Sanders v. Pilley

684 So. 2d 460, 52 Soc. Serv. Rev. 477
CourtLouisiana Court of Appeal
DecidedNovember 8, 1996
Docket96 CA 0196
StatusPublished
Cited by9 cases

This text of 684 So. 2d 460 (Sanders v. Pilley) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sanders v. Pilley, 684 So. 2d 460, 52 Soc. Serv. Rev. 477 (La. Ct. App. 1996).

Opinion

684 So.2d 460 (1996)

Earl M. SANDERS, Curator for Douglas Sanders
v.
J. Christopher PILLEY, State of Louisiana, Secretary of the Department of Health and Hospitals.

No. 96 CA 0196.

Court of Appeal of Louisiana, First Circuit.

November 8, 1996.
Rehearing Denied January 7, 1996.

*461 Matt Greenbaum and Gwendolyn M. La Nasa, New Orleans, for Plaintiff-Appellee Earl M. Sanders, Curator for Douglas Sanders.

Mary D. O'Brien, Baton Rouge, for State of Louisiana, Department of Health and Hospitals.

Before LOTTINGER, C.J., and FOIL and FOGG, JJ.

LOTTINGER, Chief Judge.

The res nova issue presented by this appeal is whether the corpus of a trust established with an interdict's own funds and for his benefit can be considered in determining an interdict's eligibility for future Medicaid benefits. The Louisiana Department of Health and Hospitals (hereinafter, the "Department"), determined that the trust qualified as a resource and terminated Medicaid benefits. Upon judicial review of the agency's decision, the district court granted summary judgment in favor of the interdicted beneficiary. The Department now appeals.

FACTS

Earl Sanders (hereinafter, "plaintiff"), is the father and court-appointed curator of Douglas Sanders (hereinafter, "Douglas") on whose behalf this action is brought. Douglas was born blind and mentally retarded on November 13, 1956. Due to his severe disabilities, Douglas has been institutionalized since 1972, and it is expected that he will require such care for the remainder of his life. On the basis of his disabilities and need for institutionalized care, Douglas began receiving Medicaid benefits in 1978.

During the period 1982-1985, Douglas was under the care of the Louise S. Davis Developmental Center. While at this facility, he was allegedly abused sexually on two occasions by another resident at the school. A subsequent police investigation purportedly revealed that the resident in question had assaulted other students, and that the facility's administrator, upon learning of the assaults, failed to notify the parents. As a result of these incidents, plaintiff transferred his son to another institution. Acting in his capacity as Douglas' court-approved curator, plaintiff filed a civil suit against the center and its administration.

Prior to trial, plaintiff, with the concurrence of his son's under-curator, obtained authorization from the court in July of 1991 to compromise Douglas' claim and place Douglas' settlement proceeds in trust for Douglas' benefit. Plaintiff, again with the under-curator's concurrence, further obtained court authority to deposit any and all property owned or subsequently acquired *462 by Douglas under the control of the trust[1]. In August of 1991, plaintiff established the Douglas Sanders Trust and designated himself as trustee. The trust instrument authorizes the trustee to:

pay to or apply for the beneficiary's benefit so much of the accumulate income, principal or both of the trust in such amounts and at such times as the Trustee determines in the Trustee's sole discretion in accordance with the following standards. In making distributions, the Trustee shall first consider all other sources of funds available to the beneficiary, including but not limited to governmental assistance programs such as Medicaid, Medicare and Social Security Disability. Distributions shall not be made or used to provide primary support available to the beneficiary under any governmental assistance program. Instead, such distributions shall be made as a supplement to such primary support in order to provide more sophisticated medical, rehabilitative or educational aid not provided by other sources of assistance so as to improve upon the beneficiary's quality of life and needs under such programs. In no event shall the Trustee make any distributions which jeopardize the beneficiary's eligibility or continued qualification under governmental assistance programs or subject the trust assets to state reimbursement claims.

The Department administers the Louisiana Medicaid Program, a cooperative state-federal program intended to assist the nation's poor, blind, disabled and aged in accessing appropriate medical services. The Department, or its predecessor, Louisiana Department of Health and Human Resources, upon learning of the settlement and the establishment of the trust, terminated Douglas' Medicaid benefits. The stated basis for the Department's discontinuance of benefits was its determination that Douglas' "resources exceed[ed] the $2,000.00 limit for [M]edicaid assistance." An administrative appeal of this determination was filed on Douglas' behalf; however, the hearing officer subsequently upheld the Department's initial decision to terminate Medicaid benefits.

Plaintiff, acting in his capacity as Douglas' curator, filed the present action in the 19th Judicial District seeking judicial review of the administrative hearing officer's decision. The district court later granted a motion for summary judgment filed by plaintiff thereby reversing the determination made by the Department. Following a denial of its subsequent motion for a new trial, the Department now appeals.

ASSIGNMENTS OF ERROR

On appeal, the Department asserts that the district court erred in the following respects:

(1) In failing to adhere to the appropriate standard of review;
(2) In applying the provisions of the Omnibus Budget Reconciliation Act of 1993 to a trust established prior to the enactment date of said legislation; and
(3) In determining that the Douglas Sanders Trust meets the requirements set forth in OBRA '93 for a trust to be excluded from consideration as a resource when determining Medicaid eligibility.

I.

In its first assignment of error, the Department asserts that the district court, in its capacity as a reviewing court, failed to adhere to the applicable standard of review set forth in La. R.S. 49:964. This statute governs judicial review of an agency's final decision or order pursuant to the Administrative Procedure Act, La. R.S. 49:950 et seq. La. R.S. 49:964 F provides that a reviewing court is confined to the record established before the agency (except in cases of alleged irregularity in procedure before the agency). Obafunwa Family v. Appeals Bureau, 93-0820 (La.App. 1st Cir. 4/8/94); 635 So.2d 714, 717. It is elementary that a reviewing court's function is not to weigh de novo the available evidence and to substitute its judgment for that of the agency. Save Ourselves *463 v. Louisiana Environmental Control Commission, 452 So.2d 1152, 1159 (La.1984). Nevertheless, the district court has the authority to reverse or modify the decision of the agency if substantial rights of the party seeking review have been prejudiced because the administrative findings, inferences, conclusions, or decisions are: (1) in violation of constitutional or statutory provisions; (2) in excess of the agency's statutory authority; (3) made upon unlawful procedure; (4) affected by other error of law; (5) arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion; or (6) manifestly erroneous in view of the reliable, probative and substantial evidence in the record. La. R.S. 49:964 G; Obafunwa Family v. Appeals Bureau, at 716.

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Bluebook (online)
684 So. 2d 460, 52 Soc. Serv. Rev. 477, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sanders-v-pilley-lactapp-1996.