Benjamin v. Tandem Healthcare, Inc.

• Decision Date: 23 December 2008
• Docket Number: No. SC07-2423.,SC07-2423.
• Parties: Jodi BENJAMIN, etc., Petitioner, v. TANDEM HEALTHCARE, INC., etc., Respondent.
• Court: Florida Supreme Court

998 So.2d 566

Jodi BENJAMIN, etc., Petitioner, v. TANDEM HEALTHCARE, INC., etc., Respondent.

No. SC07-2423.

Supreme Court of Florida.

December 23, 2008.

Jane Kreusler-Walsh and Rebecca Mercier Vargas of Kreusler-Walsh, Compiani and Vargas, P.A., West Palm Beach, Florida, and Jeffrey M. Fenster and Stacie L. Cohen of Fenster, Cohen and Sobol, P.A., Sunrise, Florida, for Petitioner.

Thomas A. Valdez of Quintairos, Prieto, Wood, and Boyer, P.A., Tampa, Florida, for Respondent.

Karen L. Goldsmith and Jonathan S. Grout of Goldsmith, Grout and Lewis, P.A., Winter Park, Florida, on behalf of Florida Health Care Association; and Philip M. Burlington of Burlington and Rockenbach, P.A., West Palm Beach, Florida, on behalf of Florida Justice Association, as Amici Curiae.

WELLS, J.

In this case, we consider a certified question inquiring whether article X, section 25 of the Florida Constitution, titled "Patients' Right to Know About Adverse Medical Incidents" and also known as Amendment 7, encompasses nursing homes. In Tandem Healthcare, Inc. v. Benjamin, 969 So.2d 519 (Fla. 4th DCA 2007), the Fourth District Court of Appeal certified this question to be of great public importance:

WHETHER "NURSING HOMES" OR "SKILLED NURSING FACILITIES" FALL WITHIN THE DEFINITION

OF "HEALTH CARE FACILITY" OR "HEALTH CARE PROVIDER" AS CONTEMPLATED BY AMENDMENT 7 TO THE FLORIDA CONSTITUTION?

Id. at 521-22. We have jurisdiction. See art. V, § 3(b)(4), Fla. Const. We approve the decision of the Fourth District and answer the certified question in the negative, finding that nursing homes do not fall within the definition of "health care facility" or "health care provider" in article X, section 25.

The Fourth District described the unfortunate facts underlying this case:

Jodi Benjamin, as personal representative of the estate of Marlene Gagnon, sued Tandem [Healthcare, Inc., a nursing home,] for negligence resulting in the death of Gagnon, a patient at the home. Gagnon suffered cardiac failure and brain damage when food became lodged in her airway [due to Tandem's alleged failure to serve her food in compliance with her treatment plan]. Benjamin requested that Tandem produce "all reports or records of any `Adverse Medical Incident'" involving Gagnon, as provided by Article X, section 25, of the Florida Constitution. [Benjamin] also requested peer review documents and quality assurance records.

Tandem Healthcare, 969 So.2d at 520. The trial court granted Benjamin's discovery request, and Tandem Healthcare appealed to the Fourth District. The Fourth District noted that the requested materials would normally be privileged as peer review and quality assurance records under Florida law. Id. Benjamin argued, however, that those peer review and quality assurance privileges had been abrogated when Florida's voters approved article X, section 25 of the Florida Constitution.

Article X, section 25 of the Florida Constitution was adopted in 2004.¹ This provision, also referred to as Amendment 7 because of its numbering seventh on the November 2004 ballot, gave patients "a right to have access to any records made or received in the course of business by a health care facility or provider relating to any adverse medical incident." Art. X, § 25(a), Fla. Const. It defines "health care facility" and "health care provider" as "hav[ing] the meaning given in general law related to a patient's rights and responsibilities." Id. § 25(c)(1). Petitioner contends that nursing homes fall under this definition.

The Fourth District concluded that article X, section 25, does not encompass nursing homes because section 25(c)(1) of that provision defines the terms as having the meaning given in "general law related to a patient's rights and responsibilities." Tandem Healthcare, 969 So.2d at 522. The Fourth District read the term "patient's rights and responsibilities" as a specific reference to section 381.026, Florida Statutes, titled "Florida Patient's Bill of Rights and Responsibilities." In reaching this conclusion, the Fourth District agreed with and relied upon the First District's opinion in Avante Villa at Jacksonville Beach, Inc. v. Breidert, 958 So.2d 1031 (Fla. 1st DCA 2007), stating:

The petitioner in Avante Villa was a nursing home, and the order on review, as in this case, compelled discovery of documents which the nursing home claimed were privileged. The [First D]istrict ... concluded that the nursing home was not subject to the amendment. Id. at 1032.

The district court focused on the following language of Article X, section 25: "The phrases `health care facility' and `health care provider' have the meaning given in general law related to a patient's rights and responsibilities." Art. X, § 25(c)(1), Fla. Const. (emphasis added). It noted that while there are provisions of general law that include nursing homes within the meaning of "health care facility" or "health care provider," only one statute deals with "a patient's rights and responsibilities," and that statute was section 381.026, enacted in 1991. That was the only statute using that language at the time Amendment 7 was adopted. The court, therefore, concluded that "the specific language in Amendment 7 requiring that the definition be `related to a patient's rights and responsibilities' can be reasonably interpreted as adopting the definitions used in the Florida Patient's Bill of Rights and Responsibilities." Id. at 1033.

Tandem Healthcare, 969 So.2d at 521. Accordingly, the Fourth District concluded that nursing homes were not encompassed by article X, section 25.²

ANALYSIS

Our review of this question of constitutional construction is de novo. Zingale v. Powell, 885 So.2d 277, 280 (Fla. 2004). We begin by observing that the polestar of constitutional construction is voter intent. City of St. Petersburg v. Briley, Wild & Assocs., Inc., 239 So.2d 817, 822 (Fla.1970). "We are obligated to give effect to [the] language [of a Constitutional amendment] according to its meaning and what the people must have understood it to mean when they approved it." Id. Further, when interpreting a constitutional provision we must give effect to every provision and every part thereof. Dep't of Envtl. Prot. v. Millender, 666 So.2d 882, 886 (Fla.1996) ("[E]ach subsection, sentence, and clause must be read in light of the others to form a congruous whole so as not to render any language superfluous."). "Ambiguity is an absolute prerequisite to judicial construction" and "when constitutional language is precise, its exact letter must be enforced...." Fla. League of Cities v. Smith, 607 So.2d 397, 400 (Fla.1992). These foundational principles guide our analysis.³

In interpreting a constitutional amendment, we begin with the amendment's plain language. Ervin v. Collins, 85 So.2d 852, 855 (Fla.1956) ("We are called on to construe the terms of the Constitution, an instrument from the people, and we are to effectuate their purpose from the words employed in the document."); see also Fla. Soc'y of Ophthalmology v. Fla. Optometric Ass'n, 489 So.2d 1118, 1119 (Fla.1986) ("Any inquiry into the proper interpretation of a constitutional provision must begin with an examination of that provision's explicit language."). As pointed out by both the First and Fourth District Courts of Appeal, article X, section 25, defines "health care facility" and "health care provider" as having "the meaning given in general law related to a patient's rights and responsibilities." Art. X, § 25, Fla. Const. (emphasis added). Section 381.06 is titled "Florida Patient's Bill of Rights and Responsibilities." § 381.026, Fla. Stat. (2004) (emphasis added). The Fourth District held that "[a] plain reading of the amendment reflects its reference to section 381.026 by its name." Tandem Healthcare, 969 So.2d at 522. We agree.

Again, as noted by the district courts, when Amendment 7 was enacted no other statute in Florida used the phrase "patient's rights and responsibilities" in its title. No other statute used that phrase in its text either. Section 381.026, however, both used the phrase "patient's rights and responsibilities" in its title and also contained definitions of the terms that article X was defining when it used the phrase "patient's rights and responsibilities."

The statement of purpose accompanying article X, section 25, also refers to section 381.026 by name. The statement of purpose provides:

1) Statement and Purpose:

The Legislature has enacted provisions relating to a patients' bill of rights and responsibilities, including provisions relating to information about practitioners' qualifications, treatment[,] and financial aspects of patient care.

In re Advisory Opinion to the Atty. Gen. re Patients' Right to Know About Adverse Med. Incidents, 880 So.2d 617, 618 (Fla. 2004) (emphasis added). The emphasized text is a near exact recitation of the title of section 381.026. The "provisions" described in the "Statement and Purpose" section quoted above also refer to rights included in section 381.026.⁴ It is clear that article X, section 25 was drafted with the Florida Patient's Bill of Rights and Responsibilities, section 381.026, directly in mind.

As noted earlier in this opinion, the First District has also analyzed article X, section 25. See Avante Villa, 958 So.2d 1031. In Avante Villa, the First District held that article X, section 25, incorporated the definitions in section 381.026 and that under those definitions, a nursing home was not a "health care facility" or "health care provider." Id. at 1034. Avante Villa noted that section 381.026 had been titled "Florida Patient's Bill of Rights and Responsibilities" since 1991, over ten years prior to the adoption of article X, section 25. Accordingly, the First District concluded that the reference in article X, section 25, to "patient's rights and responsibilities" had to be deemed an intentional reference to the definitions contained in section 381.026. We agree.

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