Szewczyk v. Department of Social Services

Decision Date20 September 2005
Docket NumberNo. 17034.,17034.
Citation881 A.2d 259,275 Conn. 464
CourtConnecticut Supreme Court
PartiesZbigniew SZEWCZYK v. DEPARTMENT OF SOCIAL SERVICES.

Thomas J. Riley, New London, for the appellant (substitute plaintiff).

Tanya Feliciano DeMattia, assistant attorney general, with whom, on the brief, were Richard Blumenthal, attorney general, and Richard J. Lynch, assistant attorney general, for the appellee (defendant).

Jennifer L. Cox, Jennifer A. Osowiecki and Patrick J. Monahan II filed a brief for the Connecticut Hospital Association as amicus curiae.

Sheldon V. Toubman, Jamey Bell, Angel Feng, Greg Bass and Shirley Bergert, filed a brief for the Connecticut Legal Services, Inc., et al., as amici curiae.

SULLIVAN, C.J., and BORDEN, NORCOTT, PALMER and ZARELLA, Js.

NORCOTT, J.

The principal issue in this certified appeal is whether an illegal alien with acute myelogenous leukemia suffers from an "emergency medical condition" under the federal statute, 42 U.S.C. § 1396b (v),1 and the state regulation, Department of Social Services, Uniform Policy Manual § 3000.01 (Uniform Policy Manual),2 and is, therefore, entitled to medicaid benefits. Michael R. Kerin, the temporary administrator of the estate of the plaintiff, Zbigniew Szewczyk,3 appeals, following our grant of certification,4 from the judgment of the Appellate Court concluding that the plaintiff did not suffer from an emergency medical condition, and affirming the judgment of the trial court dismissing his administrative appeal from the decision of the defendant, the department of social services (department), denying medicaid benefits to the plaintiff. Szewczyk v. Dept. of Social Services, 77 Conn.App. 38, 52, 822 A.2d 957 (2003). We conclude that the plaintiff suffered from an emergency medical condition. Accordingly, we reverse the judgment of the Appellate Court. Chief Judge Lavery aptly set forth the facts and procedural history in his dissent from the Appellate Court opinion in this case. "The plaintiff, a native of Poland, illegally remained in this country after his visa expired. On November 24, 1998, the plaintiff sought treatment from his family physician. At that time, he suffered from intense pain, nausea and overall weakness so severe that he could take only one to two steps before collapsing. After reviewing the results of tests performed on the plaintiff's blood samples, the plaintiff's physician immediately referred the plaintiff to Robert B. Erichson, an oncologist at Stamford Hospital (hospital).

"On that same day, Erichson diagnosed the plaintiff with acute myelogenous leukemia and admitted him to the hospital. The plaintiff received treatment consisting of chemotherapy, surgery and biopsies at the hospital until his discharge on December 26, 1998. The hospital charges from November 24 through December 26, 1998, totaled $82,046.85.5

"An application for benefits from November through December, 1998, was filed with the [department], an agency of the state. Erichson wrote a letter, which was admitted into evidence by the department's hearing officer, that stated that `acute myelogenous leukemia ... is a rapidly fatal disease unless treated aggressively with chemotherapy.' . . . Erichson also opined that such chemotherapy is always administered in a hospital, associated with severe infections requiring aggressive antibiotic and transfusion treatment, and that `in the absence of such therapy, [the plaintiff] would probably not be alive today.'6. . . Despite the absence of any medical evidence to the contrary, the hearing officer determined that the plaintiff did not suffer from an emergency medical condition and therefore was not eligible for benefits. Specifically, the hearing officer found that the plaintiff did not suffer from an emergency medical condition because the plaintiff would not have immediately died on November 24, 1998, if he had not received treatment." (Emphasis in original.) Id., at 53-54, 822 A.2d 957 (Lavery, C.J., dissenting).

The plaintiff appealed from the denial of benefits to the trial court pursuant to General Statutes §§ 4-183 and 17b-61. The trial court applied the explanation of "emergency medical condition" from the decision of the United States Court of Appeals for the Second Circuit in Greenery Rehabilitation Group, Inc. v. Hammon, 150 F.3d 226, 232-33 (2d Cir.1998), and cited another trial court case for the proposition that "an emergency is any condition that is of such severity that in the absence of immediate medical attention, the patient's health would be placed in serious jeopardy." (Internal quotation marks omitted.) The trial court credited the hearing officer's conclusions that the biopsy and catheterization were not "`emergency events,'" and that the plaintiff "`would not have immediately died' on the date of admission." The trial court concluded that these findings were supported by substantial evidence, and, therefore, dismissed the plaintiff's administrative appeal.

The plaintiff thereafter appealed from the judgment of the trial court to the Appellate Court. Szewczyk v. Dept. of Social Services, supra, 77 Conn.App. 38, 822 A.2d 957. The Appellate Court relied on the standards articulated in Greenery Rehabilitation Group, Inc. v. Hammon, supra, 150 F.3d at 232, and concluded that the hearing officer did not use an inappropriately "narrow" legal standard. Szewczyk v. Dept. of Social Services, supra, at 48, 822 A.2d 957. The Appellate Court also concluded that the hearing officer's decision was supported by substantial evidence, similarly crediting his determination that the biopsy and catheterization were not emergency procedures, and that the hearing officer's decision not to adopt Erichson's determination was a question of credibility that it would not disturb.7 Id., at 52, 822 A.2d 957. Accordingly, the Appellate Court affirmed the judgment of the trial court, and this certified appeal followed. See footnote 4 of this opinion.

On appeal, the plaintiff contends that the Appellate Court correctly relied upon, but misapplied, the Second Circuit's explanation of the term "emergency medical condition" from Greenery Rehabilitation Group, Inc. v. Hammon, supra, 150 F.3d at 233. The plaintiff also contends that the Appellate Court's improperly restrictive application of the term "emergency medical condition" will have dire consequences for patient care, and will interfere with hospitals' discharge of their patient care responsibilities under the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd.8 Finally, the plaintiff claims that the hearing officer's determination that he did not suffer from an "emergency medical condition" was not supported by substantial evidence.9 We agree with the plaintiff's contention that the Appellate Court improperly affirmed the judgment of the trial court because the hearing officer correctly relied upon, but misapplied, the standard set forth in Greenery Rehabilitation Group, Inc.

In the present case, the plaintiff concedes that there is no Connecticut law that provides broader health coverage to illegal aliens than that provided under federal law, and acknowledges that the definition of "emergency medical condition" in § 3000.01 of the Uniform Policy Manual is controlled by the coordinate federal statute. See, e.g., Lewis v. Thompson, 252 F.3d 567, 570 (2d Cir.2001). Thus, in order to establish his eligibility for payments under § 3005.05(C) of the Uniform Policy Manual, the plaintiff must establish that he suffered from an emergency medical condition as that term is defined in 42 U.S.C. § 1396b (v)(3), and also that he received treatment for the emergency medical condition within the meaning of 42 U.S.C. § 1396b (v)(2)(A).

We begin with the applicable standard of review. "In Cadlerock Properties Joint Venture, L.P. v. Commissioner of Environmental Protection, 253 Conn. 661, 669, 757 A.2d 1 (2000), cert. denied, 531 U.S. 1148, 121 S.Ct. 1089, 148 L.Ed.2d 963 (2001), we stated: Although the interpretation of statutes is ultimately a question of law ... it is the well established practice of this court to accord great deference to the construction given [a] statute by the agency charged with its enforcement.... Conclusions of law reached by the administrative agency must stand if the court determines that they resulted from a correct application of the law to the facts found and could reasonably and logically follow from such facts. . . . We also have held that an exception is made when a state agency's determination of a question of law has not previously been subject to judicial scrutiny . . . the agency is not entitled to special deference. . . . Accord Bridgeport Hospital v. Commission on Human Rights & Opportunities, [232 Conn. 91, 109, 653 A.2d 782 (1995)] ([a]s we have stated many times, the factual and discretionary determinations of administrative agencies are to be given considerable weight by the courts . . . [however] it is for the courts, and not for administrative agencies, to expound and apply governing principles of law . . .)." (Internal quotation marks omitted.) Wallingford v. Dept. of Public Health, 262 Conn. 758, 771-72, 817 A.2d 644 (2003).

The construction and application of § 1396b (v)(3) presents an issue of law not heretofore considered by this court. Accordingly, our review is plenary. See, e.g., Manifold v. Ragaglia, 272 Conn. 410, 419, 862 A.2d 292 (2004). With respect to the construction and application of federal statutes, "principles of comity and consistency" require us to follow the plain meaning rule for the interpretation of federal statutes "because that is the rule of construction utilized by the United States Court of Appeals for the Second Circuit."10 Webster Bank v. Oakley, 265 Conn. 539, 554-55, 830 A.2d 139 (2003) (construing federal Americans with Disabilities Act and Fair Housing Amendments Act of 1988), cert. denied, 541 U.S. 903, 124 S.Ct. 1603, 158...

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