397 P.3d 285
Alaska2017Background
- Sunny Radebaugh, a Medicaid Home and Community‑Based Waiver recipient, had in‑home nursing waiver services terminated after a 2012 Consumer Assessment Tool (CAT) reassessment performed by nurse Karen Mattson concluded she no longer met nursing‑facility level‑of‑care criteria.
- The Department reviewed the CAT; internal and third‑party nurse reviews (Qualis Health) agreed with Mattson and the Department mailed a termination notice; Radebaugh requested a fair hearing.
- At the administrative hearing Mattson did not testify (she had left Alaska). Radebaugh presented her treating physician Dr. Erickson and her personal care aide Ella Savage, who testified that Radebaugh often needed weight‑bearing assistance for transfers and toileting and attended physical therapy.
- The ALJ credited Radebaugh’s witnesses and reversed the Department’s termination, giving weight to the absence of Mattson’s testimony. The Department, as final decisionmaker, rejected the ALJ’s proposed decision, reinstated the termination, and explained its reasoning in writing.
- The superior court first found a due‑process violation (lack of cross‑examination of Mattson) but on rehearing reversed and upheld the Department. Radebaugh appealed to the Alaska Supreme Court.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Radebaugh’s due‑process right to confront/cross‑examine the CAT assessor was violated | Radebaugh: absence of Mattson at hearing denied meaningful opportunity to challenge the CAT evidence | Department: plaintiff waived the objection by not timely objecting and treated Mattson’s absence as a weight issue; agency procedures preclude compelling Mattson | Waived — failure to object at hearing precluded appellate review; not plain error |
| Whether the Department permissibly overruled ALJ credibility findings | Radebaugh: reversal of the ALJ’s credibility findings requires heightened scrutiny and was inadequately justified | Department: as final decisionmaker may reject ALJ findings and provided reasons tied to CAT, internal and third‑party reviews, and Mattson’s observations | Upheld — substantial evidence supports Department and its written explanation adequately discernible |
| Whether substantial evidence supports termination of waiver services | Radebaugh: testimony of physician and caregiver shows need for intermediate nursing care (weight‑bearing transfers; PT present) | Department: CAT narrative, internal reviewer, and Qualis review show limited assistance and improved function inconsistent with nursing‑facility level | Substantial evidence supports termination; record not overwhelmingly contrary |
| Whether agency provided adequate explanation when reversing ALJ | Radebaugh: Department failed to explain why it rejected eyewitness testimony of treating providers | Department: identified CAT, multiple nurse reviews, and that ALJ gave excessive weight to Radebaugh’s witnesses; explained why it credited CAT evidence | Adequate — Department’s path reasonably discernible; explanation met review standards |
Key Cases Cited
- Shea v. State, Dep’t of Admin., Div. of Ret. & Benefits, 267 P.3d 624 (Alaska 2011) (describes substantial‑evidence review and deference to agency factfinding)
- Universal Camera Corp. v. Nat’l Labor Relations Bd., 340 U.S. 474 (U.S. 1951) (examiner credibility findings deserve special weight when agency disagrees)
- Sea Lion Corp. v. Air Logistics of Alaska, Inc., 787 P.2d 109 (Alaska 1990) (standards for preservation of issues and plain‑error review)
- Handley v. State, Dep’t of Revenue, 838 P.2d 1231 (Alaska 1992) (definition of substantial evidence review)