Dillard, Presiding Judge. These consolidated appeals arise from the Georgia Department of Community Health’s grant of a certificate of need to Coliseum Medical Center, LLC, which Coliseum applied for to establish a free standing emergency department in Houston County. Several nearby hospitals, including the appellees, opposed the project and Coliseum’s CON application. And following the Department’s decision (which was issued by its commissioner), Houston Hospitals, Inc. sought judicial review of that decision in the Superior Court of Houston County, while the Medical Center of Peach County, Inc. d/b/a Medical Center of Peach County, Navicent Health sought judicial review of the same agency decision in the Superior Court of Peach County. Both trial courts granted judicial review of the commissioner’s decision and reversed it, effectively denying Coliseum’s CON application.[1] In Case Nos. A22A1013 and A22A1014 (the “Houston County cases”), the Department and Coliseum, respectively, appeal the Houston County court’s reversal of the Department’s decision to grant a CON to Coliseum. And in related Case Nos. A22A1249 and A22A1250 (the “Peach County cases”), the Department and Coliseum, respectively, appeal the Peach County court’s decision to do the same. While these appeals arise from two separate trial court orders issued in different counties, they all require our review of the same decision by the Department to grant Coliseum a CON for its proposed FSED. In several separate claims of error, both the Department and Coliseum essentially argue the Houston and Peach County courts erred by (1) failing to apply the proper judicial standard of review to the Department’s decision, including the failure to afford sufficient deference to the commissioner’s findings of fact and conclusions of law; (2) misinterpreting the scope of the commissioner’s statutory and regulatory authority; and (3) finding that certain unappealed lower-level agency decisions issued in 2012 were precedential and binding on the Department and its commissioner in these proceedings. For the reasons set forth infra, we vacate the orders of both the Houston and Peach County courts and remand the cases to those courts with direction.[2] I. Statutory and Regulatory Framework. Before detailing the underlying factual and procedural background, it is instructive to first review the statutory and regulatory framework pertinent to evaluating CON applications. The State Planning and Development Act—which is codified at OCGA § 31640 et seq. (the “CON Act”)—”establishes a comprehensive system of planning for the orderly development of adequate healthcare services throughout the state.”[3] To this end, OCGA § 31640 (a) provides that “[o]n and after July 1, 2008, any new institutional health service shall be required to obtain a [CON] . . . .” And these services include, inter alia, “[t]he construction, development, or other establishment of a new, expanded, or relocated health care facility . . . .”[4] Particularly relevant here, in 2019, the General Assembly amended the CON Act’s definition of “health care facility” to include “freestanding emergency departments or facilities not located on a hospital’s primary campus.”[5] Of course, in determining whether the Department was authorized to promulgate a rule to create a category of “new institutional health service” requiring a CON, “we first look to the relevant legal texts.”[6] And those include a “comprehensive statutory scheme defining and establishing the CON program, as well as regulations the Department has promulgated with respect to CONs.”[7] As a result, the statutory framework that “sets forth the CON program is not the only text relevant to our inquiry.”[8] Indeed, to administer the [CON] program, the Department is authorized to adopt, promulgate, and implement rules and regulations sufficient to administer the [CON] program, to establish, by rule, need methodologies for new institutional health services and health care facilities . . . .[9] As to the administrative process for obtaining a CON to build a new healthcare facility in Georgia (such as the FSED proposed by Coliseum), a party must first submit an application with the Department.[10] Then, the Department reviews the application and “all written information submitted by the applicant . . . and all information submitted in opposition to the application to determine the extent to which the proposed project is consistent with the applicable considerations”[11] delineated in the statutory and regulatory scheme governing CONs.[12] And following this review, the Department “provide[s] written notification to an applicant of [its] decision to issue or to deny issuance of a [CON] for the proposed project.”[13] Next, any party opposing the Department’s initial so-called desk decision may request an administrative appeal to the Certificate of Need Appeal Panel, which is a separate administrative agency responsible for conducting a review of the Department’s initial decision through a designated hearing officer.[14] And once appointed, the hearing officer conducts a full evidentiary hearing on the matter.[15] Specifically, the hearing officer must decide whether, “in the hearing officer’s judgment, the application is consistent with the considerations as set forth in Code Section 31642 and the [D]epartment’s rules, as the hearing officer deems such considerations and rules applicable to the review of the project.”[16] Subsequently, “[w]ithin 30 days after the conclusion of the hearing, the hearing officer shall make written findings of fact and conclusions of law as to each consideration as set forth in Code Section 31642 and the [D]epartment’s rules, including a detailed statement of the reasons for the decision of the hearing officer.”[17] If no party appeals to the commissioner, the hearing officer’s ruling becomes the Department’s final agency decision.[18] But any party, including the Department, “which disputes any finding of fact or conclusion of law rendered by the hearing officer in such hearing officer’s decision and which wishes to appeal that decision may appeal to the commissioner . . . .”[19] If a party does so, the decision of the commissioner “shall become the [D]epartment’s final decision by operation of law.”[20] And in such an appeal, the commissioner may adopt the hearing officer’s order as the final order of the [D]epartment or the commissioner may reject or modify the conclusions of law over which the [D]epartment has substantive jurisdiction and the interpretation of administrative rules over which it has substantive jurisdiction.[21] The scope of the commissioner’s authority and review defined in OCGA § 31-6-44 (k) (1) is particularly relevant to the issues presented in these appeals. Specifically, [b]y rejecting or modifying [a hearing officer's] conclusion of law or interpretation of administrative rule, the [D]epartment 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.[22] Further, a commissioner’s “[r]ejection or modification of conclusions of law may not form the basis for rejection or modification of findings of fact.”[23] Lastly, [t]he [C]ommissioner 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.[24] Following the commissioner’s decision, “[a]ny party to the initial administrative appeal hearing conducted by the appointed appeal panel hearing officer, excluding the [D]epartment, may seek judicial review of the final decision. . . .”[25] And during such review, the court may reverse or modify the final decision only if substantial rights of the appellant have been prejudiced because the procedures followed by the [D]epartment, the hearing officer, or the commissioner or the administrative findings, inferences, and conclusions contained in the final decision are: (1) [i]n violation of constitutional or statutory provisions; (2) [i]n excess of the statutory authority of the [D]epartment; (3) [m]ade upon unlawful procedures; (4) [a]ffected by other error of law; (5) [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; or (6) [a]rbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.[26] Upon further discretionary appeal to this Court, “[w]e apply the same standards of judicial review when considering the superior court’s decision on appeal.”[27] Importantly, our duty is not to “review whether the record supports the superior court’s decision but whether the record supports the final decision of the administrative agency.”[28] Further, we are generally charged with treating the Department’s final decision with deference because “agencies provide a high level of expertise and an opportunity for specialization unavailable in the judicial or legislative branches.”[29] But importantly, we only “defer to an agency’s interpretation . . . when we are unable to determine the meaning of the legal text at issue.”[30] II. The Relevant Hospitals. Turning to the medical facilities at issue, the record shows Coliseum is a 310-bed acute care hospital located in Macon, Georgia, which is in Bibb County. Coliseum’s hospital has a 25-bed emergency department that provides emergency services to both Houston and Bibb county residents. And Coliseum’s parent company, HCA, Inc., is a large, for-profit healthcare system that owns and operates hospitals, FSEDs, and Urgent Care Centers (“UCCs”) throughout the United States. As to the parties opposing Coliseum’s CON application, Houston operates two nonprofit acute care hospitals in Houston County: (1) Houston Medical Center, which has 247 hospital beds; and (2) Perry Hospital, which has 35 hospital beds.[31] HMC is a teaching hospital with a full-service, 31-bed emergency department, as well as a Rapid Medical Evaluation Treatment (“RMET”) area that can serve up to 40 lower-acuity patients.[32] HMC also operates four UCCs in Houston County. Additionally, Perry offers a full-service emergency department with nine beds, as well as a RMET area that can serve six lower-acuity patients. The Medical Center of Peach County,[33] which is part of the Navicent Health healthcare system, is a 25-bed hospital. Peach has a 14-bed emergency department with two trauma/cardiac rooms. Finally, Navicent Health—the largest hospital at issue—has 637 beds and 87 treatment spaces in its general and pediatric emergency departments. III. Administrative Proceedings. On January 21, 2020, Coliseum filed an application for a CON with the Department’s Division of Health Planning to build its proposed FSED. Specifically, the application described the project as an FSED[34] to be located in Bonaire, Georgia, which is in Houston County. According to the application, Coliseum planned to “expand its emergency service by building [an FSED]” more than 20 miles away from its hospital’s main campus. Coliseum sought to construct a 12,760 square-foot facility on approximately 6.61 acres of land. And the “ primary components” of the facility would include one trauma room, one secured holding room, one bariatric exam room, one isolation room, one triage room, eight general exam rooms, computerized tomography (CT Scans), general radiology, laboratory services, a reception area, a patient and family waiting area, an ambulance entrance and vestibule, a nurses station, and space for support staff. On June 9, 2020, several months after Coliseum submitted its application for the CON, the Department issued a desk decision, granting it and issuing the requested CON. As hospitals that provide “substantially similar services” nearby or within the Coliseum FSED’s proposed services area,[35] Houston, Peach, and Navicent Health appealed the Department’s decision to the CON Appeals panel. In that appeal, the designated hearing officer conducted the evidentiary hearing remotely and also reviewed videotaped depositions. The hearing officer ultimately issued a 26-page decision with detailed findings of fact and conclusions of law, reversing the Department’s initial desk decision and denying Coliseum’s CON application because, in his view, the proposed FSED was inconsistent with many of the general review considerations for evaluating a CON application. Thereafter, Coliseum appealed the hearing officer’s ruling to the Department’s commissioner, who issued the Department’s final decision. In that appeal, the commissioner reversed the hearing officer’s decision to deny Coliseum’s CON application. In his final order, the commissioner rejected or modified over half of the hearing officer’s findings of fact for various specified reasons. The commissioner also rejected several of the hearing officer’s legal conclusions as flawed. The Department ultimately granted Coliseum’s CON application to build an FSED in Bonaire. IV. Judicial Review. Following the Department’s decision, Houston sought judicial review in the Houston County court, and Navicent Health sought the same in the Peach County court. Both trial courts reversed the commissioner’s decision, effectively denying Coliseum’s requested CON. Further, both courts concluded the commissioner erred by failing to follow four precedential desk decisions from 2012, all of which denied CON applications to construct FSEDs. Additionally, both courts found the commissioner failed to satisfy the statutory requirement that, in order to reject or modify the hearing officer’s findings of fact, he must first state with particularity in his written order that (1) the fact at issue was not based on competent substantial evidence; or (2) the proceedings upon which the findings were based did not comply with the essential requirements of law. We granted discretionary review as to each court’s order, and these four consolidated appeals follow. V. Case Nos. A22A1013 and A22A1014 – The Houston County cases. Because the primary arguments raised by the Department and Coliseum in the Houston County cases are substantially similar, we address them together to the extent possible and individually when necessary. On appeal to this Court, we review the Department’s final decision regarding whether to grant a CON, rather than the trial court’s judgment.[36] Nevertheless, a central argument raised by both the Department and Coliseum is that the trial court failed to apply the proper judicial standard of review when reversing the Department’s final decision and improperly limited the scope of the commissioner’s statutory authority in reversing the hearing officer’s decision. As a result, we must address these threshold issues before turning to the substance of the Department’s final decision. Both the judicial standard of review of the Department’s final decision, as well as the scope of the commissioner’s authority during the administrative process, are codified in the CON Act. And in construing statutes, agency rules, and regulations, we “employ the basic rules of statutory construction and look to the plain language [of the provision in question] to determine its meaning.”[37] In doing so, we must construe the statute, rule, or regulation “according to its own terms, to give words their plain and ordinary meaning, and to avoid a construction that makes some language mere surplusage.”[38] Still, even if words are apparently plain in meaning, they “must not be read in isolation and instead, must be read in the context of the [statute, rule, or] regulation as a whole.”[39] And importantly, we only “defer to an agency’s interpretation . . . when we are unable to determine the meaning of the legal text at issue.”[40] As a result, when a statute is “not ambiguous after we apply canons of statutory construction[,] . . . [o]ur case law . . . does not support any deference to the Department’s interpretation of the relevant CON statutes, or to its interpretation of its own unambiguous regulations.”[41] Here, none of the parties have argued OCGA § 31-6-44 (k) (1) is ambiguous or contended that we are unable to determine its meaning.[42] So, under these circumstances, we owe no deference to the Department. With these guiding canons of construction in mind, we turn now to the parties’ arguments regarding the statutory and regulatory authorities at issue. (1) In Case No. A22A1013, the Department contends the trial court misconstrued both the judicial standard of review of its final decision, as well as the scope of the commissioner’s authority in rejecting or modifying the hearing officer’s findings of fact and conclusions of law. And in Case No. A22A1014, Coliseum raises similar claims of error. We disagree with both of them.. As to the applicable judicial review of the Department’s decision under the CON Act, OCGA § 31-6-44.1 (a) provides six separate bases, listed disjunctively, upon which a court is authorized to modify or reverse the Department’s final decision regarding a CON application. As previously mentioned, that statute provides, the court may reverse or modify the [Department's] final decision only if substantial rights of the appellant have been prejudiced because the procedures followed by the [D]epartment, the hearing officer, or the commissioner or the administrative findings, inferences, and conclusions contained in the final decision are: (1) In violation of constitutional or statutory provisions; (2) In excess of the statutory authority of the [D]epartment; (3) Made upon unlawful procedures; [or] (4) Affected by other error of law. (5) Not 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; or (6) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.[43] And here, the trial court based its reversal of the Department’s decision to grant the CON to Coliseum on OCGA § 31-6-44.1 (a) (1)-(4); but given the use of the word “or” in this statute, the trial court was authorized to reverse the Department’s decision if any one of the six provisions applied.[44] The trial court found the first three criteria in OCGA § 31-6-44.1 (a) were satisfied because the commissioner violated and exceeded his authority under OCGA § 31-6-44 (k) (1), which provides, in relevant part, [t]he commissioner may not reject or modify the findings of fact [of the hearing officer] 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.[45] Specifically, the trial court determined the commissioner modified or rejected more than half of the hearing officer’s findings of fact without ever stating, with particularity or otherwise, that those findings were not supported by “competent substantial evidence.” The court then went on to provide several examples of instances in which the commissioner failed to do so. The trial court further found the commissioner violated OCGA § 31-6-44 (k) (1) because, under its terms, “[r]ejection or modification of conclusions of law may not form the basis for rejection or modification of findings of fact[,]“[46] and the commissioner rejected or modified many of the hearing officer’s factual findings based on his determination that the hearing officer’s legal conclusions were erroneous. The court again provided several examples from the commissioner’s decision to support this finding. Additionally, the court held that several of the commissioner’s conclusions of law were erroneous because they were based on findings of fact he improperly rejected in violation of the scope of his review under OCGA § 31-6-44 (k) (1). Then, applying the judicial standard of review for reversing the Department’s final decision, the court found the “[c]ommissioner’s procedures and his [f]inal [o]rder were contrary to the CON Act’s statutory provisions, in excess of his authority, [and] made upon unlawful procedures . . . .” Our review of the commissioner’s decision, the underlying administrative proceeding, and the record as a whole supports the trial court’s findings. To begin with, the only instance in the commissioner’s 16-page order that includes the phrase “competent substantial evidence” is when he quotes OCGA § 31-6-44 (k) (1) as the standard of review at the outset of his decision. Indeed, instead of considering whether competent substantial evidence—or even any evidence at all—supported the hearing officer’s findings of fact, the commissioner provided a myriad of other reasons for disregarding or rejecting most of those findings—some of which were impermissibly based on his rejection of the hearing officer’s legal conclusions. OCGA § 31-6-44 (k) (1) expressly forbids the commissioner from basing the modification or rejection of factual findings on the “[r]ejection or modification of conclusions of law . . . .” But the commissioner repeatedly did just that. For example, the commissioner found that, while the hearing officer’s findings of fact 4, 13, and 17 were “properly in the record[,]” they “ [led] to a faulty conclusion of law.“[47]And in rejecting the factual findings detailed in those paragraphs, the commissioner concluded that they were a “thinly veiled attempt to blur the distinctions among hospital emergency departments (EDs), FSEDs, and . . .[UCCs]“; but he never stated whether those facts were supported by the evidence—competent, substantial, or otherwise. Further, as to the hearing officer’s finding of fact number 30, the commissioner determined that, although “the record and testimony acknowledge[d] the overlap of many of the diagnosis treated in EDs, FSEDs, and UCCs,”[48] UCCs are not a viable alternative to FSEDs and should not be taken into account when evaluating the need for Coliseum’s FSED under the general review considerations. The commissioner also struck two sentences in one paragraph containing several factual findings because they ignored parts of the record, not because they were unsupported by competent substantial evidence. The commissioner further found the hearing officer’s findings of fact numbers 35-36 related to the “Effects on Payers Rule[,]“[49] and for “reasons concerning [UCCs], the fact statement contained in [f]inding of [f]act 36 regarding lower cost charges at UCCs is not relevant and is misleading.“[50] But whether a fact is misleading or irrelevant depends entirely upon the conclusions of law to which they would or would not relate to.[51] As to the hearing officer’s factual finding number 22 that there was a downward trend in utilization of emergency services (despite population growth in the proposed service area), the commissioner found an argument made by Coliseum to be “more persuasive.” But OCGA § 31-6-44 (k) (1) does not permit the commissioner to reject the hearing officer’s findings of fact based on arguments, as arguments relate to legal conclusions, not facts. Essentially, the commissioner rejected many of the hearing officer’s findings of fact regarding the types of existing healthcare services already available in the proposed service area provided by hospital emergency rooms and UCCs, as well as the population’s need for additional emergency services, because he rejected the hearing officer’s legal conclusions that those facts were relevant to general review consideration regarding existing services.[52] In doing so, the commissioner violated and exceeded the scope of his authority under OCGA § 31-6-44 (k) (1). Although Coliseum argues that “form over nomenclature” controls, and the Department contends the commissioner was not required to “recite the ‘competent substantial evidence standard[,]“‘[53] they point to no other language in the commissioner’s decision suggesting that he complied with the evidentiary standard required by OCGA § 31-6-44 (k) (1).[54] Importantly, the phrase “competent substantial evidence” is a term of art with a specific meaning. Indeed, “[s]ubstantial evidence”—which is a portion of the statutory phrase at issue—is defined in the CON Act; and OCGA § 31-6-44.1 (a) (5) explains that a finding of fact is [n]ot supported by substantial evidence . . . [when] 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 . . . .”[55] At a bare minimum, then, the commissioner’s order must establish that, in rejecting or modifying the hearing officer’s factual findings, he is applying a standard “in excess of the any evidence standard.” Neither Coliseum nor the Department have identified any language in the commissioner’s order suggesting that he did.[56] Additionally, although not defined in the CON Act, our Supreme Court has explained—in another context—that “[c]ompetent evidence is that which is admissible.”[57] Thus, regardless of the specific language used in his decision, the commissioner must substantively establish that he applied this statutorily required standard. This statutory directive is not about using “magic words,” it is about satisfying an explicit evidentiary requirement. So, before rejecting or modifying a hearing officer’s findings of fact, the commissioner must first determine with particularity that those findings of fact are not supported by “competent substantial evidence,” which is the only way for him to demonstrate that he faithfully applied the statutorily imposed evidentiary standard. Importantly, OCGA § 31-6-44 (k) (1) expressly requires the commissioner not only state this requisite finding, but to do so with particularity in writing. Under these circumstances, despite the deference courts generally afford to administrative agencies, when “the statutory text is clear and unambiguous, we attribute to the statute its plain meaning . . . .”[58] We are not at liberty to do otherwise.[59] Coliseum further argues the hearing officer made several legal conclusions disguised as factual findings. But even if the sentences in the hearing officer’s findings of fact cherry-picked by Coliseum can be construed as legal conclusions in disguise, Coliseum provides no legal authority suggesting the commissioner no longer had to comply with OCGA § 31-6-44 (k) (1) as to the hearing officer’s factual findings. The appellants also claim the factual findings at issue were not stricken, deleted, or modified, but instead, the commissioner merely explained that they were not relevant to his legal conclusions. But again, the relevance of the hearing officer’s factual findings turned solely on the commissioner’s rejection of his legal conclusions. Furthermore, in at least one instance, the commissioner expressly stated that a certain finding of fact by the hearing officer was “stricken in its entirety” based on his legal conclusion that the hearing officer could not consider Coliseum’s proposed location as it related to the socioeconomic status of the relevant population.[60] In doing so, the commissioner based the rejection of the hearing officer’s factual finding on a legal conclusion regarding the application of the general review considerations, which is expressly prohibited by OCGA § 31-6-44 (k) (1).[61] Simply put, nothing in OCGA § 31-6-44 (k) (1) allows the commissioner to circumvent its procedural requirements merely by rejecting a fact as irrelevant to his legal conclusions without, as an initial matter, determining whether it was supported by competent substantial evidence. Citing OCGA § 31-6-44.1 (a) (5), the Department maintains that, although the commissioner may only reject the hearing officer’s factual findings if he first finds they are unsupported by competent substantial evidence, courts are limited to considering whether the Department’s ultimate factual findings are supported substantial evidence. But as explained supra, under OCGA § 31-6-44.1 (a), the lack of substantial evidence to support the Department’s final decision is only one of six independent bases for reversing that decision. And here, the trial court relied on different subsections of this statute in reversing the Department’s decision. The Department also contends the trial court erred in finding that it had no authority to reweigh the evidence. But the Department does not identify any independent, alternative, or material factual findings made by the commissioner for this Court to consider, and the commissioner based his decision primarily on his rejection of the hearing officer’s legal conclusions, rather than on any alternative factual findings or re-weighing the evidence. In sum, the commissioner’s rejections of the hearing officer’s factual findings were based on a myriad of reasons, none of which related to whether they were supported by competent substantial evidence; and in some instances, the commissioner even acknowledged that evidence did support the relevant factual findings. The commissioner also relied upon his rejections of the hearing officer’s legal conclusions regarding the application of the general review consideration in disregarding or rejecting several factual findings. Thus, the commissioner violated the plain language of OCGA § 31-6-44 (k) (1) and exceeded the scope of his authority under that statute. And as a result, the trial court was authorized under OCGA § 31-6-44.1 (a) to reverse the Department’s final decision to grant the CON to Coliseum on this basis.[62] (2) The Department further argues the trial court erred by finding that Houston’s substantial rights were prejudiced by any potential errors made by the commissioner.[63] We disagree.[64] As noted by the Department, even if the commissioner errs in his rejection or modification of the hearing officer’s findings of fact, a trial court is only authorized to reverse the Department’s final decision on a CON application “if substantial rights of the appellant[[65]] have been prejudiced”[66] by those errors. Here, the trial court found that Houston’s substantial rights were prejudiced because the commissioner’s decision “contain[ed] all the errors for reversal in OCGA § 31-6-44 (a)” and issuing the CON to Coliseum would result in “devastating financial consequences on Houston and other existing providers.” In this regard, we have already held the commissioner’s decision satisfied at least three independent bases for reversal outlined in that statute. Importantly, neither the Department nor Coliseum challenge the accuracy of the hearing officer’s findings of fact regarding whether Houston would be financially harmed by Coliseum’s proposed FSED. Instead, the Department argues the trial court erred in finding the commissioner was required to consider the financial impact the proposed FSED would have on existing area hospitals when applying the “positive-relationship rule.”[67] We address the positive-relationship general review consideration below in Division v. (3) infra. Relevant here, the Department argues Houston was not prejudiced by the commissioner’s alleged errors because, even if the commissioner adopted all of the hearing officer’s findings of fact, there is no reasonable probability the outcome of the proceedings would have been different.[68] Thus, in evaluating the Department’s argument in this regard, we will presume (for the sake of argument) that the hearing officer’s findings of fact were supported by competent substantial evidence and address only whether the commissioner’s legal conclusions were sound even if he had adopted those findings. As to the commissioner’s application of the general review considerations outlined in OCGA § 31-6-1 (a), we note that “[t]he interpretation of [a] statute[ ] . . . is a question of law, which we review de novo on appeal.”[69] In considering the meaning of a statute, this Court must afford the statutory text its plain and ordinary meaning,[70] consider the text contextually,[71] read the text “in its most natural and reasonable way, as an ordinary speaker of the English language would,”[72] and seek to “avoid a construction that makes some language mere surplusage.”[73] Simply put, when the language of a statute is “plain and susceptible of only one natural and reasonable construction, courts must construe the statute accordingly.”[74] With these guiding principles in mind, we turn now to the appellants’ specific arguments. (a) Existing Alternatives Consideration. The Department first argues the trial court’s interpretation of the “existing services” general review consideration conflicts with the CON Act and is “unworkable.” Similarly, Coliseum argues the trial court erred in finding the commissioner’s ultimate legal conclusions depended on impermissible factual findings and were otherwise inconsistent with the CON Act’s general review considerations. In this regard, the CON Act lists 17 general review considerations in evaluating a CON application. Relevant here, OCGA § 31-6-42 (a) (2)-(3) provides, [t]he [D]epartment shall issue a [CON] to each applicant whose application is consistent with the following considerations and such rules deemed applicable to a project . . . (2) [t]he population residing in the area served, or to be served, by the new institutional health service has a need for such services; [and] (3) [e]xisting alternatives for providing services in the service area the same as the new institutional health service proposed are neither currently available, implemented, similarly utilized, nor capable of providing a less costly alternative, or no certificate of need to provide such alternative services has been issued by the department and is currently valid[.][75] Furthermore, in setting forth the codified policy and purpose of the CON Act, the General Assembly enacted OCGA § 31-6-1, which provides that “[h]ealth care services and facilities should be provided in a manner that avoids unnecessary duplication of services, that is cost effective, that provides quality health care services, and that is compatible with the health care needs of the various areas and populations of the state.”[76] Additionally, the Department’s own rules mandate that existing services in the proposed service area and the need for similar services in the area be taken into account when issuing a CON. Indeed, in relevant part, Department Rule 111-2-2.09 (1) (c) (3)—which delineates general review considerations for issuing a CON—provides existing alternatives for providing services in the service area the same as the new institutional health service proposed are neither currently available, implemented, similarly utilized, nor capable of providing a less costly alternative, or no [CON] to provide such alternative services has been issued by the Department and is currently valid 1. The Department supports the concept of regionalization of those services for which a servicespecific Rule exists. 2. The Department shall consider economies of scale where need exists for additional services or facilities. 3. Utilization of existing facilities and services similar to a proposal to initiate services shall be evaluated to assure that unnecessary duplication of services is avoided. Where there exists significant unused capacity, initiating a similar service in another health care facility would require strong justification under other criteria.[77] Turning to the instant case, the hearing officer made detailed factual findings regarding the existing emergency services available in and around the proposed service area, which, again, we accept for purposes of considering the prejudice requirement in OCGA § 31-6-44.1 (a). Specifically, the hearing officer noted that Coliseum acknowledged the overlap of patients to be treated at the proposed FSED, hospital emergency departments, and UCCs. And in considering such overlap in services, the hearing officer found there were numerous existing alternatives to the services that would be provided at Coliseum’s proposed FSED. Specifically, the hearing officer determined that there were six hospital emergency departments and 20 UCCs in the relevant service area. And he further concluded that three of those hospitals are located less than 8 miles from Coliseum’s proposed project site. Additionally, the evidence shows that four of Houston’s UCCs were within four miles of the proposed FSED location and those UCCs treat the top 10 diagnostic codes at other FSEDs owned by Coliseum’s parent company in other areas of the country. Significantly, by statute, each of the hospitals that challenged Coliseum’s CON application were only permitted to do so by the Department because they offered substantially similar services within a 35 mile radius of the proposed FSED or had a service area that overlapped with the FSEDs proposed location.[78] Given these and other similar factual findings, the hearing officer ultimately found that the “services area residents with lower[-]acuity illnesses and injuries of the sort that Coliseum’s proposed FSED would treat already have many options for care, including in Bonaire where the proposed FSED would be located.”[79] In reversing the hearing officer’s decision, the commissioner concluded that his factual findings led to a faulty legal conclusion that hospital emergency departments and UCCs are comparable existing alternatives to FSEDs for purposes of the CON Act. In doing so, the commissioner reasoned that they are not comparable alternatives under the CON Act because they provide different “delivery models of care.” The commissioner then concluded that the “fashioning of [the hearing officer's findings of fact] only works if all three service modalities are considered comparable.” Similarly, the commissioner determined that “unnecessary duplication assumes all [three] service delivery models are comparable,” and then concluded that they were not comparable. In sum, as to the “existing alternatives” general review consideration, the commissioner concluded that the Department must only consider the way in which the various entities delivered care, rather than whether the types of medical services provided by each entity were the same or similar. This legal conclusion directly conflicts with the plain and unambiguous language in both the CON Act and the Department’s own rules. The relevant language in the CON Act requires the Department to consider existing alternatives to the proposed new healthcare facility and instructs it to avoid duplication of healthcare services. The relevant statutes repeatedly and explicitly instruct the Department to consider the similarity or unnecessary duplication of healthcare services, rather than evaluating different types of facilities or “delivery models.“[80] And in its similar provisions, the Department’s own rules regarding the existing-alternatives general review consideration and unnecessary duplication of services also refer to alternative healthcare “services.”[81] In fact, the Department’s rules go further, emphasizing that when “[t]here exists significant unused capacity, initiating a similar service in another health care facility would require strong justification under other criteria.”[82] Simply put, neither the commissioner nor the appellants have identified any language in the CON Act or the Department’s rules remotely suggesting the consideration of “existing alternatives” for a new healthcare facility means the consideration of other similar facilities or similar methods by which they provide care, rather than the overlap of similar healthcare services provided by those facilities. Nevertheless, the Department maintains it should only consider similar types of facilities or delivery models of care because, under OCGA § 31-6-40 (a) (1), “[n]ew institutional healthcare services” is defined as “[t]he construction, development, or other establishment of a new, expanded, or relocated health care facility . . . .”[83] But even if words in a statute are apparently plain in meaning, they “must not be read in isolation and instead, must be read in the context of the [statute, rule, or] regulation as a whole.”[84] And in the sections of the CON Act and the Department’s rules specifically delineating the general review considerations for granting or denying a CON, the language used does not require the Department to consider whether the healthcare facilities at issue are similar. Moreover, as our Supreme Court has rightly emphasized, under our general rules of statutory construction, there is a “preference to specific provisions over general ones.”[85] Here, both the context and relevant canons of construction make it clear that the Department’s argument is a nonstarter. The Department further contends the commissioner had no authority to consider UCCs when evaluating Coliseum’s CON application because they are not CON-regulated entities.[86] But the legal authorities cited by the Department do not address that issue,[87] and the Department has not identified any language in the CON Act supporting this contention. The Department further argues the hearing officer’s application of the general review considerations is impractical, unworkable, unfair, and would effectively prevent the construction of any FSEDs in Georgia, which would contravene the “intent” of the General Assembly in making them CON regulated. But the numerous legislators’ personal interpretations of the general review considerations under the CON Act are ultimately of no consequence. This Court’s only concern is with the plain meaning of the statutes at issue, which is rightfully our sole focus in determining the General Assembly’s collective “intent.”[88] In sum, the commissioner erred in determining that, when considering existing alternatives to Coliseum’s FSED, the Department must consider only whether the various entities have a similar delivery model, rather than whether they provide similar services at the proposed healthcare facility. And because the commissioner’s legal conclusions were erroneous, the Department and Coliseum cannot show that Houston’s rights were not substantially prejudiced by his statutory violations. (3) Positive-Relationship Consideration. The Department also argues the hearing officer improperly added an “adverse impact” requirement to the general review consideration concerning whether the proposed FSED has a “positive relationship” with the existing healthcare delivery system.[89] This argument is based purely on semantics. Any proposed healthcare facility that would have an adverse impact on the existing healthcare delivery system would necessarily lack a positive relationship to that system. Furthermore, the Department mischaracterizes the hearing officer’s conclusion in this regard. Indeed, in addressing the positive-relationship consideration, the trial court outlined the adverse impact the proposed FSED would have on the existing healthcare system, but did not find that there was a specific adverse-impact requirement the Department must consider. As to Coliseum’s proposed FSED’s impact on the existing healthcare system, Coliseum even projected that if its FSED were approved, “HMC would lose 10%, Perry would lose 8.2%, and Peach would lose 7.1% of their respective 2019 [emergency department visits].” Further, Peach was “particularly financially vulnerable and is not in the position to absorb the losses that would result from Coliseum’s proposed project[,]” as it already “ operated at a loss of -$1.5 million” in 2018. Additionally, expert testimony established that lost emergency room visits alone would cause Peach to lose roughly $2.7 million. Under these circumstances, not only would the proposed FSED lack a positive relationship with the existing healthcare delivery system, it could financially devastate at least one of the area hospitals. To summarize, the commissioner violated OCGA § 31-6-44 (k) (1) and exceeded the scope of his statutory authority by failing to find, with particularity, in his written order that any rejected or modified findings of fact by the hearing officer were unsupported by competent substantial evidence. He further violated the same statute by repeatedly basing his rejection of the hearing officer’s factual findings on the rejection of his legal conclusions. And because the commissioner’s legal conclusions were also flawed, the appellants cannot show that Houston was not substantially prejudiced by his ultimate decision. For all these reasons, we vacate the Houston County court’s judgment and remand the case with instructions for the trial court to vacate the Department’s final decision and remand the case for the Department’s further consideration of Coliseum’s CON application in a manner consistent with this opinion.[90] VI. Case Nos. A22A1249 and A22A1250 - The Peach County Cases. Because in Division v. supra, we determined the Department must reconsider Coliseum’s CON application consistent with this opinion and issue a revised decision, we need not address the arguments raised by Coliseum and the Department, challenging the Peach County court’s similar judgment. Instead, we likewise vacate that judgment and provide the same instructions given to the Houston County court, detailed supra. Judgments vacated and cases remanded with direction in Case Nos. A22A1013, A22A1014, A22A1249, and A22A1250. Mercier and Markle, JJ., concur in judgment only.
