County Dept. of Public Welfare of Vanderburgh County v. Deaconess Hosp., Inc.
| Decision Date | 30 March 1992 |
| Docket Number | No. 82A05-9103-CV-83,82A05-9103-CV-83 |
| Citation | 588 N.E.2d 1322 |
| Parties | COUNTY DEPARTMENT OF PUBLIC WELFARE OF VANDERBURGH COUNTY, Indiana Department of Public Welfare, and Dorothy Walker, Appellants-Defendants, v. DEACONESS HOSPITAL, INC., Appellee-Plaintiff. |
| Court | Indiana Appellate Court |
Mary Jane Humphrey, Evansville, for appellants-defendants.
Wm. Michael Schiff, Mary Lee Franke, Kahn, Dees, Donovan & Kahn, Evansville, for appellee-plaintiff.
Appellee-plaintiff Deaconess Hospital provided in-patient treatment to Dorothy Walker, then requested payment for its services from appellants-defendants the Department of Public Welfare of Vanderburgh County ("County DPW") and the Indiana Department of Public Welfare ("State DPW") under the Hospital Care for the Indigent Act, Ind.Code 12-5-6-1, et seq. ("HCI Act"). Payment was denied. After exhausting administrative remedies to no avail, Deaconess sought judicial review. The trial court set aside the administrative denial of payment and remanded for further proceedings. From that order, the agencies appeal. We affirm.
The HCI Act provides in pertinent part:
A resident of Indiana who meets the income and resource standards established by the [State DPW] ... is eligible for assistance to pay for any part of the cost of care provided in a hospital in Indiana that was necessitated after the onset of a medical condition that manifested itself by symptoms of sufficient severity that the absence of immediate medical attention would probably result in:
(1) placing the person's life in jeopardy;
(2) serious impairment to bodily functions; or
(3) serious dysfunction of any bodily organ or part.
In addition, a qualified resident is eligible for assistance to pay for any part of the cost of care that is a direct consequence of the medical condition that necessitated the emergency care.
I.C. 12-5-6-2.1(a) ("Sec. 2.1"). The HCI Act further provides that application for payment is made by the hospital, to the county DPW of the county in which the hospital is located. I.C. 12-5-6-4(a). A patient may The County DPW determined Walker met the residency and indigency requirements for eligibility, but that the condition for which Deaconess treated Walker did not meet the standards of Sec. 2.1. After that initial denial, a hearing was held before an administrative law judge ("ALJ") of the State DPW. The ALJ denied payment, and Deaconess requested review by the Board of the State DPW. The Board adopted the ALJ's decision, which stated, in pertinent part:
similarly file, but reimbursement will only be made to the care-providers. I.C. 12-5-6-4(f). Once an HCI Act application has been filed, the county DPW determines eligibility. I.C. 12-5-6-5(a). Upon a determination of non-eligibility, any affected person may appeal to the State DPW, which must provide a hearing and determine eligibility anew. I.C. 12-5-6-8(a). Section 8(a) also states that determinations of the State DPW are subject to judicial review as provided in I.C. 4-21.5-1-1 et seq. (the Indiana Administrative Adjudication Act).
17. That on December 17, 1986, [Walker's] mother brought [her] to Deaconess Hospital because [Walker] was feeling suicidal.
18. That [Walker] voluntarily admitted herself into the psychiatric unit of Deaconess Hospital on December 17, 1986.
19. That although [attending physician] Dr. Rietman's opinion was that [Walker] met the requirements of [Sec. 2.1], the medical evidence submitted is somewhat conflicting and does not support this opinion.
20. That although at the time of [Walker's] admission to the hospital she appeared sad, dejected and depressed and was determined by the emergency room physician to be potentially suicidal, she also seemed alert, was in good contact with her environment, was oriented in all spheres, no clear cut evidence of delusions or hallucinations was apparent, her memory was intact and she had not formulated any definite plans on how to harm herself.
21. That although during her stay at Deaconess Hospital [Walker] at times verbalized some suicidal thoughts, these thoughts quickly passed and she made no attempt to harm herself throughout her stay and in fact, when playing her guitar or when participating in group activities, seemed relatively calm, happy and at ease.
22. That the medical evidence presented does establish that [Walker] was being affected by depression which required treatment but this evidence does not establish that this medical condition met the requirements for HCI eligibility under I.C. 12-5-6-2.1.
23. That in accordance with the preceding findings of fact, the Administrative Law Judge finds that this denial of HCI benefits is correct.
We note as a preliminary matter our supreme court's holding that mental health emergencies are not excluded from HCI benefits. Lutheran Hosp. of Fort Wayne, Inc. v. State Dep't of Pub. Welfare (1991), Ind., 571 N.E.2d 542, 545. In the case of Walker, the trial court, in setting aside the administrative denial of benefits, entered comprehensive findings of fact and conclusions of law. The trial court's exemplary work is reproduced here in lieu of restatement by this court. Of critical importance are finding of fact # 7 and conclusions of law # 2, 3, and 4:
1. Dorothy Walker ("Walker") was admitted to Deaconess Hospital, Inc. ("Deaconess Hospital") in Evansville, Indiana, on December 17, 1986, for treatment of an affective disorder and she was discharged on February 12, 1987.
2. Walker was a resident of Vanderburgh County, Indiana residing at 111 E. Maryland Street at the time of her admission.
3. Walker is a citizen of the United States or a lawfully admitted alien as required by I.C. 12-5-6-2.1(d).
4. An application for HCI benefits for Walker was timely filed with the Vanderburgh County Department of Public Welfare ("County DPW") on December 22, 1986.
5. The County DPW denied this application on May 18, 1987, for the stated reason: "Failure to meet emergency hospitalization requirement." This decision was made by a supervisor with the County DPW who has no medical training and who did not consult beforehand with a medical professional. The County DPW notified Walker and Deaconess Hospital in writing of its decision as required by I.C. 12-5-6-5(c) on May 18, 1987. This matter was timely appealed to the State Department of Public Welfare ("State DPW") on July 22, 1987, by Walker's attending physician, Dr. Jerome Rietman ("Dr. Rietman").
6. A second notice was mailed to the patient and Deaconess Hospital on February 24, 1988, by the State DPW. This notice stated the application had been denied for the reason: "The hospital admission does not meet the emergency criteria specified by state law, I.C. 12-5-6-2.1, P.L. 16, 1986."
7. A notice of hearing was sent to all interested persons known to the State DPW and on November 9, 1988, a hearing was scheduled and heard before an Administrative Law Judge ("ALJ") under the provisions of I.C. 12-5-6-8. The only witnesses who testified at said hearing were Dr. Rietman and a caseworker from the County DPW. In his testimony, Dr. Rietman, a Board certified psychiatrist who has practiced medicine since 1958, reviewed Walker's condition at the time of and during her hospitalization noting that she exhibited signs of depression, sadness, dejection, pessimistic thoughts of despair, hopelessness, helplessness, continuous mood swings and that she had made a previous attempt at suicide. Dr. Rietman further testified that in his professional opinion at the time of Walker's admission to Deaconess Hospital and during her stay there she suffered from a medical condition with symptoms of sufficient severity that the absence of immediate medical attention would have placed her life in jeopardy. Over objections by counsel the ALJ allowed the caseworker for the County DPW to introduce into the record a copy of a letter dated November 3, 1988, from Dr. David Ellis, Medical Director-Medicaid to the Director of the County DPW, Wm. Lark Buckman. As support for the State DPW's denial of HCI benefits, Dr. Ellis' letter noted that Walker's medical condition of depression was accompanied by "suicidal thoughts or ideation, but no gesture." Dr. Ellis's letter concluded by noting that "actually the decision (to deny benefits) is based upon restrictive emergency criteria because of limitations in HCI funding."
8. On January 5, 1989, the ALJ issued his Findings of Fact and a Decision sustaining the denial of HCI benefits by the County DPW and the State DPW for hospital care furnished by Deaconess Hospital to Walker. In his decision, the ALJ rejected Dr. Rietman's professional opinion stating that the "medical evidence submitted is somewhat conflicting" and that Walker's medical condition did not meet "the requirements for HCI eligibility under I.C. 12-5-6-2.1."
9. On January 12, 1989, Deaconess Hospital timely requested review by the Indiana Board of Public Welfare on the decision of said ALJ in this matter. At its meeting held February 20, 1989, the Indiana Board of Public Welfare sustained the decision of the ALJ and notified all interested parties of such fact by Order dated March 2, 1989. Deaconess Hospital timely filed its Petition for Judicial Review with this Court on March 20, 1989, and has complied with all other statutory prerequisites to invoking judicial review by this Court.
10. Any Finding of Fact herein deemed to be a Conclusion of Law shall be a Conclusion of Law.
1. The law is with the Petitioner and against Respondents, State DPW and the County DPW.
2. I.C. 12-5-6-2.1 reads in pertinent part as follows:
"(a) A resident of Indiana ... is eligible for assistance to pay for any part of the cost of care provided in a hospital in Indiana that was necessitated after the onset of a medical condition that manifested itself by symptoms of sufficient severity that the absence of immediate medical attention...
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