*1 987A.2d 681 E.D.B., person, by through incapacitated D.B. J.R.B., Jr., Court-Appointed Guardians of the
&
Estate and Person of E.D.B. Community Hospital, Corporation. Gerald CLAIR and Centre Appeal Pennsylvania, of Commonwealth of
Department of Public Welfare.
Supreme Pennsylvania. Court of
Argued May 2009.
Decided Dec. *2 Welfare, Warshaw, Department Public Jason Allen C. Manne, Dees, B. PA Public Department Lisa William Welfare, of Public for Welfare. Pennsylvania Department P.C., for Hilko, Perry, Pittsburgh,
Paul A. Rosen Louik & J.R.B., E.D.B., through D.B. & Jr. person, an Incapacitated Bluth, McCormick Law Pittsburgh, K. Brian J. Vey, Paul Firm, Community Hospital. for Center Williamsport, Edelstein, Hill, Badowski, Camp Margolis
Michael M.
Gerald Clair. *3 Becker, Kline & Specter, Lyman Specter, Charles
Shanin P.C., for Amicus Curiae. Philadelphia, CASTILLE, EAKIN, BAER, C.J., SAYLOR,
BEFORE: McCAFFERY, GREENSPAN, TODD, JJ.
OPINION Justice McCAFFERY. in the Pennsylva- issue case is whether
The presented (hereinafter “DPW”) can of Public Department nia Welfare expendi- from a tortfeasor for Medicaid obtain reimbursement when claim made behalf of a disabled minor tures on the statute of by parents by the minor’s is barred therefor can such reim- conclude that DPW obtain limitations. We bursement, the of the Superi- reverse decision accordingly and or Court. (hereinafter 11, 1985, was born on “Emily”)
E.D.B. October Nearly mental disabilities. suffering physical from severe and later, by through in and years Emily, eighteen August (hereinafter J.R.B., D.B. and Jr. guardians, and parents Hos- Bowmasters”), Community filed Centre “the suit born, pital, Emily where was attending physician, and an alleging that their wаs negligence proximate the cause of Emily’s complaint disabilities. The specifically alleged, inter alia, “has been forced expend sums of money for physicians, hospitals, personnel, home paramedical care attendance, medications and other necessary items for her proper care and treatment and be may forced expend similar sums for like items in future” the and that her “earning capacity has been gravely permanently im- paired.” Complaint at 8-9. The parties negotiated reached a settlement, the a petition Bowmasters filed for leave to 31, 2006, settle an incapacitated person’s case. On August the settlement, court of pleas approved common the which includ- ed the special establishment of a needs for Emily.1 trust
Because had been medical receiving assistance bene- through fits program, Medicaid the Bowmasters notice to of their required DPW suit March by 1409(b)(5). statute. See 62 P.S. DPW with responded statement of claim a lien asserting on award settlement resolving litigation, in the amount that had expended Emily’s case, for medical care. In order settling pleas accepted court common propоsal Bowmasters’ $56,517.81 DPW) (the ultimately sought amount aside, settlement be pending set a determination of the exact necessary amount to satisfy DPW’s lien.2 Following further briefing lien, issue of DPW’s the court ordered the special trustee of needs Emily’s trust reimburse DPW in $56,517.81 expenses. full amount Court, appealed Superior *4 Bowmasters to the which remanded, holding reversed and that DPW could be reim- paid bursed for those medical on expenses behalf granted Community Hospital's 1. The trial court also Centre motion to relating Community Hospital seal record to the settlement. Centre record, portions filed a motion in this seal appellate Court to 7, granted April which we on $86,092.53 initially Emily's 2. DPW spent determined that it had care, $79,193.12. subsequently but down revised amount pleas amount be final common court ordered to set aside attorneys’ proportionate reflected deduction for fees and costs. Clair, she reached the age majority. Bowmaster v. after 86, 933 A.2d 91-92 (Pa.Super.2007). The Superior Court’s reasoning law, was as follows: Pennsylvania Under common claim for expenses medical a minor because of personal injury rests with the parents, minor’s not with the minor herself. See Hathi v. Krewstown Park Apartments, 613, (1989). 385 Pa.Super. 1261, However, A.2d in complаint filed, when the was the Bowmasters were legally barred from seeking reimbursement for medical ex penses incurred during Emily’s minority because the statute of limitations for Bowmaster, such a suit expired. had supra at 88-89. Although Emily could pursue a claim for medical in claim, her own right, law, such a under common would be necessarily limited to expenses incurred she after Thus, reached the age majority. Id. the Superior Court concluded, the instant litigation could not have resulted award or settlement that included the medical expenses Emily had incurred while minor, she was a and accordingly DPW could not satisfy its lien for Medicaid benefits paid during Emily’s minority from the settlement. sought allowance appeal Court, from this which we
granted issues, on the following as stated by DPW:
a. Where a minor child’s estate may be legally pay liable to medical expenses resulting from an injury, can the child sue the tortfeasor for reimbursement of those medical ex- penses?
b. Did the Pennsylvania Legislature intend to permit a minor receiving assistance to sue a tortfeasor for medical expenses 1409(b)? when it enacted 62 P.S.
c. Is a minor child a “beneficiary” medical assistance as 1409(b)(13)? defined in 62 P.S. Clair, (2008).
Bowmaster v.
598 Pa.
78 Act, 1 be Pa.C.S. guided by Statutory must Construction Grim, Advance, §§ Inc. v. 599 Pa. Jersey 1901-91. See Penn 682, (2009); 584, Youngwood v. Borough 962 A.2d 635 of Board, 603, Pa. Prevailing Wage Appeals 596 Pennsylvania (2008). 724, have summarized the recently 947 A.2d 730 We as follows: principles statutory interpretation relevant object and construction of all statutes interpretation the intent of the is to ascertain and effectuate General 1921(a). of a § 1 Pa.C.S. When words Assembly. See their ambiguity, plain statute are clear and free from all the best indication of intent. language generally legislative A court should resort to other considerations to reviewing determine intent when words legislative 1921(b). are not 1 explicit. statute Pa.C.S.
[*] [*] [*] Moreover, legislative it in determining is axiomatic intent, a must be and in together all sections of statute read other, conjunction with each and construed with reference to the entire statute. y (internal Advance, at 635-36 citations supra
Penn Jerse omitted). lead to reading
If we must avoid a would possible, statutes or between individual conflict between different Authority County of a statute. parts single Housing Commission, 556 State Civil Service Pennsylvania Chester (1999). we must Finally, presumе Pa. 730 A.2d 946 statute, intend Assembly the General enacting any that when interest. against any private ed to favor the interest as public Board Appeal Compensation v. Workers’ Corporation Vitac (2004) (Rozanc), Pa.574, 1 Pa.C.S. (citing 854 A.2d 485 578 1922(5)). in the instant case is Fraud The statute at issue Act, variety of matters Abuse which addresses Control Medicaid, which provides to the Medicaid relating program. care for those who of medical joint funding federal and state between the states cooperation to pay, requires cannot afford Department Arkansas government. and the federal See Ahlborn, 268, 275, Human Services v. U.S. Health and (2006); 1752, 164 Title XIX of Social L.Ed.2d 459 S.Ct. *6 is Act, each state Although § 42 1396-1396v. Security U.S.C. Medicaid development in the of its allowed discretion broad must to federal a state funding in order maintain program, conditions, an to seek including obligation of a number satisfy a Medic that are liable for from third parties reimbursement Ahlborn, 275-77, supra aid medical recipient’s expenses. (a)(25)(B), 1396a(a)(25)(A), §§ 42 (citing 126 1752 U.S.C. S.Ct. (a)(25)(H), 1396(k)). to § and This federal mandate led the the and Abuse Act. enactment of Fraud Control Shaffer- 500, 506 Welfare, Doan Public 960 A.2d Department of (Pa.Cmwlth.2008) 152 Hospital, Miller v. Lankenau (quoting (1992)). 1197, 1198 Pa.Cmwlth. A.2d Medicaid, DPW, is the state that administers agency charged responsibility with the of from liable third recovering under the parties provided the reasonable value of benefits 1409(b)(1). 201; § § A program. recipient 62 P.S. 62 P.S. benefits, assistance, by medical the act of such accepting to assigns “by operation rights to DPW of law or [his her] support, specified by recover a court as for care, payment of medical medical care payment 1404(b). § from third set forth in the any party.” 62 P.S. As statute, a benefits are or will be provided “[w]hen beneficiary injury under section because an for which liable, ... is an is liable person another or for which insurer person right [DPW] have the to recover from or shall such provided.” 62 insurer the reasonable value of benefits so 1409(b)(1) added). (emphasis § P.S.
The Fraud and Abuse Act that DPW contemplates Control beneficiary initiate a suit or claim to recover may and/or At the person from a third insurer. liable or DPW, an such request attorney general may bring beneficiary. action in the name of or of the 62 P.S. 1409(b)(1). beneficiary brings § or the When either DPW insurer, a or then DPW or against person action or claim third the action or give must notice to other of beneficiary 1409(b)(5). beneficiary may DPW or the claim. 62 P.S. become an action the other at party brought by any time 1409(b)(5)(v). However, before trial on the facts. P.S. as a general practice, by DPW has sought reimbursement lien on asserting any judgment, award, or settlement. This 1409(b) practice set forth in subsection of the Fraud and Act, Abuse Control which provides part relevant as follows: award, ... in the event of or settlement in judgment, a suit against or claim such party third or insurer: (i) If the action or claim is prosecuted beneficiary alone, the court paid [ ] shall first order from judgment or litigation award reasonable After expenses.... pay- fees[,] ment of such expenses and the court attorney’s [] shall, [DPW], on the application allow as a first lien judgment award, the amount such *7 expenditures amount of the for the benefit of the benefi- ciary under the medical assistance program. 1409(b)(7)(i) added). § 62 P.S. (emphasis Act, Another of provision the Fraud and Abuse Control see 1409(b)(ll), 62 P.S. some the for particulars addresses of a satisfaction lien: act, notwithstanding
Except as otherwise in provided this any provision law, any other the entire amount of injured claim, settlement of the beneficiary’s action or with suit, subject or to [DPW’s] without claim for reimburse- any ment of the benefits lien filed pursuant there- to, no event but in shall claim exceed one-half of [DPW’s] beneficiary’s recovery deducting attorney’s after for fees, costs, litigation and expenses relating for injury paid by beneficiary. 1409(b)(ll) added). verbatim;
62 (reproduced emphasis P.S. 1409(b)(ll) limitation required qualifi Subsection some and cation after the United Ahlb Supreme States Court decided orn, Ahlborn, in 2006. In court considered supra, high 1409(b)(ll), that, an similarly Arkansas statute to subsection agency allowed a state lien Medicaid benefits be satis settlement, entirety judgment, fied from the of a or award. Court, As Arkansas explained Supreme “claim[ed]
81
just
to more than
of a
or
portion
judgment
entitlement
represented] payment
expenses;”
settlement that
for medical
fact,
in
claimed a
to recover all of the funds
right
the state
beneficiary’s
that it
on a Medicaid
behalf even if
expended
had
that amount
allocated in the settlement
exceeded
monies
Ahlborn,
278-79,
for medical costs.
U.S.
S.Ct.
Thus,
statute,
under the Arkansas
the state’s lien for
entirety
Medicaid
could be satisfied in its
from
reimbursement
tortfeasor,
when,
beneficiary’s
settlement with the
even
so,
portions
do
those
of the settlement allocated for other
lost
had to
types
damages, e.g.,
wages
pain
suffering,
Supreme
be diverted to the state’s lien. The United States
provision
Court concluded
of the Arkansas statute
in
third-party liability
had “no
the federal
provisions,
in
squarely
fact
conflicts with the anti-lien
provision
federal Medicaid laws.”4 Id. at
1752. The
S.Ct.
Supreme
that a
accordingly
Court
held
state’s lien for Medic
aid
could be
expenditures
portion
satisfied
from that
settlement that represented payments for medical care. Id. at
282,
4. The anti-lien of the federal Medicaid statute to which the high provides, part, court referred as follows: (a) Imposition against property of lien of an individual on account of plan[.] medical assistance rendered to him under a Slate (1) may imposed against property No lien be individual prior paid paid to his death on account of medical assistance or to be plan, except— on his behalf under the State (A) pursuant judgment to the of a court on account of benefits incorrectly paid on behalf of such individual^] *8 Ahlborn, 1752). § 1396p (quoted supra 42 U.S.C. in at 126 S.Ct. Recognizing that Ahlborn necessitated some limitation subsection 1409(b)(ll), 1409.1, Assembly our General enacted Section effective 2, 2008, September provides part following: which in relevant (a) department’s recovery To the extent that Federal law limits the portion
medical assistance reimbursement to the medical of a benefi- ciary's judgment, against award in a or settlement claim third party, provisions apply. of dtis section shall (b) judgment, In the event of in award or settlement a suit or claim against (1) party a third or insurer: alone, prosecuted by beneficiary If the action or claim is paid any judgment court shall first order from or award the [] litigation expenses together attorney reasonable ... with reasonable fees, payment expenses attorney After [ ] fees. and the court
There provision is one other of the Fraud and Abuse case, Act that highly specifi- Control relevant to the instant 1409(b)(13), cally Section which sets forth the definition of 1409(b) “beneficiary” purposes for of subsection as follows: any person who has received benefits or will be any injury benefits under this act because of for which another person may beneficiary’s be liable. It includes such conservator, guardian, personal representative, or other his estate or survivors. 1409(b)(13).
62 P.S.
case,
As
supra,
discussed
the instant
the Superior Court
that,
determined
the Fraud and Abuse Control Act notwith-
standing,
expenditures
DPW was not entitled to recover its
program
provision
under the Medicaid
for the
of medical care
Bowmaster,
her
during
minority.
Under to a Pennsylvania personal injury [common minor rise to two and gives separate distinct causes action, one the claim parents^] expenses for medical and loss of the minor’s services the other the minority, minor’s claim for pain suffering and and for losses after minority. Hathi, 1262); at (quoting
Id. 561 A.2d see also Schmidt Kratzer, (1961) (“The 402 Pa. 168 A.2d minor is entitled to and and plaintiff damages pain suffering loss of he reaches his while probable earnings majority[,] after they his are entitled to for medical parents damages will incur of their injury have because son’s portion judgment shall allocate the or award the medical between damages and other a first lien [DPW] and shall allow award, portion judgment expen- the amount of the beneficiary ditures for the benefit of the under the medical assistance program. added). (emphasis 62 P.S. 1409.1 1409(b)(l 1), Notably, Assembly repealed General subsection has not scope by but rather has limited its enactment of Section 1409.1. *9 83 in during minority”) (emphasis loss of services for their his Co., 182, 182 37 Pa. v. Erie Electric Motor originаl); Woeckner (1897) the claim that the has (reiterating parent 936-37 A. child, based on injury to a minor loss caused pecuniary child). maintain, the protect, to and educate duty parental a However, advancing from the Bowmasters were barred during expenses Emily in 2003 for the medical claim limitations claim for such a minority her because the statute Thus, Bowmaster, concluding 91. expired. supra had at the nor could recover the Emily that neither Bowmasters her the during minority, she had incurred medical from precluded Court held that DPW was likewise Superior such recovering expenses. rejected that Superior argument
The
DPW’s
Court
Act,
the
Abuse
was a
under
Fraud and
Control
“beneficiary”
statutorily-conferred
therefore
the
agency
that
had
recovery
to
for the reasonable
right
settlement
In
of medical
her.
Id.
89-90.
provided
value
benefits
Superior
this
concluded that
rejecting
argument,
Court
“true”
stat-
the Bowmasters were the
beneficiaries under the
they,
obligation
ute because
as
had an
parents,
Id.
minority.6
at 91.
denied
year
Superior
three months after the
Court
One
Bowmaster,
in
right
DPW the
reimbursement
Common-
in
case
opposite
reached the
conclusion
another
wealth Court
issue on
facts. See
presented
the same
similar
Shaffer-
following
in
noting
Superior Court's decision
It is worth
Bowmaster,
following
Assembly
provision
General
enacted
to the
and Abuse
Act:
amendment
Fraud
Control
care,
provided or will
for minor’s
Where benefits are
be
any
repose applicable to an action or claim
statute of limitation or
sought
expenses may
tolled
which the
be
shall be
minor's
period minority
age majority.
minor
until the
reaches
portion
period
within which
not be deemed a
the time
shall
clause,
"minor”
As
the term
action must be commenced.
used in this
age
yet attained the
of 18.
mean
individual who has not
shall
P.S.,
4, 2008,
9,§
as of
July
No. 44
effective
Act of
P.L.
2, 2008;
1409(b)(4)(iii)(D).
September
P.S.
Although
provision post-dates and
is not relevant to the instant
thus
case,
Assembly's disagree-
unequivocally clear
it does make
the General
Superior
holding
ment with the
Court's
in Bowmaster.
*10
Doan,
Bowmaster,
At its argument the before this Court is since failed bring Parents their claim the two-year within limitations, statute of DPW cannot recover the lien. This position only based on the can premise parents that, recover for a expenses minor’s medical and since lien is expenses, DPW’s for minor’s medical DPW is precluded from argue that recovering. because [Parents] the settlement not provide any past did for compensation care, medical there should be no re-payment DPW for past In expenses. position, [Par- Bowmaster, rely on [supra], ents] in which the Superior Court concluded that and parents, injured not minor child, were the intended beneficiaries of [medical assistance] from benefits the minor child’s medical expenses. (internal Shaffer-Doan, supra marks quotation omitted). citation
Following review the relevant sections of the thorough Fraud and Abuse Act and of the decisional law on Control Bowmaster, which Superior relied Court Common wealth Court declined follow Bowmaster reasoning statutory Based on the holding. “beneficiary,” definition the Commonwealth with the strongly disagreed Superi Court or Court’s determination that the minor child’s parents —and not the minor beneficiaries of the medical child—were true majority. assistance benefits received to the child’s prior addition, Shaffer-Doan, at 514. In the Commonwealth supra , receiving a minor prohibition against described the Court for his or her medical compensation anachronism,” in a now-
minority as a “common law rooted proper that considered children to be the repudiated tradition ty Finally, of their father. Id. at 511. Commonwealth Court held that Sections 1404 and 1409 of Fraud superseded Abuse Act the common law rule insofar as Control necessary pay to allow DPW to recover medical assistance to a minor the claims of the minor’s ments even when timely. were no Id. at 516-17. parents longer After careful of the incompatible op consideration —indeed posite holdings reached Court and the Com Superior — *11 monwealth Court with to the issue here we regard presented, conclude that the decision of the latter reflects the intent of the Assembly General in the enacting Fraud and Abuse Act. emphasize Control We that this case a presents question of state law the requiring interpretation of Fraud and Abuse Control Act. the Supreme While United States holding Court’s portion in Ahlborn restricts the of a settlement that bemay used to satisfy agency’s state lien for medical assistance it payments, does not control the central question presented here, i.e., whether, Act, under the Fraud and Abuse Control DPW can obtain reimbursement for Medicaid on expenditures behalf aof disabled minor when a claim the by parents minor’s is by barred the statute of limitations. our begin analysis question
We with the of whether the minor child Emily “beneficiary” is a under subsection 1409(b)(13). text, statutory Based the definition’s we plain strongly disagree must with the determina- Superior Court’s tion that the “true” beneficiaries of the medical assistance provided to Emily during minority parents were her the they obligation because had her. No reading definition statutory “beneficiary” Emily, can exclude A Superior appears beneficiary Court to do. is defined 1409(b) purposes following subsection two sentences: any person who has received benefits or will be any injury benefits under this act because of for which person may another be liable. It includes such beneftcia- guardian, ry’s conservator, personal representa- or other tive, his estate or survivors. 1409(b)(13) added).
62 P.S.
(emphasis
Thus,
is,
foremost, any person
a beneficiary
first and
who has received or will receive benefits
under
Fraud
and Abuse Control Act.
With
second sentence of the
definition,
beneñciary’s
the statute makes clear that such
guardian,
in
this case
parents,
also included in the
definition
beneficiary.
But the statutory inclusion of “such
beneficiary’s guardian” in the definition
beneficiary
does not
in any sense remove
from her
in
Emily
beneficiary
status as
her own
As
out
right.
pointed
by the Commonwealth Court in
Shaffer-Doan,
supra
at
statutory characterization of
beneficiary’s
guardian
as the
guardian makes indisput
benefits,
clear
ably
that the direct
of the medical
recipient
Thus,
Emily,
the instant case
is the primary beneficiary.
we
that,
1409(b)
hold
under subsection
of the Fraud and Abuse
Act,
beneficiaries,
both Emily
parents
Control
and her
are
Emily
with
being
primary beneficiary and her
also
parents
being
they
beneficiaries insofar as
serve as Emily’s guardians.7
agree
7. We
appeal
with the dissent that "resolution of this
revolves
Emily’s parents
Emily
around whether either
herself werе the
payments paid by
'beneficiaries' of the medical assistance
DPW while
However,
Dissenting Op.
was a minor."
they why they determinative or can be or should be “beneficiary” Control Act. Further- in the Fraud and Abuse definition of more, Assembly intended to no indication that the General we discern statutory meaning definition of “beneficia- plain of its own override the extra-statutory factors. any other ry” importation of these or with the meaning disregarded plain that the dissent has We must conclude thereby misconstrued statutory "beneficiary,” and has definition of *13 subsections, plain From the text above it that, is clear notwithstanding any provision law, other of the General As- sembly has conferred upon statutory right DPW to reim- from a beneficiary’s bursement settlement with his or her Nothing tortfeasor. in the statute distinguishes beneficiary who is a minor from one has age who reached the of majority. 1409(b)(ll)’s Furthermore, subsection directive that the entire beneficiary’s settlement of the subject lien, claim is to DPW’s nоtwithstanding any provision law, other of would seem to preclude reliance on any might common law rule that bar a beneficiary recovering from from his or her tortfeasor the monies that expended his or her behalf during minority.
By express of incontrovertible text subsection 1409(b)(ll), which was prior enacted to the United States’ Ahlbom, Supreme Court decision in supra, General As sembly made clear its that the amount intent entire settlement of a claim subject would be beneficiary’s DPW’s Thus, claim plain for reimbursement. under text of 1409(b)(ll) Ahlborn, subsection the allocation prior of a categories settlement into different of damages, e.g., for medi etc., cal expenses, pain suffering, wages, loss of was neither required to determine whether lien DPW’s should be satisfied, nor to to what extent it should be quantify satisfied. Rather, the clear Assembly intent of the General subsection 1409(b)(ll) that, was notwithstanding any provision other law, law, including presumably common of a entirety beneficiary’s be subject settlement would to DPW’s claim. directives, express Given these we cannot conclude that the Assembly General that the application intended subsection 1409(b)(ll) would be law in such constrained common beneficiary manner to bar a assistance Medicaid from from monetary his or her tortfeasor the value of recovering provided during minority. assistance his or her Such an 1409(b)(ll) interpretation subsection would also be inconsis- Assembly's regard with Fraud and General intent to the Abuse Control Act. Emily's monetary claim in this case far less than one-half of DPW’s recovery.
89 1409(b)(1), which authorizes to tent with subsection person from a provided beneficiary recover the benefits to a liable the from the bene- beneficiary’s injury who is for —not ficiary herself. Ahlborn,
As discussed we are aware that in supra, U.S. 292, 1752, Supreme at 126 S.Ct. States held United Court unenforceable as violative of federal Medicaid law an Arkansas that, 1409(b)(ll), statute to satis similarly required subsection agency expenditures faction of a state lien for Medicaid from settlement, of a of how the entirety regardless settlement Ahlborn, had been allocated. necessitated modification of sub 1409(b)(ll) section the extent that Federal law limits “[t]o recovery of medical assistance reimbursement to the [DPW’s] portion beneficiary’s medical of a or settle judgment, award However, ment....” nothing P.S. 1409.1. in Ahlbom weakens, affects, negates, or calls into question reasoning outlined above as to the intent Assembly’s General with regard to the filing claims beneficiaries for Medicaid expenditures incurred their during minority.9 that,
Finally,
recognize
we
when
presumption
enacting
statute,
Assembly
General
intended to favor the public
interest as against any private
1922(5);
interest. 1 Pa.C.S.
Corporation,
Vitac
9. We
with the dissent’s view that Ahlborn is the
analysis. Dissenting Op.
“death knell” for our
at
parents historically
rearing
have borne and continue to bear for the
acknowledges,
obligation
parents
their children. As the
dissent
*15
law,
only
to
their minor children is set forth not
in decisional
4321(2)).
statutory
(citing
but also in
law. Id.
23 Pa.C.S.
Neither is
Rather,
implicated in this case or in our resolution.
this case is focused
severely
parents
financially
disabled child whose
were
unable to
provide
required, prompting
her with all the medical care that she
public
assistance
the form of Medicaid.
We
thoughtful summary
have cited the Commonwealth Court's
of the
history
rights
parents
respect
of the
and duties of
with
to their children.
Majority Op.
(citing Shaffer-Doan,
See
at
Chief join Justice Justices EAKIN and TODD the opinion.
Justice files a opinion. SAYLOR concurring Justice BAER files in which dissenting opinion Justice joins. GREENSPAN SAYLOR,
Justiсe
concurring.
join
I
the majority opinion, but for its waiver analysis. See
Majority Opinion, op.
90-92 n.
987 A.2d at
n. 11.
692-93
In this
DPW
regard,
argues
application of the
against
waiver
doctrine based
the
upon
“significant modification to the pub-
lished case law” occasioned by
v. Common-
Shaffer-Doan
wealth,
(Pa.Cmwlth.2008),
Pub.
Dep’t
Welfare,
proceeds
neither
because
the Bowmasters nor
could recover
by Emily during
minority
medical
and hence
(2)
expenses;
settlement did
include
not
such
trial court erred in
holding
that DPW was entitled to
all of
recover
expenses,
just
capitation
assistance
rather than
fees that DPW had
behalf;
(3)
paid
organization
Emily's
managed-care
tо a
by failing
adjust
trial court erred
the amount of DPW's lien
reflect
Superi
subsequently
amended statement
claim
filed DPW. The
issue,
reversing
or Court
considered
first
the trial court’s
text,
holding,
supra
in the
that DPW was entitled to
discussed
(the
proceeds
not
reimbursement from
appear
settlement
third issue does
Court).
pursued
Superior
to have been
before the
See Bowmas
ter,
&
Justice I respectfully dissent from the Majority Opinion upon based that, my conclusion under the applicable provisions (FACA),1 Fraud and Abuse Control Act of 1980 Emily Bow- master not the (Emily) beneficiary was of medical assistance (DPW) from the payments Department of Public Welfare Rather, her during minority years. these were payments parents made to her to assist them in meeting obligation their her support Emily during years minority. Accordingly, herein, and as I explained agree cannot can assert a DPW lien the settlement reached this case to recover monies them in her paid parents meeting assist substantial care obligations years. minor
As noted by Majority, upon case is based medical that occurred birth in malpractice during Emily’s Community Hospital. malpractice, Centre As a result of the disabilities, born physical was with severe and mental birth, many years and over the since for Emily’s totaling approximately
assistance childhood care $86,000. neither Despite malpractice, existence of amended, §§ 1. Act of 105 of P.L. 62 P.S. 1401-12.
Emily’s parents nor DPW commenced litigation against or hospital physicians during Emily’s years minority.
Then, just prior to her eighteenth birthday, Emily’s parents initiated a lawsuit on Emily’s behalf as an “incapacitated Clair, person,”2 against Gerald M.D. and Community Centre Hospital, alleging malpractice was the proximate cause of permanent injuries. and The disabling suit sought damages past related to and present pain and suffer- ing, expenditures “of money physicians, hospitals, para- personnel, attendance, home care medications and other treatment,” items for her necessary proper care and well as reduced earning capacity. Complaint 8-9. The parties settled the litigation, and the trial court subsequently approved a for leave to petition settle an incapacitated per- son’s estate. See Pa. No. R.C.P. 2064.3 The trial court further directed the creation of a trust for Emily’s future needs and care. Id. noted, minor,
As
during Emily’s years as a
$86,000in
approximаtely
medical assistance payments towards
her care. Accordingly, upon commencement of the lawsuit
against Dr. Clair and Centre Community Hospital, DPW
asserted a lien against any award or settlement from the
$56,517.81.4
in the
litigation
amount of
DPW did so under the
FACA,
auspices
DPW,
of the
permits
which
upon application
court,
with the trial
to assert “as a first
lien
award,
amount of such
judgment
the amount of the expen-
fully
infra,
explained,
"incapacitated
2. As will be
person”
explicit-
ly
Pennsylvania
being,
defined
Rules of Civil Procedure as
first
foremost,
and
"an adult.” Pa. R.C.P. No. 2051.
fully acknowledge
complaint
"past”
I
that the
made claims for
dam-
ages
specifying
post-Emily’s
without
whether
these were
limited
eighteenth birthday,
damages
or for
suffered while she was a minor.
This is of no concern as the statute of limitations is an affirmative
Home),
(Bryn
Nursing
defense see Romaine v. WCAB
Mawr Chateau
(2006)
and,
1030),
(citing
Pa.
5. As noted payments since she received medical assistance whether has that, has, undisputed DPW can assert a eighteen. It if she has turned is Thus, recovery money. I would of that lien the settlement for court is Superior a remand to the trial agree with the Court that also litigation. Regard- aspect of the necessary unanswered to resolve this less, payments appeal solely medical assistance concerns and, Emily's years for a minor for medical care view, reasons, Emily’s parents the true benefi- my were multitude of period. payments during that time made ciaries of the 96
At the heart of this
dispute
centuries’ worth of Pennsylva
nia jurisprudence, which places the responsibility to raise a
child upon her parents. While the Majority summarily dis
misses such jurisprudence as a
anachronism,”
“common law
Maj.
atOp.
In part, because parents responsible are for the well-being and protection children, of their Pennsylvania has traditionally action, and, causes of segregated consequently, the award of minors, damages when a injured minor is aby third-party tortfeasor. “The measure damages where a parent sues for
97
...
and medical
hospital
to a minor child
is
personal injury
a
Disco
injury----”
incurred because
expenses
bills
Co.,
228,
122,
Pa.
A.2d
Transp.
v.
369
85
Ridge
vich Chestnut
Little,
546,
(1952);
v.
407 Pa.
180 A.2d
124-25
see also Meisel
(1962)
recover
772,
may only
that minors
(recognizing
773
loss
suffering
for
and future
compensation
pain
reasonable
injured
when
are
tortfea
earning power
they
by third-party
sors).
a
of action is
on
light,
brought
In that same
when cause
tortfeasor,
behalf of a
and the minor wins
minor
verdict, the verdict in favor of the minor child shall not include
bills;
all
hospital expenses
“one cent for
or doctor’s
such
verdict,
any,
items
have to be included in the
if
for the
would
father; and that
would have to look to the father
[lienholders]
Mikasinovich,
252, 168
In re
110
A.
pаyments.”
Pa.Super.
(1933)
506,
Orbann,
(citing e.g.
509
Phila. Traction
v.
119
Co.
(1888)).
37,
thus,
contrary,
equally
Pa.
A. 816
true:
injured
claims for losses suffered after an
reaches the
party
age majority,
including
expenses,
medical
to the
belong
alone,
injured
and not her
parents.
City
Brower
Phila
(1989)
delphia,
Pa.Cmwlth.
557 A.2d
(citing
Quinn
(1914)).
v. City
Pittsburgh, 243 Pa.
To into this the aggrieved parties Emily’s expenses during as concerns are her minority years parents. Conversely, damages sought instantly, brought for medical the suit as an incapacitated person, belong behalf alone, and are for her solely care as an adult.6 end, worthy 6. To that it is of note that the trial court instituted a trust appointed fund and a trustee for the disbursement of funds out of the view, Community Hospital. my settlement with Dr. Clair and Centre In appointment proceeds of a trustee to oversee the settlement lends suggestion even more credence to the was the sole beneficia- *21 ry Emily’s proceeds. of the If action's these funds were to reimburse (or DPW) parents spent during for monies on care her child- hood, unnecessary, proceeds have thе trust would been could (or DPW). directly parents have been distributed to 98
As by conceded all parties, Emily’s parents lost their claims for medical expenses they incurred during Emily’s minor years over twenty years ago under the statute of limitations applicable to those claims. A statute of limitations “begins to run as soon as the right arises; institute and maintain a suit lack of mistake knowledge, or misunderstanding do not toll the running the statute of limitations. The statute of limita tions requires aggrieved individuals to their bring claims within a certain otherwise, time of the injury,” the aggrieved party generally loses all right recovery injuries. for sustained Brown, Dal rymple 164, 549 Pa. 701 A.2d (1997). Here, Emily’s parents were required bring any litigation their own right Emily’s minor-year for expenses and loss of services years within two of the alleged i.e., date of Emily’s injury, by Emily’s birthday. second See Fancsali v. Univ. Health Ctr. Pgh., 563 Pa. 761 A.2d (2000) (holding parents’ causes of action aris ing injuries out of to their child at birth when “accrued [the born, was two-year child] but the limitation period for their began time.”); claims to run at that § see also 42 Pa.C.S. (providing that an action to damages injuries recover for done unto a person must be years commenced within two occurrence). date of the
Conversely, the Legislature has an specifically provided exception to the statute of limitations for minors: period minority
[...] shall not be deemed a portion the time period within which the action must be commenced. person Such shall have the same time for commencing action[7] after attaining majority is allowed to others the provisions of this subchapter. 5533(b). Thus,
42 Pa.C.S. while Emily’s parents had until her birthday second to sue for medical expenses incurred Emily’s behalf her years, Emily’s minor cause of action in her right own for medical after expenses her eighteenth birthday, as well as pain suffering Here, i.e., years eighteen, 7. such time would be two after turned birthday. her twentieth 42 Pa.C.S.
99 Thus, birthday.8 twentieth life, not until her expire entire did care be- (1) years’ minor to relating because claims (2) claims expired and those parents, to her longed exclusively included have instantly only could in settlement adult during Emily’s medical expenses monies for years.9 reasons, that under the I must also conclude
For these same of the medical FACA, were the beneficiaries Emily’s parents eighteenth say to wait until her to that was forced 8. This is not Fancsali, damages. A.2d at 1164 birthday See 761 to seek those claim, brought at the same time as (recognizing a child’s while claim, when viewed parents’, fact that [the сhild’s] "does not alter the isolation, any prior to child's [the have been filed at time in could birthday].”) twentieth Moreover, while, ambig- Emily’s complaint is mentioned in note as uous, proposition that her counsel therein for the there is expense recognized that the instant action could recover Emily, by explicitly listing damages Emily's years' care related to adult action, person.” "incapacitated The rules plaintiff in the as an sole "incapacitated person” procedure an of civil define effectively ability receive and evaluate information an adult whose to signifi- any way impaired to such a and communicate decisions is manage person partially totally cant extent that the unable requirements physical meet financial resources or to the essential safety. health and Furthermore, added). (emphasis the comments to Pa. R.C.P. No. 2051 distinguish incapacitated persons and specifically Rule between minors: procedure to conform to the Several rules of civil have been amended Probate, and Fiduciaries Code recent amendments to the Estates nomenclature, a new Act No. 24 of 1992. The Act introduced "incapacitated pеr- "incompetent” the term replacing the term with throughout the Code and in a number of other statutes. son” most of governing incompetents provided the rules Rule 2052 Former applied Thus, relating of all other rules to disabilities. exclusion party if were both a minor prior the enactment of Act No. governing incompetents prevailed over incompetent, the rules However, "incapac- governing Act No. 24 an the rules minors. defines incapacitated .person person” can no itated as an adult so that subject chapters there are no other longer to two mies. Since be disabilities, been governing Rule became obsolete and has rules rescinded. Id., added). upon portions relevant (emphasis Based comment then, to infer that the complaint's language, appears it reasonable i.e., Clair, settlement, Community Emily, Dr. and Centre parties to the DPW), (and, only compensating notably, contemplated Hospital not will, has, an adult. incur as for medical she assistance payments provided by Emily’s minor and, thus, years, DPW cannot recuperate those funds from this settlement. The Majority holds otherwise for two rea- First, sons. it looks to the statutory definition of “beneficia- ry” within the FACA:
“Beneficiary” means who person has received benefits or will be benefits under this act because of an injury for which another person may be liable. It includes *23 such beneficiary’s guardian, conservator, or other personal representative, his estate or survivors. 1409(b)(13). § fashion, P.S. in Majority, cursory reads definition,
the second sentence of this
which includes the
phrase “beneficiary’s guardian,” as making “indisputably clear
that
the direct
of the
recipient
medical benefits”
Emily.
is
Maj.
86,
Op. at
To the contrary, Pennsylvania law seems clear that the parent shall take charge of a child’s health and well-being, and, at concerned, least as this appeal is thus solely also standing retains to seek damages for a minor’s medical ex- Therefore, penses. DPW could assert a lien against the parents for recuperation of the funds it expended Mikasinovich, minor care on their behalf. See years’ supra p. 696.10I cannot agree with the that Majority the General Assembly’s of “beneficiary’s inclusion within guardian” the statutory definition is proof positive that minor children are automatically beneficiaries of medical assistance payments course, notes, Majority legislative 10. Of as response the there was a to Superior opinion instantly, permits the Court which now minors to actions, pursue may such such that DPW now also assert liens 4, 2008, 44, July awards settlements. Act of P.L. No. effective 2, 2008, 1409(b)(4)(iii)(D). Sept. codified, response 62 P.S. Such a that, Assembly indicates to me that even the General understood with- action, legislative possessed legal right out simply pursue minors no damages years’ expenses. for their minor DPW, a minor’s merely (generally) from because received or her guardian. is also his parent the
Second, by claiming draws Majority and statuto- for courts to common ignore intended Legislature construing law when FACA: ry act, notwithstanding in this provided as otherwise
Except law, any the entire amount of any provision other claim, injured action or with beneficiary’s settlement suit, subject claim reimburse- or without [DPW’s] ment of the benefits [...]. 1409(b)(ll), at Maj. at 987 A.2d quoted Op.
62 P.S.
added).
In
holds that
(emphasis
light, Majority
law
“notwithstanding any
provision
other
would seem
might
reliance on
common law rule that
bar
preclude
beneficiary
recovering
from
from his or
tortfeasors
or her
expended
monies that DPW
on his
behalf
statement,
at
minority.” Maj. Op.
987 A.2d
690. This
however,
horse, because,
cart before the
puts
proverbial
statute,
upon
plain language
above-quoted
based
subject
must first be a
before
other
person
beneficiary
“any
*24
challenging
of law”
him or her from
provision
precludes
lien
an award. As I cannot
that
agree
DPW’s
beneficiary,
I do not believe that this generalized language
employed
abrogate
long-standing principles
should be
care for
children.
concerning parents’ responsibilities to
their
holding
States
Court’s recent
Finally,
Supreme
United
v.
in Arkansas
Health and Human Services
Department of
Ahlborn,
(2006),
547
126
As view, discussed at length, my generat- settlement ed out of this litigation could include a claim for medical by Emily during her majority years. For herein, the reasons set forth claims for minor-year expenses were Emily’s alone; parents’ and as the medical assistance payments relevant to this relate appeal only to Emily’s minor years, redress DPW’s was through parents, as they were the true beneficiaries of the medical assistance payments made for Emily’s care time. Notwith- standing these claims have since long expired, DPW cannot now attack the settlement for Emily’s care adult-years’ lien, to satisfy its when she was not the beneficiary of the subject sure, funds.11 To be the Majority’s permitting such a course of action allows DPW recover funds it spent for minor, care settlement, as a from a necessarily which only includes monies for incurred, medical expenses and to be incurred, while Emily is adult.
Moreover, even after Emily’s parents’ expired claims on her birthday, second DPW was still not without recourse to recov er the medical assistance payments. FACA, Under the specifically has the authority, through General, the Attorney to pursue third-party directly tortfeasors for reimbursement 1409(b)(1). of medical payments. assistance 62 P.S. Such themselves, however, actions five-year have statutes of limita tion, which has expired. also Jordan 1409(b)(4); P.S. Western Pennsylvania (Pa.Cmwlth.2 Hosp., A.2d 220 008).12 While its common practice may be to sit back and await an initiation of proceedings by a private party, only now after DPW finds itself bound hundreds years of prece dent and an expired statute of limitations does it advocate radical interpretation of the law so that it may recover those funds from injured party. Such an interpretation, howev- decided, 11. Had Ahlborn never been appear it would to me that DPW *25 settlement, could have attacked specifically damages as it included pain suffering related to entire life. 12. The Assembly amendments to the FACA enacted the General 2008, supra see period note increased this limitations from five to years. above, however, seven As with the amendments mentioned such applicable appeal. increase is not to the instant Penn- longstanding face of in the not survive er, does simply sylvania jurisprudence. herein, I must articulated reasons for the
Accordingly, dissent. respectfully joins opinion.
Justice GREENSPAN
987A.2d 699 Pennsylvania, Appellee COMMONWEALTH BROWN, Appellant. Lavar Pennsylvania. Supreme Court of April 2009. Submitted Decided Dec.