State, Department of Social Services v. Rodvik

264 N.W.2d 898, 1978 S.D. LEXIS 161
CourtSouth Dakota Supreme Court
DecidedApril 6, 1978
Docket12176
StatusPublished
Cited by11 cases

This text of 264 N.W.2d 898 (State, Department of Social Services v. Rodvik) is published on Counsel Stack Legal Research, covering South Dakota Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State, Department of Social Services v. Rodvik, 264 N.W.2d 898, 1978 S.D. LEXIS 161 (S.D. 1978).

Opinion

*899 DUNN, Chief Justice.

This is an appeal from the judgment of the Circuit Court, Second Judicial Circuit, which reversed a decision of a hearing examiner for the Department of Social Services. The Department had denied the respondent’s nursing home a contract to continue to participate in the Medicaid program. The hearing examiner upheld the Department’s action, but the trial court reversed. The Department appeals to this court. We reverse the circuit court’s judgment.

In order to deal with the issues presented, it is necessary to describe the Medicaid program as it is administered in South Dakota. In 1974, South Dakota elected to participate in the Medicaid program, which is Title XIX of the Social Security Act, 42 U.S.C.A. § 1396, et seq. The program is designed to provide medical services to indigents of all ages, and extensive federal requirements for participation in the program have been promulgated.

Under this program the Department of Health is the “survey agency” and the Department of Social Services is the “single state agency.” Participating facilities are categorized according to the level of care provided to the patients. Some are called “skilled nursing facilities” and others “intermediate care facilities.” The facility at issue in this case is one of the latter.

A nursing home can choose whether or not to participate in the Medicaid program. When a nursing home chooses to participate, the Department of Health conducts a survey of the home. After the survey has been completed, the Department of Health sends a “Statement of Deficiencies” to the home, listing the deficiencies found as a result of the survey. The nursing home must then fill out a “Plan of Corrections,” which briefly explains the steps it will take to rectify the deficiencies and gives a proposed date for completion of the corrections. This statement is returned to the Department of Health, which then evaluates the plan and makes recommendations to the Department of Social Services concerning the facility’s participation in the Medicaid program. These recommendations are binding on the Department of Social Services. The contract which a nursing home signs when it participates in the Medicaid program has a maximum length of one year, necessitating a constant process of evaluation.

In 1974, Valley Springs Manor Nursing Home elected to participate in the federal program. A survey was done in that year by the Department of Health, and forty-four deficiencies were found. The home was certified for only a six-month contract, which was then extended one more month.

In April 1975, a survey team visited the nursing home to conduct another survey to determine whether the home met federal standards. It spent an entire day conducting the survey, and at the end of the day, one member of the team explained to the administrator, Mr. Rodvik, what had been found and what must be done. On June 17, 1975, the Department of Health sent Mr. Rodvik a “Statement of Deficiencies” listing forty-two deficiencies and asked that he return his Plan of Corrections by July 7, 1975. The plan was received on July 7th, together with a letter from Mr. Rodvik saying that his mother-in-law was ill and that a more complete plan would follow, as would a request for waiver of some of the deficient items. The plan submitted on July 7th was only partially completed, some of the areas were left completely blank and several of them were without any time table for correction of deficiencies. On July 14th, a detailed letter was sent to Mr. Rodvik spelling out what he needed to do to maintain his contract. On July 30th, having received no further plans or requests for waivers, the Department of Health notified the administrator that his contract would not be renewed for the following reasons: (1) nonconformity with federal regulations concerning compliance with federal, state and local laws, drugs and biologi-cals, and environment and sanitation, (2) repeat deficiencies from the previous survey, and (3) failure to submit an adequate Plan of Corrections. On August 6th, the Department of Health received a letter *900 from Mr. Rodvik detailing some of the corrections, but the contract had expired on July 31, 1975, and the Department' of Health determined that a new one would not be granted.

The hearing examiner, in upholding the action of the Department of Social Services, first stated that the issue was whether the home was correctly “denied certification,” not whether it was correctly “decertified.” The administrator has consistently argued that this was a decertification, yet the hearing examiner pointed out that the time of the contract had expired, so the issue was whether it should have been renewed.

The examiner found that Mr. Rodvik’s Plan of Corrections was incomplete and that he had indicated to the Department of Health that he would send a completed one and apply for waiver of some deficiencies at a later date. A complete plan was never filed, and the waivers were never requested, but the examiner found that many of the deficiencies had been corrected by the time of the hearing. Repeat deficiencies were found to exist from 1974, and the examiner determined that the nursing home was not a safe place for the care and treatmént of intermediate care patients. This determination was based on the lack of a fire alarm or smoke detector in the home. Mr. Rodvik admitted no such detection system existed but argued that the close proximity of the fire station to the home would make up for the lack of such a system. The only way for a fire to have been detected in the home would have been for one of the staff to have observed it.

From these facts, the examiner concluded that the uncorrected deficiencies and the repeat items from 1974, together with violations of the Life Safety Code requirements, supported the agency’s action. He pointed out that federal regulations prohibit a facility from participating in the program if it has repeat deficiencies from a prior survey, thus the agency had no choice in this matter. The . Health, Education and Welfare Office in Denver had confirmed the nonre-newal of the contract after reviewing the file of the Department of Health.

The trial court treated the matter as a “decertification” and applied SDCL 1-26-36 as its standard of review. It found the decertification to be an abuse of discretion and ruled that the hearing examiner’s conclusions as to repeat deficiencies were .unsupported by the record because there was lack of notice and denial of reasonable time within which to comply and a denial of adequate trained assistance in filling out the Plan of Corrections, and because the Statement of Deficiencies was in some cases ambiguous, unclear and arbitrary. The court ruled the “decertification” invalid, gave the nursing home forty-five days to prepare a Plan of Corrections, and awarded the nursing home $22,728.76, plus 8% interest “exclusive of any damages that may be forthcoming because of the arbitrary and capricious acts of the [Department of Social Services].”

The first question raised by this appeal deals with the proper statute on which to base an appeal from an administrative decision such, as this one. The Department of Social Services urges the application of the narrower scope of review found at SDCL 28-1-22

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Bluebook (online)
264 N.W.2d 898, 1978 S.D. LEXIS 161, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-department-of-social-services-v-rodvik-sd-1978.