VANTAGE CANCER CENTERS OF GEORGIA, LLC v. GEORGIA DEPARTMENT OF COMMUNITY HEALTH (Three Cases)

NOTICE: This opinion is subject to modification resulting from motions for reconsideration under Supreme Court
Rule 27, the Court’s reconsideration, and editorial revisions by the Reporter of Decisions. The version of the
opinion published in the Advance Sheets for the Georgia Reports, designated as the “Final Copy,” will replace any
prior version on the Court’s website and docket. A bound volume of the Georgia Reports will contain the final and
official text of the opinion.

In the Supreme Court of Georgia

Decided: February 20, 2024

S23G0405. VANTAGE CANCER CENTERS of GEORGIA, LLC et
al. v. GEORGIA DEPARTMENT OF COMMUNITY HEALTH et
al.
S23G0408. NORTHEAST GEORGIA MEDICAL CENTER, INC. et
al v. NORTHSIDE HOSPITAL, INC. d/b/a NORTHSIDE
HOSPITAL GWINNETT.
S23G0409. NORTHEAST GEORGIA MEDICAL CENTER, INC. et
al. v. GEORGIA DEPARTMENT OF COMMUNITY HEALTH.

BOGGS, Chief Justice.

This case concerns the standard of review that the

Commissioner of the Georgia Department of Community Health

must apply when reviewing the decision of a hearing officer on an

application for a certificate of need to establish a new health service.

The Court of Appeals held that in this case the Commissioner

applied the correct standard of review, see Northside Hosp., Inc. v.

Northeast Georgia Med. Ctr., Inc., 365 Ga. App. 778, 782-785 (880

SE2d 286) (2022), and we granted certiorari to review that decision.

We now vacate the Court of Appeals’ judgment, set forth the
standard applicable to the Commissioner’s review, and remand the

case to the Court of Appeals.

1. In 2020, Northside Hospital, Inc., d/b/a Northside Hospital

Gwinnett (“Northside”), applied to the Georgia Department of

Community Health (“the Department”) for a certificate of need

(“CON”) to establish a new radiation therapy service at the

Northside Gwinnett Hospital. Northside filed its application under

a Department regulation permitting need exceptions for atypical

barriers to care, asserting that atypical barriers impeded the

delivery of radiation therapy services to inpatients at Northside

Gwinnett.1 More specifically, Northside contended that its inpatient

cancer patients had to be transported offsite for radiation therapy

1 Ga. Comp. R. & Regs., r. 111-2-2-.42 sets forth the requirements for a

CON to establish a new radiation therapy service. Among other things, an
applicant must either show a need for the service, see Ga. Comp. R. & Regs., r.
111-2-2-.42 (3) (a), or establish grounds for applying an exception to the usual
need requirement. See Ga. Comp. R. & Regs., r. 111-2-2-.42 (3) (b). The atypical
barrier exception to the need standard permits the Department to issue a
certificate “[t]o remedy an atypical barrier to [radiation therapy] services based
on cost, quality, financial access and geographic accessibility.” Ga. Comp. R. &
Regs., r. 111-2-2-.42 (3) (b) (4).

2
and that, as a result, its inpatients experienced negative quality

issues, such as missed appointments and delayed treatment. The

Northeast Georgia Medical Center (“Northeast”), RCOG Cancer

Centers, LLC (“RCOG”), and Vantage Cancer Centers of Georgia,

LLC (“Vantage”), opposed the application. Northeast provides

radiation therapy service at three locations in Hall County, one of

which is just across the Gwinnett County line. Northeast provides

radiation therapy to numerous Gwinnett County residents.

Vantage and RCOG provide radiation therapy at facilities in

Gwinnett County that are about .3 miles and .8 miles from

Northside, respectively. 2 The Department’s staff granted the CON

on June 16, 2020, concluding, among other things, that Northside

had justified an exception to the numerical need methodology based

on quality of care. See OCGA § 31-6-43 (b) (providing that

Department staff makes an initial decision to grant or deny a CON).

2 See OCGA § 31-6-43 (d) (2) (A) (allowing certain parties to “oppose an

application for a certificate of need for a proposed project,” including parties
who “offer[ ] substantially similar services as proposed within a 35 mile radius
of the proposed project”).
3
 (a) Appeal to Hearing Officer

Northeast, RCOG, and Vantage filed administrative appeals to

a hearing officer. See OCGA § 31-6-44 (d). The hearing officers are

part of a “Certificate of Need Appeal Panel” that is “an agency

separate and apart from the department,” the purpose of which is

“to serve as a panel of independent hearing officers to review the

department’s initial decision to grant or deny a certificate of need

application.” OCGA § 31-6-44 (a). The hearing officer conducts “a de

novo review of the decision of the department.” OCGA § 31-6-44 (f).

Here, on April 21, 2021, following a hearing, the hearing officer

reversed the Department’s decision approving the CON. The

hearing officer’s decision contained 86 paragraphs designated as

“Findings of Fact” (“FOF”). FOF 29, for example, stated that “the

evidence at [the] hearing did not support the proposition that there

is any atypical quality barrier to care associated with a hospital’s

inpatients receiving radiation therapy at a nearby freestanding

center, as they have for decades.” FOF 34 stated that “[t]here is

nothing atypical about a hospital such as [Northside] utilizing

4
nearby freestanding [radiation therapy] providers staffed by

physicians on the hospital’s medical staff to treat its inpatients, and

that situation does not constitute an atypical barrier to care”; that

“[t]his is consistent with the overwhelmingly-outpatient nature of

the service, and medical transport to nearby radiation therapy

centers offers good access and quality for those few patients who

would benefit from radiation while admitted”; and that “[t]he

available data presented at the hearing further indicated that

inpatients at [Northside] are not accessing radiation at lower rates,

thus confirming that inpatients at [Northside] have good access, and

relying upon a detached nearby facility does not pose a barrier to

care.” Meanwhile, FOF 37 stated that the “[m]edical transport of

cancer inpatients for radiation therapy is routine, safe, and

effective” and “has been the practice at [Northside] for many years.”

(b) Appeal to the Commissioner

Northside and the Department appealed the hearing officer’s

decision to the Commissioner of the Department. See OCGA § 31-6-

44 (i) (permitting parties, including the Department, to appeal the

5
hearing officer’s decision to the commissioner). The Commissioner’s

scope of review is defined by OCGA § 31-6-44 (k) (1), which provides:

In the event an appeal of the hearing officer’s decision is
filed, the commissioner may adopt the hearing officer’s
order as the final order of the department or the
commissioner may reject or modify the conclusions of law
over which the department has substantive jurisdiction
and the interpretation of administrative rules over which
it has substantive jurisdiction. By rejecting or modifying
such conclusion of law or interpretation of administrative
rule, the department must state with particularity its
reasons for rejecting or modifying such conclusion of law
or interpretation of administrative rule and must make a
finding that its substituted conclusion of law or
interpretation of administrative rule is as or more
reasonable than that which was rejected or modified.
Rejection or modification of conclusions of law may not
form the basis for rejection or modification of findings of
fact. The commissioner may not reject or modify the
findings of fact unless the commissioner first determines
from a review of the entire record, and states with
particularity in the order, that the findings of fact were
not based upon any competent substantial evidence or
that the proceedings on which the findings were based did
not comply with the essential requirements of law.

Here, in conducting this review, the Commissioner quoted the

standard of review set forth in OCGA § 31-6-44 (k) (1), overturned

the hearing officer’s decision, and granted a CON for the project.

6
The Commissioner rejected many of the FOFs of the hearing officer

on the grounds that they were “conclusion[s] couched as a finding of

fact,” “irrelevant,” or “contain[ed] opinions.” The Commissioner

concluded, among other things, that:

Northside defined a population in need of the service it is
proposing. The gap, from a quality perspective, is the
service is not now available on site at its existing facility
and inpatients requiring such treatments must be
transported to nearby free-standing outpatient facilities
for radiation therapy. The balancing of the needs of the
patients, their comfort, their medical fragility, the costs
to transfer them for a regimen of radiation treatments,
and the involvement of clinical staff to transport the
patient relates directly to quality.

The Commissioner thus determined that Northside had

justified “an atypical barrier based on quality to inpatient

[radiation therapy] services for the population it serves.”

(c) Judicial Review in Superior Court

Vantage and RCOG filed a petition for judicial review in

Gwinnett Superior Court, and Northeast sought review in Hall

7
County Superior Court.3 See OCGA § 31-6-44.1 (a). Under OCGA §

31-6-44.1 (a), a superior court is authorized to reverse or modify the

Commissioner’s final decision only if “substantial rights of the

appellant have been prejudiced because the procedures followed by

the department, the hearing officer, or the commissioner or the

administrative findings, inferences, and conclusions contained in

the final decision are,” among other things, “[i]n violation of

constitutional or statutory provisions,” “[i]n excess of the statutory

authority of the department,” or

[n]ot supported by substantial evidence, which shall
mean that the record does not contain such relevant
evidence as a reasonable mind might accept as adequate
to support such findings, inferences, conclusions, or
decisions, which such evidentiary standard shall be in
excess of the ‘any evidence’ standard contained in other
statutory provisions[.]

3 The petitions for judicial review were filed in the superior courts of

different counties because OCGA § 31-6-44.1 (a) provides that a party “may
seek judicial review of the final decision in accordance with the method set
forth in Chapter 13 of Title 50” and because OCGA § 50-13-19 (b) provides that
an interested party may file a petition for judicial review in Fulton County or,
if the petitioner is a corporation, “in the superior court of the county where the
petitioner maintains its principal place of doing business in this state[.]”
8
OCGA § 31-6-44.1 (a) (1), (2), (5). Here, Northeast, Vantage, and

RCOG contended, among other things, that the Commissioner

violated the statutory standard of OCGA § 31-6-44 (k) (1) for

reviewing the findings of fact of the hearing officer and that the

Commissioner’s decision was not supported by substantial evidence.

The Gwinnett County court upheld the Commissioner’s decision,

concluding that the decision was supported by substantial evidence

and was consistent with the atypical barrier exception and that,

even if the Commissioner erred in failing to follow the standard of

review of OCGA § 31-6-44 (k) (1), Vantage and RCOG had failed to

show that the failure violated their substantial rights. On the other

hand, the Hall County court reversed the Commissioner’s decision,

concluding, among other things, that the Commissioner exceeded

the limits of his statutory authority under OCGA § 31-6-44 (k) (1) by

rejecting and modifying findings of fact without concluding that the

findings were “‘not based upon any competent substantial

evidence.’” The Hall County court concluded that Northeast’s

substantial rights were prejudiced by this error.

9
 (d) Court of Appeals Decision

In the Gwinnett County case, Vantage and RCOG filed a joint

application for discretionary appeal in the Court of Appeals. In the

Hall County case, Northside and the Department filed separate

applications for discretionary appeal. The Court of Appeals granted

all three applications. In the Northside and the Department

appeals, the Court of Appeals reversed the judgment of the Superior

Court of Hall County. See Northside Hosp., 365 Ga. App. at 783-784.

The Court of Appeals concluded that the Hall County court

“conflated the commissioner’s scope of review with that of its own,”

id. at 783, when the trial court stated:

Like reviewing courts, the [c]ommissioner is not
authorized under the substantial evidence standard to
reweigh the evidence, perform a de novo review of the
facts, substitute his judgment for that of the hearing
officer as to the proper weight to give evidence, or make
his own factual findings.

Id. (emphasis in original). The Court of Appeals concluded that this

language indicated that the trial court “ignored the plain language

of OCGA § 31-6-44 (k) (1), which commands the commissioner to

10
review the entire record and to evaluate whether the hearing

officer’s findings of fact were supported — not only by substantial

evidence, as is required of the superior court — but by competent

substantial evidence.” Id. (emphasis in original). The Court of

Appeals reasoned that, unlike the limited authority granted to

superior courts on judicial review, the use of the word “competent”

“requires the commissioner to apply an additional layer of

qualitative inquiry” and that “[t]his higher inquiry comports with

[the Department’s] codified policy-making directive.” Id. at 784. The

Court of Appeals thus essentially concluded that the Commissioner,

in reviewing the hearing officer’s decision under OCGA § 31-6-44 (k)

(1), was not prohibited from reweighing the evidence that was

presented to the hearing officer like a superior court is constrained

by OCGA § 31-6-44.1 (a) (5) in reviewing whether the

Commissioner’s decision is supported by substantial evidence.

In addition, the Court of Appeals concluded that the

Commissioner did “state with particularity his reasons for rejecting

or modifying each finding of fact” in that he rejected them “as

11
conclusory, speculative, or mere opinion,” id. at 785, and that the

“clear inference” was that “the Commissioner viewed [the hearing

officer’s] findings — to the extent they are factual findings — as also

unsupported by competent substantial evidence,” thus substantially

complying with OCGA § 31-6-44 (k) (1). Northside Hosp., 365 Ga.

App. at 785 (emphasis in original). In reaching this conclusion,

however, the Court of Appeals majority opinion did not undertake to

determine the meaning of the requirement that the Commissioner

“state with particularity” his reasons for concluding that the hearing

officer’s findings of fact were not supported by “competent

substantial evidence.”

In Vantage’s appeal from the Gwinnett County court, the Court

of Appeals affirmed on the ground that it had determined in the

appeals by Northside and the Department that the Commissioner’s

decision was proper. Northside Hosp., 365 Ga. App. at 788.

Presiding Judge Dillard dissented in both cases on the ground

that “the commissioner repeatedly violated the unambiguous

requirements and prohibitions delineated in OCGA § 31-6-44 (k)

12
(1).” Northside Hosp., 365 Ga. App. at 788. He explained that “the

commissioner never used the words ‘competent,’ ‘substantial,’ or

even ‘evidence’ in applying OCGA § 31-6-44 (k) (1)”; that “the

commissioner . . . needs to establish which specific standard of

evidentiary review he applied and do so with particularity”; that

“not only did the commissioner fail to apply the competent

substantial evidence standard of OCGA § 31-6-44 (k) (1), he instead

gave a laundry list of statutorily prohibited reasons for rejecting or

modifying the hearing officer’s findings of fact”; and that “[t]he trial

court’s judgments . . . should be vacated and the cases remanded

with instructions to vacate the [the Department’s] final decision and

instruct the commissioner to issue a new decision.” Id. at 792-794

(emphasis in original).

RCOG and Vantage filed a timely petition for certiorari, which

we granted. Northeast filed two companion petitions for certiorari,

and we granted both. We granted the petitions to address the

meaning of the standard of review that OCGA § 31-6-44 (k) (1)

13
requires the Commissioner to apply in reviewing the hearing

officer’s findings of fact.

2. As explained below, we conclude that the Court of Appeals

erred in determining the meaning of the phrase “competent

substantial evidence” in OCGA § 31-6-44 (k) (1). Moreover, we

undertake to define the meaning of the requirement that the

Commissioner must “state with particularity” his reasons for

rejecting or modifying a finding of fact of the hearing officer. Because

we conclude that the Court of Appeals should determine in the first

instance whether the Commissioner complied with the standard of

review of OCGA § 31-6-44 (k) (1), as that standard is applied

properly, we vacate and remand the case to it for proceedings

consistent with this opinion.

“When we consider the meaning of a statute, we must presume

that the General Assembly meant what it said and said what it

meant.” Camp v. Williams, 314 Ga. 699, 702 (879 SE2d 88) (2022)

(cleaned up). “To that end, we must afford the statutory text its plain

and ordinary meaning, we must view the statutory text in the

14
context in which it appears, and we must read the statutory text in

its most natural and reasonable way, as an ordinary speaker of the

English language would.” McBrayer v. Scarbrough, 317 Ga. 387, 393

(893 SE2d 660) (2023) (cleaned up). Of course, “as we have said

many times before when interpreting legal text, we do not read

words in isolation, but rather in context.” Seals v. State, 311 Ga. 739,

740 (860 SE2d 419) (2021) (cleaned up), disapproved on other

grounds by Gonzales v. State, 315 Ga. 661, 665 n.7 (884 SE2d 339)

(2023). “For context, we may look to other provisions of the same

statute, the structure and history of the whole statute, and the other

law — constitutional, statutory, and common law alike — that forms

the legal background of the statutory provision in question.”

Zaldivar v. Prickett, 297 Ga. 589, 591 (774 SE2d 688) (2015) (cleaned

up).

The text of OCGA § 31-6-44 (k) (1) requires the Commissioner

to accept the hearing officer’s findings of fact “unless the

commissioner first determines from a review of the entire record,

and states with particularity in the order, that the findings of fact

15
were not based upon any competent substantial evidence.” Several

interpretive issues are presented by this language. One is the

meaning of “competent substantial evidence,” and another is the

meaning of the requirement that the Commissioner “state[ ] with

particularity in the order” why the Commissioner is rejecting or

modifying a finding of fact.

(a) We turn first to the phrase “competent substantial

evidence.” We note that the term is not defined by the laws

governing the certificate of need program, see OCGA § 31-6-40 et

seq., and has not been interpreted by the courts of this State.

However, the phrase “substantial evidence” is defined in another

provision of the act governing the certificate of need program, OCGA

§ 31-6-44.1 (a) (5), Northside contends that that definition is

controlling, and “there is a natural presumption that identical words

used in different parts of the same act are intended to have the same

meaning.” Zaldivar, 297 Ga. at 592 (cleaned up). In this regard,

OCGA § 31-6-44.1 (a) (5), which sets forth the standard for a

16
superior court’s review of the Department’s final decision, provides

that a superior court

may reverse or modify the final decision only if . . . the
administrative findings, inferences, and conclusions
contained in the final decision are . . . [n]ot supported by
substantial evidence, which shall mean that the record
does not contain such relevant evidence as a reasonable
mind might accept as adequate to support such findings,
inferences, conclusions, or decisions, which such
evidentiary standard shall be in excess of the ‘any
evidence’ standard contained in other statutory
provisions[.]

We note that this definition of “substantial evidence” is consistent

with the meaning of the term as used in a legal context. See Black’s

Law Dictionary 599 (8th ed. 2004) (“substantial evidence” means

“[e]vidence that a reasonable mind could accept as adequate to

support a conclusion; evidence beyond a scintilla”). See Zaldivar,

297 Ga. at 596 (looking to Black’s Law Dictionary for “the usual and

customary meaning of [a] term as used in a legal context”). Cf.

Biestek v. Berryhill, 587 U.S. ___ (139 SCt 1148, 1154, 1156, 203

LE2d 504) (2019) (explaining that “the phrase ‘substantial evidence’

is a ‘term of art’ used throughout administrative law to describe how

17
courts are to review agency factfinding”; that it means reviewing the

administrative record for “such relevant evidence as a reasonable

mind might accept as adequate to support a conclusion”; that the

standard is a “deferential” one; and that the threshold for such

evidentiary sufficiency is not high, but is “more than a mere

scintilla”) (cleaned up)). Moreover, in two cases involving the

predecessors to OCGA § 31-6-44.1 (a) (5) (formerly OCGA §§ 31-6-44

(m) and 31-6-44 (i) (5)) and involving the exact same definition of

“substantial evidence,” the Court of Appeals held that the standard

was a deferential one that did not permit a reviewing court to

reweigh findings of fact. See Dept. of Community Health v. Gwinnett

Hosp. System, 262 Ga. App. 879, 883 (586 SE2d 762) (2003); Hosp.

Auth. of Gwinnett County v. State Health Planning Agency, 211 Ga.

App. 407, 409-410 (438 SE2d 912) (1993).

Given that the term “substantial evidence” is defined in

another provision of our certificate-of-need laws and that the

definition tracks the commonly understood meaning of that

standard in the legal context, we conclude that the phrase

18
“substantial evidence” in OCGA § 31-6-44 (k) (1), has the meaning

given to that term by OCGA § 31-6-44.1 (a) (5).4 See Zaldivar, 297

Ga. at 592.

4 Presiding Justice Peterson recently noted that a petition for certiorari
“persuasively suggest[ed]” that this Court and the Court of Appeals “may have
gone astray” by on occasion interpreting the phrase “substantial evidence” in
Georgia statutes governing review of administrative agency decisions “to mean
essentially ‘any evidence.’” Fla. Rock Indus., Inc. v. Clayton County Bd. of
Commissioners, 316 Ga. 380, 381-382 (888 SE2d 573) (2023) (Peterson, P.J.,
concurring in the denial of certiorari). He explained that

it appears that the phrase “substantial evidence” had an
identifiable, stable meaning in the law by the time many of our
state’s review provisions were enacted. See, e.g., Consol. Edison
Co. v. Nat. Labor Relations Bd., 305 U.S. 197, 229 (59 SCt 206, 83
LE 126) (1938) (“Substantial evidence . . . means such relevant
evidence as a reasonable mind might accept as adequate to support
a conclusion.”) . . . . And that meaning . . . apparently referred to
something more than literally any evidence. See Universal Camera
Corp. v. Nat. Labor Relations Bd., 340 U.S. 474, 477 (71 SCt 456,
95 LEd 456) (1951) (“substantial evidence is more than a mere
scintilla . . . it must do more than create a suspicion of the existence
of the fact to be established”).

Fla. Rock, 316 Ga. at 381-382 (cleaned up). Despite his reservations about prior
case law interpreting the “substantial evidence” standard of review as “any
evidence,” Presiding Justice Peterson concurred in the denial of certiorari
because the statute at issue in that petition would no longer be in force by the
time we could have decided the case. Id. at 382. Here, we need not address
those cases because the General Assembly has defined the phrase “substantial
evidence” in the context of cases involving certificates of need.
19
 (b) Resolving the meaning of “substantial evidence” in OCGA §

31-6-44 (k) (1), however, does not end our inquiry, because the

applicable standard in subsection (k) (1) is “competent substantial

evidence.” See State v. SASS Grp., 315 Ga. 893, 902 (885 SE2d 761)

(2023) (explaining that “courts generally should avoid a construction

that makes some language mere surplusage” (cleaned up)).

Northside and the Department contend that the use of the word

“competent” in OCGA § 31-6-44 (k) (1) signifies that the General

Assembly intended for the addition of “competent” in the

“substantial evidence” component of OCGA § 31-6-44 (k) (1) to give

the Commissioner greater power in reviewing the hearing officer’s

findings of fact than that of “substantial evidence” as defined in

OCGA § 31-6-44.1 (a) (5). More specifically, Northside argues that

the word “competent” permits the Commissioner to consider the

proper weight to be given to evidence introduced before the hearing

officer, to permit the Commissioner to review the evidence in light

of his expertise, and to review the evidence before the hearing officer

for reliability. In the same vein, the Court of Appeals concluded that

20
use of the phrase “competent substantial evidence” permitted the

Commissioner “to apply an additional layer of qualitative inquiry”

to the review permitted by the “substantial evidence” prong of OCGA

§ 31-6-44.1 (a) (5). Northside Hosp., 365 Ga. App. at 783-784. The

Court of Appeals also suggested that the word “competent” permits

the Commissioner to consider policy concerns in reviewing the

hearing officer’s findings of fact. Id. at 784 (noting that “additional

layer of qualitative inquiry” “comports with [the Department’s]

codified policy-making directive.”).

We disagree that “competent substantial evidence” carries

such meanings. In determining the meaning of “competent

substantial evidence,” we may look to other statutory law that

“forms the legal background of the statutory provision in question.”

Zaldivar, 297 Ga. at 591 (cleaned up). At the time of the

enactment of OCGA § 31-6-44 (k) (1) in 2008, former OCGA § 24-1-

1 (1) provided that “[c]ompetent evidence is that which is

admissible.” See also Guye v. Home Indem. Co., 241 Ga. 213, 215

(244 SE2d 864 (1978) (citing to former version of OCGA § 24-1-1 (1)

21
for the proposition that “[c]ompetent evidence is that which is

admissible”). This definition, in fact, has existed since Georgia’s first

Code in 1863. See Code of 1863, § 3671 (“Competent evidence is that

which is admissible”); Code of 1933, § 38-102 (same). This legal

background is relevant context for understanding the meaning of

“competent substantial evidence.” See Zaldivar, 297 Ga. at 591. See

also Black’s Law Dictionary 596 (8th ed. 2004) (defining “competent

evidence” as “admissible evidence” and “relevant evidence”). Accord

Undisclosed LLC v. State, 302 Ga. 418, 428-430 (807 SE2d 393)

(2017) (in determining the meaning of court rules, which are

interpreted in the same way as statutes, we looked to a statute as it

existed at the time the court rule was adopted for relevant context).5

Given the longstanding definition of “competent evidence” in our

statutory law at the time OCGA § 31-6-44 (k) (1) was enacted, we

conclude that “competent” in the phrase “competent substantial

5 We note that the provision of the old Evidence Code defining
“competent evidence” was repealed in 2013 by our current Evidence Code. See
Ga. L. 2011, p. 99, 100. That repeal had no effect on the meaning OCGA § 31-
6-44 (k) (1) had when it was enacted years earlier.
22
evidence” is most naturally and reasonably understood to mean

substantial evidence that was admissible.

Northside, however, asserts several arguments against this

reading of “competent substantial evidence.” Northside notes that a

reviewing court is authorized to reject factual findings when they

are not supported by “substantial evidence,” OCGA § 31-6-44.1 (a)

(5), and correctly notes that the word “competent” is not included in

that standard of review. It argues that a superior court could not

reverse a final decision of the agency for errors relating to the

admissibility of evidence under the “substantial evidence” review

authorized by OCGA § 31-6-44.1 (a) (5) if “competent” evidence

equals admissible evidence, because then “substantial evidence”

would not encompass admissibility determinations. Lack of

“substantial evidence,” however, is not the only basis for judicial

review. See OCGA § 31-6-44.1 (a) (3) and (4) (authorizing judicial

review, respectively, when final decisions are “[m]ade upon unlawful

procedures” and “[a]ffected by other error of law”). Those grounds for

judicial review are broad enough to permit a court to consider

23
whether the final decision of an agency rested upon inadmissible

evidence. See, e.g., Jackson Elec. Membership Corp. v. Georgia

Public Serv. Comm., 294 Ga. App. 253, 260 (2008) (noting standard

of review of agency decision regarding competency or relevancy of

evidence in administrative proceedings under APA); Georgia Real

Estate Comm. V. Peavy, 229 Ga. App. 201, 201, 204 (493 SE2d 602)

(1997) (reviewing a superior court’s reversal of a final agency

decision under OCGA § 50-13-19 (h), which mirrors OCGA § 31-6-

44.1 (a), for an error regarding the admissibility of evidence).

Northside further contends that “competent substantial

evidence” could not mean admissible evidence because the rules of

evidence do not strictly apply in administrative proceedings.

However, OCGA § 31-6-44 (e) provides that, with exceptions not

applicable here, “the hearing officer shall act, and the hearing shall

be conducted as a full evidentiary hearing, in accordance with

Chapter 13 of Title 50, the ‘Georgia Administrative Procedure Act,’

relating to contested cases.” OCGA § 50-13-15 governs evidentiary

24
issues in contested cases under the APA. Among other things, that

statute says:

Irrelevant, immaterial, or unduly repetitious evidence
shall be excluded. The rules of evidence as applied in the
trial of civil nonjury cases in the superior courts shall be
followed. When necessary to ascertain facts not reasonably
susceptible of proof under such rules, evidence not
admissible thereunder may be admitted, except where
precluded by statute, if it is of a type commonly relied upon
by reasonably prudent men in the conduct of their affairs
or if it consists of a report of medical, psychiatric, or
psychological evaluation of a type routinely submitted to
and relied upon by an agency in the normal course of its
business. Agencies shall give effect to the rules of privilege
recognized by law.

OCGA § 50-13-15 (1) (emphasis supplied). The italicized language

indicates that there is a limited exception to the application of the

rules of evidence to contested hearings, but the rules of evidence as

applied in “civil nonjury cases” otherwise apply and “[i]rrelevant,

immaterial, or unduly repetitious evidence shall be excluded.” Id.

Thus, contrary to Northside’s contention, the notion of admissible

evidence does have meaning in administrative proceedings.

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 Next, Northside correctly notes that OCGA § 50-13-15 (4) says

that, in contested cases, “[t]he agency’s experience, technical

competence, and specialized knowledge may be utilized in the

evaluation of the evidence” and argues that the phrase “competent

substantial evidence” should be read to permit the Commissioner in

CON cases to use his experience and specialized knowledge to judge

the weight of the evidence heard by the hearing officer. Northside

essentially argues that the Commissioner should be able to review

the evidence that was presented to the hearing officer de novo to the

extent the Commissioner’s specialized knowledge is applicable.

However, under the CON statute, when a case is contested, it

is the hearing officer, rather than the agency, that is tasked with

evaluating the evidence. OCGA § 31-6-44 (e) says that the hearing

before the hearing officer “shall be conducted as a full evidentiary

hearing, in accordance with [the APA], relating to contested cases,

except as otherwise specified in this Code section.” In contested CON

cases, after the Department’s staff makes its initial decision, see

OCGA § 31-6-43 (b), the hearing officer conducts the full evidentiary

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hearing de novo, see OCGA § 31-6-44 (f), and OCGA § 31-6-44 (a)

provides that the purpose of a panel of hearing officers “shall be to

serve as a panel of independent hearing officers to review the

department’s initial decision to grant or deny a certificate of need

application.” After the evidentiary hearing, the hearing officer, not

the Commissioner, evaluates the evidence and “make[s] written

findings of fact and conclusions of law.” OCGA § 31-6-44 (i). Because

the Commissioner plays no role in the evidentiary hearing under

OCGA § 31-6-44, the provision of OCGA § 50-13-15 (4) that permits

an agency that is conducting a hearing to evaluate the evidence

presented at that hearing based on its expertise does not apply to

contested CON hearings.

Moreover, to the extent that the Commissioner is arguing that

OCGA § 50-13-15 (4) should be incorporated into his review of the

hearing officer’s decision under OCGA § 31-6-44 (k) (1), the

argument has no merit. To begin, there is nothing in the limited

power of review granted to the Commissioner by OCGA § 31-6-44 (k)

(1) that permits the Commissioner to independently evaluate the

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evidence before the hearing officer based on his expertise. In

contrast, the General Assembly granted agencies broader powers to

review the initial decisions of one of their own agency

representatives under the APA. In this regard, OCGA § 50-13-17 (a)

provides that, when an agency is reviewing an initial decision of an

agency representative in a contested case, the agency “shall have all

the powers it would have in making the initial decision,” which

would include the power to evaluate the evidence based on its

specialized knowledge, as authorized by OCGA § 50-13-15 (4). OCGA

§ 50-13-17 (a), however, is inapplicable here, as the hearing officer

panel that was created by OCGA § 31-6-44 (a) is an “agency separate

and apart from the department.”

Finally, the Commissioner expresses concern that, given his

expertise in health planning, he should not be hamstrung in making

decisions about healthcare delivery systems in Georgia by the

findings of fact of a hearing officer, who does not have similar

expertise. However, although the General Assembly could have

included language in OCGA § 31-6-44 (k) (1) granting the

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Commissioner the authority to review the hearing officer’s findings

of fact in light of his expertise and specialized knowledge, as it did

in OCGA § 50-13-15 (4), the text of OCGA § 31-6-44 indicates that

the General Assembly did not do so and instead created a system

that requires the Commissioner to give deference to the hearing

officer’s findings of fact.

For the foregoing reasons, we conclude that the term

“competent substantial evidence” is most reasonably understood to

refer to evidence that is “relevant” such that “a reasonable mind

might accept [it] as adequate to support” a finding of fact, OCGA §

31-6-44.1 (a) (5), and that is admissible. Moreover, as the foregoing

indicates, this standard is a deferential one that does not permit the

Commissioner to reweigh the evidence, judge the credibility of

witnesses, or substitute his judgment on factual issues for that of

the hearing officer based on the Commissioner’s expertise.

(c) We now address the meaning of the language that the

Commissioner must “state with particularity in the order” his

reasons for concluding that a finding of fact of the hearing officer is

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“not based upon any competent substantial evidence.” OCGA § 31-

6-44 (k) (1).

To begin, we note that the phrase “state with particularity” is

not defined in OCGA § 31-6-44 or elsewhere in the CON laws. We

may therefore look to “dictionaries that were in use” around the time

the statute was enacted in 2008. McBrayer, 317 Ga. at 394. Around

that time, “particularity” was defined as “attentiveness to detail:

exactness,” Merriam-Webster’s Collegiate Dictionary (11th ed.

2003). It was also defined as “[t]he quality or state of being

particular rather than general”; “[e]xactitude of detail”; and

“[a]ttention to or concern with detail.” The American Heritage

Dictionary of the English Language (1992). This understanding of

“particularity” is also reflected in decisional law around the time

OCGA § 31-6-44 (k) (1) was enacted. For example, Georgia courts

have said that the requirement of OCGA § 9-11-9 (b) that fraud be

pled with “particularity” means that “a general allegation of fraud

amounts to nothing” and that “it is necessary that the complainant

show, by specifications, wherein the fraud consists.” Fairfax v. Wells

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Fargo Bank, N.A., 312 Ga. App. 171, 172 (718 SE2d 16) (2011)

(cleaned up) (holding that the plaintiff failed to satisfy the

particularity requirement of OCGA § 9-11-9 (b) by failing to make

“specific factual allegations” to support her fraud claim); Dockens v.

Runkle Consulting, Inc., 285 Ga. App. 896, 900 (648 SE2d 80) (2007)

(setting forth same requirements for pleading fraud with

particularity and holding that purchaser of property failed to meet

those requirements by failing to allege specific facts in her complaint

that an engineer intentionally made false statements).

Given these meanings of the term “particularity” and given the

context in which the “particularity” requirement appears — the

hearing officer conducting a de novo evidentiary hearing

independent of the Department, and the Commissioner given

limited ability to overturn the officer’s findings of fact — we conclude

that the most reasonable understanding of the “particularity”

requirement is that the Commissioner must provide sufficient detail

in his order from which a reviewing court can determine whether

the Commissioner has or has not improperly substituted his

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judgment for the findings of fact of the hearing officer. See T-Mobile

S., LLC v. City of Roswell, Ga., 574 U.S. 293, 301 (135 SCt 808, 190

LE2d 679) (2015) (holding that the substantial evidence standard of

review requires a local government to provide reasons for denying

an application to build a cell tower that are sufficient to enable a

reviewing court to carry out its duty of judicial review); Johnson v.

State, 300 Ga. 252, 258 (794 SE2d 60) (2016) (explaining that

findings of fact required on a defendant’s claim of the denial of his

constitutional right to a speedy trial should be consistent with the

framework of such a claim and sufficient to provide a basis for

appellate review of the issue), overruled on other grounds by

Johnson v. State, 315 Ga. 876 (885 SE2d 725) (2023); Brogdon v.

Brogdon, 290 Ga. 618, 625 (723 SE2d 421) (2012) (holding that

required statutory findings on deviation of child support must be

sufficient so that “we know that the court considered the correct

factors in exercising its discretion”).

3. Because the Court of Appeals’ conclusions regarding the

Commissioner’s “competent substantial evidence” standard of

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review under OCGA § 31-6-44 (k) (1) do not comport with the

discussion above and because the Court of Appeals should

undertake in the first instance to determine whether the

Commissioner complied with the “particularity” requirement of

OCGA § 31-6-44 (k) (1) as defined above, we vacate its judgments

and remand the case to that Court for proceedings consistent with

this opinion.

Judgments vacated and case remanded with direction. All the
Justices concur.

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