Theresa Byrnes v. Jacob Martinez Md

CourtMichigan Court of Appeals
DecidedDecember 19, 2019
Docket345061
StatusUnpublished

This text of Theresa Byrnes v. Jacob Martinez Md (Theresa Byrnes v. Jacob Martinez Md) is published on Counsel Stack Legal Research, covering Michigan Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Theresa Byrnes v. Jacob Martinez Md, (Mich. Ct. App. 2019).

Opinion

If this opinion indicates that it is “FOR PUBLICATION,” it is subject to revision until final publication in the Michigan Appeals Reports.

STATE OF MICHIGAN

COURT OF APPEALS

THERESA BYRNES, a legally incapacitated individual, by her conservator and guardian, PAUL UNPUBLISHED BYRNES, M.D., December 19, 2019

Plaintiffs-Appellees/Cross- Appellants, and

PAUL BYRNES, M.D.,

Plaintiff, and

DEPARTMENT OF HEALTH AND HUMAN SERVICES,

Intervening-Plaintiff- Appellant/Cross-Appellee,

v No. 345061 Lenawee Circuit Court Jacob Martinez, M.D., CRG LYNWOOD, LLC LC No. 16-005579 doing business as LYNWOOD MANOR HEALTHCARE CENTER, VICTORIA VACCARO, FNP, and PROMEDICA CENTRAL CORPORATION OF MICHIGAN,

Defendants.

Before: RIORDAN, P.J., and JANSEN and STEPHENS, JJ.

PER CURIAM.

Intervening plaintiff, the Department of Health and Human Services (DHHS), appeals as of right the trial court’s order approving final distribution of settlement proceeds. Plaintiffs,

-1- Theresa Byrnes and Paul Byrnes, have cross-appealed. This Court is asked to decide whether the trial court committed error requiring reversal when it (1) calculated the amount the DHHS could recover from the settlement proceeds under a Medicaid lien; (2) did not require the DHHS to prove the elements of plaintiff’s medical malpractice claim before finding that it was entitled to reimbursement; and (3) limited the DHHS’s ability to fully participate in the lawsuit. We affirm in part, reverse in part, and remand to the trial court for further proceedings.

I. FACTS & PROCEDURAL HISTORY

On August 16, 2014, plaintiff Theresa Byrnes (“Byrnes”) (then age 53) went to the hospital with a severe headache. Scans revealed that she had suffered a subarachnoid hemorrhage (brain bleed) which required surgical intervention. She received rehabilitative care at Lynwood Manor Health Care Center (“Lynwood”) where Lynwood’s alleged malpractice occurred. In short, her headaches persisted and she was unable to participate in therapy. Eventually, it was discovered that she had suffered another brain bleed which required additional surgery. As a result of her brain bleeds, Byrnes is left-sided hemiplegic and dependent on skilled nursing care for her daily needs.

Byrnes received Medicaid benefits while she was treated at Lynwood. On May 6, 2016, plaintiffs filed a medical malpractice lawsuit against Lynwood. On June 2, 2017, the DHHS filed a motion to intervene in the lawsuit, and the trial court granted the motion, but ordered that the DHHS’s intervention be “silent.” Specifically, the order provided:

IT IS ORDERED that the [DHHS] is allowed to intervene as Plaintiff to protect its subrogation right under MCL 400.106(1). Although the intervention will be silent, the [DHHS] can participate in settlement negotiations; exercise any interest it may have with respect to the verdict form; and participate post-verdict. The interests or identity of the [DHHS] shall not be disclosed to the jury. The [DHHS] will not participate at trial, and will make no jury presentation.

The DHHS filed its intervening complaint, and the parties submitted the matter to facilitation in March 2018. At the facilitation, plaintiffs settled their claim with defendants for approximately 1/3 of what they had demanded. The DHHS participated in the facilitation, but was not a party to the settlement agreement.

Plaintiffs and the DHHS each filed a motion requesting that the trial court apportion the settlement proceeds and address how much the DHHS would receive in Medicaid reimbursement. At the hearing on the motions, plaintiffs argued that pursuant to the federal anti- lien statute, 42 USC 1396p(a)(1), the Medicaid claim must be reduced pro rata to 32.45% to reflect the reduced amount that plaintiffs had accepted under the settlement agreement, and that it should be further reduced by 39.73% to reflect the amount paid for plaintiffs’ attorney fees and costs. The DHHS argued that the trial court must allocate the settlement proceeds into medical and non-medical expenses, or hold an evidentiary hearing to allocate the proceeds before determining the amount of the Medicaid claim as required by Neal v Detroit Receiving Hospital, 319 Mich App 557; 903 NW2d 832 (2017).

The trial court ordered that the DHHS be reimbursed for a portion of the Medicaid claim.

-2- The trial court explained that it applied the formula from Neal to reduce the DHHS’s claimed Medicaid expenditure proportionate to the amount of the entire settlement, and then reduced that sum by a proportionate amount for attorney fees.

The DHHS appeals by right arguing that the trial court committed error requiring reversal when it calculated this amount, and when it limited the DHHS’s intervention. Plaintiffs cross- appealed and argue that the DHHS was not entitled to any reimbursement because it did not first prove the elements of a medical malpractice claim against defendants, and in the alternative, that the trial court erred in its calculations. We consider each of the arguments in turn.

II. STANDARD OF REVIEW

This case involves issues of statutory interpretation which are reviewed de novo as questions of law. Neal, 319 Mich App at 564. “All matters of statutory interpretation begin with an examination of the language of the statute.” McQueer v Perfect Fence Co, 502 Mich 276, 286; 917 NW2d 584 (2018). Where the statutory language is clear and unambiguous, the statute must be applied as written. Id. A court may not read anything into an unambiguous statute that is not within the manifest intent of the Legislature as derived from the words of the statute itself. Id. “A statutory term or phrase cannot be viewed in isolation, but must be construed in accordance with the surrounding text and the statutory scheme.” Id. (internal quotation marks and citation omitted). We review a trial court’s decision on a motion to intervene for abuse of discretion. Auto-Owners Ins Co v Keizer-Morris, Inc, 284 Mich App 610, 612; 773 NW2d 267 (2009). “An abuse of discretion occurs when the decision results in an outcome falling outside the principled range of outcomes.” Radeljak v Daimlerchrysler Corp, 475 Mich 598, 603; 719 NW2d 40 (2006).

III. CALCULATING MEDICAL EXPENSES

The DHHS argues that the trial court erred when it failed to allocate the settlement proceeds attributable to medical expenses before apportioning them. We agree.

42 USC 1396a(a)(25)(A) requires states to take “all reasonable measures to ascertain the legal liability of third parties (including . . . parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service) to pay for care and services . . . .” 42 USC 1396a(a)(25)(B) requires “that in any case where such a legal liability is found to exist . . . the State . . . will seek reimbursement . . . to the extent of such legal liability[.]” 42 USC 1396a(a)(25)(H) requires “that . . . in any case where a third party has a legal liability to make payment for such assistance, the State has in effect laws under which . . . [it] is considered to have acquired the rights of such individual to payment by any other party for such health care items or services.” Under, § 1396k “as a condition of [Medicaid] eligibility . . . , the individual is required . . . (A) to assign [to] the State any rights . . . to payment for medical care from any third party; . . . (B) to cooperate with the State . . . in obtaining [such] payments . . . and . . . (C) . . . in identifying, and providing information to assist the State in pursuing, any third party who may be liable[.]”

“[A]ny amount collected by the State under [such] an assignment . . . shall be retained by the State . . .

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Theresa Byrnes v. Jacob Martinez Md, Counsel Stack Legal Research, https://law.counselstack.com/opinion/theresa-byrnes-v-jacob-martinez-md-michctapp-2019.