Doe v. Institute of Living, Inc.
Doe v. Institute of Living, Inc.
Opinion of the Court
This case comes to the court on reservation upon stipulation from the Superior Court in Hartford County.
For over one hundred years the Institute has functioned without the benefit of state appropriations granted by the General Assembly. At the time of its inception, in 1822, the act of incorporation chartering the Institute authorized a conditional appropriation of $5000 provided the Institute raised an additional $15,000 privately. This appropriation was received in 1824. In 1845, 1853 and 1855, the General Assembly authorized payments to the Institute of $5000, $8000 and $6000, respectively, for building purposes. Additional payments were made by the General Assembly as fees for services rendered to enable the Institute to take care of the indigent insane until the establishment of the first state hospital in Middletown in 1868. The Institute has neither applied for appropriations made by the General Assembly for payment to psychiatric hospitals, nor does it receive any state or federal assistance for the care of its patients other than fees for services rendered to those patients. The Institute claims that an affirmative decision was made not to apply for state grants and appropriations on the basis of several factors including awareness of the provisions of General Statutes § 4-104 pertaining to the production of patient records by hospitals receiving state aid. As a matter of psychiatric practice, the Institute preferred not
The taxability of the Institute by the city of Hartford has been a continuing subject of negotiation and litigation. As early as 1877, the city imposed a tax of $7000 on the Institute for certain sewers and other services which was continued yearly. See Braceland, The Institute of Living, 1822-1972, p. 111. Then, in 1887, the Hartford assessors imposed the so-called Washington School tax which was continued at least through 1896. Id., 131. This tax was later removed but it was restored again in 1901 and the Institute paid property taxes up through 1927. Id., 175.
Revoked in 1927 for a decade, the tax was again revived and in 1938 there began a struggle between the Institute and the tax assessors for the city of Hartford. In that year this court ruled that the Institute was a charitable institution. While the question of tax exemption was not at issue, it was held that the retreat was “operated for the public welfare without profit to itself or any individual.” Boardman v. Burlingame, 123 Conn. 646, 653-54, 197 A. 761. In 1943 the Hartford board of tax review voted to tax the Institute anew commencing in 1944. The Institute brought suit in the Court
By 1951, the city property tax had risen to over $100,000. The superintendent of the Institute and its counsel appeared before the 1953 session of the General Assembly to attempt to obtain an exemption from local property taxes. Section 854c of the 1953 supplement to the General Statutes granted a property tax exemption to any “hospital society or corporation” which was on May 1, 1953, “supported wholly or in part by state appropriations.” The General Assembly declined to remove the language limiting tax exemptions to state-supported hospitals. In 1955, however, the legislature enacted Public Act No. 130 which deleted the requirement of state support and extended exemption from local property taxes to all hospital societies and corporations. It is under this act, now General Statutes § 12-81 (16), that the Institute receives its current exemption from local property taxes.
The Institute retains psychiatric records on all of its patients. Such records, which contain both observed objective data and subjective data obtained by the treating psychiatrist from a variety of sources, are maintained under conditions of strict confidentiality. Stored and locked in the medical records section, the records are accessible only to
The plaintiff, a resident of the town of New Haven, was a patient at the Institute during the period of January 22, 1969, to April 25, 1970. Following her discharge, the plaintiff, upon written application, sought the Institute’s permission to examine and copy the records maintained on her during the period of her confinement. The applications were denied and the plaintiff brought this action seeking an order, pursuant to General Statutes §§ 4-104 and 4-105, directing the defendants to produce such records.
General Statutes § 4-104 in part requires that “[e]aeh private hospital, public hospital society or
The plaintiff claims that the Institute receives “state aid” in that it receives (a) a property tax exemption pursuant to General Statutes § 12-81 (16), (b) direct payments from the state pursuant to various contractual relations with a number of state offices and agencies, and (c) reimbursements from the state for services rendered to indigent patients, again pursuant to contractual arrangements with specific state agencies. The Institute, on the other hand, contends that the term “state aid” within General Statutes §§ 4-104 and 4-105, the record inspection provisions, refers specifically and solely to appropriations by the General Assembly for capital projects.
An interpretation of the language of a legislative enactment involves the question of “the expressed intention, that is, the intention of the legislative
The ordinary meaning of the word “aid” is “help, assistance, succor, relief.” Oxford English Dictionary (1971). The phrase “state aid” may, then, commonly refer to the assistance or support given by the state. See, e.g., Beach v. Bradstreet, 85 Conn. 344, 353, 82 A. 1030. However, as this court noted in Corbin v. Baldwin, 92 Conn. 99, 105, 101 A. 834, “[w]hile . . . the presumption is that the words of the statute were used in their ordinary signification, it does not necessarily follow that the term ‘State aid’ was not used [in the succession tax
Accordingly, we examine first the context of General Statutes §§ 4-104 and 4-105. In their current form, these provisions fall into title 4, “Management of State Agencies,” part II, “Budget and Appropriations.” They constitute the fourth and fifth provisions in a series of six, all concerning hospitals, and each utilizing the term “state aid” or “aid from the state.” Because these statutes are related, we may look to them for guidance in understanding the commonly used term “state aid.” New Haven v. United Illuminating Co., supra, 485; Bania v. New Hartford, 138 Conn. 172, 176-77, 83 A.2d 165. “Unless the context indicates otherwise, words or
The first in the relevant series of statutes, § 4-101, concerns appropriations by the General Assembly to hospitals.
Our opinion in this ease accords with an earlier opinion concerning the Institute of Living. In 1946, this court was confronted with the question of whether the Institute of Living was a tax-exempt institution. In the very year in which §§ 4-104 and 4-105 were enacted, the legislature altered the exemption statute to include “all property of, or held in trust for, any hospital society or sanatorium which is supported wholly or in part by state appropriations.” 1927 Public Acts, c. 319 § 1 (14). The court concluded that while this was the sole exemption provision available to the Institute, it was not, in fact, available to it because the Institute had chosen not to procure appropriations. The court was less hesitant in reaching this conclusion because such “aid” was widely available. Noting the obligations imposed upon a “hospital receiving state aid,” the court, citing the provisions reviewed above, continued: “It does not appear that the plaintiff has at any recent time sought state aid and been refused. If it is willing to assume the obligations incumbent upon a state-aid[ed] hospital . . . there is little reason to doubt that it could secure a state appropriation, with an incidental exemption from taxation.” Institute of Living v. Hartford, 133 Conn. 258, 272, 50 A.2d 822. It was apparently clear then, as now, that it is the appropriations by the General Assembly which trigger the obligations imposed upon state-aided hospitals by §§ 4-101-4-107.
Because the Institute chose not to reap the benefits of a state appropriation, it cannot now be called upon to accept the obligations imposed on those institutions which chose to accept such benefits. It is not for this court to impose obligations not intended by the legislature. That our analysis has led to the determination that the Institute does not receive “state aid” within the meaning of §§ 4-104 and 4-105 forecloses us from addressing those questions reserved which concern the nature of the duty imposed upon state-aided hospitals to allow discharged patients to obtain hospital records. We realize the importance of those issues. It is, however, for the legislature to delineate the nature and extent of the obligations it imposes.
No costs will be taxed in this court to either party.
In this opinion House, C. J., Lougo and Speziale, Js., concurred.
The questions reserved to this court are as follows:
“1. Is the Institute of Living a ‘private hospital, public hospital or corporation' within the meaning of that term as contained in § 4-104 of the Connecticut General Statutes (Rev. 1958) ?
“2. If the answer to (1) is yes, is the Institute of Living receiving ‘state aid' within the meaning of the aforesaid § 4-104?
“3. Is a psychiatric record, such as that maintained by the Institute of Living for each of its patients, a ‘hospital record' within the meaning of that term as contained in the aforesaid § 4-104?
“4. If the Institute of Living is covered by the provisions of the aforesaid § 4-104, does the court have discretion, on a case-by-ease basis, to determine whether or not the records of a psychiatric patient should be turned over to that patient?
“5. If the answer to (4) is yes, (a) what is the standard to be applied by the court in exercising such discretion? (b) must the Institute of Living turn over to the former patient the entire psychiatric record of such patient?”
The Institute in 1955 commenced handling a number of indigent patients who are receiving financial assistance from the state welfare department and are in need of treatment for mental illness. The Institute entered into an agreement with the welfare department under which the Institute is presently paid at the rate of $50.30 per patient per day as reimbursement for services rendered. This rate has increased from its initial level of $15.00 per patient per day in stages to its present level. Included in the rate is 30 cents per day to defer personal expenses of the patient himself. At the request of the welfare department, the maximum number of welfare patients in attendance at any one time is eight. The daily rate charged for welfare patients is all-inclusive. Unlike the daily rate charged private patients, the charge for welfare patients includes medications, the cost of craft materials, personal items, psychological testing, etc.
The welfare department is billed on a regular basis at the daily rate for each welfare patient being treated during the billing period. The Institute absorbs the difference between the $50.30 daily rate per patient charged the welfare department and its normal daily rate. During fiscal year 1974-1975 the Institute sustained a loss on welfare patients of approximately $61,000.
These agencies include the Connecticut department of corrections, the Hartford Retardation Clinic, high schools, the University of Connecticut and out-patient clinics.
The additional factors noted in the stipulation are as follows:
“2. The administrative costs and procedures involved in applying for state aid together with obligations attendant thereon have been a deterrent.
3. The administrators of the Institute have taken the position that as long as it can remain fiscally sound and independent, the state money can be better spent on facilities more in need of same.”
The stipulation specifies that “[a]ecess thereto is limited to the treating psychiatrist, staff psychiatrists engaged in group discussions of the patient’s condition, medical or clinical doctors actually engaged in the diagnosis and treatment of a particular patient, the chief of the section for patients in his section, and possibly the social worker handling the patient’s case if the need arises. The superintendent of the Institute, who is also its chief medical officer and who must be a psychiatrist pursuant to the Institute’s by-laws, has general authority to examine all patient records. Nurses are shown only abbreviated admission notes to guide them in the care of the patibnt. They do not see the psychiatric history. The nurses might also be shown parts of the patient’s physical record if there are peculiarities therein that warrant special attention for the patient’s care.”
“[General Statutes] Sec. 4-101. appropriations to hospitals. All appropriations to hospitals by the general assembly shall be expended under the direction of the governor and of the managers of such institutions, respectively, for the support of charity patients, and so used as to benefit the state as application is made from time to time, a report of which expenditures shall be made biennially to the general assembly; but no part of such appropriations shall be paid to any of such hospitals unless the same is in actual operation, unless the purpose for which an appropriation is to be expended is for a building and is so specified in the aet making such appropriation. Each such hospital receiving state aid shall be paid at a rate determined as provided by section 17-312 for the care and treatment of any patient when such expense is to be paid from state funds either directly or through the agency of any town or organization.”
The plaintiff: looks to General Statutes § 4-107 to support a broader interpretation of the term “state aid.” This provision, entitled “Institutions receiving state aid; visitation” provides: “Each private institution receiving, directly or by way of contract, any money from the state for purposes including the support or board of beneficiaries of the state, which refuses access to the proper board or official authorized by the state to visit such institution, shall forfeit all unpaid moneys or appropriations which it would otherwise have been entitled to receive from the state. All contracts with any such private institution made by the state, or by any authority acting for the state, shall be made subject to the provisions of this section.” Clearly this provision was intended to have broader sweep than those previously mentioned. Eirst, although it
A thorough, reading of the appropriations statute, § 4-101, in both its present and prior forms, persuades us that the defendant, too, errs in its assertion that the term “state aid” within §§ 4-104 and 4-105 refers to appropriations for capital projects only.
Dissenting Opinion
(dissenting). The sole issue in this case is the interpretation of a plainly worded statute:
Section 4-104 of the General Statutes provides that a private hospital receiving state aid shall, upon the demand of any discharged patient, permit such patient to examine his or her medical records. That the plaintiff, Jane Doe, is a former patient and that the defendant Institute of Living is a hospital which receives property tax exemptions cannot he disputed. See Institute of Living v. Hartford, 133 Conn. 258, 272, 50 A.2d 822.
This court has repeatedly held that when the state grants exemptions to an institution from the payment of taxes, it gives aid to such institution
Indeed, to the recipient institution, an exemption from taxes is in many ways a more effective way of receiving state aid than a direct pecuniary appropriation. A direct appropriation depends each year upon the will of the legislature and the fullness of the state’s coffers. The tax exemptions, on the other hand, are granted on a perpetual basis as long as the exempt institution abides by the provisions of § 12-81
In any event, the statute under consideration says nothing about direct appropriations: it speaks only of state aid. Because the Institute of Living
Whether a discharged mental patient should have unrestricted access to his or her medical record is a matter which must be addressed to the legislature and not to the court. “Legislation consists of formulating a rule for the future. A judgment [of the court] applies the law to past or present facts.” Eastern Oil Refining Co. v. Court of Burgesses, 130 Conn. 606, 610, 36 A.2d 586; Prentis v. Atlantic Coast Line Co., 211 U.S. 210, 29 S. Ct. 67, 53 L. Ed. 150. This court, therefore, cannot go any further than to apply the law to the statute as presently written.
Moreover, the effect of the majority opinion is to invite a challenge to the statute as discriminatory and violative of the equal protection clauses of the Connecticut and the federal constitutions on the ground that the state cannot grant rights to one class of persons and deny those same rights to
The questions reserved should be answered as follows: (1) Yes; (2) Yes; (3) Yes; (4) No.
“[General Statutes] See. 4-104. inspection and subpoena op hospital records. Each private hospital, public hospital society or corporation receiving state aid shall, upon the demand of any patient who has been treated in such hospital and after his discharge therefrom, permit such patient or his physician or authorized attorney to examine the hospital record, including the history, bedside notes, charts, pictures and plates kept in connection with the treatment of such patient, and permit copies of such history, bedside notes and charts to be made by such patient, his physician or authorized attorney. . . .”
General Statutes § 12-81 provides in pertinent part: “The following-described property shall be exempt from taxation: . . . (16) Hospitals and sanatoriums” provided that “quadrennially ... a statement on forms prepared by the tax commissioner shall be filed by such hospital society, corporation or sanatorium on or before the last day required by law for the filing of assessment returns with the local board of assessors of any town, consolidated town and city or consolidated town and borough, in which any of its property claimed to be exempt is situated.”
Reference
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- Jane Doe v. Institute of Living, Inc., Et Al.
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