Court Opinion

ID: 9513194
Source: CourtListenerOpinion
Date Created: 2023-08-06 22:32:41.431714+00
Date Added: 2024-06-11T09:05:46.271587
License: Public Domain

MESCHKE, Justice,
dissenting.
The majority concludes Swanson has no standing to challenge the Bureau’s lack of compliance with statutorily directed procedures that affect the claimant’s rights. Because I believe the majority is wrong, I respectfully dissent.
The majority correctly describes how this question has been developed, but refuses to decide Swanson’s specific question whether “the Bureau’s practice of relying on its consultant’s recommendations [or] its practice of picking and choosing adverse medical opinions constitutes an established ‘system of peer review in cooperation with professional organizations of doctors and health care providers’ ” that is required by law.
Swanson was denied more chiropractic care for his 1980 back injury after April 25, 1993, because Workers Compensation/Casualty Services (WCCS) recommended the cessation of chiropractic care and an independent chiropractic examiner advised the Bureau further treatment was not “reasonably effective” to restore mobility and function. Both recommendations were made disregarding any need for palliative relief from pain. The Bureau expressly decided that WCCS’s and the independent examiner’s recommendations were a “form of peer review” under NDCC 65-05-07, a legal conclusion that Swanson contested without developing independent medical evidence. The majority decides the judicial branch should not review the Bureau’s decision about what constitutes “peer review,” and so reverses the district court’s conclusion that the “Bureau has not implemented the peer-review procedure required by N.D.C.C. Section 65-05-07(3).”
The majority interprets the statute to “not allow claimants to appeal adverse Bureau decisions on those matters” of “payment denials for unjustified treatments” by a “doctor or health care provider.” The claimant becomes the forgotten figure — his well-being may be affected by a workplace injury, but he has no way to do anything about it. Really, in this context of a dwindling compensation program that litigates more than compensates, a health care provider can question the lack of compensation for treatment but the person treated cannot? Orwellian!
*213A claimant is specifically entitled to appeal any adverse decision by the Bureau. NDCC 65-10-01 directs that, "... if the bureau allows the claimant to participate in the fund to a lesser degree than that claimed by the claimant, if such allowance is less than the maximum allowance provided by this title, the claimant may appeal....” Nothing in NDCC 65-05-07 suggests repeal or reduction of a claimant’s entitlement to judicial review. Under NDCC 1-02-07, a primary rule of statutory interpretation instructs us to construe related statutes to give full effect to each, rather than as conflicting or meaningless. See also NDCC 1-02-88: “[I]t is presumed that: ... 2. The entire statute is intended to be effective.” Also, as Birst v. Sanstead, 493 N.W.2d 690, 694-95 (N.D.1992) elaborates, an implied repeal of an existing statute is disfavored.
The Bureau’s regulations on “medical services disputes,” as amended effective January 1, 1994, purports to implement a “peer review system.” NDAC 92-01-02-47. Its companion procedural rule expressly recognizes the claimant’s standing as an aggrieved party for review of an adverse decision:
An aggrieved party is an employee, employer, or health care provider who raises a bona fide dispute.
NDAC 92-01-02-46(3). Further:
Any dispute that is solely a question of law is not subject to binding dispute resolution under this section. In such case, the bureau shall issue an administrative order. The sole remedy for an aggrieved party is appeal to the appropriate district court. A fact hearing may not be conducted in such case, absent order of a court.
NDAC 92-01-02-46(5)(c). I believe that this regulatory framework firmly fixes a claimant’s right to judicial review of the agency’s compliance with the peer review law.
Generally, an aggrieved party is entitled to judicial review of agency action. NDCC 28-32-15(1). As we pointed out in Shark v. U.S. West Communications, Inc., 545 N.W.2d 194, 198 (N.D.1996):
The over-arching concept of standing for justiciability has been explained by this court:
The question of standing focuses upon whether the litigant is entitled to have the court decide the merits of the dispute. It is founded in concern about the proper — and properly limited — role of the courts in a democratic society. Without the limitation of the standing requirements, the courts would be called upon to decide purely abstract questions. As an aspect of justiciability, the standing requirement focuses upon whether the plaintiff has alleged such a personal stake in the outcome of the controversy as to justify exercise of the court’s remedial powers on his behalf. The inquiry is two-fold. First, the plaintiff must have suffered some threatened or actual injury resulting from the putatively ille- . gal action. Secondly, the asserted harm must not be a generalized grievance shared by all or a large class of citizens; the plaintiff generally must assert his own legal rights and interests, and cannot rest his claim to relief on the legal rights and interests of third parties.
State v. Carpenter, 301 N.W.2d 106, 107 (N.D.1980) (citations omitted); see also Application of Otter Tail Power Co., 451 N.W.2d 95, 98 (N.D.1990) (quoting Duke Power Co. v. Carolina Envtl. Study Group, Inc., 438 U.S. 59, 80, 98 S.Ct. 2620, 2634, 57 L.Ed.2d 595 (1978)) (“The reasons for this limitation on standing are ‘the avoidance of the adjudication of rights which those not before the Court may not wish to assert, and the assurance that the most effective advocate of the rights at issue is present to champion them.’ ”).
Swanson is certainly the most effective advocate on whether appropriate peer review affecting his health has taken place.
In this case, the majority makes little or no effort to square its lack-of-standing conclusion with our existing standing jurisprudence. Unlike the situation in Vickery v. North Dakota Workers Compensation Bureau, 545 N.W.2d 781 (N.D.1996), which the majority refers to, Swanson has been denied health care services here as a result of the Bureau’s refusal to pay for peer review reasons. Vickery only feared a potential denial of services; Swanson has been denied ser*214■vices. I believe, therefore, the majority incorrectly uses the standing doctrine to dodge a difficult subject.
I share some of the majority’s hesitancy. I, too, doubt that the judicial branch can decide how “a system of peer review” should be established by the Bureau “in cooperation with professional organizations of doctors and healthcare providers.” The exact shape of a system of peer review is beyond the province of judges. In keeping with the constitutional separation of the judicial power from the executive power, the courts should not try to define exactly what a “system of peer review” is. Just as with many other responsibilities of an administrative agency, there is a potentially wide range of allowable executive action.
Still, as the district court recognized, the judicial branch has the duty to decide whether agency action complies with the law. See NDCC 28-32-19: “... the court must affirm the order of the agency unless it shall find that any of the following are present: 1. The order is not in accordance with the law_ 4. The rules or procedure of the agency have not afforded the appellant a fair hearing.” Little v. Tracy, 497 N.W.2d 700, 704 (N.D.1998) (quoting Moore v. North Dakota Workmen’s Compensation Bureau, 374 N.W.2d 71, 74 (N.D.1985)), summarizes the concept: “It is a’ basic rule of administrative law that an administrative regulation may not exceed statutory authority or supersede a statute, and that a regulation which goes beyond what the Legislature has authorized is void.”
Here, the district court reasoned:
The record does not disclose what efforts have been made by the Bureau to establish the system of peer review in cooperation with professional organizations of doctors and healthcare providers. There is no evidence in the record that the Bureau contacted or collaborated with North Dakota professional organizations of doctors and health care providers about the system. While the Court does not rule out the possibility that documentation of such collaboration may exist, given that compliance with § 65-05-07(3) is the sole issue on this
appeal, ... the inference can be drawn that such collaboration never took place.
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The legislature directed the Bureau to establish a mechanism or system for peer review. A “system” implies something more than the opinion of a doctor handpicked by the Bureau. At least, Dr. Las-kowski [, appearing before a legislative committee for the Bureau to endorse the enactment of NDCC 65-05-07(3),] contemplated a peer-review committee, rather than a review by a single professional or even a series of reviews by single professionals.
Bearing in mind that it was the unilateral nature of the reviews desired by the Bureau, but rejected by the legislature, which led to the adoption of N.D.C.C. Section 65-05-07(3) in the first place, it defies logic that WCCS is the “system” mandated by the legislature.
Because I agree with this reasoning and with the district court’s conclusion that “the process involved” in denying Swanson’s claim “was flawed,” and thus does not comply with the law, I would affirm the district court’s order reversing denial of Swanson’s claim and remanding to the Bureau for further proceedings consistent with the Bureau’s statutory duly to implement a system of peer review in cooperation with North Dakota professional organizations.
Therefore, I respectfully dissent.
MARING, J., concurs.