Opinion
No. C.A. 04A-11-005 PLA.
Submitted: March 18, 2005.
Decided: April 13, 2005.
On Appeal from a decision of the Division of Social Services.
REVERSED AND REMANDED.Kevin R. Shannon, Esquire, as Father and Guardian of Brian J. Shannon, Appellant.
A. Ann Woolfolk, Deputy Attorney General, Attorney For Appellee.
Memorandum Opinion
On Appeal from a decision of the Delaware Division of Social Services ("DSS" or "Agency"), the Court finds that the Agency deprived Appellant of constitutional due process rights when it terminated his benefits after misleading him about the grounds for the termination proceeding. The decision is therefore REVERSED AND REMANDED so that Appellant may receive and fair and equitable hearing regarding his disability entitlement.
Facts
Appellant Brian Shannon ("Brian") was born on May 7, 1998 with cystic fibrosis, a genetic, incurable breathing disorder that is progressive in nature and ultimately fatal. On April 21, 1999, DSS approved Brian's application for Medicaid benefits for disabled children, so that he could be treated by his parents at home rather than being institutionalized.
During the spring of 2004, DSS decided to review Brian's file to determine if he still qualified as a disabled child for Medicaid purposes. The Agency discovered that Brian lives life largely as a normal six-year-old, including attending school and playing sports with little or no difficulty. DSS therefore decided that Brian had improved such that he was no longer disabled within the criteria set out by the applicable Medicaid program, and terminated his benefits.
Brian, through his parents, demanded a hearing, which took place on September 17, 2004. In this hearing, Brian's treating physician, Dr. Chidekel, opined that his condition had not improved, and indeed could not as there are no curative treatments for cystic fibrosis, meaning that, with the best medicine currently available, Brian cannot improve, but must inevitably worsen and die. Dr. Chidekel further testified that he had cared for Brian since he was diagnosed, including before Brian was initially granted benefits in 1999, and that the child's condition has been functionally the same his entire life, i.e. that it is stable.
DSS presented the expert testimony of its director, Dr. Brazen. Dr. Brazen testified, in essence, that he did not know why Brian was originally approved for Medicaid, but that he assumes that decision was correct. In Dr. Brazen's opinion, however, Brian's condition has improved. The doctor noted that Brian has not needed to be hospitalized or have any abnormal or emergency treatments for years, functions as a normal boy his age, and is not "disabled" within the normal understanding of that term. Disturbingly, Dr. Brazen's testimony was plagued by misstatements, inaccurate assumptions, and admissions that other DSS personnel had made significant errors in reviewing Brian's case, even calling him "Joshua" in the form letter sent to his parents terminating his benefits.
The Hearing Officer, on behalf of DSS, issued its opinion on November 19, 2004, affirming denial of benefits. The Hearing Officer noted that the law does not require DSS to prove that Brian's condition has improved, but only that there is any good cause for terminating benefits. The Hearing Officer opined that "DSS is not stating that there has been an `improvement' in Brian's medical condition," but rather that, "environmental factors and changes in therapies [have] become available. Based on those changes . . . DSS re-evaluated Brian and found that he is not disabled under Social Security guidelines and does not require and institutional level of care at this time." The Officer further noted that the law has changed since Brian was approved for benefits in 1999, that Medicaid now requires a seven-factor test before giving disability benefits, and that Brian does not meet this test.
Appellant's Contentions
Brian promptly and properly appealed, bringing the case before this Court. He has raised numerous problems with the Hearing Officer's decision, which can be summarized into two main arguments. First, Brian argues, and DSS concedes, that the Agency had always stated that Brian's benefits were being terminated because his condition had improved. The Hearing Officer's statement that DSS was basing its termination on "other good cause" and not on "improvement" was therefore clearly erroneous. Brian argues that this error deprived him of due process because the termination letter only mentioned improvement, and both sides only argued about improvement at the Hearing, only to have the Hearing Officer duck the improvement issue to decide the case on change-of-law grounds that Brian had no chance to prepare for or rebut.
Second, Brian points out numerous misstatements and inaccurate assumptions made by Dr. Brazen in his initial decision to terminate Brian's benefits. Since Brian's due process reasoning is correct, the Court will not discuss the fact argument in any detail.
Standard of Review
The adequacy of the process afforded administrative litigants is a pure question of law that the Court reviews de novo. The Court reviews the Agency's findings of fact only to determine whether they are supported by substantial evidence.
See e.g. Lawson v. Department of Health and Social Services, 2004 WL 440405 at 5 (Del.Super.).
Id.
Discussion
Frankly, the Hearing Officer was plainly in error when he opined that "DSS is not stating that there has been an `improvement' in Brian's medical condition." The Court has plumed the extensive record of this case, and confirmed that DSS not only argued improvement, but that improvement was the only basis DSS offered for terminating Brian's benefits. From the initial termination letter, through all of Dr. Brazen's testimony, to DSS' closing argument, the Agency consistently stated that it believed that the initial disability determination had been correct, but that Brian had now improved to the point where he is no longer "disabled" under Medicaid's definition.There appears to be a dispute among the experts about whether "stabilization," from a point of not knowing whether a disease will rapidly deteriorate to a point of knowing that the same disease will deteriorate slowly, is "improvement" within the meaning of the Medicaid statute. If the Hearing Officer had decided that this "stabilization" is indeed "improvement," the Court would have given deference to the Agency's interpretation, and likely have upheld it. That, however, is not what happened. Instead, the Officer declined to rule on the grounds that the parties had argued, and instead utilized a new statute to decide Brian's case that even the Agency does not seem to think applies.
If the question could be decided simply by running Brian's file through the seven-part test in the new statute, the Agency probably would not have gone to the trouble to try to prove that Brian has improved, when his parents and physicians are adamant that he has not. It seems likely that there are grandfathering and due process issues involving the new statute that the Agency did not believe it could surmount in this case.
The Court could construct an extensive due process opinion to explain why Hearing Officer's ruling must be reversed, but it is not necessary to do so. The basic concerns of due process are notice, opportunity to be heard, and fundamental fairness. Brian and his family were notified that DSS believed that the child had improved and was therefore no longer disabled, and given a fair opportunity to argue that the Agency was wrong. They were not notified, because DSS never said, that a change in the law had made Brian ineligible for benefits, and they therefore had no chance to argue that his vested property right could not be taken away on that ground. To endorse the decision of Hearing Officer would therefore be a fundamentally unfair due process violation.
Remedy
The remedy for this due process violation is obvious. Brian must be given another hearing in which he may argue whether the Agency may remove his benefits because he does not meet the disability criteria in the new Medicaid statute. The new hearing should be strictly limited to that issue, which is basically a legal question, because adequate testimony on the "improvement" question has already been presented. The Hearing Officer must then issue a new opinion that addresses both the "improvement" originally cited by the Agency, and the change-of-law issues cited in his decision.
The Court offers no opinion of the factual sufficiency of DSS' evidence at this time.