Dogwood Realty, Inc. v. Virginia Department of Social Services

53 Va. Cir. 236, 2000 Va. Cir. LEXIS 164
CourtSuffolk County Circuit Court
DecidedSeptember 1, 2000
DocketCase No CL00-84
StatusPublished

This text of 53 Va. Cir. 236 (Dogwood Realty, Inc. v. Virginia Department of Social Services) is published on Counsel Stack Legal Research, covering Suffolk County Circuit Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dogwood Realty, Inc. v. Virginia Department of Social Services, 53 Va. Cir. 236, 2000 Va. Cir. LEXIS 164 (Va. Super. Ct. 2000).

Opinion

BY JUDGE D. ARTHUR KELSEY

Dogwood Realty, Inc., operates an adult-care facility known as the Suffolk Retirement Center licensed and regulated by the Virginia Department of Social Services. The Department conducted an investigation of the Suffolk Retirement Center and cited it for violating administrative regulations prohibiting licensed facilities from changing or discontinuing medications administered to residents. Seeking to overturn the agency decision and to vacate any civil penalties, the Suffolk Retirement Center claims the Department both misinterpreted its own regulations and misapplied them to the facts of this case. For the following reasons, the Court disagrees.

The administrative record reveals that the Department began investigating the Suffolk Retirement Center (“SRC”) in 1999. An inspector from the Division of Licensing Programs conducted an audit into the handling of prescription medications at the facility. A random selection of residents’ medical records demonstrated that “three residents were out of medications and needed a reorder and an appointment with their doctor to have the [237]*237prescriptions renewed.” Adm. Record at 57. “As of June 8, only one had an appointment to see a doctor, and that was a week later.” Id. “There was no apparent means in place to anticipate the expiration of the prescriptions by scheduling appointments or locating resources to help defray the costs of seeing the doctors.” Id:, see also id. at 74.

Later, on August 9, 1999, “a resident was brought to the hospital emergency room (ER) after Suffolk Police officers found him in the middle of a major highway, U.S. 460, having a seizure.” Id. at 57; see also id. at 66. “At the ER he was found to have below effective levels of Dilantin in his blood.” Id. at 57. Records at SRC “showed he had not received Dilantin,” an anti-seizure medication, on “several days in July and in August because he was not in the building when medication was given.” Id:, see also id. at 59. SRC records “did not indicate efforts to give him his medication when he returned, or to change the administration schedule to a time when he was more likely to be present.” Id. at 57. SRC’s improper administration of Dilantin, the Department concluded, was causally related to the resident’s seizure. Id. at 59.

Based upon these factual findings, the Department concluded that SRC violated an administrative regulation that stated: “No medication ... shall be started, changed or discontinued by the facility without an order by the physician.” 22 VAC 40-71-400(A). This regulation comes from the Department’s “Standards and Regulations for Licensed Adult Care Residences” at Part IV, section 400(A), entitled “Resident Accommodations, Care and Related Services.” The violations, the Department believed, were “serious” and the “potential impact of this situation could involve significant risk to all residents for whom the home takes the responsibility for administering medication.” Adm. Record at 57. “Failure to maintain compliance with standards in the future,” the Department warned SRC, “could place your license in jeopardy.” Id. at 57.

When the Department brought these matters to SRC’s attention, the President and owner of SRC, Dr. Nazir Chaudhary, requested an informal conference to present his position. He brought with him SRC’s Director of Operations, the Medical Technician, the Administrator, and an employee nurse. Id. at 6. At the conference, Dr. Chaudhary asserted that a legitimate explanation could be made for each of the incidents. With respect to the three resident files found during the random audit, he argued that the first patient had his medication originally filled by a Veterans’ Administration (“VA”) hospital and the patient had no local private physician. Id. at 7. After receiving the original violation letter, SRC staff contacted the local VA hospital, which, in turn, lined the patient up with a local physician. Id. The second patient had his medication discontinued by his doctor before the investigation, Dr. [238]*238Chaudhary pointed out. Id. And the third patient had his medication discontinued by his physician at some point after the investigation. Id.

Concerning the resident found on Route 460 having a seizure, Dr. Chaudhary asserted that this resident was an alcoholic and was not receiving a sufficiently high “therapeutic dose” of Dilantin. Id. at 6. Moreover, the patient would both wander off from the facility and, even when present, would - sometimes refuse his medications when SRC staff offered them to him. Id. The staff could not give the medications “more than an hour” after the designated time, Dr. Chaudhary believed, without violating another regulation. Nor could the staff force him to take the medications against his will, Dr.

■ Chaudhary argued. Id. Finally, Dr. Chaudhary contended that the resident’s “alcohol abuse,” not any problem with the administration of medication, caused the seizure. Id.

The Department accepted none of Dr. Chaudhary’s arguments, except the explanation given for the second randomly selected patient who had his medication discontinued by his physician before the inspection. Id. at 7. As to that incident, the Department explained, it had already been dismissed by the investigator prior to recommending the proposed penalty. Id. (“The second resident addressed was not one for whose records a violation had been cited.”).

• The Commissioner for the Department of Social Services issued a final “Special Order” holding SRC in violation of agency regulations and assessing a civil penalty against the facility. The Commissioner predicated his decision on two separate violations: (i) the random audit discovered two patients with unfilled medical orders at the time of the inspection, and (ii) the Dilantin patient found on Route 460 had not received his anti-seizure medication pursuant to his doctor’s orders. Id. at 4. Dissatisfied with the Commissioner’s decision, SRC filed this action seeking judicial review under the Virginia Administrative Process Act (“VAPA”), Va. Code Ann. § 9-6.14:1, et seq. (Michie 1998 & Supp. 2000). The Commissioner’s “Special Order” qualifies as an appealable “case decision” under the VAPA. See Va. Code Ann. § 63.1-179.1 (Michie Supp. 2000).

In an appeal under the VAPA, the burden of proof must be shouldered by the party challenging the agency action. See Johnston-Willis, Ltd. v. Kenley, 6 Va. App. 231, 241, 369 S.E.2d 1, 6 (1988). The legal challenge also must be routed through an appellate matrix, rather than the de novo standard typically employed by trial courts. Thus, a “circuit court’s role in an appeal from an agency decision is equivalent to an appellate court’s role in an appeal from atrial court.” York County Sch. Bd. v. Nicely, 12 Va. App. 1051, 1062, 408 S.E.2d 545, 551 (1991). In this sense, “the General Assembly has [239]*239provided that a circuit court acts as an appellate tribunal.” J. P. v. Carter, 24 Va. App. 707, 721, 485 S.E.2d 162, 169 (1997) (citation omitted); see also Pence Holdings, Inc. v. Auto Center, Inc., 19 Va. App. 703, 707-08, 454 S.E.2d 732, 734 (1995).

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Bluebook (online)
53 Va. Cir. 236, 2000 Va. Cir. LEXIS 164, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dogwood-realty-inc-v-virginia-department-of-social-services-vaccsuffolk-2000.