St. Francis Hospital v. D'Elia

71 A.D.2d 110, 422 N.Y.S.2d 104, 1979 N.Y. App. Div. LEXIS 13236
CourtAppellate Division of the Supreme Court of the State of New York
DecidedNovember 19, 1979
StatusPublished
Cited by31 cases

This text of 71 A.D.2d 110 (St. Francis Hospital v. D'Elia) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
St. Francis Hospital v. D'Elia, 71 A.D.2d 110, 422 N.Y.S.2d 104, 1979 N.Y. App. Div. LEXIS 13236 (N.Y. Ct. App. 1979).

Opinion

OPINION OF THE COURT

Mollen, P. J.

I—MATTER OF ST. FRANCIS HOSPITAL, AS ATTORNEY-IN-FACT FOR JOSEPH LOPILATO

For approximately two weeks in May, 1977, Joseph Lopilato was a patient at St. Francis Hospital (St. Francis). He incurred a bill of $4,794.90 and applied for medical assistance. The Nassau County Department of Social Services, however, declared him ineligible and his application was denied. He appealed the denial and, after a fair hearing which he attended along with an attorney retained by the hospital, the State Department of Social Services affirmed the determination of the local agency.

Thereafter, Lopilato executed a power of attorney to St. Francis under which the hospital has now commenced this article 78 proceeding as his attorney in fact to review and annul the determination of his ineligibility. It is alleged that the determination, inter alia, was arbitrary and capricious.

At the outset, we are confronted with the threshold issue of whether St. Francis has standing to maintain this proceeding. Respondents, relying primarily on the Court of Appeals decision in Matter of Peninsula Gen. Nursing Home v Sugarman (44 NY2d 909), contend that, even under a power of attorney, a provider is prohibited from bringing a CPLR article 78 proceeding to review an agency’s determination, and may seek relief only by way of a plenary action. We disagree.

In Peninsula (supra) a voluntary not-for-profit nursing home applied for Medicaid coverage on behalf of one Jacob Stupler, a former resident at the home. The application was denied by the local agency and both the nursing home and Stupler’s [113]*113family submitted requests for a fair hearing. When Stupler died prior to the scheduled date of the hearing, his family withdrew its challenge to the agency’s determination. The State Department of Social Services thereupon canceled the fair hearing taking the view that the nursing home had no independent right to administrative review. The nursing home then commenced a CPLR article 78 proceeding seeking an opportunity for a fair hearing in its own right. Special Term granted the petition and ordered that the department hold a hearing. The Appellate Division, First Department, affirmed, with Mr. Justice Lane, joined by Presiding Justice Murphy, dissenting (57 AD2d 268, 277-281). On appeal, the Court of Appeals reversed and dismissed the petition on the dissenting opinion of Justice Lane (44 NY2d 909, supra).

Justice Lane’s dissent at the Appellate Division was based largely on the view that, because a provider of services did not come within the purview of the statutes and regulations governing administrative review, the nursing home could not claim the benefit of those provisions in challenging the determination of ineligibility. Justice Lane wrote (57 AD2d, supra, at pp 279-281):

"[T]he interested party within the intendment of the statute is the 'eligible,’ as defined in section 366 of the Social Services Law and not the provider of services.
"A provider such as the petitioner is entitled to payment only to the extent that it has afforded goods or services to an 'eligible.’ If, as in the case at bar, it develops that services have been provided to one deemed ineligible for benefits, a cause of action may be spelled out against that ineligible or even against the governmental agency designated to declare ineligibility. However, vindication of that claim, available as it is in a plenary suit, need not be afforded through the medium of administrative review. * * *
"The unilateral private financial interest of the nursing home in recovering expenditures made for services rendered creates a relationship of purchaser and seller. A breach of this relationship would give rise to a plenary suit for breach of contract”.
In our view, Peninsula is plainly distinguishable from the case at bar. The crux of the Peninsula holding is that administrative review is unavailable to providers whenever they act solely in their own right with the exclusive purpose of vindicating their "unilateral private financial interest”. We do not [114]*114read Peninsula, however, as precluding a provider’s participation in the review process under all circumstances.-

In the case at bar the posture of the provider’s participation is significantly different. Unlike in Peninsula, the patient’s interests here are very much at stáke. The patient is alive and owes a debt to St. Francis for which he will remain responsible in the event that the finding of his ineligibility is sustained. He appeared at the fair hearing and expressed a desire to have his interests represented by the attorney retained by the hospital. Thereafter, he executed a valid power of attorney empowering St. Francis to seek, on his behalf, judicial review of the determination of his ineligibility. Hence, the provider’s participation is not limited to the vindication of its own interests. Instead, it appears as the designated agent and representative of the patient, selected by him to defend his rights. That the interests of the patient and provider may coincide is insufficient reason to deprive the patient of the agent of his choice.

We hold, therefore, that Peninsula is inapposite and presents no bar to a proceeding brought by a hospital as attorney in fact for its patient.

Our decision in Matter of North Shore Univ. Hosp. v D’Elia (71 AD2d 991) is not to the contrary. That case turned on the fact that the power of attorney under which the hospital sought to act had been executed not by the patient but by his estranged wife after his death. Since she had not been a member of her husband’s family household, she was without standing to seek administrative review of the determination of his ineligibility. (See 18 NYCRR 360.25.) Consequently, she could not grant to the hospital greater rights than she herself possessed.

In our view, then, neither Peninsula nor North Shore precludes St. Francis from maintaining the instant proceeding. Moreover, we are convinced that, under the circumstances at bar, prohibiting the hospital from seeking judicial review as attorney in fact for the patient would run counter to the language of controlling statutes and regulations and to the broad purposes underlying the Medicaid legislation.

The relevant statutes generally provide that action may be taken on the applicant’s behalf by his authorized representative. Thus, for example, subdivision 1 of section 366-a of the Social Services Law provides, in pertinent part: "Any person requesting medical assistance may make application therefor [115]*115in person, through another in his behalf or by mail” (emphasis supplied).

Likewise, in the event of an adverse determination of the application: "Any [applicant for medical assistance] * * * or any individual authorized to act on behalf of any such person, may appeal to the department from decisions of social services officials or failures to make decisions [regarding applications for medical assistance]” (Social Services Law, § 22, subd 1; emphasis supplied).

Similarly, regulations of the department also permit a representative to act in the applicant’s stead.

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Bluebook (online)
71 A.D.2d 110, 422 N.Y.S.2d 104, 1979 N.Y. App. Div. LEXIS 13236, Counsel Stack Legal Research, https://law.counselstack.com/opinion/st-francis-hospital-v-delia-nyappdiv-1979.