Case:
Scewczyk v. Department of Social Services 275 Conn. 464 (2005)
Medicaid :
Connecticut Supreme Court
September 20, 2005
In
an extremely important decision, the Connecticut Supreme Court tackled
the difficult issue of what exactly constitutes an "emergency medical
condition" under federal Medicaid law and state social services
policy. While the ultimate question of what in general constitutes
an emergency medical condition still remains somewhat ambiguous,
the question of whether treatment of acute myelogenous leukemia
("AML") is now a settled one - answered in the positive in this
thoughtful but split decision.
The
case involved the plaintiff, a native of Poland, who overstayed
his temporary visa and was diagnosed with AML in November 1998.
His primary care physician immediately admitted him into Stamford
Hospital on November 24, 1998, where he received treatment consisting
of chemotherapy and biopsies until his discharge on December 26,
1998. As a result, he incurred hospital charges totaling over $82,000.
Mr.
Scewczyk filed an application with the state Department of Social
Services ("DSS") requesting payment for the charges, and subsequently
DSS denied the application, a decision which was later affirmed
in an administrative fair hearing by a DSS hearing officer. Despite
the absence of any medical evidence to the contrary the hearing
officer determined that Mr. Scewczyk didn't suffer from an emergency
medical condition and therefore was not eligible for benefits. The
plaintiff's appeal to Superior Court was for naught, as the trial
court affirmed the decision based on the explanation of what constitutes
"emergency medical condition" from the landmark second circuit case
of Greenery Rehabilitation Gp. V. Hammon, 150 F.3d 226 (2d
Cir. 1998), expounding on the premise that anything short of the
plaintiff's death on the date of admission precluded coverage for
medical services, a finding that the appellate court later affirmed.
The
Supreme Court reversed the lower courts findings based on its interpretation
of Greenery. Concluding that the appellate court misapplied
Greenery, the Court indicated that the operating statute,
42 U.S.C. § 1396b(v)(3) must be applied in a way that provides for
coverage to "acute, rather than chronic symptoms." Greenery
(citation omitted). Borrowing from sister states (including similar
cases from Arizona and North Carolina), Justice Norcott opined that
chemotherapy - including all modules of treatment provided to Mr.
Scewczyk, constituted acute, life saving treatment that was analogous
to organ transplantation, a specific treatment provided for under
42 U.S.C. § 1396b. Here, Mr. Scewczyk suffered from intense pain,
nausea, weakness, and was literally hours away from death. The full
course of chemotherapy provided the only method to save his life,
and despite his illegal immigration status, his medical condition,
namely the AML, satisfied the formerly undefined test of what exactly
an emergency medical condition is.
In
a vigorous dissent, Chief Justice Sullivan, joined by Justice Zarella,
indicated the majority's use of Greenery as the guiding principle
to interpret the federal statute was both "unworkable and incorrect."
His preferred interpretation involved the use of the 1986 Emergency
Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd,
which governs emergency care and treatment to anyone who walks into
a hospital. Using Greenery as a guidepost for defining "emergency
medical condition" would result in terrible consequences and serve
to usurp EMTALA's breadth and jurisdiction.
