208 Conn. 187 | Conn. | 1988
The central issue in this appeal is whether a litigant is collaterally estopped from rearguing an issue that was adversely decided in an administrative proceeding not subject to judicial review. The plaintiffs, Convalescent Center of Bloomfield, Inc., and Maple View Manor, Inc., brought an administrative action pursuant to General Statutes § 17-314
There is no dispute about the relevant facts. The plaintiffs operate nursing homes that are provider par
The plaintiffs elected to pursue this disagreement by first seeking relief with regard to their Medicare reim
After they had exhausted their federal Medicare remedies, the plaintiffs requested a rehearing on their Medicaid reimbursements for their rental expenses. The defendant refused to consider the merits of the plaintiffs’ claim, ruling instead that the plaintiffs were collaterally estopped from pursuing a Medicaid rate
The trial court upheld the plaintiffs’ appeal from the defendant’s decision and remanded for an administrative hearing on the merits. The court concluded that collateral estoppel was inappropriate in light of the absence of an opportunity for judicial review of the HCFA decision. The validity of this conclusion is the only issue that the defendant has raised in its appeal.
I
Before we reach the collateral estoppel issue, we must decide whether this appeal is properly here. Because the trial court ordered a remand of this case for further administrative proceedings, we must inquire into the possibility that there has not as yet been a final judgment. “Under the Uniform Administrative Procedure Act, General Statutes § 4-166 et seq., further appellate review of superior court rulings on administrative appeals is limited to cases in which the Superior Court has rendered a final judgment. General Statutes § 4-184. That statutory provision accords with the general proposition that, except in special cases, such as appeals upon reservations; State v. Sanabria, 192 Conn. 671, 681-85, 474 A.2d 760 (1984); or upon certification pursuant to General Statutes § 52-265a; Laurel Park, Inc. v. Pac, 194 Conn. 677, 678-79 n.1, 485 A.2d 1272 (1984); the jurisdiction of this court is restricted to appeals from judgments that are final. General Statutes § 52-263; Practice Book § 3000 (now § 4000); Melia v. Hartford Fire Ins. Co., 202 Conn. 252, 255, 520 A.2d 605 (1987); Doublewal Corporation v. Toffolon, 195 Conn. 384, 388-89, 488 A.2d 444 (1985).” Schieffelin & Co. v. Department of Liquor Control, 202 Conn. 405, 408-409, 521 A.2d 566 (1987).
In Schieffelin & Co., we held that administrative appeals are governed by the rule of State v. Curcio, 191
In resolving that question in Schieffelin & Co. v. Department of Liquor Control, supra, 410, we found it helpful to inquire into whether the administrative ruling “is in some fashion incomplete and therefore not ripe for final adjudication.” Schieffelin & Co. involved an attempt by the plaintiff to terminate liquor distributorships, in accordance with the requirements of General Statutes § 30-17 (a) (2) (B), by sending written notices setting forth “just and sufficient cause.” The administrative agency had denied the plaintiff relief on the ground that its notice was procedurally inadequate, without determining whether the plaintiff had sustained its burden of establishing good cause for the terminations. The trial court, sustaining the plaintiff’s appeal with regard to the procedural adequacy of its notice, remanded for administrative adjudication of the issue of good cause. We held that, in the absence of a complete adjudication of the plaintiff’s right to terminate the distributorships, the trial court’s interlocutory ruling was not an immediately appealable final judgment. Id., 411-12.
Schieffelin & Co. distinguished the administrative ruling that “is in some fashion incomplete”; id., 410; from one involving a final resolution of an issue that is ripe for appellate judicial review. For the latter category,
In the circumstances of the present case, we view the issue of collateral estoppel as ripe for immediate appellate review. Further proceedings on the substantive merits of the plaintiffs’ claim for rental reimbursement cannot affect the rights of the parties with respect to collateral estoppel. Indeed, to postpone appellate review and to require further exhaustion of administrative remedies would defeat the very purpose that collateral estoppel is intended to serve. “[T]he basic proposition . . . has always been essentially the same: A party should not be allowed to relitigate a matter that it already had opportunity to litigate.” F. James & G. Hazard, Civil Procedure (3d Ed. 1985) p. 589. If the defendant is correct that the plaintiffs are precluded from relitigating their entitlement to reimbursement, it would be unfair to require the defendant to expend its resources to defeat the plaintiffs’ claims on the merits. We have held an interlocutory order to be final for purposes of appeal if it involves a claimed right “ ‘the legal and practical value of which would be destroyed if it were not vindicated before trial.’ ” State v. Powell, 186 Conn. 547, 553, 442 A.2d 939, cert. denied sub nom. Moeller v. Connecticut, 459 U.S. 838, 103 S. Ct. 85, 74 L. Ed. 2d 80 (1982), quoting United States v. MacDonald, 435 U.S. 850, 860, 98 S. Ct. 1547, 56 L. Ed. 2d 18 (1978); State v. Curcio, supra, 34. In
II
Whether access to judicial review is a necessary precondition to administrative collateral estoppel is a matter of first impression. As a general proposition, the governing principle is that administrative adjudications have a preclusive effect when “the parties have had an adequate opportunity to litigate.” United States v. Utah Construction & Mining Co., 384 U.S. 394, 422, 86 S. Ct. 1545, 16 L. Ed. 2d 642 (1965). That standard was met, in Utah Construction & Mining Co., because “the factual disputes resolved were clearly relevant to issues properly before [the administrative agency], and both parties had a full and fair opportunity to argue their version of the facts and an opportunity to seek court review of any adverse findings.” (Emphasis added.) Id. Subsequent cases that have relied on Utah Construction & Mining Co. to apply the doctrines of collateral estoppel and res judicata to the decisions of administrative agencies have involved parties who in fact had access to judicial review. See, e.g., University of Tennessee v. Elliott, 478 U.S. 788, 106 S. Ct. 3220, 3227, 92 L. Ed. 2d 635 (1986); Kremer v. Chemical Construction Corporation, 456 U.S. 461, 480-84, 102 S. Ct. 1883, 72 L. Ed. 2d 262 (1982); Kirkland v. Peekskill, 828 F.2d 104, 109 (2d Cir. 1987); Yancy v. McDevitt, 802 F.2d 1025, 1030 n.3 (8th Cir. 1986); Plaine v.
The Restatement of Judgments mirrors the indeterminacy of the prevailing case law. The most directly relevant section is § 83, which provides, in the black letter, that “a valid and final adjudicative determination by an administrative tribunal has the same effects under the rules of res judicata, subject to the same exceptions and qualifications, as a judgment of a court.”
The defendant maintains that Connecticut law has established that the availability of judicial review is not an absolute prerequisite to collateral estoppel in the analogous context of arbitration awards. The defendant reminds us that in Corey v. Avco-Lycoming Division, 163 Conn. 309, 318, 307 A.2d 155 (1972), cert. denied, 409 U.S. 1116, 93 S. Ct. 903, 34 L. Ed. 2d 699 (1973), we declared that “a decision of an administrative board, acting in a duly authorized judicial capacity, is a prior decision within the rule of res judicata.” We agree with the defendant that Corey established the principle that an administrative adjudication may give rise to res judicata or collateral estoppel. For two independent reasons, we do not, however, agree that Corey decided that judicial review is irrelevant to administrative collateral estoppel.
We can draw only limited guidance from Corey with regard to the significance of judicial review because the arbitration decision to which Corey gave preclusive effect was not a decision entirely outside of the realm of judicial oversight. While judicial scrutiny of arbitral determinations is severely limited by the terms of General Statutes § 52-418; East Hartford v. East Hartford Municipal Employees Union, Inc., 206 Conn. 643, 650-56, 539 A.2d 125 (1988); O & G/O’Connell Joint Venture v. Chase Family Limited Partnership No. 3, 203 Conn. 133, 145-48, 523 A.2d 1271 (1987); it is not entirely nonexistent. See, e.g., Stratford v. Local 134, IFPTE, 201 Conn. 577, 585-86, 519 A.2d 1 (1986).
In this case, the plaintiffs had no choice about the administrative route that they were required to pursue in order to obtain review of their claims for Medicare rental reimbursement. That route afforded them no judicial review of any sort. Further, that route was compulsory with respect to Medicare, even though the plaintiffs had other alternatives for pursuit of their Medicaid claims; we do not agree with the defendant that this route became less compulsory because the plaintiffs might have elected first to pursue their Medicaid claims, for which judicial review is available.
The defendant maintains that we should nonetheless preclude the plaintiffs from relitigating their rental reimbursement claims because the Medicare hearing, apart from the unavailability of judicial review, met the requirements of due process. The defendant reminds us that the plaintiffs have not alleged that the HCFA decision is void for lack of subject matter jurisdiction, was not based on substantial evidence or violated any procedural requirements of fundamental fairness. In effect, the defendant maintains that unless the plaintiffs are prepared to mount a collateral attack on the validity of the HCFA decision, they are collaterally estopped from relitigating the issues therein determined. We are not persuaded that this is a trade-off that serves the interests of jurisprudence.
Collateral attacks on judgments are disfavored. Department of Health Services v. CHRO, 198 Conn. 479, 487-89, 503 A.2d 1151 (1986); Cologne v. Westfarms Associates, 197 Conn. 141, 147, 496 A.2d 476 (1985); Monroe v. Monroe, 177 Conn. 173, 177, 413 A.2d 819, appeal dismissed, 444 U.S. 801, 100 S. Ct. 20, 62 L. Ed. 2d 14 (1979). Unless a litigant can show an absence of subject matter jurisdiction that makes the prior judgment of a tribunal entirely invalid, he or she must resort
For these reasons, we conclude that it would be inappropriate to denominate a judgment as conclusive for collateral estoppel purposes and yet to invite collateral attack on the merits of such a conclusive judgment. The recurrent theme in our collateral attack cases is that the availability of an appeal is a significant aspect of the conclusiveness of a judgment. We are persuaded that, without the availability of judicial review, neither the decision of an administrative agency nor that of a court is ordinarily entitled to be accorded preclusive effect in further litigation. We do not need to decide today what forms of judicial review may suffice to provide the needed judicial scrutiny of administrative adjudications, or whether preadjudication waiver may dispense with the need for access to judicial review. See, e.g., Orselet v. DeMatteo, 206 Conn. 542, 539 A.2d 95 (1988). The circumstances of the present case persuade us, as they did the trial court, that the absence of judicial review of the plaintiffs’ Medicare claims significantly undermined the conclusiveness of that administrative adjudication and the plaintiffs therefore are
There is no error.
In this opinion the other justices concurred.
General Statutes § 17-314 provides in relevant part: “rates of payment TO CHRONIC AND CONVALESCENT HOSPITALS, REST HOMES, HOMES FOR THE AGED AND RESIDENTIAL FACILITIES FOR THE CARE OF THE MENTALLY RETARDED. REGULATIONS. RECOVERY OF EXCESS PAYMENTS, (a) The rates to be paid by or for persons aided or cared for by the state or any town in this state to licensed chronic and convalescent hospitals, rest homes with nursing supervision and to licensed homes for the aged, as defined by section 19a-490, and to residential facilities for the mentally retarded which are licensed pursuant to section 19a-467 and certified to participate in the Title XIX Medicaid program as intermediate care facilities for the mentally retarded, for room, board and services specified in licensing regulations issued by the licensing agency shall be determined annually, except
The Medicare claim of the named plaintiff amounted only to $5081 and that of Maple View Manor, Inc., amounted only to $2899.
“[42 U.S.C.] § 139500 PROVIDER REIMBURSEMENT REVIEW BOARD
“(a) Establishment
“Any provider of services which has filed a required cost report within the time specified in regulations may obtain a hearing with respect to such cost report by a Provider Reimbursement Review Board (hereinafter referred to as the ‘Board’) which shall be established by the Secretary in accordance with subsection (h) of this section, if—
“(1) such provider—
“(A) is dissatisfied with a final determination of the organization serving as its fiscal intermediary pursuant to section 1395h of this title as to the amount of total program reimbursement due the provider for the items and services furnished to individuals for which payment may be made under this subchapter for the period covered by such report,
“(B) has not received such final determination from such intermediary on a timely basis after filing such report, where such report complied with the rules and regulations of the Secretary relating to such report, or
“(C) has not received such final determination on a timely basis after filing a supplementary cost report, where such cost report did not so comply and such supplementary cost report did so comply,
“(2) the amount in controversy is $10,000 or more, and
“(3) such provider files a request for a hearing within 180 days after notice of the intermediary’s final determination under paragraph (1) (A) or with respect to appeals pursuant to paragraph (1) (B) or (C), within 180 days after notice of such determination would have been received if such determination had been made on a timely basis.”
This distinction is emphasized in comment (a) to § 28 of the Restatement of Judgments. Comment (a) starts out by noting that “the availability of review for the correction of errors has become critical to the application of preclusion doctrine.” It goes on to state that the unavailability of judicial review has significance “only when review is precluded as a matter of law . . . [and not] where review is available but is not sought.” 1 Restatement (Second), Judgments (1982) § 28, comment (a), p. 274.
Judicial review of adverse determinations with respect to Medicaid is provided in this state by General Statutes § 4-183, which provides: “appeal to superior court, (a) A person who has exhausted all administrative remedies available within the agency and who is aggrieved by a final decision in a contested case is entitled to judicial review by way of appeal under this chapter, provided, in case of conflict between this chapter and federal
The holding in Johnson Co. v. Wharton, 152 U.S. 252, 256-57, 14 S. Ct. 608, 38 L. Ed. 429 (1894), upon which the defendant relied in oral argument, does not persuade us to the contrary. Subsequent United States Supreme Court cases have not relied on Johnson Co. and, in any case, it does not bind us as a matter of Connecticut law.