Peters v. Comm'r, Maine Dep't of Health and Human Servcs

CourtSuperior Court of Maine
DecidedNovember 10, 2014
DocketANDap-13-16
StatusUnpublished

This text of Peters v. Comm'r, Maine Dep't of Health and Human Servcs (Peters v. Comm'r, Maine Dep't of Health and Human Servcs) 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
Peters v. Comm'r, Maine Dep't of Health and Human Servcs, (Me. Super. Ct. 2014).

Opinion

IN I IRED .NOV 1 9 LUl~

STATE OF MAINE SUPERIOR COURT ANDROSCOGGIN, ss. CIVIL ACTION Docket No. AP-13-16 M~~ -C{Ut..-{- 11-lt'-lq JENNIFER PETERS,

Petitioner ORDER v. RECEIVED & FILED NOV 1 0 2014 COMMISSIONER, MAINE ANDROSCOGGIN DEPARTMENT OF HEALTH SUPERIOR COURT AND HUMAN SERVICES,

Respondent

This matter is before the court on Petitioner Jennifer Peters' Rule 80C appeal of

the Decision of Respondent Maine Department of Health and Human Services

("DHHS"), which found that Ms. Peters is no longer eligible for coverage under the

MaineCare Home and Community Based Benefits Program for Adults with Disabilities

("HCB Program"). Pursuant to 5 M.R.S. § 11001 et seq. and Rule 80C, Ms. Peters is

asking that this court vacate the decision made by DHHS. Respondent DHHS has

opposed Ms. Peters' Appeal. After hearing on May 7, 2014, review of the record and the

parties' filings, the court denies Ms. Peters' Appeal for the reasons set forth below.

I. Factual and Procedural Background

The record on appeal provides the following:

Ms. Peters is 38-years-old and receives MaineCare. Ms. Peters suffers from

numerous ailments, including, but not limited to neurofibromatosis II, three brain tumors,

and cervical and lumbar spinal tumors. She is wheel chair dependent as a result of lack

of sensation and motor activity of the left leg. She also suffers from psoriasis, f ,,_·. ~- ~~ 1-: agoraphobia, post-traumatic stress disorder, bipolar disorder, fibromyalgia, legal

blindness, poor balance, memory loss, hypersomnolence, depression, systemic Lupus

Erythematosus, and obstructive sleep apnea. (App. Ex. 3.) • According to the Journal of the American Medical Association, • - "Neurofibromatosis (NF) is a genetic disorder causing skin abnormalities and tumors

that form on nerve tissues." (App. Ex. 6)(Emphasis in the original). At the time of her

assessment, Ms. Peters had recently undergone surgery to remove a 'tumor from

underneath her fingernail. (HO Ex. 5.) The year before, she had a brain tumor removed.

(ld.) She was also hospitalized earlier in the year for a reaction to medication. (ld.) Ms.

Peters has inoperable tumors in her brain as well as in her thighs. (R. at 33: 17-20.) At the

hearing, Ms. Peters stated that her physical condition has deteriorated over the course of

the last year. (R. at 33:13-16.) She conveyed that her physical condition is only expected /:) to dec line in the future. (R. at 33 :9-16.)

RN Charlene McPhee, a representative from Goold Health Systems 1, assessed

Ms. Peters for her eligibility for the HCB program. (HO Exs. 4, 5.) Ms. McPhee performs

18 assessments per week. (R. at 17.) On June 17, 2013, Ms. McPhee conducted the

assessment with Ms. Peters and Ms. Peters' stepmother and personal support specialist

("PSS"), Deborah Girard, at Ms. Peters.' apartment. (HO Ex. 5.) Ms. McPhee's

assessment period covered from June 10, 2013 to June 16, 2013, and her findings are

noted on the Medical Eligibility Determination ("MED") form dated June 17, 2013. (Dec.

at 4; HO Ex. 5.) Ms. McPhee had no contact with Ms. Peters' medical providers. (R. at

25:17-26:4.)

0 1 DHHS contracts with Goold Health Systems for it to perform assessments regarding in-home care cases. (R. at 7.)

-" Prior to June of 2013, Ms. Peters was eligible for and received services through

the HCB Program, based on a prior DHHS assessment that found that Ms. Peters, a

MaineCare recipient, requires extensive assistance with three out of five "Activities of

Daily Living" ("ADL"). It was previously determined that she requires extensive

assistance with transfers, locomotion and bed mobility. (App. Ex. 8.)

A reassessment of Ms. Peters HCB Program eligibility was conducted on June 17,

2013. At that time it was determined that Ms. Peters no longer requires extensive

assistance with bed mobility. According to Ms. McPhee's notes, "She does need help

putting her 'back leg' into bed at night. Consumer has no difficulty turning or situating

herself in bed though she usually stays in one position by choice." (HO Ex. 5.) It was also

determined that Ms. Peters does not require assistance with toileting. Ms. McPhee's

assessment notes provide: "Consumer and her PSS state that she is totally independent in

toileting. She occasionally has dribbling when she sneezes but does not use pull-ups or

depends." (HO Ex. 5.) Based upon the June 17, 2013 reassessment, DHHS determined

that Ms. Peters no longer met the minimum eligibility requirements for the HCB

Program.

Ms. Peters receives home care from Ms. Girard. Up until the reassessment, Ms.

Peters had received 40 hours a week of care. She now qualifies for 16.75 hours a week of

care from a PSS through the MaineCare Private Duty Nursing/Personal Care Services

program (PDN-Level III program). Ms. Peters will also receive help from a nurse for one

hour per month.

Ms. Peters timely filed a request for an administrative hearing, which was held on

September 30, 2013. Ms. Peters and Ms. Girard testified on Ms. Peters' behalf. Debra

3 Turner, R.N., an appeals specialist for Goold Health Systems, and Ms. McPhee testified

on behalf of DHHS. On November 6, 2013, the Hearing Officer issued a Decision finding

that DHBS was correct 'that Ms. Peters is no longer eligible for MaineCare coverage of

her expenses under the Home and Community Based Benefits Program for Adults with

Disabilities. The Hearing officer's Decision provides that Ms. Peters "is eligible for

services under level III of the PDN Program." (Dec. at 3.)

Ms. Peters timely filed her Petition For Review of Agency Action.

II. Standard of Review

In its appellate capacity, the court reviews agency decisions for "abuse of

discretion, error of law, or findings not supported by the evidence." Rangeley

Crossroads Coal. v. Land Use Reg. Comm'n, 2008 ME 115, ~ 10,955 A.2d 223.

The burden of proof is on a petitioner to prove that "no competent evidence

supports the [agency's] decision and that the record compels a contrary conclusion."

Bischoffv. Maine State Ret. Sys., 661 A.2d 167, 170 (Me. 1995). "Inconsistent evidence

will not render an agency decision unsupported." Id. "Judges may not substitute their

judgment for that of the agency merely because the evidence could give rise to more than

one result." Gulick v. Bd. of Envtl. Prot., 452 A.2d 1202, 1209 (Me. 1982).

The court must give great deference to an agency's construction of a statute it is

charged with administering. Rangeley Crossroads Coal., 2008 ME 115, ~ 10, 955 A.2d

223. "A court will 'not vacate an agency's decision unless it: violates the Constitution or

statutes; exceeds the agency's authority; is procedurally unlawful; is arbitrary or

capricious; constitutes an abuse of discretion; is affected by bias or an error of law; or is

unsupported by the evidence in the record.'" Kroeger v. Dep 't of Environmental Prot.,

4 2005 ME 50,~ 7, 870 A.2d 566 (quoted in Alexander, Maine Appellate Practice § 452 at

312 (4th ed. 2013)); see also 5 M.R.S.A. § 11007(4)(c).

Where there have been multiple levels of administrative decision-making, the

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