Almonte v. Rhode Island Department, Human Services, 01-0904 (2002)

CourtSuperior Court of Rhode Island
DecidedAugust 26, 2002
DocketC.A. No. P.C. 01-0940
StatusPublished

This text of Almonte v. Rhode Island Department, Human Services, 01-0904 (2002) (Almonte v. Rhode Island Department, Human Services, 01-0904 (2002)) is published on Counsel Stack Legal Research, covering Superior Court of Rhode Island primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Almonte v. Rhode Island Department, Human Services, 01-0904 (2002), (R.I. Ct. App. 2002).

Opinion

DECISION
Before the Court is an appeal by appellant Marie Almonte from a decision of the Rhode Island Department of Human Services ("DHS") that denied her application for medical assistance benefits. For the reasons set forth in this decision, this Court reverses the decision of DHS and remands this case to DHS for an award of medical assistance benefits to appellant Almonte, together with attorneys' fees and costs.

Facts/Travel
The Rhode Island Department of Human Services is an agency within the executive branch of state government that is responsible for the management of the medical assistance program. The state statute governing the provision of medical assistance benefits states:

it is declared to be the policy of this state to provide medical assistance for those persons in this state who possess the characteristics of persons receiving public assistance under the provisions of R.I. Gen. Laws § 40-5.1-9 or 40-6-27, and who do not have the income and resources to provide it for themselves or who can do so only at great financial sacrifice.

R.I. Gen. Laws § 40-8-1(c). To receive federal funding, DHS must pay medical assistance benefits to all eligible individuals according to the regulations established by the federal Social Security Act. It is pursuant to this public assistance program that appellant, Marie Almonte, sought benefits in this case.

Marie Almonte is a sixty-one year-old woman with a second grade education. She cannot read or write English. (Exh. 7C). She was employed as a machine operator for twelve years — a job that required her to sit for eight hours per day. (Exh. 7C). In 1999, back pain caused appellant Almonte to stop working, and she subsequently applied for benefits under the medical assistance program in June 2001.

Appellant Almonte's medical record demonstrates that she suffers from persistent spinal problems. X-rays of her cervical spine taken in 1998 reveal severe degenerative disease in her lower cervical spine, with marked degenerative disease of the cervical vertebrae located at C4-C7. (Exh 8A).

Dr. Collins, who has served as appellant Almonte's treating physician since September 1998, completed DHS's MA-63 form and found that Ms. Almonte suffers from consistent chronic back pain and degenerative joint disease of the cervical and thoracic spine. (Exhs. 7B and 8E). He concluded that her impairment is expected to last at least twelve months and that she has only a fair prognosis for eliminating or reducing her conditions through medication or treatment. (Exh. 8G). He determined that appellant Almonte's condition limited her physical activity. Id. According to Dr. Collins, she can walk for a maximum of two to three hours per day, sit for two to three hours per day, stand for one to two hours per day, reach for one to two hours per day, and sit or stand intermittently (with breaks) for a maximum of two to three hours per day. She cannot lift and carry more than ten pounds. (Exh. 7B). Dr. Collins diagnosed appellant Almonte as suffering from "chronic shoulder and back pain not helped by medicine." (Exh. 7B). He recommended occupational therapy, physical therapy and breast reduction surgery, but appellant Almonte has been unable to try to alleviate her condition because she is unable to afford the recommended treatment. (Tr. at 17). According to Dr. Collins, her impairments "significantly limit" her physical ability to do work activities and she is unable to sustain full time employment. (Exh. 8G). He noted that her pain, which is "moderate to severe," has not responded to conservative treatment (including medication) and that she is unable to afford the recommended treatment. Id. Dr. Collins found that her pain is of such severity as to preclude the concentration and productivity that is necessary to sustain work. Id.

From October 1999 to February 2000, appellant Almonte received chiropractic treatment from Dr. Kerry Kasegian-Langley. Her medical records document his persistent findings of decreased cervical range of motion, including paraspinal spasm and other muscle spasm, and mid-thoracic and cervical tenderness on palpation. (Exh. 7D). Moreover, Dr. Kasegian-Langley observed that appellant Almonte suffers from decreased cervical extension and guarded range of motion. Id.

Dr. Bernado reviewed appellant Almonte's medical records to determine her residual functional capacity for the Social Security Administration. He concluded that she she suffers from chronic back pain, characterized by severe degenerative disease in the lower cervical spine. (Exh. 8A). He found decreased cervical range of motion by 50% and severe restriction of range of motion in her right shoulder. Id. He also found tenderness by palpation in her cervical and thoracic spine. Id. He concluded that Ms. Almonte can lift up to twenty pounds, stand or walk for six hours out of eight and sit for eight hours out of eight. Id. He found her symptoms to be attributable to a medically determinable impairment, that the severity and duration of the symptoms were not disproportionate to the expected severity or duration on the basis of the impairment and that the severity of the symptoms and the effect on function were consistent with the medical and nonmedical evidence, including statements by the claimant and others, observations regarding her activities of daily living and alterations of her of usual behavior. Id.

Appellant Almonte applied for medical assistance benefits from DHS in June 2000. The Medical Assistance Review Team ("MART") from DHS denied her application for benefits on August 23, 2000. At the time, MART had no X-rays for appellant Almonte nor did it have any physician's reports indicating objective medical evidence to support her subjective symptoms or any records suggesting that her chronic back pain was severe. She appealed from that decision and sought an administrative hearing before a DHS Appeals Officer.

At the administrative hearing on January 10, 2001, appellant Almonte testified that she filed an application for medical assistance benefits because "I'm sick. I can't work. I can't do anything." (Tr. at 14). When asked to describe her back pain, she stated "Pain. Complete pain. I cannot sleep. If I turn on my side, I can't sleep, and if I sleep with my face down, I can't sleep either." Id. She claimed that she sleeps about an hour per night. Id. at 17. When asked to describe her shoulder pain, she stated "Everything hurts. Everything from the top to like the nerves-something wrong with this arm." Id. at 15. She stated that she could not lift her arms at all before the pain appears. Id. Ms. Almonte takes Motrin and a high dosage of Vioxx. Id. at 17.

Appellant Almonte testified further that she cannot work, that she cannot bend or reach above her head and that she can stand for only one or two hours. Id. at 18. She stated that she can sit for only one or two hours and walk slowly for one or two hours. Id. at 19. She indicated that she does no household chores except making beds. (Exh. 7C). She drives a car but also needs help getting places. Id. She also needs help with food preparation. Id. Ms. Almonte testified that she cannot obtain occupational therapy because she cannot afford it. (Tr. at 17).

Following the hearing, the Hearing Officer gave MART seven days to review appellant Almonte's X-rays and the additional medical records submitted on her behalf that it had not reviewed at the time it denied her request for benefits in August 2000. (Tr. at 22).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Bowen v. Yuckert
482 U.S. 137 (Supreme Court, 1987)
Dikeman v. Halter
245 F.3d 1182 (Tenth Circuit, 2001)
Milardo v. Coastal Resources Management Council
434 A.2d 266 (Supreme Court of Rhode Island, 1981)
Newport Shipyard, Inc. v. Rhode Island Commission for Human Rights
484 A.2d 893 (Supreme Court of Rhode Island, 1984)
Caswell v. George Sherman Sand & Gravel Co.
424 A.2d 646 (Supreme Court of Rhode Island, 1981)
Costa v. Registrar of Motor Vehicles
543 A.2d 1307 (Supreme Court of Rhode Island, 1988)
Jack C. JEFFCOAT v. SECRETARY OF HHS
910 F. Supp. 1187 (E.D. Texas, 1995)
Bunch v. Board of Review, Rhode Island Department of Employment & Training
690 A.2d 335 (Supreme Court of Rhode Island, 1997)
Holley v. Chater
931 F. Supp. 840 (S.D. Florida, 1996)
Taft v. Pare
536 A.2d 888 (Supreme Court of Rhode Island, 1988)
St. Pius X Parish Corp. v. Murray
557 A.2d 1214 (Supreme Court of Rhode Island, 1989)
Baldeo K. Singh v. Kenneth S. Apfel
222 F.3d 448 (Eighth Circuit, 2000)
Tackett v. Apfel
180 F.3d 1094 (Ninth Circuit, 1999)

Cite This Page — Counsel Stack

Bluebook (online)
Almonte v. Rhode Island Department, Human Services, 01-0904 (2002), Counsel Stack Legal Research, https://law.counselstack.com/opinion/almonte-v-rhode-island-department-human-services-01-0904-2002-risuperct-2002.