in question, as required by the regulation. However, the uncontradicted testimony was that written guidelines were kept but were updated each year and the old guidelines were thrown out. Guidelines for a later year were presented and competent witnesses testified they were substantially identical to the guidelines for the years at issue. These guidelines clearly applied specifically to the intermediate unit, as required by the regulation. While they provide some support for the contention that the unit in some respects could have served as a stepdown, the written guidelines cannot substitute for testimony as to what actually occurred in the unit to determine how the unit functioned in fact as opposed to on paper.
The substantial evidence test applicable in cases such as this does not require that the weight of the evidence support the Secretary's decision. However, "at a minimum . . . a decision is not supported by substantial evidence unless there is 'such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. '" Airport Shuttle Service, Inc. v. ICC, 219 U.S. App. D.C. 238, 676 F.2d 836, 840 (D.C. Cir. 1982). Based on the record here and the foregoing analysis, the Court is of the firm view that the Board's disallowance of the intermediate care unit does not meet this standard when viewed in light of the applicable regulations. When one focuses on how the unit actually functioned, it is apparent that it provided virtually the same intensity of services as those given on the recognized special care units. Accordingly, the plaintiff's motion for summary judgment on this issue is granted and the defendant's motion is denied.
An appropriate Order is filed herewith. [EDITOR'S NOTE: The following court-provided text does not appear at this cite in 602 F. Supp.]
Upon consideration of defendant's motion for judgment on the pleadings, plaintiff's cross-motion for summary judgment, the arguments of counsel and the entire record herein, for reasons stated in an accompanying Memorandum, it is hereby
ORDERED that as to the interest expense issue, defendant's motion for judgment is granted and plaintiff's motion is denied, and judgment is entered for defendant; and it is further
ORDERED that as to the intermediate care unit issue, plaintiff's motion for summary judgment is granted and defendant's motion is denied, and judgment is entered for plaintiff; and it is further
ORDERED that the Secretary reimburse plaintiff for its intermediate care unit as a special care unit for fiscal years 1977, 1978 and 1980, in the sums of $22,689, $75,062 and $15,022 for these years, respectively, plus interest as provided by 42 U.S.C. § 1395oo(f)(2).