Opinion
2013-624
03-26-2013
In the Matter of the Application of United Health Services Hospitals, Inc., Petitioner, v. For a Judgment Requiring J.W., Respondent, To Discharge Herself Forthwith from United Health Services Hospitals, Inc.
Aswad & Ingraham, Charles O. Ingraham, Esq., counsel to Petitioner J. W., pro se
Aswad & Ingraham, Charles O. Ingraham, Esq., counsel to Petitioner
J. W., pro se
David H. Guy, J.
Petitioner, United Health Services Hospitals, Inc., filed a petition dated March 13, 2013, supported by an affidavit of counsel and a memorandum of law of the same date, seeking a judgment pursuant to New York Public Health Law § 2801-c requiring respondent, a patient at one of petitioner's hospitals, to discharge herself from the hospital and accept placement in an appropriate skilled nursing facility. Petitioner also requested the Court records be sealed pursuant to 22 NYCRR § 216.1.
An Order to Show Cause on the petition was issued on March 14, 2013 and the papers were duly served upon the petitioner and her husband the same day. The matter came before the Court for a hearing held in a conference room at the hospital on March 15, 2013, with appearances by the petitioner; counsel for petitioner, Aswad & Ingraham, Charles O. Ingraham, Esq, of counsel; the respondent; and respondent's husband and nephew. Respondent chose to act pro se. Testimony was given by Kathleen Dugo, the Nurse Care Manager for respondent's unit at the hospital, and by respondent. Respondent's family members were also given the opportunity to be heard.
FACTS
Respondent was admitted to the hospital on January 9, 2013, needing acute care for various medical conditions. Respondent was a patient at the hospital intensive are unit (ICU) for several days. When her condition stabilized, she was transferred to an acute care unit with a focus on respiratory care issues, on January 23, 2013.
Respondent continued to improve to the point that petitioner determined she no longer needed acute care in a hospital setting, but instead needed rehabilitation services, provided either in a skilled nursing facility, or potentially in a home setting, with appropriate aide support and training to family members. While respondent and her family deny recollection of these discussions with the respondent's representatives, the Court finds that respondent and her family were so advised.
Respondent's family initially indicated to the hospital that they would like to have respondent discharged to home. The family was advised they would need training in wound care services which respondent would continue to require at home. Shortly thereafter, the family expressed to the hospital that they did not think they were in fact able to appropriately care for respondent at home; they never sought or received the offered training.
The petitioner concluded that Medicare would no longer pay for respondent's hospital care because her necessary care could be provided at a lower level care setting (e.g. a skilled nursing facility). On February 7 and 8, 2013 petitioner advised respondent, orally and in writing, that she would be responsible for the cost of her continued care in the hospital and also advised her of her right to an independent review of the hospital's decision, to a Quality Improvement Organization (QIO).
An appeal was made by respondent, or on her behalf by her family, and her chart was forwarded to the QIO, Island Independent Peer Review Organization (IPRO). By written decision dated February 13, 2013, the IPRO confirmed the hospital's decision that respondent's continued stay in the hospital was not medically necessary. The IPRO decision includes notice of the patient's ability to request reconsideration of the decision. This was done by the respondent, or on her behalf by her family. The respondent's chart was again reviewed by a different reviewer at IPRO. That review also concluded hospital care was not medically necessary, and agreed with the hospital's proposed discharge plan in a written decision dated February 20, 2013. Petitioner had respondent evaluated by a neuropsychologist who concluded respondent was capable of making her own decisions with respect to her medical care. Respondent continued to refuse discharge and this petition ensued.
Until the filing of this petition, the respondent refused to even discuss discharge planning with the petitioner. At least two beds in a skilled nursing facility were located, but the respondent refused discharge to both. At the hearing, respondent indicated that she was not adverse to discharge, but only to any place other than her home. At the beginning of the hearing, respondent was advised by the Court of her right to retain counsel and chose to represent herself, pro se.
APPLICABLE LAW
New York Public Health Law § 2805-b provides for the admission to a hospital of patients who are in need of hospital services, without regard to the patient's ability to pay. Public Health Law § 2801-c authorizes the Supreme Court to enjoin violations of the Public Health Law and the regulations promulgated thereunder. Included in such regulations is 10 NY CRR § 405.9(f)(7), which provides that the discharge of a patient shall be carried out by written order of a physician that, in his or her judgment, the discharge will not create a medical hazard to the patient, or that the discharge is considered to be in the patient's best interests despite potential risks of movement - a safe discharge plan". Such a discharge shall only be made after explaining the need for discharge to the patient and to the patient's family or representative and prior notification to the medical facility expected to receive the patient.
DECISION
Ms. Dugo testified to the care received by the respondent through her course of admission at the hospital, and to the determination made by the hospital that respondent's inpatient care was no longer medically necessary. The hospital's written notice of non-covered continued stay and the two written IPRO appeal decisions were admitted into evidence. Ms. Dugo testified to discussions by her, and by other hospital staff under her direct supervision, with the respondent and her family regarding medical necessity and discharge issues. Ms. Dugo also testified that respondent's presence in an acute bed at the hospital had caused other patients in need of such a bed to be held for extended periods in the hospital emergency room. Over the period of the respondent's admission, the hospital was at a crisis census for acute care beds.
The petitioner seeks a mandatory injunction requiring the respondent to leave the hospital on the basis that she no longer requires acute hospital care and unreasonably refuses to cooperate with her safe discharge plan. A mandatory injunction is a proper remedy in a case such as this. New York Methodist Hospital v. EH, 25 Misc 3d 648 (Supreme Court, Kings County, 2009); Wyckoff Heights Medical Center v. Rodriguez, et al, 191 Misc 2d 207 (Supreme Court, Kings County, 2002).
A review of the relevant discharge guidelines in New York, as set forth in 10 NYCRR § 405.1, et seq, shows that they were meticulously followed in this case. Respondent received proper written notice of her discharge, which was based on her medical assessment by the hospital. Respondent was afforded the opportunity to appeal the discharge determination, which she in fact did twice. In each case, the petitioner's decision was upheld. Respondent refused to cooperate in any discharge planning before the hearing and at the hearing consented to discharge, but only to home, despite such a discharge being contrary to petitioner's proposed safe discharge plan, as upheld on appeal, and no evidence having been presented that respondent's family had received any of the required training which might afford respondent the ability to discharge to home. Respondent's actions deprived the public and other needy patients of a bed at the petitioner's hospital to meet their acute medical needs.
Petitioner has adequately demonstrated its need for an injunction to discharge respondent. Respondent must accept discharge to any skilled nursing facility which is willing and able to meet her various medical needs; or, having been found competent to make her own medical decisions, is free to exercise her right to discharge herself against medical advice. New York Methodist Hospital v. EH, supra; Wyckoff Heights Medical Center v. Rodriguez, et al, supra
Petitioner's application to seal the Court record is unopposed by respondent and is premised on a desire to keep respondent's confidential medical records private. The Court finds good cause to grant the application and directs the sealing of the record.
In furtherance thereof, it is hereby
ORDERED that Respondent, J.W., discharge herself from United Health Services Hospitals, Inc. forthwith, but no later than the time that arrangements have been made to transfer her to a skilled nursing facility in Broome County that has a bed available for her; and it is further
ORDERED that, good cause having been shown, the records of this proceeding be under seal and not open to the public; and it is further
ORDERED that the relief granted to Petitioner is granted without costs; and it is further
ORDERED that this Order shall not be construed to interfere with Respondent's right to discharge herself to home against medical advice.
Signed this 26 day of March, 2013, in Binghamton, NY.
Hon. David H. Guy
FILED: April 10, 2013