Opinion ID: 2191635
Heading Depth: 1
Heading Rank: 4

Heading: Alleged Due Process Violations

Text: Appellees have also asserted constitutional bases for requiring Retreat to remain operational; specifically, appellees raise the protections of life, liberty and property interests embodied in Article I, Section 1 of the Pennsylvania Constitution and the Fourteenth Amendment of the United States Constitution. The United States Supreme Court has recently decided this issue against appellees. In O'Bannon v. Town Court Nursing Center, 447 U.S. 773, 100 S.Ct. 2467, 65 L.Ed.2d 506 (1980), that Court reversed the Court of Appeals for the Third Circuit which had sustained a preliminary injunction prohibiting patient transfers from Town Court Nursing Center until they had been granted a hearing. In that case, the patients asserted a constitutionally protected entitlement to continued residency at the nursing home of their choice. The sources claimed as the bases of that entitlement were similar to those claimed by appellees herein; namely, a statutory entitlement (from three Medicaid provisions including one which prohibited transferring patients except for certain specific reasons not applicable therein) and life and liberty interests which they claimed were jeopardized by the trauma that would accompany transfer. The transfers in Town Court were necessitated by loss of federal funds because the facility had lost its Medicaid certification. The United States Supreme Court phrased the issue as whether the patients have an interest in receiving benefits for care in a particular facility that entitles them, as a matter of constitutional law, to a hearing before the Government can decertify that facility. The Court was not persuaded by either asserted justification for the right to remain in a particular facility. As to the Medicaid regulations argument, that Court stated: Whether viewed singly or in combination, the Medicaid provisions relied upon by the Court of Appeals do not confer a right to continued residence in the home of one's choice. 42 U.S.C. § 1396a(a)(23) gives recipients the right to choose among a range of qualified providers, without government interference. By implication, it also confers an absolute right to be free from government interference with the choice to remain in a home that continues to be qualified. But it clearly does not confer a right on a recipient to enter an unqualified home and demand a hearing to certify it, nor does it confer a right on a recipient to continue to receive benefits for care in a home that has been decertified. Second, although the regulations do protect patients by limiting the circumstances under which a home may transfer or discharge a Medicaid recipient, they do not purport to limit the Government's right to make a transfer necessary by decertifying a facility. Id. at 784, 100 S.Ct. at 2475 (emphasis added). That Court was also unpersuaded by the transfer trauma argument, even though they proceeded on the assumption that there was a risk that some residents could encounter severe emotional and physical hardship as a result of transfer. The assumed risk to life and liberty was an indirect and incidental result of the Government's enforcement action [and hence did] not amount to a deprivation of any interest in life, liberty or property. Id. The Court more fully explained: Medicaid patients who are forced to move because their nursing home has been decertified are in no different position for purposes of due process analysis than financially independent residents of a nursing home who are forced to move because the home's state license has been revoked. Both groups of patients are indirect beneficiaries of government programs designed to guarantee a minimum standard of care for patients as a class. Both may be injured by the closing of a home due to revocation of its state license or its decertification as a Medicaid provider. Thus, whether they are private patients or Medicaid patients, some may have difficulty locating other homes they consider suitable or may suffer both emotional and physical harm as a result of the disruption associated with their move. Yet none of these patients would lose the ability to finance his or her continued care in a properly licensed or certified institution . . . . The simple distinction between government action that directly affects a citizen's legal rights, or imposes a direct restraint on his liberty, and action that is directed against a third party and affects the citizen only indirectly or incidentally, provides a sufficient answer to all of the cases on which the patients rely in this Court. Id. at 787, 100 S.Ct. at 2476 (emphasis added). Therefore, no statutory or constitutional rights existed to prevent the transfer of the Town Court patients. Similarly in the instant proceeding, the appellants' decision to close Retreat imposes no direct restraint on the patients' life or liberty. That decision was made in the interest of the entire state-wide mental health program in order to maximize utilization of available resources. Exercising their statutorily imposed powers and duties, appellants have determined the transfers necessary to maintain adequate standards of treatment. [5] Objections to this determination should be voiced in the political arena. As noted in Mr. Justice Blackmun's concurring opinion in Town Court : The determinative question is whether the litigant holds such a legitimate claim of entitlement that the Constitution, rather than the political branches, must define the procedures attending its removal . . . Claims of entitlement spring from expectations that are justifiable, Vitek v. Jones, 445 U.S. 480, at 489, 100 S.Ct. 1254, at 1261, 63 L.Ed.2d 552 (slip op., at 7), protectable, Greenholtz v. Nebraska Penal Inmates, 442 U.S. 1, at 7, 99 S.Ct. 2100, at 2104, 60 L.Ed.2d 668; sufficient, Bishop v. Wood, 426 U.S. 341, at 344, 96 S.Ct. 2074, at 2077, 48 L.Ed.2d 684; or proper, id., at 362, 96 S.Ct. at 2085 (dissenting opinion). In contrast, the Constitution does not recognize expectancies that are unilateral, Board of Regents v. Roth, 408 U.S. 564, at 577, 92 S.Ct. 2701, at 2709, 33 L.Ed.2d 548, or too ephemeral and insubstantial. Meachum v. Fano, 427 U.S. 215, 228, 96 S.Ct. 2532, 2540, 49 L.Ed.2d 451 (1976). ..... Reason and shared perceptions should be consulted to define the scope of the claimant's justifiable expectations. Nor should constitutional policy be ignored in deciding whether constitutional protections attach. This approach not only permits sensible application of due process protections; it reflects the unremarkable reality that reasonable legal rules themselves comport with reasonable expectations. Id. at 796, 100 S.Ct. at 2481 (emphasis added). Mr. Justice Blackmun then identified several considerations leading him to conclude that a patient has no constitutional entitlement to residence in a particular facility. One of these considerations was that Town Court was the underlying source of the benefits the patients sought to retain. As Mr. Justice Blackmun notes: this fact is important, for the property of a recipient of public benefits must be limited, as a general rule, by the governmental power to remove, through prescribed procedures, the underlying source of those benefits. The Constitution would not have entitled John Kelly to a fair hearing if New York had chosen to disband its public assistance programs rather than to cut off his particular award. See Goldberg v. Kelly, 397 U.S. 254, 90 S.Ct. 1011, 25 L.Ed.2d 287 (1970). Nor would Texas have had to afford process to Professor Sindermann had it decided for budgetary reasons to close Odessa Junior College. See Perry v. Sindermann, 408 U.S. 593, 92 S.Ct. 2694, 33 L.Ed.2d 570 (1972). And we would be surprised to learn that Dwight Lopez had a constitutional right to procedures before the Ohio Department of Education suspended classes at Columbus High School for 10 days due to the discovery of faulty electrical wiring requiring that must time for repair work. See Goss v. Lopez, 419 U.S. 565, 95 S.Ct. 729, 42 L.Ed.2d 725 (1975). These observations comport with common understanding and shared expectations. A farmer may sue for conversion if his upstream neighbor improperly diverts his water. But both can only grumble if the spring rains cease and the river runs dry. Id. at 798, 100 S.Ct. at 2482 (emphasis added). So too in the within proceedings, those charged with assuring adequate mental health treatment throughout the Commonwealth have decided to eliminate one of the underlying sources of that treatment, Retreat State Hospital. Common understanding recognizes that particular facilities are not immune from deterioration and that they therefore will, at some point, outlive their usefulness. When that point is reached, it is reasonable for a patient to expect to receive adequate treatment somewhere-it is unreasonable to expect to receive it at that particular facility. We do not wish to seem callous to any risks of transfer trauma to which Retreat residents might be exposed. However, the record in the instant case leads us to the same conclusion reached by Mr. Justice Blackmun in Town Court : . . . the patients cannot establish that transfer trauma is so substantial a danger as to justify the conclusion that transfers deprive them of life or liberty. Substantial evidence suggests that transfer trauma does not exist, and many informed researchers have concluded at least that this danger is unproved. Recognition of a constitutional right plainly cannot rest on such an inconclusive body of research and opinion. Id. at 804, 100 S.Ct. at 2485 (footnote 13 omitted-emphasis added). As the Chancellor herein has made no findings of fact, it is unclear whether he found the risk of transfer trauma to be a real one, or whether his decision was based purely on section 207 of the Mental Health Procedures Act. Our review of the record, however, reveals substantial evidence that the fears of transfer trauma are largely unfounded. Several expert witnesses for the Commonwealth, including the superintendents for the receiving state facilities, testified as to the actual track record of prior transferees from Retreat. That track record contradicts that transfer risks asserted by appellees as justification for the preliminary injunction. The principal evidence offered by appellees to support their claims of transfer trauma danger was that of a Dr. Norman C. Bourestom, a Michigan psychologist. Dr. Bourestom visited Retreat for three days, studied the patients' histories and charts, then concluded that, based upon his research and findings of certain nursing home facilities, a substantial danger of transfer trauma, including lethal consequences, existed for Retreat patients. Dr. Bourestom testified the dangers of transfer trauma were significant only when the danger involved a radical change which occurs when there is a substantial change in (1) the staff, (2) the patient's peer group, (3) the program of treatment and (4) the physical environment. Dr. Bourestom then stated he felt the proposed transfers would involve a radical change. As Dr. Bourestom had never visited the receiving facilities, and as appellants' witnesses testified that, to the fullest extent possible, peers and staff would be relocated in the same wards and that the respective treatment programs and physical environments were similar, Dr. Bourestom's characterization of the proposed changes as radical is dubious, and is certainly contradicted by Retreats' prior experience. At any rate, here, as in Town Court, recognition of a constitutional right to remain in a particular facility cannot rest on such an insubstantial record concerning the dangers of transfer. For the foregoing reasons, the order of the Commonwealth Court is reversed and the preliminary injunction is dissolved. KAUFFMAN, J., did not participate in the consideration or decision of this case.