Dayspring of Miami Valley v. Shepherd, 06-Ca-113 (5-25-2007)
Dayspring of Miami Valley v. Shepherd, 06-Ca-113 (5-25-2007)
Opinion of the Court
{¶ 2} We conclude that the trial court did err by affirming the decision of the Hearing Officer, because that decision is contrary to the provisions of R.C.
{¶ 4} On October 29, 2004, Dayspring issued notice to Shepherd, pursuant to R.C.
{¶ 5} Dayspring filed a notice of appeal to the Clark County Common Pleas Court pursuant to R.C.
{¶ 7} "THE COURT MUST REVERSE THE DECISION BECAUSE THE HEARING OFFICER IMPROPERLY EXCEEDED HIS LIMITED, STATUTORY AUTHORITY BY DETERMINING THAT `OTHER RELEVANT FACTORS' COULD BAR DAYSPRING'S RIGHT TO DISCHARGE APPELLEE DESPITE THE UNDISPUTED FACT THAT DAYSPRING HAD CLEARLY ESTABLISHED A RIGHT TO DISCHARGE APPELLEE PURSUANT TO R.C. § 3721.13(A)(30)(e)."
{¶ 8} Dayspring contends that the decision of the Hearing Officer is based upon factors not provided for by statute, and that it is therefore contrary to law, requiring reversal of both the administrative decision and the judgment of the trial court affirming that decision.
{¶ 9} Dayspring sought to discharge Shepherd for non-payment of her bill pursuant to R.C.
{¶ 10} "* * *
{¶ 11} "(e) The resident has failed, after reasonable and appropriate notice, to pay or to have the medicare or medicaid program pay on the resident's behalf, for the care provided by the home. A resident shall not be considered to have failed to have the resident's care paid for if the resident has applied for medicaid, unless both of the following are the case:
{¶ 12} "(i) The resident's application, or a substantially similar previous *Page 5 application, has been denied by the county department of job and family services.
{¶ 13} "(ii) If the resident appealed the denial pursuant to division (C) of section
{¶ 14} Residents who wish to challenge a nursing home's notice of discharge, may request a hearing before a Hearing Officer of the Department of Health. R.C.
{¶ 15} Thereafter, the party aggrieved by the decision of the Hearing Officer may file an administrative appeal to the common pleas court pursuant to R.C.
{¶ 16} As noted above, following the hearing requested by Shepherd, the Hearing Officer found that Dayspring presented sufficient evidence showing that Shepherd had failed to make payment under the provisions of R.C.
{¶ 17} However, the Hearing Officer did not end his inquiry at that point. Instead, he went on to find as follows:
{¶ 18} "Other relevant factors must be taken into consideration in making a final determination on the proposed discharge which are as follows:
{¶ 19} "1. The facility in January 2004 admitted resident at a rate of $184.00/day without checking on resident's finances or the finances of her daughter or their ability to pay the facility's charges.
{¶ 20} "2. Resident, through her daughter, almost immediately (i.e. in February 2004) applied for Medicaid but ultimately was denied eligibility. No doubt the Facility was aware of this application and like the daughter, felt it would be approved and therefore there would be no problem with payment.
{¶ 21} "3. The facility was aware of Medicaid's initial denial but made no demands for payment thereafter (other than their continued monthly statements); continued to allow resident to remain at the facility and did not initiate collection or discharge proceedings.
{¶ 22} "4. The facility was notified that upon reapplication, resident had been approved for Medicaid effective August 1, 2004 and Residenthas been current since said date. *Page 7
{¶ 23} "5. The sole reason for the discharge is the inability to collect the approximate $33,000.00 balance because `we can't carry a balance that large' and, after all, `they are a business.' However the facility has carried a balance from day one and prior to August 1, 2004 it was some $17,000.00 higher than it is now. After the balance was `frozen' and payments were being made on a current basis, the facility waited three (3) months before serving its notice on resident. In addition, if resident is discharged, it is highly unlikely that the facility will recoup any of the balance due it since resident's resources and the Medicaid payments will go to the new facility but if she remains at the facility, minimally the balance will not increase and perhaps * * * * can either be paid in full or greatly reduced.
{¶ 24} "6. There appears to be no reason for a discharge other than money because the staff at the facility seem to be exceptionally fond of resident and no other reasons were set forth in the notice or presented at the hearing.
{¶ 25} "Based on the above considerations the undersigned concludes that the facility was complicit in helping to create the initial balance (i.e. at least up to August 1, 2004) by not making adequate up front provisions for payment and by relying on a Medicaid application of which it had notice and in which it had involvement. The facility cannot on the one hand help create the debt and then suddenly, upon denial of the Medicaid application expect immediate or full payment. The facility must come with `clean hands' which it has not. Further the facility, upon notified of Medicaid's denial, continued to provide resident with room, board and care; took no steps to collect the monies due it such as working out a payment plan * * * and did not seek to discharge resident. It simply let things ride while the debt continued to escalate. The above *Page 8 actions and inactions of the Facility constitute waiver, estoppel, laches and negligence."
{¶ 26} Following Dayspring's appeal to the Common Pleas Court, that court determined that the Hearing Officer's findings were supported by reliable, probative and substantial evidence and that the decision was in accordance with law. The trial court also stated that R.C.
{¶ 27} Dayspring contends that both the Hearing Officer and the trial court exceeded the scope of the statute. Dayspring has not cited, and we have not found, case law regarding the application of R.C.
{¶ 28} Courts must look to the specific language contained in a statute, and then, if the language is not ambiguous, apply the clear meaning of the words used there. Roxane Laboratories, Inc. v.Tracy,
{¶ 29} While the statute does provide some protection for nursing home residents, in that it only permits transfer or discharge under certain circumstances, the portion relevant to this appeal specifically permits discharge for non-payment. Further, the statute does not refer to any equitable defenses nor does it cite any factors to be considered in determining whether discharge is appropriate. Indeed, as noted above, the Administrative Code provides that in order to transfer or discharge a resident, a nursing home facility need only present evidence demonstrating compliance with R.C.
{¶ 30} When reviewing a trial court's judgment in an administrative appeal, an appellate court is "limited to determining whether the trial court abused its discretion in reviewing the administrative order."Harris, supra, at 13. Absent an abuse of discretion, the trial court's decision must be affirmed. Id. However, the construction of a statute is a question of law. Brennaman v. R.M.I. Co. (1994),
{¶ 31} The First Assignment of Error is sustained. *Page 10
{¶ 33} "THE COURT MUST REVERSE THE DECISION BECAUSE THE HEARING OFFICER'S FACTUAL FINDINGS REGARDING THE `OTHER RELEVANT FACTORS' ARE NOT SUPPORTED BY SUBSTANTIAL, RELIABLE AND PROBATIVE EVIDENCE AND ARE CONTRARY TO LAW."
{¶ 34} Dayspring contends that the evidence does not support the decision of the Hearing Officer with regard to the extra-statutory factors cited in his decision.
{¶ 35} We need not address this argument as it has been rendered moot by our resolution of the First Assignment of Error in Part II, above. Therefore, the Second Assignment of Error is overruled as moot.
*Page 1GRADY and DONOVAN, JJ., concur.
Reference
- Full Case Name
- Dayspring of Miami Valley v. Nell Shepherd
- Cited By
- 5 cases
- Status
- Published