Case Title: MICHELS v DEPT OF SOCIAL REHABI

Citation: 

Docket Number: 79-030

State: montana

Court: Montana Supreme Court

Date: 1980-03-25T00:00:00Z

Document:
No. 79-30 IN THE SUPREME COURT OF THE STATE OF MONTAhTA MELANIE MICHELS, Petitioner and Appellant, VS. DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES OF THE STATE OF MONTANA; CASCADE COUNTY, a political subdivision of the State of Montana; and the CASCADE COUNTY WELFARE BOARD, Respondents and Respondents. Appeal from: ~istrict Court of the Fourth Judicial ~istrict, In and For the County of Cascade. Honorable Joel G. Roth, Judge presiding. Counsel of Record: For Appellant: Richard Ganulin, Great Falls, Montana For Respondents: David A. Scott, Helena, Montana J. Fred Bourdeau, County Attorney, Great Falls, Montana Alexander and Baucus, Great Falls, Montana Filed : f'PIflR 2:; 1389 Submitted on briefs: March 24, 1 9 8 0 ~ecided: MAR 2 6 1989 M r . J u s t i c e John Conway Harrison d e l i v e r e d t h e Opinion of t h e Court. The a p p e l l a n t sought a j u d i c i a l review of an adverse d e c i s i o n of the S t a t e Board of S o c i a l and R e h a b i l i t a t i o n Services Appeals concerning the d e n i a l of medical a s s i s t a n c e . The ~ i s t r i c t Court affirmed t h e a d m i n i s t r a t i v e decision, and a p p e l l a n t brings t h i s appeal. Appellant is a twenty year o l d female. She w a s born i n Great F a l l s , Montana, and has l i v e d her e n t i r e l i f e t h e r e . I n t h e spring of 1978 she l e f t Great F a l l s t o a t t e n d Western Montana College i n Dillon, Montana. During t h e period of time she attended school, she returned t o her home nearly every weekend and considered Great F a l l s her permanent address. The testimony i n d i c a t e s t h a t she intends t o make Great F a l l s her home when she f i n i s h e s school. I n t h e summer of 1978 a p p e l l a n t found employment with t h e G a l l a t i n National F o r e s t on a summer job t h a t was t o a s s i s t her i n her education, and she i n d i c a t e d t h a t she intended t o r e t u r n t o c o l l e g e t h a t f a l l . O n August 5, 1978, a p p e l l a n t was involved i n a head-on automobile c o l l i s i o n . The d r i v e r of t h e o t h e r v e h i c l e was k i l l e d , and a p p e l l a n t was s e r i o u s l y i n j u r e d . She was taken t o t h e emergency room of Bozeman Deaconess Hospital, was i n t h e i n t e n s i v e c a r e u n i t f o r s e v e r a l days and remained i n t h e h o s p i t a l two weeks before being released t o r e t u r n t o her home i n Great F a l l s . A s a r e s u l t of t h e accident, she w a s incapacitated t h r e e months with t h e following medical and physical problems: compound f r a c t u r e of her l e f t l e g , broken chin, broken arm, and four missing t e e t h . She was unable t o go o u t on her own u n t i l approximately t h r e e months a f t e r t h e accident. Total medical expenses r e s u l t i n g from t h i s accident were $6,500. Neither appellant nor her parents had ever received any welfare assistance prior to the accident. Her family con- sisted of seven members and the income of the family was approximately $9,000. Following the accident, a relative recommended that appellant's mother apply for disability benefits from the social security administration to help defray medical bills. Such an application was made but denied two months after it had been made. No one at the hospital or no medical personnel con- tacted appellant's family concerning the availability of county medical benefits. They learned that county medical benefits might be available in their notice of denial from the social security administration some two months after applying. Appellant then applied for medical benefits. Her application was denied since she applied later than five days after receiving the medical care. Three issues are presented for our consideration: 1. Is the five-day rule valid? 2. Was the finding of a lack of good cause for extend- ing the five-day limit proper? 3 . Was appellant a resident of Cascade County for the purposes of county medical insurance? Section 53-3-103, MCA, provides broad coverage of medical assistance for those persons who, finding themselves under calamitous circumstances because of medical costs, look to the county to obtain coverage. That section pro- vides for medical aid and hospitalization for indigents: " (1) Except as provided in other parts of this title, medical aid and hospitalization for county residents and nonresidents within the county unable to provide these necessities for themselves are the legal and financial respon- sibility of the county commissioners and are payable from the county poor fund. . ." Counties of t h i s state have the o b l i g a t i o n t o provide medi- cal a s s i s t a n c e t o i n d i g e n t s under t h i s s e c t i o n . See, F l a t - head Health Center v. Cty. of Flathead (1979), Mont . , 598 P.2d 1 1 1 1 , 36 St.Rep. 1465, 1469; Wheatland County v. Bleeker (1978), 175 Mont. 478, 575 P.2d 48, 35 St.Rep. 166, 169; S a i n t P a t r i c k Hospital v. Powell County (1970), 156 Mont. 153, 477 P.2d 340. I t should be noted t h a t i n S a i n t P a t r i c k Hospital, t h i s Court s a i d t h a t under t h e welfare s t a t u t e , an i n d i g e n t person ". . . include[sl those persons who do not have t h e p r e s e n t o r f u t u r e hope of resources s u f f i c i e n t t o pay f o r a l l t h e medical and h o s p i t a l s e r v i c e s required i n emergency instances." 477 P.2d a t 343. I n S a i n t P a t r i c k Hospital t h i s Court a l s o held t h a t ". . . t h e S t a t e Welfare Department has t h e r i g h t t o set up standards so long a s they a r e reasonable. . ." 477 P.2d a t 343. I n i n t e r p r e t i n g t h e above r e g u l a t i o n s , the Department adopted an a d m i n i s t r a t i v e r e g u l a t i o n , ARM §46-2.10(38)- S101950, which provides: "GENERAL (1) Medically Needy persons may apply t o county welfare departments i n t h e county i n which they are r e s i d i n g f o r medical a i d and hos- p i t a l i z a t i o n care. " ( a ) Application by a r e c i p i e n t f o r payment of medical s e r v i c e s rendered t o him s h a l l be e f - f e c t i v e r e t r o a c t i v e l y i n t h e minimum amount of f i v e days p r i o r t o d a t e of n o t i f i c a t i o n t o t h e county of t h e i n t e n t of t h e r e c i p i e n t t o apply f o r payment of s a i d medical s e r v i c e s . "(i) R e t r o a c t i v i t y beyond t h e above five-day l i m i t s h a l l be allowed a t t h e d i s c r e t i o n of t h e county welfare board upon good cause shown f o r f a i l u r e t o meet s a i d five-day l i m i t . " (2) 'Medically Needy Persons' f o r t h e purposes of t h i s Sub-chapter 38 of t h e Economic A s s i s - tance Division a r e those persons who a r e eli- g i b l e f o r General Relief a s provided i n R.C.M. 1947, T i t l e 71, Chapter 3, and m e e t t h e require- ments a s s e t f o r t h i n t h i s Sub-chapter." A s previously noted, it i s w e l l e s t a b l i s h e d i n t h i s j u r i s d i c t i o n t h a t i n d i g e n t s have t h e r i g h t t o county medical a s s i s t a n c e . Appellant here applied f o r such a s s i s t a n c e two months a f t e r being r e l e a s e d from t h e h o s p i t a l . She was denied a s s i s t a n c e simply because she applied later than f i v e days a f t e r receiving medical services. A t no t i m e was her indigency an i s s u e i n t h e case. It has been held t h a t where a s t a t u t e makes it t h e duty of t h e s t a t e o r l o c a l a u t h o r i t i e s t o provide f o r i n d i g e n t persons, t h a t duty is mandatory and must be s t r i c t l y complied with. See, Wayne Township v. Lutheran Hospital (1974), 160 1nd.App. 427, 312 N.E.2d 120; S t a t e ex rel. Arteaga v. Silverman (1972)r 56 Wis.2d 110, 2 0 1 N.W.2d 538; Mooney v. P i c k e t t (1971), 94 Cal.Rptr. 279, 483 P.2d 1231; Lawson v. Shuart (1971), 323 N.Y.S.2d 488; Williams v. Shapiro (1967), 4 Conn.Cir. 4 4 9 , 234 A.2d 376. W e f i n d t h a t t h e provision of a five-day l i m i t f o r t h e a p p l i c a t i o n f o r funds i n cases such a s t h i s f o r medical insurance are i n v a l i d , f o r unless r e g u l a t i o n s e f f e c t i v e l y e f f e c t u a t e t h e purpose of t h e s t a t u t e , they are i n v a l i d . See, Desert Environmental Con. Ass'n v. Public U t i l . Com'n (1973), 106 Cal.Rptr. 31, 505 P.2d 223. Whatever f o r c e and e f f e c t t h e r e g u l a t i o n has must d e r i v e from t h e s t a t u t e under which it i s enacted, and a r e g u l a t i o n i n c o n f l i c t with t h a t s t a t u t e i s without e f f e c t . See, 2 Am.Jur.2d ~ d m i n i s t r a t i v e Law - 8289, and B e l l v. Dept. of Licensing (19791, - Mont. , 594 P.2d 331, 36 St.Rep. 880. " I t i s axiomatic t h a t a s t a t u t e cannot be changed by a d m i n i s t r a t i v e r e g u l a t i o n , " S t a t e ex rel. Swart v. Casne (1977), 172 Mont, 302, 308, 564 P.2d 983. C l e a r l y i n t h i s case t h e a d m i n i s t r a t i v e r e g u l a t i o n providing t h a t t h e a p p l i c a t i o n be made w i t h i n f i v e days of t h e provision of medical s e r v i c e s changes t h e s t a t u t e which does n o t r e q u i r e an i n d i g e n t person t o apply f o r b e n e f i t s i n any p a r t i c u l a r time. The s p i r i t and t h e purpose f o r p u b l i c a s s i s t a n c e s t a t u t e s i s t o provide f o r those c i t i z e n s who are i n "need." One must ask himself, i n what way is t h i s i d e a l f u r t h e r e d by d i s t i n g u i s h i n g between those who apply f o r t h e b e n e f i t s within f i v e days of receiving medical s e r v i c e s and those who apply a f t e r f i v e days? The very i n j u s t i c e i s apparent i n such a case a s here, where a p p e l l a n t was without knowledge of t h e county medical program, always acted i n good f a i t h , was f o r two weeks i n a h o s p i t a l away from t h e county of her home and only applied a f t e r two months of h o s p i t a l and home care. O n i t s f a c e , t h e five-day r u l e here i s p a t e n t l y unreasonable. While t h e District Court r u l e d t h a t t h e five-day r u l e d i d n o t e n g r a f t "an a d d i t i o n a l requirement on t h e s t a t u t o r y provision, but r a t h e r i s a reasonable and necessary e x e r c i s e of t h e agency's r u l e making power t o e s t a b l i s h a more speci- f i c g u i d e l i n e f o r t h e b e n e f i t of both t h e agency and t h e a p p l i c a n t , " we f i n d t h a t i n so r u l i n g it e r r e d and t h a t a p p e l l a n t w a s deprived of medical b e n e f i t s . The next i s s u e r a i s e d i s whether o r n o t a p p e l l a n t f a i l e d t o show good cause f o r w a i v i n g t h e five-day r u l e . Again, ARM 546-2.10 ( 3 8 ) -S101950 (1) ( a ) (i) provides: " R e t r o a c t i v i t y beyond t h e above five-day l i m i t s h a l l be allowed a t t h e d i s c r e t i o n of t h e county welfare board upon good cause shown f o r f a i l u r e t o meet s a i d five-day l i m i t . " The hearings o f f i c e r , t h e board and t h e D i s t r i c t Court a l l found t h a t a p p e l l a n t d i d n o t give good cause f o r f a i l u r e t o meet the five-day limit, noting that her parents or she could have telephoned or that the medical vendor or some other person could have made application for the aid within the five-day period. Appellant argues that as a matter of law she has shown good cause for failure to apply for the medical benefits within five days of receiving the services. Neither she nor her family had ever received any welfare benefits in the past. They had no knowledge of the county medical program until two months after appellant was re- leased from the hospital in a county several hundred miles away from her home. What the hearings officer, the board of county commis- sioners, and the District Court failed to take into considera- tion in the fact situation here is that appellant was involved in an accident where one person was killed; was in an inten- sive care situation for a matter of days; remained in the hospital away from her home for over two weeks; and was unable to go out of her home for nearly three months. Under these facts, this Court can and has reversed administrative decisions that are arbitrary or capricious or constitute abuse of discretion on the part of the administrative au- thority. Here the administrative decision was arbitrary and capricious. No reason was provided for the agency's decision that appellant did not have good cause for applying more than five days after receiving the medical services. The Cascade County welfare department is obliged to assist indigents in paying for medical services. In light of this we find that appellant has made a good faith and reasonably diligent effort to get this assistance from the county and that it was an abuse of discretion for the wel- fare department to determine that she did not have good cause f o r applying more than f i v e days a f t e r receiving t h e medical a s s i s t a n c e . The t h i r d i s s u e presented f o r our consideration i s whether a p p e l l a n t i s a r e s i d e n t of Cascade County f o r t h e purposes of county medical a s s i s t a n c e . This Court i n a r e c e n t case, County of Blaine v. Moore (1977), 174 Mont. 1 1 4 , 568 P.2d 1216, 34 St.Rep. 1051, considered t h e question of t h e residency of c o l l e g e s t u d e n t s a s t o receiving p u b l i c a s s i s t a n c e . There t h e Court noted: "At t h e end of t h e Moores' year of residence i n Montana, subsequent t o r e t u r n i n g from Colorado, t h e Moores were r e s i d i n g a t Havre, i n H i l l County, attending Northern Montana College and l i v i n g i n t h e married couples housing u n i t . Under a s t r i c t i n t e r p r e t a t i o n of s e c t i o n 71- 302.2 [R.C.M. 19471, one would conclude t h a t H i l l County i s t h e county of f i n a n c i a l respon- s i b i l i t y . However, a presumption arises t h a t t h e county wherein a c o l l e g e o r u n i v e r s i t y lies i s n o t t h e r e s i d e n t county of t h e a t t e n d a n t students. Generally, s t u d e n t s t r a v e l from t h e residence of t h e i r parents, a t t e n d i n g c o l l e g e only during t h e academic year, and r e t u r n t o t h e i r p a r e n t s ' residence on weekends, holidays and summer breaks. For t h i s reason, it i s cus- tomary t o look t o t h e p a r e n t s ' residence i n order t o determine t h e residence of t h e student. Otherwise, t h e county i n which t h e c o l l e g e lies would be unduly burdened with providing f o r t h e s o c i a l welfare of students." 568 P.2d a t 1224. Here a p p e l l a n t was born and r a i s e d i n Cascade County. Her p a r e n t s and family l i v e i n Cascade County. She g i v e s Cascade County a s her permanent address and intends t o r e s i d e t h e r e a f t e r she f i n i s h e s school. The f a c t t h a t she accepted temporary summer employment i n G a l l a t i n County does n o t change her place of residence. Under t h e r u l e estab- l i s h e d i n County of Blaine v. Moore, supra, a p p e l l a n t i s found t o be a r e s i d e n t of Cascade County f o r purposes of county medical a s s i s t a n c e . The judgment of t h e D i s t r i c t Court i s reversed. W e concur: 7 - 4 - 4 . . k w , Chief J u s t i c e J u s t i c e s c