Opinion ID: 2486733
Heading Depth: 2
Heading Rank: 2

Heading: Statutory Interpretation of the Phrase Resuscitation in the Immediate Postdelivery Period

Text: Because the issue involves whether the First District properly interpreted the NICA statute, this Court's standard of review is de novo. See Fla. Birth-Related Neuro. Injury Comp. Ass'n v. Dep't of Admin. Hearings, 29 So.3d 992, 997 (Fla.2010); Fla. Birth-Related Neuro. Injury Comp. Ass'n v. Fla. Div. of Admin. Hearings, 948 So.2d 705, 709-10 (Fla. 2007). The Court must begin with the actual language in the statute because legislative intent is determined primarily from the statute's text. Heart of Adoptions, Inc. v. J.A., 963 So.2d 189, 198 (Fla. 2007). As this Court has often repeated, When the language of the statute is clear and unambiguous and conveys a clear and definite meaning, there is no occasion for resorting to the rules of statutory interpretation and construction; the statute must be given its plain and obvious meaning. Fla. Birth-Related Neuro. Injury Comp. Ass'n, 29 So.3d at 997 (quoting Holly v. Auld, 450 So.2d 217, 219 (Fla. 1984)). Further, courts are without power to construe an unambiguous statute in a way which would extend, modify, or limit, its express terms or its reasonable and obvious implications. To do so would be an abrogation of legislative power. McLaughlin v. State, 721 So.2d 1170, 1172 (Fla.1998) (quoting Holly, 450 So.2d at 219). Likewise, when a court interprets a statute, it must give full effect to all statutory provisions. Courts should avoid readings that would render part of a statute meaningless. Gomez v. Vill. of Pinecrest, 41 So.3d 180, 185 (Fla.2010) (quoting Velez v. Miami-Dade Cnty. Police Dep't, 934 So.2d 1162, 1165 (Fla.2006)). Another important principle that applies in this case is that because the NICA Plan limits the remedies as a statutory substitute for common law rights and liabilities, its provisions should be strictly construed. Fla. Birth-Related Neuro. Injury Comp. Ass'n, 686 So.2d at 1354 (quoting McKaughan, 652 So.2d at 859). In turning to the statutory language, section 766.302(2) defines [b]irth-related neurological injury to mean: [I]njury to the brain or spinal cord of a live infant ... caused by oxygen deprivation or mechanical injury occurring in the course of labor, delivery, or resuscitation in the immediate postdelivery period in a hospital, which renders the infant permanently and substantially mentally and physically impaired. § 766.302(2), Fla. Stat. (2001) (emphasis added). In applying the statute to this case, there is no factual dispute that Tristan suffered from two incidents of oxygen deprivation: one on September 26, 2001, and the other on October 3, 2001. Nor is there any question that she suffered a brain injury that rendered her permanently and substantially mentally and physically impaired. The only question becomes whether Tristan's brain injury occurred  in the course of labor, delivery, or resuscitation in the immediate postdelivery period in a hospital . Here, the ALJ made factual findings that Tristan did not suffer a birth-related neurological injury as defined by the NICA Plan because Tristan's profound neurologic impairments resulted from a brain injury caused by oxygen deprivation that occurred [on] October 3, 2001, and not during labor, delivery, or resuscitation in the immediate postdelivery period in the hospital. 29 F.A.L.R. at 3880. In making this determination, the ALJ found that although the record established that Tristan, more likely than not, suffered from oxygen deprivation at birth on September 26, resulting in a multi-system failure that included her liver and kidneys, this oxygen deprivation did not cause a substantial neurological impairment. In support of this finding, the ALJ noted that the record established that she was delivered atraumatically, responded well to initial resuscitation, and her neurological examinations during the first seven days of life were normal. However, on October 3, she suffered prolonged and severe acidosis and shortly thereafter evidenced seizure activity and neurological decline. The First District reversed, holding instead that both incidents of oxygen deprivation were within the term immediate postdelivery period in a hospital. Bennett, 27 So.3d at 70. To reach this conclusion, the First District interpreted the term immediate postdelivery period in a hospital to include an extended period of days when a baby is delivered with a lifethreatening condition and requires close supervision. Id. In support, the First District relied on language from the Fifth District's decision in Orlando Regional. Bennett, 27 So.3d at 70. Thus, it is instructive to review the decision in Orlando Regional and how it interpreted the same statutory provision. In Orlando Regional, the Fifth District was faced with a factual scenario that was different from Bennett in a significant respect regarding ongoing efforts at resuscitation. The infant in the Orlando Regional case was delivered by cesarean section after the infant's heart rate rose too rapidly. Orlando Reg'l Healthcare Sys., Inc., 997 So.2d at 428. Upon delivery, the infant was unable to breathe spontaneously, and medical providers provided resuscitation. He was moved to a special care nursery where resuscitation efforts continued, and later, he was transferred again to a neonatal intensive care unit for continued aggressive resuscitation. Id. His status continued to decline, even though he was placed on high frequency oscillatory ventilation and later a heart/lung bypass machine. Id, at 429. He remained on this machine for the next six days, but later suffered from an intracranial hemorrhage and died. After reviewing the statutory terms and the medical depositions, the ALJ held that the claim was not subject to compensation under the NICA Plan. Id. at 431-32. The Fifth District noted that while the statute does not define the phrase resuscitation in the immediate postdelivery period, all of the experts agreed that the period would last until the infant was stabilized. Id. at 431. However, the experts disagreed as to when the infant was stabilized. The Fifth District undertook an appropriate statutory construction analysis of the terms resuscitation and immediate, neither of which is defined by the statute: Under the Plan, the terms resuscitation and immediate are important qualifiers to determining the compensability of a claim. However, those terms are not defined by the statute. When a term is not defined within a statute, a fundamental construction tool requires giving a statutory term its plain and ordinary meaning. Green v. State, 604 So.2d 471, 473 (Fla.1992); Dianderas v. Fla. Birth Related Neurological, 973 So.2d 523, 527 (Fla. 5th DCA 2007). When necessary, the plain and ordinary meaning can be ascertained by reference to a dictionary. Green, 604 So.2d at 473; see also L.B. v. State, 700 So.2d 370, 372 (Fla.1997) (explaining that court may refer to a dictionary to ascertain the plain and ordinary meaning). This Court has previously utilized references to dictionaries and medical references to interpret other provisions of the statute. See, e.g., Dianderas, 973 So.2d at 527. The American Heritage Dictionary defines the term resuscitate as [t]o return to consciousness, vigor or life; revive. The American Heritage Dictionary 1054 (2d ed. 1985). Dorland's Illustrated Medical Dictionary similarly defines resuscitation as the restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. Dorland's Illustrated Medical Dictionary 1145 (26th ed. 1981). Further, immediate is commonly understood to mean [n]ext in line or relation[;]... [o]ccuring without delay[;] [o]f or near the present time[;] ... [c]lose at hand; near. The American Heritage Dictionary 643 (2d ed. 1985); see Merriam-Webster's Collegiate Dictionary 578 (10th ed. 2000) (defining immediate as being next in line or relation[;]... existing without intervening space or substance[;] ... being near at hand[;] ... occurring, acting, or accomplished without loss or interval of time[;]... near or related to the present). Orlando Reg'l Healthcare Sys., Inc., 997 So.2d at 431-32. In reversing the ALJ's interpretation of the phrase resuscitation in the immediate postdelivery period, the Fifth District explained: The ALJ reviewed both the plain meaning of resuscitate and immediate, but limited the resuscitation in the immediate postdelivery period to only the first resuscitation necessarily performed on Harper as a result of the code called. However, in looking at the definition of resuscitate, it includes measures such as artificial respiration. In this case, although the code ended at 1:05 p.m., Harper continued to suffer respiratory failure that required artificial respiration. He could not breathe on his own and required active resuscitation continuously until he was placed on the [heart/lung] bypass. It is not logical to find that immediate only means through the first resuscitative attempt when Harper was initially revived but no spontaneous respirations could otherwise be established. Harper continued to need resuscitation, without interruption, and that ongoing need creates one time periodthe immediate postdelivery period . Id. at 432 (emphasis added). In reviewing the critical facts in the Fifth District's decision, the infant clearly required resuscitation by ongoing active and continuous artificial respiration until he was finally placed on a heart/lung bypass machinea fact that was crucial to the Fifth District's holding. In other words, it was the ongoing need for resuscitation that created the onetime period. Id. Because the undisputed facts in Orlando Regional showed that the infant's brain injury occurred as a result of oxygen deprivation between the time of birth and being placed on the heart/lung bypass machine, the court held that the injury qualified under the NICA Plan. Id. Although the First District relied on language from Orlando Regional, the opinion in Bennett actually conflicts with Orlando Regional because in Bennett, the First District defines the phrase resuscitation in the immediate postdelivery period much more expansively, holding that close supervision during the week-long period after birth is sufficient to qualify under the NICA Plan. Bennett, 27 So.3d at 70. It is important to note the significant difference between the facts of this case and those in Orlando Regional regarding resuscitation. In Bennett, while the medical providers provided initial resuscitation to Tristan shortly after birth, she responded well to the treatment, was stabilized, and was initially sent to the regular newborn nursery. Bennett, 27 So.3d at 68. Although Tristan was eventually sent to the special care nursery, the records do not reveal ongoing problems related to respiration in her first few days after birth and do not show any ongoing efforts related to any form of resuscitation that continued during the week after her birth. Despite the absence of such circumstances, the First District apparently relied on the fact that Tristan was placed in a special care nursery in order to hold that the second incident of oxygen deprivation was within the statutory period. Specifically, the First District stated, Shortly after delivery, Tristan was placed in the special care nursery where she remained through October 3. Under these facts, the time between Tristan's delivery by caesarean section and the events through October 3 constituted the `immediate postdelivery period in the hospital' for purposes of the NICA Plan. Id. at 70. However, requiring close supervision because of medical problems, even a life-threatening condition occurring as a result of birth, is not the statutory prerequisite for compensation, which requires a showing that Tristan's brain injury was caused by oxygen deprivation in the course of labor, delivery, or resuscitation in the immediate postdelivery period in the hospital. In contrast, in Orlando Regional, there was ongoing active and continuous artificial respiration. The First District in this case erroneously treats the statutory term in the immediate postdelivery period in the hospital as a separate time period without regard to the word resuscitation preceding it. The First District violates the tenets of statutory interpretation by reading out the word resuscitation and focusing on the phrase in the immediate postdelivery period. See Gomez, 41 So.3d at 185 (Courts should avoid readings that would render part of a statute meaningless. (quoting Velez, 934 So.2d at 1165)). However, under the plain language of the statute, the phrase in the immediate postdelivery period is a modifier and not an independent phrase. Section 766.302(2) narrows a birth-related neurological injury to one occurring in the course of labor, delivery, or resuscitation in the immediate postdelivery period. The only word that immediate postdelivery period can modify is the term resuscitation because both labor and delivery are clearly not within the immediate post delivery period. Thus, in its interpretation of the time period when the brain injury must occur, the First District alters the plain meaning of the statute, which provides that the injury must by caused by oxygen deprivation or mechanical injury that occurred during labor, delivery, or resuscitation in the immediate postdelivery period and goes against the mandate that this statute be strictly construed to include only those subjects clearly embraced within its terms. See Fla. Birth-Related Neuro. Injury Comp. Ass'n, 29 So.3d at 997 ([T]he statute must be given its plain and obvious meaning.); Fla. Birth-Related Neuro. Injury Comp. Ass'n, 686 So.2d at 1354. Furthermore, to the extent that the First District relied on the ALJ's finding of fact that at the time of birth there was an incident of oxygen deprivation resulting in a multi-system failure, the First District reads out the requirement that the permanent and substantial neurological impairment must result from a brain injury caused by oxygen deprivation occurring during labor, delivery or resuscitation in the postdelivery period. See Gomez, 41 So.3d at 185 (stating that courts should avoid readings that would render part of a statute meaningless). Specifically, the ALJ found that although there was a multi-system failure as a result of oxygen deprivation near the time of delivery, it was more likely than not that Tristan's profound neurologic impairments resulted from a brain injury caused by oxygen deprivation that occurred [on] October 3, 2001. The First District did not directly address these explicit findings, but rejected the ALJ's conclusions, stating that the definition of birth-related neurological injury does not require that neurological damage be manifest during `labor, delivery, or resuscitation in the immediate postdelivery period' under the statutory scheme. Bennett, 27 So.3d at 70 (emphasis added). It appears, however, that the First District erroneously injected the term manifest into the statutory definition when no such term occurs. See Hayes v. State, 750 So.2d 1, 4 (Fla.1999) (We are not at liberty to add words to statutes that were not placed there by the Legislature.). In reviewing the definition provided by section 766.302(2), the phrases caused by and occurring in set forth in the phrase injury to the brain ... caused by oxygen deprivation ... occurring in the course of labor, delivery, or resuscitation in the immediate postdelivery period are essential phrases that modify the injury to the brain and not each other. In other words, the injury to the brain must be caused by oxygen deprivation and that injury must occur in the course of labor, delivery, or resuscitation in the immediate postdelivery period. The First District may be correct that the actual evidence of the severe impairment need not be manifest at the time of labor, delivery or resuscitation in the immediate postdelivery period, but that is not the issue in this case where the ALJ made factual findings that the injury actually occurred on October 3. We hold that a narrow construction of the statute is the more reasonable interpretation. First, it restricts the impact of the statute to those situations involving obstetricians, who are the group of physicians that the NICA Plan was designed to benefit. Otherwise, as NICA points out in its brief, under the First District's interpretation, the statute would be expanded to cover situations where an infant is transferred from the delivery room and the obstetrician relinquishes responsibility of the infant to other health care providers. A strict interpretation of the statutory definition is also necessary based on the overriding statutory construction principle that has been applied to this statute that because the NICA Plan eliminates common law rights, its provisions should be strictly construed. Fla. Birth-Related Neuro. Injury Comp. Ass'n, 686 So.2d at 1354. For all these reasons, we disapprove of the First District's statutory interpretation holding that the injury in question occurred in the course of resuscitation in the immediate postdelivery period where the facts, as found by the ALJ, do not demonstrate that there was a continuous, ongoing need of resuscitation from the time of birth to the time of the injury that resulted in the severe impairment.