Roe v. Affleck

• Decision Date: 16 August 1978
• Docket Number: No. 77-76-A,77-76-A
• Citation: 390 A.2d 361,120 R.I. 679
• Parties: Mary ROE et al. v. John J. AFFLECK et al. ppeal.
• Court: Rhode Island Supreme Court

Page 361

390 A.2d 361

120 R.I. 679

Mary ROE et al. v. John J. AFFLECK et al.

No. 77-76-Appeal.

Supreme Court of Rhode Island.

Aug. 16, 1978.

[120 R.I. 692] William Rutzick, John M. Mola, Alden C. Harrington, Rhode Island Legal Services, Inc., Providence, for plaintiffs.

Julius C. Michaelson, Atty. Gen., Harold E. Krause, Jr., Sp. Asst. Atty. Gen., Tillinghast, Collins & Graham, Elia Germani, Normand G. Benoit, Providence, for Blue Cross of R. I. and Arthur F. Hanley.

Forrest L. Avila, Sp. Asst. Atty. Gen. for Dr. Joseph Bevilacqua.

OPINION

BEVILACQUA, Chief Justice.

The United States District Court for the District of Rhode Island, acting pursuant to Sup.Ct.R. 6, has certified to this court two questions of law together with a statement of facts relevant to the controversy in which the questions arose. The present action was initiated when the plaintiffs, Mary Roe and her son Richard, brought a civil action in the United States District Court for the District of Rhode Island seeking to enjoin the defendants, John J. Affleck, Dr. Joseph J. Bevilacqua, and Arthur F. Hanley of Blue Cross of Rhode Island from refusing to pay for Richard's necessary care and treatment at Bradley Hospital.

Mary Roe is employed full time, but because her expenses exceed her salary, she receives a money supplement from the state under the Aid to Families with Dependent Children program. In addition, both she and Richard are covered by the State Medical Assistance program. Richard Roe is a 13-year old boy who requires psychiatric hospitalization because he suffers from severe emotional and psychological illness as well as hyperactivity. As a result of his illness, on September 22, 1976, Richard was admitted to the Emma Pendleton Bradley Hospital (Bradley), an accredited hospital specializing in childhood and early adolescent psychiatric illnesses. At the present time, Richard remains at Bradley.

As Director of the Rhode Island Department of Social and Rehabilitative Services, defendant Affleck is responsible for administering the medical assistance program. This federal/state program furnishes funds for specified medical care and services to needy families with dependent children and to aged, blind, or disabled persons who may be either categorically or medically needy as defined by title XIX of the Social Security Act or Medicaid program. Congress authorized federal reimbursement under title XIX of the Social Security Act effective January 1, 1973, for inpatient psychiatric hospital services for persons under age 21; however, such services are optional. While medical care benefits are furnished to eligible beneficiaries pursuant to G.L.1956 (1977 Reenactment) § 40-8-4 through a state plan which includes inpatient hospital services, the state has opted not to provide inpatient psychiatric hospital services for individuals under age 21 under its medical assistance program. Consequently, defendant Affleck has refused to pay for the cost of inpatient psychiatric hospital care for persons under 21 years of age.

The defendant Bevilacqua, who is Director of the Rhode Island Department of Mental Health, Retardation and Hospitals (MHRH), is responsible for executing the provisions of the "Services for emotionally disturbed children" law. Sections 40.1-7-1 to 9. Those provisions establish a program for emotionally disturbed children including the placement of such children in psychiatric hospitals. Doctor Bevilacqua is currently providing care and treatment to approximately twenty children at Bradley. However, there are an additional thirty-six children who Bevilacqua has determined are eligible for program treatment and would benefit from psychiatric hospitalization, but whom he has not so placed because of insufficient funds. All these thirty-six emotionally disturbed children have been placed on a waiting list by defendant Bevilacqua.

Richard Roe, who has been found by Bevilacqua to be an emotionally disturbed child within the meaning of §§ 40.1-7-1 to 9 and therefore eligible for placement at Bradley, nevertheless was denied his request for placement at Bradley because Bevilacqua lacked the appropriate funds. Richard's name has been placed at the bottom of the waiting list until sufficient funds become available.

The first question certified to this court reads as follows:

"Do medical care benefits under the Rhode Island Medical Assistance Act, Title 40, Chapter 8, of the Rhode Island General Laws of 1956, as amended, include inpatient hospital services rendered in a psychiatric hospital to a child under age twenty-one (21) who is an eligible beneficiary under the Medical Assistance Act?"

The initial issue for our consideration is whether the coverage of inpatient hospital services under the State Medical Assistance program extends to and includes services rendered in a psychiatric hospital to eligible children under age 21.

During the 1977 legislative session, the Rhode Island General Assembly partially answered the foregoing question by enacting chapters 61 ¹ and 269 ² of the 1977 Rhode Island Public Laws. These acts amended §§ 40-8-2(d) and 40-8-4 specifically to exclude from the term "inpatient hospital services" services performed in a "hospital, institution or facility for tuberculosis or mental diseases." Therefore, it is axiomatic that as the effective dates of the enactments, May 5 and 13, medical care benefits under the Medical Assistance Act, as amended, do not include inpatient hospital services rendered in a psychiatric hospital to an eligible child under age 21.

What remains to be determined, however, is whether the phrase "inpatient hospital services" encompassed services furnished in a psychiatric hospital to children under 21 prior to the effective dates of the previously mentioned amendments. Before the passage of those acts § 40-8-4 read as follows:

"the department (of Social and Rehabilitative Services) shall furnish medical care benefits to eligible beneficiaries through a direct vendor payment plan. The plan shall include, but need not be limited to, any or all of the following benefits, which benefits shall be contracted for by the director:

a. inpatient hospital service;

b. nursing services for such periods of time as the director shall authorize;

c. visiting nurse service;

d. drugs for consumption either by inpatients or by other persons for whom they are prescribed by a licensed physician;

e. dental service."

Section 40-8-2(d) provided that the term "inpatient hospital services" included the following items and services furnished to an inpatient in a hospital:

"(1) bed and board;

"(2) such nursing services and other related services, as are customarily furnished by the hospital for the care and treatment of inpatients and such drugs, biologicals, supplies, appliances and equipment for use in the hospital, as are customarily furnished by such hospital for the care and treatment of patients;

"(3) such other diagnostic or therapeutic items or services, including but not limited to pathology, radiology and anesthesiology furnished by the hospital or by others under arrangements made by the hospital, as are customarily furnished to inpatients either by such hospital or by others under such arrangements, and services as are customarily provided to inpatients in the hospital by an intern or resident-in-training under a teaching program having the approval of the council on medical education and hospitals of the American Medical Association or of any other recognized medical society approved by the director.

"The term 'inpatient hospital services' shall be taken to include medical and surgical services provided by the inpatient's physician, but shall not include the services of a private duty nurse."

Although subsequent legislation is not entitled to much weight in construing a statute, it is not always without significance. Mattz v. Arnett, 412 U.S. 481, 93 S.Ct. 2245, 37 L.Ed.2d 92 (1973). Whether or not a later statute sheds light upon the meaning of a former statute depends upon a number of circumstances. Narragansett Racing Association, Inc. v. Norberg, 112 R.I. 791, 316 A.2d 334 (1974). In this case the definition of the term "inpatient hospital services" must be examined in order to ascertain whether such services included inpatient psychiatric treatment prior to the 1977 amendment of § 40-8-2(d).

According to § 40-8-2(d), inpatient hospital services included services customarily furnished by a hospital including But not limited to pathology, radiology, and anesthesiology. Additionally, the provision spoke in terms of "drugs, biologicals, supplies, appliances, and equipment for use in the hospital." Clearly, the Legislature is in the best position to ascertain the most desirable construction of a statute. We believe that when the Legislature amended § 40-8-2(d) to resolve the doubtful meaning of the provision, such action constituted evidence that the previous statute meant the exact contrary. 2A Sands, Statutes and Statutory Construction § 49.11 at 265 (4th ed. 1973). This conclusion is bolstered by the commonly accepted knowledge that some of the services described as "inpatient hospital" in the unamended statute are customarily performed at psychiatric hospitals. As a factual matter, psychiatric hospitals ordinarily supply hospital services such as pathology and anesthesiology. Thus, we believe that psychiatric hospital services were included within the ambit of the Medical Assistance Act.

Applying the foregoing discussion to the terms of the first certified question, we hold that prior to the effective dates of the amendments of §§ 40-8-2(d) and 40-8-4 medical care benefits under the Rhode Island Medical Assistance Act, G.L.1956 (1977 Reenactment) chapter 8 of title 40, included inpatient hospital services rendered in a psychiatric hospital to a child under age 21 who is an eligible beneficiary under said Act.

The second certified question to this court reads as follows:

"Does...