Case Name: Bethany WEEKS, as Personal, etc., Appellant, v. FLORIDA BIRTH-RELATED NEUROLOGICAL, etc., et al, Appellees
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 2008-01-31
Citations: 977 So. 2d 616
Docket Number: No. 5D05-4119
Parties: Bethany WEEKS, as Personal, etc., Appellant, v. FLORIDA BIRTH-RELATED NEUROLOGICAL, etc., et al, Appellees.
Judges: PALMER, C.J., GRIFFIN, THOMPSON, PLEUS, ORFINGER, MONACO, LAWSON and EVANDER, JJ., concur.
Reporter: Southern Reporter, Second Series
Volume: 977
Pages: 616–630

Head Matter:
Bethany WEEKS, as Personal, etc., Appellant, v. FLORIDA BIRTH-RELATED NEUROLOGICAL, etc., et al, Appellees.
No. 5D05-4119.
District Court of Appeal of Florida, Fifth District.
Jan. 31, 2008.
Rehearing Denied April 2, 2008.
Philip M. Burlington of Burlington & Rockenbach, P.A., and David J. White of Searcy Denney Scarola Barnhart & Ship-ley, P.A., West Palm Beach, for Appellant.
Wilbur E. Brewton and-Kelly B. Plante of Roetzel & Andress, L.P.A., Tallahassee, for Appellee Florida Birth-Related Neurological Injury Compensation Association.
Henry W. Jewett, II, and Jennings L. Hurt, III, of Rissman, Barrett, Hurt, Donahue & McLain, P.A., Orlando, for Appel-lee/Intervenor Orlando Regional Healthcare System, Inc., d/b/a South Seminole Hospital.
Thomas E. Dukes, III, and Ruth C. Osborne of McEwan, Martinez & Dukes, P.A., Orlando, for Appellees/Intervenors Christopher K. Quinsey, M.D. and Advanced Women’s Health Specialists.

Opinion:
TORPY, J.
We once again confront the topic of statutory notice to patients under the Florida Birth-Related Neurological Injury Compensation Plan (NICA). The particular question is whether health care providers may invoke the "emergency medical condition" exception to the notice precondition, even though the provider-obstetrical patient relationship had commenced before the onset of the emergency. We conclude that the notice must be given within a reasonable time after the commencement of the relationship and that the failure to do so is not excused by the subsequent emergency. In so holding, we must necessarily recede,, in part, from our prior decision in Orlando Regional Healthcare System, Inc. v. Alexander, 909 So.2d 582 (Fla. 5th DCA 2005).
Following the death of David Weeks from birth-related neurological injuries, his mother, Bethany Weeks, as personal representative, filed her petition for compensation under the NICA plan and asked for a determination of whether the health care providers had complied with the notice requirements of NICA. Appellee, Florida Birth-Related Neurological Injury Compensation Association, responded that it believed the claim was compensable and sought a hearing for a determination of compensability and on the disputed issue of pre-delivery notice. In the interim, Orlando Regional Healthcare System,. Inc., d/b/a South Seminole Hospital, Christopher Quinsey, M.D., David Goss, M.D., John V. Parker, M.D., and Advanced Women's Health Specialists were granted leave to intervene.
The Administrative Law Judge's order contains extensive findings of fact that are unchallenged on appeal. In material part, the ALJ found that Mrs. Weeks had received prenatal care from Advanced, an obstetrical group of which the delivering doctor, Dr. Quinsey, was a member, but she had not been given pre-delivery notice that its physicians participated in the NICA plan. As for the hospital, the ALJ noted in the order that Mrs. Weeks had pre-registered at the hospital and was actually admitted for prenatal care from October 15 to October 19 and again from October 25 to October 27. Nevertheless, the hospital had not provided Mrs. Weeks with a NICA form for her signature until less than two hours before David's birth on November 3, 2002. The ALJ found that it would have been practicable for the hospital to have delivered the NICA notice during preregistration or during the prenatal admissions. As to Dr. Quinsey, the ALJ specifically found that it would have been practicable to have delivered the notice on any one of Mrs. Weeks's visits to the clinic. The ALJ concluded, however, that the providers were excused from complying with the • notice , requirement because Mrs. Weeks was in an "emergency medical condition" when she reached the hospital the day David was delivered. In arriving at this conclusion, the ALJ understandably relied on this Court's opinion in Alexander.
Our resolution of this issue is based on the language of the statute. Section 766.316, Florida Statutes (2002), provides in pertinent part:
Notice to obstetrical patients of participation in the plan. — Each hospital with a participating physician on its staff and each participating physician, . under the Florida Birth-Related Neurological Injury Compensation Plan shall provide notice to the obstetrical patients as to the limited no-fault alternative for birth-related neurological injuries . Notice need not be given to a patient when the patient has an emergency .medical condition as defined in s. 395.002(9)(b) or when notice is not practicable.
(Emphasis added).
What this emphasized language cléarly expresses to us is that the forma tion of the provider-obstetrical patient relationship is what triggers the obligation to furnish the notice. The determination of when this relationship commences is a question of fact. Once the relationship commences, because the statute is silent on the time period within which notice must be furnished, under well-established principles of statutory construction, the law implies that the notice must be given within a reasonable time. Burnsed v. Seaboard Coastline R. Co., 290 So.2d 13, 19 (Fla.1974); Concerned Citizens of Putnam County v. St. Johns River Water Mgmt. Dist., 622 So.2d 520, 523 (Fla. 5th DCA 1993). This determination depends upon the circumstances, but a central consideration should be whether the patient received the notice in sufficient time to make a meaningful choice of whether to select another provider prior to delivery, which is a primary purpose of the notice requirement. Turner v. Hubrich, 656 So.2d 970, 971 (Fla. 5th DCA 1995).
In Alexander, our attention was directed to the last sentence of the statute, which contains the two statutory exceptions to the rule — "emergency medical condition" and "practicability." We based our holding on our conclusion that these exceptions were independent, as evidenced by the use of the conjunction "or" instead of "and." Although we continue in our belief that these two exceptions are independent, focusing now on the rule rather than the exceptions, it is clear that Alexander was wrongly decided. Were we to follow Alexander's construction of the statute, we would be permitting the exception to completely swallow the rule because "emergency medical condition," as defined, includes virtually every labor and delivery. Such a construction violates a cardinal principle of statutory construction that it "never be presumed that the legislature intended to enact purposeless and therefore useless, legislation." Sharer v. Hotel Corp. of Am., 144 So.2d 813, 817 (Fla.1962). Our conclusion in Alexander also ignores the mandatory language of the statute, requiring that providers "shall provide notice to obstetrical patients," thus violating the statutory construction maxim that "all words in a statute . be construed so as to give them some effect, not so as to render them meaningless surplus-age." Fla. Police Benev. Ass'n, Inc. v. Dep't of Agric. & Consumer Servs., 574 So.2d 120, 122 (Fla.1991). We think that the construction we adopt today gives both purpose to the statute and effect to all of its words. For these reasons, we recede from Alexander to the extent that it holds to the contrary.
Here, under the undisputed facts, Mrs. Weeks clearly became an "obstetrical patient" of both providers well before her delivery, thus triggering the obligation to furnish her with the notice within a reasonable time, which was not excused by the subsequent emergency. Because the notice was not timely furnished, neither provider may invoke the benefits of NICA. Galen of Florida, Inc. v. Braniff, 696 So.2d 308 (Fla.1997).
In summary, we hold that the NICA notice must be given within a reasonable time after the provider-obstetrical patient relationship begins, unless the occasion of the commencement of the rela tionship involves a patient who presents in an "emergency medical condition," as defined by the statute, or unless the provision of notice is otherwise "not practicable." When the patient first becomes an "obstetrical patient" of the provider and what constitutes a "reasonable time" are issues of fact. As a result, conclusions might vary, even where similar situations are presented. For this reason, a prudent provider should furnish the notice at the first opportunity and err on the side of caution.
We certify the following question to the Florida Supreme Court as one involving great public importance:
WHEN A NICA PROVIDER FAILS TO PROVIDE THE STATUTORY NOTICE TO AN OBSTETRICAL PATIENT WITHIN A REASONABLE TIME AFTER THE COMMENCEMENT OF THE PROVIDER-OBSTETRICAL PATIENT RELATIONSHIP, IS THE PROVISION OF THE NOTICE EXCUSED BECAUSE THE PATIENT SUBSEQUENTLY PRESENTS IN AN "EMERGENCY MEDICAL CONDITION."
REVERSED; QUESTION CERTIFIED.
PALMER, C.J., GRIFFIN, THOMPSON, PLEUS, ORFINGER, MONACO, LAWSON and EVANDER, JJ., concur.
SAWAYA, J., concurs in result, with opinion.
. § 766.301-.316, Fla. Stat. (2002).
. Section 395.002(9)(b), Florida Statutes, defines "emergency medical condition" as meaning:
(b) With respect to a pregnant woman:
1. That there is inadequate time to effect safe transfer to another hospital prior to delivery;
2. That a transfer may pose a threat to the health and safety of the patient or fetus; or
3. That there is evidence of the onset and persistence of uterine contractions or rupture of the membranes.
(Emphasis added).
. We appreciate Judge Sawaya's thorough special concurrence but do not think our decision today is in tension with Galen of Florida, Inc. v. Braniff, 696 So.2d 308 (Fla.1997). There, the court answered in the affirmative the following certified question:
WHETHER SECTION 766.316, FLORIDA STATUTES (1993), REQUIRES THAT HEALTH CARE PROVIDERS GIVE THEIR OBSTETRICAL PATIENTS PRE-DELIV-ERY NOTICE OF THEIR PARTICIPATION IN THE FLORIDA BIRTH RELATED NEUROLOGICAL INJURY COMPENSATION PLAN AS A CONDITION PRECEDENT TO THE PROVIDERS' INVOKING NICA AS THE PATIENTS' EXCLUSIVE REMEDY?
In dicta, the court stated that the notice must be provided "a reasonable time prior to delivery, when practicable." Id. at 310 (emphasis added). See Cirelli v. Ent, 885 So.2d 423, 427 (Fla. 5th DCA 2004) (characterizing as dicta statement addressing issue not within scope of certified question); accord Johnson v. State, 557 So.2d 203, 206 (Fla. 5th DCA 1990) (Harris, J., concurring specially). At the time Braniff -was decided, the word "practicable," or its equivalent, did not appear in the statute, nor did the statute contain any exceptions from its mandatory directive. Subsequently, the legislature amended the statute in response to Braniff. Instead of interjecting the word "practicable" as a component of the rule, the legislature added the sentence containing exceptions, including that notice "need not be given . when notice is not practicable." We are construing the amended statute and make the distinction between the rule and the exception based on the language of the amended statute. Thus, "practicability" only is relevant in an analysis of the exception, not the rule. This is why we disagree with Judge Sawaya's conclusion that the "test" for when notice is required is "practicability." As for the language in Bran-iff requiring the notice to be given "a reasonable time prior to delivery," we think it more appropriate to apply the long-standing principle that, when no time for performance of an act is specified, the law implies that the act be performed within a reasonable time after the time for performance is triggered. Bumsed, 290 So.2d at 19. This approach results in a rule that is more workable because providers need not speculate about when notice is due. Otherwise, providers and obstetrical patients are left with a rule that can only be applied in hindsight because it uses as a trigger an unpredictable subsequent event. In any event, any distinction between the two approaches is largely semantic because our analysis leads to the same result and is, therefore, entirely consistent with the Braniff dicta.