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.
The case may be found at the Judicial Branch website by going to(www.jud.state.ct.us/external/supapp/Cases/AROcr/CR275/275cr131.pdf).
The dissent may be found at(www.jud.state.ct.us/external/supapp/Cases/AROcr/CR275/275CR131E.pdf).
Filed in Tags: Medicaid
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