Lugo v. Beth Israel Medical Center

13 Misc. 3d 681
CourtNew York Supreme Court
DecidedJuly 21, 2006
StatusPublished
Cited by10 cases

This text of 13 Misc. 3d 681 (Lugo v. Beth Israel Medical Center) 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
Lugo v. Beth Israel Medical Center, 13 Misc. 3d 681 (N.Y. Super. Ct. 2006).

Opinion

OPINION OF THE COURT

Alice Schlesinger, J.

Plaintiffs commenced this medical malpractice action in May of 2004 alleging that Beth Israel Medical Center and Orli Danger, M.D. were negligent in their treatment of Cindy Lugo during her labor and delivery of Nyisha Lugo at Beth Israel in January 2002, causing the infant severe injury. Plaintiffs discontinued the action against Dr. Danger and settled the matter with Beth Israel for $3,500,000 in open court on February 15, 2006. The matter came before this court again on May 17, 2006 for a conference on plaintiffs’ proposed infant compromise order. In addition to plaintiffs’ counsel, counsel for the Department of Social Services of the City of New York (DSS) appeared at the conference in connection with its lien totaling $47,349.58. The court also had before it the following documents received before the conference: an affirmation from plaintiffs’ counsel John E. Fitzgerald, dated April 17, 2006, supported by an affidavit from plaintiff Cynthia Lugo and various exhibits; the May 15, 2006 affirmation of Richard H. Dreyfuss, counsel for DSS, raising certain objections to the proposed order; and the May 16, 2006 reply affirmation of plaintiffs’ counsel Brian J. Farrell. The competing affirmations addressed significant issues related to the May 1, 2006 decision by the United States Supreme Court entitled Arkansas Department of Health and Human Services v Ahlborn (547 US —, 126 S Ct 1752 [2006]). Following that conference, both parties supplemented their papers, DSS by letters dated June 16, June 22, and June 29, 2006, and plaintiffs by a letter dated June 16, 2006 offering a proposed revised infant compromise order and by a letter dated June 23 offering a further affirmation from plaintiffs’ counsel John M. Daly. The defendant took no position on the issues raised and waived its participation.

On July 5, 2006, this court signed a revised infant compromise order. This decision determines certain issues raised by the parties related to the order, namely, (1) whether DSS, which provided Medicaid benefits to Nyisha Lugo for medical services rendered for injuries related to this case, can recoup those expenditures in their entirety from Lugo’s settlement proceeds, or whether DSS instead can only recoup that portion of the settlement proceeds allocated to past medical expenses; (2) if [683]*683the DSS recoupment is limited to the allocated amount, how should the court proceed to determine that amount because the settlement itself does not include an express allocation for past medical expenses; and (3) whether the Medicaid lien must be satisfied before any settlement proceeds are released to the plaintiffs. The parties’ positions on these issues are diametrically opposed.

Plaintiffs assert that: (1) the DSS recoupment is limited to the amount of plaintiffs’ settlement allocated to past medical expenses; (2) the court is empowered to determine that amount by comparing the agreed upon settlement amount to the actual value of the case; and (3) plaintiffs’ counsel may hold in escrow an amount sufficient to cover the lien pending the court’s determination, but the balance of the settlement proceeds should be promptly disbursed to the plaintiffs.

DSS asserts that: (1) it is entitled to have its lien satisfied in full; (2) no allocation need be determined by the court because it is “inconceivable” that the $3,500,000 settlement does not include past medical expenses equal to the full $47,349.58 lien amount; and (3) the lien must be satisfied before any settlement proceeds are disbursed to the plaintiffs to ensure DSS a complete recovery.1

A review of the relevant statutory and decisional law, including the impact of Ahlborn on New York law, is necessary for the determination of these issues.

A. The Impact of Federal Medicaid Provisions on New York Law

Medicaid is a jointly funded federal and state medical assistance program established by title XIX of the Social Security Act (42 USC § 1396 et seq.). The Medicaid program allows state agencies such as DSS to receive federal funding so long as they comply with federal law. Thus, as acknowledged by the parties and as applicable here, because Medicaid payments were made on behalf of plaintiff Nyisha Lugo for medical expenses related to the injuries at issue in this case, DSS has the right to seek reimbursement for those payments from the tortfeasor liable for the injuries, which is defendant Beth Israel Medical Center. (42 USC § 1396a [a] [25] [H].) Indeed, under section 1396k (a) [684]*684(1), as a condition of her Medicaid eligibility, Lugo was required to assign to DSS her right to recover medical expenses from Beth Israel. This assignment reflects Congress’s intent that Medicaid be the ‘payer of last resort’ ” and that, when possible, liable parties should reimburse the State for medical expenses so as to minimize government costs. (Ahlborn, 547 US at —, 126 S Ct at 1767, quoting S Rep No. 99-146, 99th Cong, 1st Sess, at 313 [1985].)

The two leading cases which governed New York law before Ahlborn are Gold v United Health Servs. Hosps. (95 NY2d 683 [2001]) and Cricchio v Pennisi (90 NY2d 296 [1997]). Both cases address aspects of the issue presented in the case at bar, namely, the right of DSS to recoup Medicaid expenditures from a recipient’s personal injury settlement. After reviewing applicable federal and state statutes, the Court of Appeals in Gold rendered a determination on which DSS here relies to answer the first two questions in this case noted above, holding (at 691) that: “The [social service] agencies have broad authority under those provisions to satisfy the lien from the entire amount of the personal injury judgment or settlement.” Thus, DSS here argues that: (1) it can recoup the full lien amount from the entire settlement proceeds; and (2) no express allocation is required.

Similarly, the Court of Appeals in Cricchio rendered a determination on which DSS here relies to answer the third question in this case noted above, holding (at 302-303) that: “Applying both Federal and State Medicaid statutes, we conclude that the Department of Social Services (DSS) is entitled to first satisfy the lien from those [personal injury settlement] funds, leaving the remainder available for transfer to a supplemental needs trust [for the benefit of the Medicaid recipient plaintiff].” Thus, DSS here argues that no monies may be disbursed to the plaintiff until the DSS lien has been satisfied in full.

B. The Right of DSS to Recoup Medicaid Expenditures

As noted above, the parties have raised three issues relating to the right of DSS to recoup Medicaid expenditures from a recipient’s personal injury settlement. Those issues are determined as follows.

1. The DSS Recoupment is Limited to Proceeds Allocated to Medical Expenses

Contrary to the claim by DSS in the May 15, 2006 affirmation submitted to this court, Ahlborn has had a significant impact on New York law, and DSS cannot automatically recoup the [685]*685$47,349.58 lien from Lugo’s entire settlement proceeds. In fact, as plaintiff properly asserts, the Ahlborn court directly addressed that issue, and the decision applies here to bar DSS from recouping its lien from any settlement monies not allocated to past medical expenses.

Ahlborn relied in large part on the “antilien” provision found in 42 USC § 1396p (a).

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Bluebook (online)
13 Misc. 3d 681, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lugo-v-beth-israel-medical-center-nysupct-2006.