Klane v. Mayhew

CourtSuperior Court of Maine
DecidedApril 9, 2013
DocketKENap-12-29
StatusUnpublished

This text of Klane v. Mayhew (Klane v. Mayhew) is published on Counsel Stack Legal Research, covering Superior Court of Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Klane v. Mayhew, (Me. Super. Ct. 2013).

Opinion

STATE OF MAJNE SUPERIOR COURT KENNEBEC, ss CIVIL ACTION DOCKET NO. AP-11.-29 2-PrM - riG-N- LifO, /7_0~.7

EVANKIANE, Petitioner

v. ORDER ON RULE SOC APPEAL

MARY MAYHEW, Commissioner, DHHS

Before the Court is Petitioner Evan Klane' s Petition for Review of a Final Agency Action

Pursuant to M.R. Civ. P. SOC and 5 M.R.S.A. §,-r 11001 et seq. The Final Administrative

Decision, dated May 25, 2012, denied Mr. Klane MaineCare Private Duty Nursing ("PDN'')

services at Level Vat home that he had been receiving since 2004. Petitioner seeks reversal of

the Decision, issued by the Department of Health and Human Services ("DHHS") on grounds

that DHHS committed an error of law by deciding that Mr. Klane is no longer eligible for PDN

services at Level V, and also because the Decision is at odds with the plain language of the

relevant MaineCare regulations.

STATE~NTOFFACTSANDPROCEDURALBACKGROUND

The parties stipulate that the following facts are not in dispute. Evan Klane is twenty-one

years old, and has been receiving PDN services at Level V since 2004. 1 (R. Tab D at 3.)

Specifically, Registered Nurses assist Mr. Klane for 168 hours per week by maintaining and

1 The PDN program is organized into five levels of care. See .MBM, Ch. II, § 96. 02. Each level of care has specific eligibility requirements, and there is an associated financial cap. § 96.02-2; Appendix 2. Level V, the level for which Mr. Klane has qualified since 2004, has the highest eligibility requirements, and the highest financial cap-- $20,682 per month.

1 assessing his tracheostomy tube and gastrostomy tube ("G-tube"), assessing and treating his

frequent seizures, assisting him with his Activities ofDaily Living ("ADLs"), and performing

constant assessments of his physical condition. (R. Tab EK-5.) Mr. Klane also receives support

from his parents to the extent they are capable. Mr. Klane's various diagnoses include: "cardiac

dysrhythmia, osteoporosis, cerebral palsy, seizure disorder, depression, asthma, tachycardia,

brachycardia, chronic dry eye, gastroesophageal reflux disease, constipation, neuromuscular

spasticity, and history of bleeding ulcers." (R. Tab D at 4.) As a result, Mr. Klane requires

twenty-four-hour nursing care and frequent nasopharyngeal suctioning. (R. Tab D at 4.) Mr.

Klane is completely dependent on others for his care, receives nutrition, hydration, and

medication through a G-tube, and breathes through a tracheostomy tube. (R. Tab D at 4.)

Mr. Klane had been receiving PDN services while he was under the age of twenty-one by

way ofDllliS approval? However, when Mr. Klane or any individual reaches the age of

twenty-one, the Department's agent, Goold Health Systems ("GHS") reassesses the patient to

determine his or her needs going forward, and authorizes anew services based on the individual's

medical eligibility. (R. Tab D at 4.) Mr. Klane was assessed by GHS on August 22, 2011 when

his twenty-first birthday was approaching, and it was determined that he was no longer medically

eligible for PDN services at Level V. (R. Tab D at 4.) Instead, it was found that Mr. Klane was

eligible for twenty-eight hours of services per week under MaineCare' s Adults with Disabilities

waiver ("ADW waiver") provision. (R. Tab D at 4.)

When GHS informed Mr. Klane and his parents that he was found eligible for twenty-

eight hours of nursing care through its Advisory Home & Community Benefits Assessment

2 Petitioner explains that when a person is under twenty-one, the many agencies that come together to provide PDN care assess the prospective patient to determine whether he or she is medically eligible, decide what type of services the individual needs, and then submits a proposal to DHHS who then authorizes the necessary services. (R. Tab D at 3.)

2 notice on August 22, 2011, Mr. Klane, through his parents, filed a timely administrative appeal

ofthe Department's determination on August 23, 2011. (R. Tab H0-6 at 1.) At a hearing held

on November 22, 2011, the hearing officer addressed the issue of whether the GHS agent was

correct when it denied Mr. Klane' s eligibility for Level V PDN services under the MaineCare

program. 3 (R. Tab H0-6 at 1.) Mter the November 22 hearing, but before reconvening on

March 6, 2012, the parties agreed to submit a second issue for consideration-whether GHS was

correct when it found Mr. Klane was eligible for twenty-eight hours of services per week under

the ADW waiver program. (R. Tab D at 1.)

On April 12, 2012, the hearing officer issued a Recommended Decision finding that Mr.

Klane requires frequent nasopharyngeal suctioning and twenty-four-hour nursing care; that he is

completely dependent on others for the performance of all his ADLs; that he has a G-tube for

nutrition, hydration, and medication; that he has a tracheostomy for breathing; and that he has an

unstable seizure disorder. (R. Tab D at 4.) The hearing officer found that the GHS agent was

correct when it determined Mr. Klane was not eligible for Level V PDN services under

MaineCare, and found him eligible for twenty-eight hours of services per week under the ADW

waiver. (R. Tab D at 4.)

On April 27, 2012, Mr. Klane filed written responses and exceptions to the Department

decision, stating that the hearing officer erred in his application ofMaineCare's PDN Level V

eligibility requirements. (R. Tab E.) The Respondent, the DHHS Commissioner, issued a Final

Decision on May 25, 2012, adopting the hearing officer's factual findings, and accepting the

Recommended Decision. 4 (R. Tab F.) Mter Mr. Klane received the Final Decision on May 30,

2012, he filed a timely Petition for Review of Final Agency Action pursuant to Rule SOC and 5

3 The determination of the hearing officer was adopted by the Department. (Pet. 's 80C Br. 3 n.6.) 4 Finding that Mr. Klane is eligible for twenty-eight hours of services per week under the Home & Community Benefits of the Elderly and for Adults with Disabilities. (R. Tab F.)

3 M.R.S.A. § 11001 et seq. The Court has reviewed the record, the parties' written submissions,

and considered their oral arguments presented on January 11, 2013, and issues the following

order reversing the decision of the Commissioner.

STANDARD OF REVIEW

The Superior Court may "[r]everse or modify the decision" of the administrative agency

"if the administrative findings, inferences, conclusions or decisions are: (1) [i]n violation of constitutional or statutory provisions; (2) [i]n excess ofthe statutory authority ofthe agency; (3) [m]ade upon unlawful procedure; (4) [a]ffected by bias or error oflaw; (5) [u]nsupported by substantial evidence on the whole record; or (6) [a]rbitrary or capricious or characterized by abuse of discretion.

5 M.R.S.A. § 11007(4)(C). The standard of review on a Rule 80C appeal is "limited to whether

the [governmental agency] abused its discretion, committed an error of law, or made findings not

supported by substantial evidence in the record." Seider v. Ed. ofExam 'rs ofPsychologists,

2000 ME 206, ~ 8, 695 A.2d 552.

Issues of statutory construction are questions of law, and are subject to de novo review.

See Town ofEagle Lake v. Comm 'r, Dep 't ofEduc., 2003 ME 37, ~ 7, 818 A.2d 1034;/n re

Jeremiah Y, 2002 ME 135, ~ 7, 804 A.2d 357; Hallissey v. Sch. Admin. Dist. No. 77, 2000 ME

143, ~ 14, 755 A.2d 1068. When the meaning of a statute is unambiguous, the Court does "not

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Related

Hallissey v. School Administrative District No. 77
2000 ME 143 (Supreme Judicial Court of Maine, 2000)
Fryeburg Health Care Center v. Department of Human Services
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State v. Cloutier
1997 ME 96 (Supreme Judicial Court of Maine, 1997)
Wood v. Superintendent of Insurance
638 A.2d 67 (Supreme Judicial Court of Maine, 1994)
Town of Eagle Lake v. Commissioner, Department of Education
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Cobb v. Board of Counseling Professionals Licensure
2006 ME 48 (Supreme Judicial Court of Maine, 2006)
Seider v. Board of Examiners of Psychologists
2000 ME 206 (Supreme Judicial Court of Maine, 2000)
McGettigan v. Town of Freeport
2012 ME 28 (Supreme Judicial Court of Maine, 2012)
In re Jeremiah Y.
2002 ME 135 (Supreme Judicial Court of Maine, 2002)
Oppenheim v. Hutchinson
2007 ME 73 (Supreme Judicial Court of Maine, 2007)

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Klane v. Mayhew, Counsel Stack Legal Research, https://law.counselstack.com/opinion/klane-v-mayhew-mesuperct-2013.