Lutheran Hospital of Indiana, Inc. v. State, Department of Public Welfare

623 N.E.2d 450, 1993 Ind. App. LEXIS 1387, 1993 WL 465364
CourtIndiana Court of Appeals
DecidedNovember 16, 1993
DocketNo. 02A04-9303-CV-109
StatusPublished

This text of 623 N.E.2d 450 (Lutheran Hospital of Indiana, Inc. v. State, Department of Public Welfare) is published on Counsel Stack Legal Research, covering Indiana Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lutheran Hospital of Indiana, Inc. v. State, Department of Public Welfare, 623 N.E.2d 450, 1993 Ind. App. LEXIS 1387, 1993 WL 465364 (Ind. Ct. App. 1993).

Opinion

CONOVER, Judge.

Petitioner-Appellant Lutheran Hospital of Indiana, Inc. appeals a judgment by the Allen Superior Court affirming a denial of assistance under the Hospital Care for the Indigent Act (HCI) by Respondent-Appel-lee State of Indiana, Department of Public Welfare. (DPW).

We affirm in part and reverse in part.

Lutheran raises the following issues for our review:

1. whether DPW's interpretation of HCI was erroneous;
2. whether DPW's interpretation of HCI discriminated against patients, such as patients Govan, Levanavich, and Pul-Tum, who suffer from acute drug or alcohol abuse or mental illness; and
8. whether the denial of assistance to patient Owen was in contravention of the plain dictates of HCI.

HCI provides in pertinent part:

A resident of Indiana who meets the income and resource standards established by the state department of public welfare under subsection (c) is eligible for assistance to pay for any part of the cost of care provided in a hospital in Indiana that was necessitated after the onset of a medical condition that manifested itself by symptoms of sufficient severity that the absence of immediate medical attention would probably result in:
(1) placing the person's life in jeopardy;
(2) serious impairment to bodily functions; or
(8) serious dysfunction of any bodily organ or part.

IND.CODE 12-5-6-2.1(a).1 In each of the cases of the four patients discussed below, Lutheran provided treatment. It appeals the denial of HCI benefits which would have been paid to the hospital.

(On December 28, 1988, Rosetta Govan was admitted to Lutheran for treatment related to a nervous breakdown. At the time of admission, Govan was in the midst of a multiple-day cocaine binge. She had also been abusing alcohol and had reported sessions of loss of consciousness. At the time of admission, she needed to be physically restrained. She saw blood on walls and reported auditory hallucinations from relatives. She was treated with anti-psy[452]*452chotic and anti-depressant medication and was released on February 9, 1989. An application for HCI assistance was denied for treatments administered after January 20, 1989, because the treatment after this date was not related to the emergency which necessitated her original admission into the hospital.

(On September 28, 1989, a hearing was held before an administrative law judge to review the denial of benefits. On February 22, 1990, the administrative law judge made a written recommendation that denial of benefits was proper. The administrative law judge found:

That the medical evidence substantiates the patient's withdrawal symptoms for which she was hospitalized subsided after the first two weeks and she was medically stable to the extent she was allowed to leave the hospital on January 20, 1989. Therefore, as of January 20, 1989, the condition which prompted the hospitalization, her withdrawal symptoms, had been alleviated.

(R. 186). The State Board and the trial court sustained the decision upon review.

On August 28, 1988, Monica Levanavich was admitted to Lutheran suffering from an exaggerated grief reaction due to the death of her infant that evening. In addition, Levanavich appeared to be intoxicated and suffering from sedative dependency.

Levanavich remained hospitalized at Lutheran until November 12, 1988. An application for HCI assistance was denied for treatments administered after August 80, 1988, because the condition which prompted her hospitalization had been alleviated in that she was then appropriately grieving the death of her baby.

On September 28, 1989, a hearing was held before an administrative law judge to review the denial of assistance. The administrative law judge found the denial of assistance after August 80, 1988, was appropriate. The State Board and the trial court affirmed the administrative law judge's decision.

On January 11, 1989, Frederick Pullum was admitted to Lutheran for treatment of his cocaine addiction. Pullum was discharged on January 31, 1989. An application for HCI assistance was denied when DPW determined his treatment was not in response to a medical emergency.

On January 9, 1990, a hearing was held before an administrative law judge. The administrative law judge affirmed the denial of benefits because Pullum's condition at the time of admission did not require emer-geney treatment. The State Board and the trial court affirmed the administrative law judge's decision.

On January 8, 1988, Rebecca Owen was admitted to Lutheran complaining of shortness of breath. The diagnosis was "rheumatic valvular heart disease with mitral stenosis." (R. 522). She submitted to surgery to replace her mitral valve with a mechanical valve and she was released from Lutheran on January 28, 1988. An application for HCI assistance was denied because DPW did not consider the surgery to be in response to an emergency.

On April 5, 1989, a hearing was conducted before an administrative law judge. The administrative law judge affirmed the denial of benefits. In so doing, the judge stated:

That the evidence does not support the onset of a medical condition that manifested itself by symptoms of sufficient severity that the absence of immediate medical attention would probably result in: (1) placing the person's life in jeopardy; (2) serious impairment to bodily functions; or (8) serious dysfunction of any bodily organ or part (470 IAC 11.1-2-1).

(R. 550). The administrative law judge's decision was affirmed on review by the State Board and the trial court.

Our standard of review for the alleged wrongful denial of benefits by agency action is "whether such action is arbitrary, capricious, an abuse of discretion or otherwise not in accordance with the law." Lutheran Hospital of Fort Wayne, Inc. (Patient: Michael R. Campbell) v. State, Department of Public Welfare [453]*453(1991), Ind., 571 N.E.2d 542, 544.2 We do not reweigh the evidence presented to an administrative agency, and we will reverse only if the agency's findings lack the support of substantial evidence or are contrary to law. Id.

Lutheran first contends the benefits should have been extended to pay for treatments beyond those administered under emergency conditions. Lutheran asserts such treatments were essential to alleviate the conditions which necessitated hospital ization.

Specifically, Lutheran asserts the "condition" referred to in IC 12-5-6-2.1 in the cases involving Govan, Levanavich, and Pullum, is the underlying mental health problem or addiction, not the specific symptoms causing the immediate hospitalization. Lutheran claims this position is supported by IC 12-5-6-12(b), which provides HCI payments should conclude when the "patient is medically stable and can be safely discharged."

The same argument was made to our supreme court in Campbell, supra. The State's response and the court's holding reads:

...

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
623 N.E.2d 450, 1993 Ind. App. LEXIS 1387, 1993 WL 465364, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lutheran-hospital-of-indiana-inc-v-state-department-of-public-welfare-indctapp-1993.