Humana of Florida, Inc. v. McKaughan

652 So. 2d 852
CourtDistrict Court of Appeal of Florida
DecidedMarch 3, 1995
Docket94-01369, 94-01693 and 94-01757
StatusPublished
Cited by22 cases

This text of 652 So. 2d 852 (Humana of Florida, Inc. v. McKaughan) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Humana of Florida, Inc. v. McKaughan, 652 So. 2d 852 (Fla. Ct. App. 1995).

Opinion

652 So.2d 852 (1995)

HUMANA OF FLORIDA., INC., d/b/a Humana Women's Hospital — Tampa, William L. Capps, M.D., and William L. Capps, M.D., P.A., Appellants,
v.
Jaimes McKAUGHAN and Darlene McKaughan, on Behalf of and natural guardians of Michael McKAUGHAN, a minor, Appellees.
FLORIDA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION ASSOCIATION, Appellant,
v.
Jaimes McKAUGHAN and Darlene McKaughan, on Behalf of and natural guardians of Michael McKAUGHAN, a minor, Appellees.
Kenneth SOLOMON, M.D., Kenneth Solomon, M.D., P.A. and Neonatal Associates, Inc., Appellants,
v.
Jaimes McKAUGHAN and Darlene McKaughan, on Behalf of and natural guardians of Michael McKAUGHAN, a minor, Appellees.

Nos. 94-01369, 94-01693 and 94-01757.

District Court of Appeal of Florida, Second District.

March 3, 1995.

*854 Daneil M. McAuliffe, Timon V. Sullivan, and Bradley J. Goewert of Gunn, Ogden & Sullivan, P.A., and Raymond T. Elligett, Jr. and Amy S. Farrior of Schropp, Buell & Elligett, P.A., Tampa, for appellant Humana.

Ted R. Manry, III, Stephen H. Sears, and Mark E. McLaughlin of MacFarlane, Ausley, Ferguson & McMullen, Tampa, for appellants William L. Capps, M.D. and William L. Capps, M.D., P.A.

Wilbur E. Brewton, W. Douglas Moody, Jr., and Kelly Brewton Plant of Taylor, Brion, Buker & Greene, Tallahassee, for appellant Florida Birth-Related Neurological Injury Compensation Ass'n.

Philip D. Parrish of Stephens, Lynn, Miami, for appellants Kenneth Solomon, M.D., *855 Kenneth Solomon, M.D., P.A., and Neonatal Associates, Inc.

Phillip H. Taylor, West Palm Beach, Bruce S. Rogow and Beverly A. Pohl, Ft. Lauderdale, for appellees.

LAZZARA, Judge.

The Florida Birth-Related Neurological Injury Compensation Association (the Association), as well as Humana Women's Hospital, Dr. Kenneth Solomon and his professional association, Dr. William Capps and his professional association, and Neonatal Associates, Inc. (the Intervenors),[1] appeal a final order of dismissal without prejudice entered by an administrative hearing officer on a supplementary petition for benefits filed by the appellees, Jaimes and Darlene McKaughan (the McKaughans), on behalf of their minor son under the Florida Birth-Related Neurological Injury Compensation Plan (the Plan), sections 766.301-.316, Florida Statutes (1993). We reject the McKaughans' argument that we lack jurisdiction to entertain this appeal but affirm the order under review because the hearing officer correctly ruled that the allegations of the McKaughans' supplementary petition did not vest him with jurisdiction to determine whether their son suffered a "birth-related neurological injury" as defined by the Plan.

We also certify a question of great public importance regarding whether the Plan vests exclusive jurisdiction in an administrative hearing officer to determine if an injury suffered by a new-born infant is covered by the exclusive remedy of the Plan once that remedy is raised as an affirmative defense to a medical malpractice action in circuit court.

Our resolution of this case requires us to first undertake a statutory analysis of the Plan and to set forth the procedural background giving rise to this appeal and the basis for our jurisdiction. In reaching our decision, we will analyze and rely upon the analogous law of workers' compensation and the doctrine of primary jurisdiction, as well as the law of legislative intent as it relates to the Plan's provision tolling the medical malpractice statute of limitations. We will conclude with some general observations which will hopefully assuage any concerns that our decision will open a "pandora's box" of medical malpractice claims directed at "birth-related neurological injuries" which the Plan was designed to prevent.

STATUTORY ANALYSIS OF THE PLAN

The legislature enacted the Plan to stabilize a perceived medical malpractice insurance crisis affecting obstetricians and to ensure the continued availability of essential obstetrical services. § 766.301(1). The Plan establishes an administrative system that provides compensation on a no-fault basis for an infant who suffers a narrowly-defined birth-related neurological injury. § 766.301(2). The Association has been given broad powers to administer the Plan, including payment of claims on behalf of the Plan. § 766.315.

To fund the Plan, which the Florida Supreme Court has compared to a form of insurance supported by a tax, the legislature imposed mandatory yearly assessments on all licensed physicians and hospitals. § 766.314(4)(a)(b); Coy v. Florida Birth-Related Neurological Compensation Plan, 595 So.2d 943 (Fla. 1992) (upholding constitutionality of section 766.314).[2] As noted in Coy, "obstetricians are not required to join the Plan, and insurance thus is available only if the obstetrician has elected to join." 595 So.2d at 944. Obstetricians who decide to participate pay a much higher assessment. § 766.314(4)(c). In return, they are given the benefit of the Plan's exclusive administrative remedy and thus are immune from malpractice claims for birth-related neurological injuries except in situations involving "clear and convincing evidence of bad faith or malicious purpose or willful and wanton disregard of human rights, safety, or property." § 766.303(2).

*856 Claims filed under the Plan are heard and determined by an administrative hearing officer who must schedule an expedited hearing at which the claimant and the Association are mandatory parties. §§ 766.304; 766.307. The hearing officer is charged with determining whether the injury claimed is a birth-related neurological injury and whether obstetrical services were delivered by a participating physician. § 766.309.

Under the Plan, a "birth-related neurological injury" means:

[I]njury to the brain or spinal cord of a live infant weighing at least 2,500 grams at birth caused by oxygen deprivation or mechanical injury occurring in the course of labor, delivery, or resuscitation in the immediate postdelivery period in a hospital, which renders the infant permanently and substantially mentally and physically impaired.

§ 766.302(2). If the hearing officer finds that the statutory criteria are satisfied, then the infant, as well as the infant's parents or legal guardians, are entitled to the award of specifically defined, but limited, financial benefits without regard to fault. § 766.31.

PROCEDURAL BACKGROUND

The McKaughans sued the Intervenors for medical malpractice in circuit court claiming that their son suffered permanent neurological damage in the form of a spinal cord injury after the immediate postdelivery period. The Intervenors responded by raising the exclusive administrative remedy of the Plan as a defense. They were ultimately successful in convincing the circuit court judge to abate the malpractice action pending a determination in a proceeding brought under the Plan as to whether the injury constituted a "birth-related neurological injury."

Acting under the direction of the circuit court's order, the McKaughans then filed a petition for benefits under the Plan, which they later supplemented. The gravamen of their supplementary petition was that the injury to their son did not qualify as a birth-related neurological injury as defined in the Plan. The McKaughans therefore requested that the case be returned to the circuit court for resolution.

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Bluebook (online)
652 So. 2d 852, Counsel Stack Legal Research, https://law.counselstack.com/opinion/humana-of-florida-inc-v-mckaughan-fladistctapp-1995.