Court Opinion

ID: 9563917
Source: CourtListenerOpinion
Date Created: 2023-08-21 18:50:10.130769+00
Date Added: 2024-06-11T09:18:08.305099
License: Public Domain

STEELMAN, Judge,
dissenting.
I must respectfully dissent from the majority opinion. That opinion is grounded entirely upon the concept that, under the provisions of N.C. Gen. Stat. § 108A-79(k), the trial court was completely free to disregard the findings of fact made by the Hearing Officer for the Department of Health and Human Services and make its own independent findings of fact. I disagree with this analysis for several reasons.
Background
Contrary to the assertions of the majority opinion, there was sharply conflicting medical evidence presented to the hearing officer in this matter. The condition for which petitioner was hospitalized was not a new condition. She was hospitalized for this condition on several previous occasions, in 1999 or 2000, and again in 2002. Rather than returning to her country of origin and seeking treatment there, she remained in the United States. The episodes in October of 2004 and January of 2005 were triggered by petitioner’s not taking any of the medications prescribed for her during her last hospitalization.
Dr. Benjamin reviewed petitioner’s records and testified that, as to the first admission, there was no sudden onset of petitioner’s condition. Rather he found it to be a chronic illness and that only the first day of admission fit into the emergent criteria. The report of Dr. Mehta was also in evidence. He opined that all of the care of petitioner on the first admission, from 15 October 2004 through 29 *361October 2004, was necessary for the treatment of an “emergency medical condition as defined in the statute.” The hearing officer found a middle ground position that the emergency condition existed from 15 October 2004 through 21 October 2004.
As to the second admission, 17 January 2005 to 11 February 2005, Dr. Benjamin concluded that petitioner’s condition was not acute, but rather was chronic, and thus should not have been covered by Medicaid. Dr. DiNome disagreed, stating in his letter that the care of petitioner from 17 January 2005 to 11 February 2005 constituted a single course of treatment that was necessary for the treatment of “an emergency medical condition as defined in the statute.” The hearing officer ruled that none of this hospitalization was covered by Medicaid.
There was thus a clear and distinct conflict in the expert testimony of the medical witnesses as to whether the treatment of petitioner was covered under the provisions of 42 U.S.C. 1396b. There is evidence in the record to support either the position of the hearing officer or that of Judge Evans. The questions then presented are: who should make the determinations of credibility and weight that will resolve the case; what was the appropriate standard of review for the superior court; and what is the appropriate standard of review for this Court.
Standard of Review of Superior Court
The majority argues that the standard of review for the superior court under N.C. Gen. Stat. § 108A-79(k) is de novo and is controlled by this Court’s decision in Chatmon v. N.C. Dep’t of Health & Human Servs., 175 N.C. App. 85, 622 S.E.2d 684 (2005), disc. rev. denied, 360 N.C. 479,-S.E.2d-(2006). The majority attempts to distinguish the express holding found in the Supreme Court decision of Diaz v. Div. of Soc. Servs., 360 N.C. 384, 628 S.E.2d 1 (2006). I refuse to so blithely dismiss the holding of our Supreme Court.
In Diaz, the first issue addressed was the appropriate standard of review for. the courts in cases arising under the provisions of N.C. Gen. Stat. § 108A-79(k). The language used by the Supreme Court could not have been more clear and concise:
In cases appealed from administrative tribunals, we review questions of law de novo and questions of fact under the whole record test. See N.C. Dep’t of Env’t & Natural Res. v. Carroll, 358 N.C. 649, 659, 599 S.E.2d 888, 894-95 (2004).
*362Id. at 386, 628 S.E.2d at 2-3. It is for the Supreme Court and not the Court of Appeals to overrule decisions of our Supreme Court. Dunn v. Pate, 334 N.C. 115, 118, 431 S.E.2d 178, 180 (1993),
A whole record test review of findings of fact by an administrative agency is a deferential review. Carroll, 358 N.C. at 660, 599 S.E.2d at 895. If there is any evidence in the record to support the findings, they are binding on the courts, even though the courts, looking at the evidence anew, might reach a different result. Id. As noted above, there was evidence in the record supporting the hearing officer’s findings and decision. The application of the whole record test in this case required that the trial court affirm the decision of the hearing officer.

Chatmon v. N.C. Devartment of Health & Human Services

Even applying the tests set forth in Chatmon to the instant case, I believe that the majority has construed Chatmon far too liberally, and that a more restrictive interpretation of that case is appropriate. In Chatmon, this Court wrestled with the appropriate standard of review for the trial court under N.C. Gen. Stat. § 108A-79(k). The relevant portions of that statute state:
The hearing shall be conducted according to the provisions of Article 4, Chapter 150B, of the North Carolina General Statutes. The .court shall, on request, examine the evidence excluded at the hearing under G.S. 108A-79(e)(4) or G.S. 108A-79(i)(l) and if the evidence was improperly excluded, the court shall consider it. Notwithstanding the foregoing provisions, the court may take testimony and examine into the facts of the case, including excluded evidence, to determine whether the final decision is in error under federal and State law, and under the rules and regulations of the Social Services Commission or the Department of Health and Human Services.
N.C. Gen. Stat. § 108A-79(k) (2007). Aside from its reference to the Administrative Procedure Act (“APA”), the statute is silent as to the appropriate standard of review. Chatmon construed the provisions of N.C. Gen. Stat. § 108A-79(k), as follows:
The task of the. superior court in this case was not to determine whether a sanction was warranted on any basis, but rather whether the Department of Health and Human Services’ decision, and the basis upon which it relied, was legally and factually justi*363fied. While section 108A-79(k) authorizes a trial court to take testimony and reexamine the facts, this authorization is only “to determine whether the final decision [of the Department of Health and Human Services] is in error . . . .” N.C. Gen. Stat. § 108A-79(k) (emphasis added). . . . Section 108A-79(k) should not be read to authorize the trial court to rehear the case, make wholly new factual findings, and determine that alternative grounds not relied upon by the Department of Health and Human Services would also justify the sanction.
Id. at 90-91, 622 S.E.2d at 688. Chatmon also recites the well-established two-pronged test that appellate courts must follow in administrative appeals under the APA. First, the court shall determine whether the trial court, sitting as an appellate court, applied the correct standard of review, and, second, whether the trial court properly applied that standard. Id. at 89, 622 S.E.2d at 688. Neither Chatmon nor N.C. Gen. Stat. § 108A-79(k) explicitly grants the superior court the authority to engage in de novo review of the administrative agency’s findings.
In the instant case, the trial court did not hear any evidence that any party contended was improperly excluded, nor did it take any testimony. Thus, under Chatmon, its role was limited to whether the decision was “legally and factually justified.” Id. at 90, 622 S.E.2d at 688. This is not what the trial court did in this case. Rather, the trial court, based upon the identical evidence before the hearing officer, made its own independent findings of fact and reached a different conclusion of law. This was in direct contravention of the holding in Chatmon stating that the trial court was not authorized “to rehear the case [and] make wholly new factual findings.” Id. at 90-91, 622 S.E.2d at 688.
Conclusion
In Diaz, our Supreme Court adopted the test set forth in Greenery Rehabilitation Group v. Hammon, 150 F.3d 226 (2d Cir. 1998), which utilized a “stabilization” construction of the provisions contained in 42 U.S.C. § 1396b(v)(3). Emergency medical conditions under the statute are to be “sudden, severe, and short-lived physical injuries or illnesses that require immediate treatment to prevent further harm.” Diaz at 387-88, 628 S.E.2d at 4. The Supreme Court went on to state that “the role of the Court is not to sit as a super legislature and second-guess the balance struck by elected officials.” Id. at 389, 628 S.E.2d at 5 (citing State v. Bryant, 359 N.C. 554, 555, 614 *364S.E.2d 479, 486 (2005)). Our courts are to defer in this matter to the policy adopted by the United States Congress.
I would hold that the trial court erroneously made new findings of fact in this case and applied the wrong standard of review. The decision of the trial court should be reversed.