K.O. v. Lawsky

50 Misc. 3d 742, 18 N.Y.S.3d 840
CourtNew York Supreme Court
DecidedOctober 14, 2015
StatusPublished
Cited by1 cases

This text of 50 Misc. 3d 742 (K.O. v. Lawsky) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
K.O. v. Lawsky, 50 Misc. 3d 742, 18 N.Y.S.3d 840 (N.Y. Super. Ct. 2015).

Opinion

OPINION OF THE COURT

Marsha L. Steinhardt, J.

In a case of, what this court perceives to be first impression, plaintiff and medical malpractice defendants (Joan Bryson, CNM; Kristen Leonard, CNM; Community Midwifery, PC) join together to bring a CPLR article 78 proceeding against the Superintendent of the New York State Department of Financial Services and as Administrator of the New York State Medical Indemnity Fund for the arbitrary and capricious denial of infant plaintiff’s admission into the Fund by AliCare, third-party administrator. In sum and substance it is the petitioners’ position that an amended infant compromise order, signed by this court on or about October 15, 2014, and containing the language, “Ordered, that the infant [K.O.] qualifies as an infant who sustained a birth related neurological injury as defined under PHL § 2999 (h)[l]” is binding on the administrator of the fund and that the child’s disqualification for enrollment was ultra vires and without constitutional authority. Respondents maintain that the infant plaintiff is not eligible for enrollment, as the facts and circumstances surrounding his birth preclude same.

In January 2011, in response to New York State’s mounting Medicaid cost crisis, Governor Andrew Cuomo created the Medicaid Redesign Team. The Team was comprised of 25 members, appointed by the Governor, with input from the leaders of both houses of the legislature and “stakeholders” with expertise in areas such as health care delivery, health care insurance, business, etc. In particular the Team was charged with the duty of reviewing and making recommendations regarding the Medicaid program, “which shall include specific cost saving and quality improvement measures for redesigning the Medicaid program to meet specific budget [744]*744reductions for Medicaid spending.” As part of their “Proposal to Redesign Medicaid” the Team recommended the “creation of a neurologically impaired infant medical indemnity fund . . . that would provide payment for medical expenses of eligible children .... Participation would be mandatory.” Funding would be achieved by a charge on the obstetrical revenues of New York hospitals. The stated purpose of the Fund was “reducing medical malpractice premiums for both physicians and hospitals.” On April 1, 2011 the New York State Medical Indemnity Fund (MIF or Fund) became law (Public Health Law, art 29-D, tit 4, §§ 2999-g—2999-j). It provides the enrollee with access to medical care for life. The “[qualifying health care costs” include “future medical, hospital, surgical, nursing, dental, rehabilitation, custodial, durable medical equipment, home modifications, assistive technology, vehicle modifications, prescription and non-prescription medications, and other health care costs actually incurred for services rendered to and supplies utilized by qualified plaintiffs . . . .” (Public Health Law § 2999-h [3].) The Fund became operational on October 1, 2011.

“The fund applies to medical malpractice actions in which compensation is on behalf of ‘qualified plaintiffs’ (as defined in Pub. Health Law § 2999-h(4)) for ‘birth-related neurological injuries’ (as defined in Pub. Health Law § 2999-h(l)). It provides that all ‘qualifying health care costs’ (as defined in Pub. Health Law § 2999-h(3)) shall be paid by the fund rather than by the defendants, and that the judgment or settlement agreement shall so provide. See Pub. Health Law § 2999-j(6)(13)” (Matthew Gaier & Norman Bard, New York Medical Malpractice § 26:79 [2015]).

A “ ‘[q]ualified plaintiff’ means every plaintiff or claimant who (i) has been found by a jury or court to have sustained a birth-related neurological injury” (Public Health Law § 2999-h [4]) which is previously defined in Public Health Law § 2999-h (1) as

“an injury to the brain or spinal cord of a live infant caused by the deprivation of oxygen or mechanical injury occurring in the course of labor, delivery or resuscitation or by other medical services provided or not provided during delivery [745]*745admission that rendered the infant with a permanent and substantial motor impairment or with a developmental disability . . .

“The fund shall be administered by the superintendent of financial services [formerly the superintendent of insurance] or his or her designee . . . (Public Health Law § 2999-i [2] [a].) No definition of “delivery admission” is found in the statute. The regulations governing the Fund qualifies it as “a hospital admission for the specific purpose of giving birth.” (10 NYCRR 69-10.1 [h].)

The procedure for enrollment into the Fund is clearly set forth in the statute (Public Health Law § 2999-j [6] [a], [b]) and clarified in the regulations. An application for enrollment shall be submitted on the application form provided by the fund administrator. A copy of the court approved settlement (infant compromise order) and medical records (in addition to numerous other documentation) must be included with the submission. The infant compromise order must contain language that the plaintiff or claimant has been deemed or found to have sustained a birth-related neurological injury (defined above) and that in the event the plaintiff is enrolled into the Fund all future medical expenses are to be paid by it. A further provision regarding the eventuality of nonacceptance into the Fund is contained in the compromise order as well.

An action sounding in medical malpractice was commenced in 2011 by Tamara Petrovic and Garner Oh, as parents and natural guardians, on behalf of their infant son, K.O., for injuries allegedly sustained by him at birth on xx/xx/xxxx. It is undisputed that the child was delivered at home and rushed to the hospital sometime after birth. The fact that K.O. sustained neurological injuries during the birth process is also not contested by the parties to the instant applications before the court. The underlying lawsuit took its usual course and was settled before the undersigned in July 2014. The total amount of the settlement was $3,065,899.17, said sum representing both “Fund” and “non-Fund” compensation. The defendants were required to pay (in “real” or “actual” dollars) a total amount of $1,226,359.67, which included proportionate attorneys’ fees. An infant compromise order, reflecting the terms of the settlement and the language required for enrollment into the Fund was signed on or about October 14, 2014. An ap[746]*746plication was submitted by plaintiffs to the fund administrator sometime thereafter and on or about November 20, 2014 plaintiffs’ attorney was notified that the child was deemed to not qualify for enrollment in that “the infant plaintiff was delivered at home . . . . As such, the injury to plaintiff was not sustained in the course of a ‘hospital admission,’ as required by the regulation in order to constitute a ‘qualified plaintiff.’ ”

Plaintiffs and defendants to the original lawsuit (petitioners) contend, in their joint application, that the determination by the court regarding the eligibility of the child for enrollment in the Fund is binding upon the administrator. They further argue that the role of the administrator is to determine that the appropriate paper work accompanies the application and that substantive decisions regarding eligibility are left to the judiciary. Respondents, on the other hand, argue that the facts and circumstances surrounding the birth of the infant plaintiff (home, as compared to hospital delivery) preclude enrollment into the Fund.

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K.I. ex rel. Azam v. Vullo
57 Misc. 3d 244 (New York Supreme Court, 2017)

Cite This Page — Counsel Stack

Bluebook (online)
50 Misc. 3d 742, 18 N.Y.S.3d 840, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ko-v-lawsky-nysupct-2015.