TIMBER TOWN LIVING, INC., Petitioner, v. DEPARTMENT OF HUMAN SERVICES, Respondent.
2020DHS12708; A175192
In the Court of Appeals of the State of Oregon
June 8, 2022
320 Or App 154 (2022) | 513 P3d 28
Aoyagi, J. (Tookey, P. J., dissenting.)
Argued and submitted February 7, 2022
Petitioner operates a residential care facility that is licensed and regulated by the Department of Human Services (DHS). After a contested case hearing, DHS issued a final order concluding that petitioner violated DHS rules by failing to timely and appropriately respond to changes in a resident‘s condition after a witnessed fall in the dining room. Two days after the fall, the resident was sent to the hospital and determined to have a hip fracture. DHS deemed the violation to be “Level 4,” which is the most severe violation level, based on the resident having suffered “serious harm” as defined in
Reversed and remanded.
Clark E. Rasche argued the cause for petitioner. Also on the briefs was Watkinson Laird Rubenstein, P.C.
Patricia G. Rincon, Assistant Attorney General, argued the cause for respondent. Also on the brief were Ellen F. Rosenblum, Attorney General, and Benjamin Gutman, Solicitor General.
Before Tookey, Presiding Judge, and Aoyagi, Judge, and Armstrong, Senior Judge.
AOYAGI, J.
Reversed and remanded.
Tookey, P. J., dissenting.
AOYAGI,
Petitioner operates a residential care facility that is licensed and regulated by the Department of Human Services (DHS). After a contested case hearing, DHS concluded that petitioner had violated certain DHS rules in its handling of a resident‘s fall-related injury. DHS deemed the violation to be “Level 4,” based on the resident having suffered “serious harm” as defined in
FACTS
On a Tuesday at 3:00 p.m., a resident fell in the dining room of petitioner‘s residential care facility. Petitioner‘s staff monitored her over the next two days, during which time she experienced pain and swelling, could not lift her right foot, and was unable to stand. On Thursday at 4:45 p.m., the resident was transported to the hospital, where she was determined to have a hip fracture that required surgery.
Petitioner notified DHS of the incident. After investigation, DHS issued a Notice of Proposed Civil Penalty. The notice described the incident as petitioner having “failed to assess and intervene” with respect to the resident‘s change of condition after her witnessed fall, which resulted in the resident “experiencing unreasonable discomfort for approximately 48 hours before being transported to the hospital and diagnosed with a hip fracture.” The notice further advised that DHS had concluded that petitioner violated OAR 411-054-0027(1)(f) and (r); OAR 411-054-0028(2); OAR 411-054-0036(2)(g); and OAR 411-054-0040(1)(b) and (c). Finally, the notice stated that DHS was proposing a $2,500 civil penalty for a Level 4 violation, based on the resident having suffered “serious harm” as defined in
Petitioner requested a contested case hearing. An administrative law judge (ALJ) concluded that DHS had proved the violation by a preponderance of the evidence. In
Petitioner seeks judicial review. Petitioner does not contest that the violation occurred. The only issue on review is whether DHS erred in concluding that the violation qualified as Level 4.
LEGAL ANALYSIS
DHS has authority to impose civil penalties on residential care facilities for violating DHS rules. See
When imposing a civil penalty, DHS is required to consider certain factors, including the “severity” of the violation.
In this case, DHS determined that petitioner‘s violation was a Level 4 violation because it resulted in “serious harm” to the resident, specifically a long-term loss of physical function, rather than “minor harm” (temporary pain with no loss of function) or “moderate harm” (temporary loss of function). In explaining its severity decision, DHS did not expressly engage in any statutory analysis. Rather, it simply pointed to a hypothetical example of a Level 4 violation included in an “interpretative guide” to DHS rules titled Compliance Framework Guide for Community Based Care (Residential Care and Assisted Living). In the hypothetical, a resident falls, the facility fails “to seek medical attention until the resident complain[s] of pain for several days,” and the resident is then sent to the hospital and found to have a hip fracture. In its final order, DHS agreed with the ALJ that that hypothetical was materially indistinguishable from the facts of this case, while also acknowledging (in response
On judicial review, petitioner contends that DHS misconstrued
We begin with petitioner‘s argument that DHS misconstrued “long-term” in
Statutory construction is inherently a question of law. Bergerson v. Salem-Keizer School District, 341 Or 401, 411, 144 P3d 918 (2006). To construe a statute, we generally examine the text, context, and any useful legislative history of which we are aware, with the goal of discerning the legislative intent. State v. Gaines, 346 Or 160, 171-72, 206 P3d 1042 (2009). However, “depending on the nature of the statutory term at issue, an administrative agency‘s construction of a statute *** may be entitled to a measure of deference.” OR-OSHA v. CBI Services, Inc., 356 Or 577, 585, 341 P3d 701 (2014). Whether we give any deference to the agency‘s construction depends on whether the disputed term is exact, inexact, or delegative, which is “itself a question of statutory construction, requiring us to examine the text of the statute in its context.” Id. at 588 (noting further that “a single statutory phrase may contain terms of more than one type“).
“‘Exact’ terms are those that impart precise meaning and, in effect, require no interpretation at all.” Karjalainen v. Curtis Johnston & Pennywise, Inc., 208 Or App 674, 680, 146 P3d 336 (2006), rev den, 342 Or 473 (2007). “‘Inexact’ terms are less precise” and are therefore open to different interpretations, but they are still complete expressions of legislative intent, and we apply the ordinary rules of statutory construction to discern the legislative intent. Id.; Springfield Education Assn. v. School Dist., 290 Or 217, 224-25, 621 P2d 547 (1980). “‘Delegative’ terms are those that
Here, we agree with petitioner that “long-term” is an inexact term. DHS floats the idea that it could be delegative, but nothing about the text in context suggests to us that the legislature intended “long-term” to “express non-completed legislation” that DHS was “given delegated authority to complete.” Id. at 228. To the contrary, several aspects of the text in context indicate that the legislature intended “long-term” to convey a complete legislative policy judgment, albeit inexactly. There is the fact that “long-term” is part of an express statutory definition of another term (“serious harm“), which tends to suggest that the legislature was trying to pin down the meaning of “serious harm,” not delegate it to DHS to decide. There is also the fact that “long-term” is a common word with a fairly straightforward, albeit inexact, meaning. See Webster‘s Third New Int‘l Dictionary 1334 (unabridged ed 2002) (defining “long-term” to mean “extending over or involving a relatively long period of time“). Relatedly, “long-term” appears in a statutory section that contains three common words—“temporary,” “long-term,” and “permanent“—that together create a durational spectrum for losses of function.
Relevant legislative history, although slim, also supports the conclusion that “long-term” in
Having concluded that “long-term” is an inexact term, the next question is what the legislature intended it to mean. By its nature, “long-term” is relative, as its dictionary definition recognizes. Webster‘s at 1334 (“extending over or involving a relatively long period of time“). Consequently, what is “long-term” for a person in their 80s may differ from what is “long-term” for a person in their 20s. That reality means that there will no doubt be cases in which it is difficult to be certain whether a particular period of time comes within the legislature‘s intended meaning of “long-term.” This is not one of them.
What is apparent from the statute—and consistent with the words’ common meanings—is that the legislature intended “long-term” to be more like “permanent” and less like “temporary.” For purposes of ranking the severity of a violation, the legislature defined both “minor” and “moderate” harm by reference to “temporary” discomfort, pain, or loss of function. See
The bundling of “long-term or permanent” in counterpoint to “temporary” suggests that the legislature was using “long-term” in a sense more akin to “permanent” and unlike “temporary.” That suggestion is
RESPONSE TO DISSENT
We briefly address the dissent. The dissent appears to view anything less than a “Level 4” designation as an affront to the dignity of the resident who received delayed care for her hip fracture. See 320 Or App at 164, (Tookey, P. J., dissenting). That view is misguided. The question before us is one of statutory construction, specifically what the legislature intended in distinguishing “temporary,” “long-term,” and “permanent” losses of physical, mental, or emotional function for purposes of categorizing a violation as Level 1, 2, 3, or 4. For the reasons already described, the legislature did not intend a “long-term” loss of function to encompass a 48-hour loss of function.
The additional facts included in the dissent do not bear on the statutory construction issue before us, and so we do not comment on them, except to note that they are both accurate and selective. See id. at 165-67. As for preservation, see id. at 167-69, the claim of error was adequately preserved, applying normal preservation principles, and DHS does not contend otherwise (beyond noting petitioner‘s failure to comply with ORAP 5.45). As for petitioner‘s noncompliance with ORAP 5.45, see id., we have already addressed that issue—in short, the claim of error is discernible, DHS understood and responded to it, and it would be putting form over function to refuse to reach the merits in these circumstances.
Regarding the merits, we disagree that the meanings of “temporary,” “long-term,” and “permanent” vary depending on the type of function that was lost. See id. at 161-62.
Lastly, the issue before us is purely one of statutory construction. We have no occasion to assess whether the factual findings in the final order are supported by substantial evidence—because no one has challenged
CONCLUSION
Accordingly, we conclude that DHS misconstrued the statute when it concluded that a 48-hour loss of function constituted a “long-term” loss of function within the meaning of
Reversed and remanded.
TOOKEY, P. J., dissenting.
“[I]t is the policy of this state to *** [p]romote the autonomy of residents of Oregon‘s community-based care facilities and accord them honor [and] dignity[.]”
Or Laws 2017, ch 679, § 1.
This case involves B, an 83-year-old woman who suffers from Alzheimer‘s disease and who lives in petitioner‘s residential-care facility. According to the majority, it was error for the Department of Human Services (DHS) to conclude that B suffered “serious harm” when she fell and fractured her right hip at petitioner‘s facility and was not transported to the hospital for more than two days, during which time she was unable to raise or bear weight on her injured leg and experienced continuous and ever-increasing pain such that she eventually could not be moved without “crying out in pain” and “beg[ging] for care staff to please stop moving her.” See 320 Or App at 162. I disagree with the majority‘s conclusion that B‘s injury did not constitute “serious harm” under
Petitioner seeks judicial review of a final order issued by DHS. The final order imposed on petitioner a civil penalty of $2,500 based on a determination that B had suffered “serious harm” as that term is defined in
We review an agency order in a contested case for errors of law and substantial evidence. Gala v. Board of Chiropractic Examiners, 313 Or App 664, 665, 496 P3d 1122 (2021) (citing
I. FACTUAL & PROCEDURAL BACKGROUND
Petitioner operates a residential-care facility (facility) licensed and regulated by DHS. B, an 83-year-old woman diagnosed with Alzheimer‘s disease, is a resident of petitioner‘s facility. B requires assistance to walk on uneven surfaces or navigate steps, and facility staff encouraged B to use a walker or wheelchair.
At about 3:00 p.m. on June 4, 2019, B was seated in a wheelchair in the facility‘s dining room. She stood up from the wheelchair, lost her balance, and fell from a standing position onto her bottom right side, also striking her head. Consequently, B suffered increasing pain and immobility, as evidenced by the following progress notes kept by facility staff over a period spanning three days:
- 06/04/2019 3:15 PM: “Fall investigation; incident occurred at 3 PM 6/4/19. *** [B] denies any pain until R leg is manipulated.”
- 06/04/2019 9:44 PM: “[B complained of] pain to her lower right side hip/upper leg area. She is unable to lift her right foot off the floor due to hip/leg pain. *** [B] has been in continual pain since this incident.”
- 06/05/2019 5:20 AM: “[B] has complained of pain in her right leg ***. No bruising but her leg is swollen and when care staff changed her she was in a lot of pain saying ‘ouch’ and ‘that is hurting me,’ and she was unable to stand.”
- 06/05/2019 1:33 PM: “[B] is showing signs of pain during transfers. She is unable to help stand at this time, [and] she was unable to hold her food and drinks at lunch time.”
- 06/05/2019 10:11 PM: “[B] lays without movement and her brow is furrowed. She expresses severe pain to her right side when roll changed and with transfer attempts. *** She did not get up for dinner and did not eat during entire swing shift.”
- 06/06/2019 6:12 AM: “[B] has been in a lot of pain throughout this shift, unable to move positions or move her right leg without pain/crying at which time she begs for care staff to please stop moving her.”
- 06/06/2019 12:53 PM: “[B] is in severe pain when roll changed[;] she yells when rolled and is unable to stand. She did not eat breakfast or lunch ***. She had 24 oz of fluid.”
- 06/06/2019 1:17 PM: “[B] has increasing pain to R hip area. *** [B] is now crying out in pain when rolled or attempting to get her up from bed.”
- 06/06/2019 9:21 PM: “[B] again lays without movement and responds only with yelling and wincing when roll changed. She drank 2 oz water with straw at the beginning of shift. Her cognition is poor. [B] was sent to ER at 3:45 p.m. for eval ***. [B] has a fractured hip and will remain in the hospital to have surgery.”
- As those notes indicate, B suffered from increasing pain, missed meals, and lost the ability to lift, walk with, or stand on her right leg, and, on the third day, B was eventually taken to the ER, where she underwent surgery to repair her fractured hip.”
Shortly thereafter, petitioner notified Adult Protective Services (APS) about B‘s fall and broken hip, and APS opened an investigation. As a result of the APS investigation, DHS issued a Notice of Proposed Civil Penalty. The Notice stated that petitioner‘s failure to timely intervene after B‘s fall constituted abuse and was a “Level 4
Following the contested case hearing, the ALJ issued a Proposed Order, concluding that DHS had proved the abuse violation by a preponderance of the evidence, and proposing that DHS impose a $2,500 penalty because B “suffered serious, prolonged harm” and because “[petitioner] has a history of similar prior violations.”2 DHS subsequently issued a Final Order, adopting the Proposed Order in its entirety, and imposing the $2,500 civil penalty for petitioner‘s abuse violation.
Now, petitioner requests judicial review of the DHS final order, “seek[ing] reversal of [DHS]‘s interpretation of the non-delegative statutory provision of ‘serious harm‘” contained in
II. ANALYSIS
A. Failure to Comply with ORAPs
Preliminarily, I note—as does the majority—that petitioner does not comply with multiple of this court‘s procedural requirements for judicial review.3 For one, “Assignments of error are required in all opening briefs,” and
“[e]ach assignment of error must be separately stated under a numbered heading.” ORAP 5.45(1), (2) (emphases added). Petitioner‘s briefing neither states an assignment of error, nor includes any such headings. In addition, to obtain judicial review, “[e]ach assignment of error must demonstrate that the question or issue presented by the assignment of error timely and properly was raised and preserved” below and must be set forth “[u]nder the subheading ‘Preservation of Error.‘” ORAP 5.45(4)(a). Again, petitioner‘s briefing neither contains such a subheading, nor does it indicate that the issue was preserved or where in the record the court should look to determine whether the argument raised in the petition was, in fact, raised below. After reviewing the record, it appears to me that petitioner contended below that the harm to B was only temporary and would thus constitute only “minor harm” or “moderate harm” under
This court‘s procedural rules state that “[t]he court may decline to consider any assignment of error that requires the court to search the record to find the error or to determine if the error properly was raised and preserved.” ORAP 5.45(4)(a). Those rules also state, “No matter claimed as error will be considered on appeal unless the claim of error was preserved in the lower court and is assigned as error in the opening brief in accordance with [ORAP 5.45].” ORAP 5.45(1) (emphasis added). As the majority correctly observes, compliance with those rules “is not a matter of mere form,” 320 Or App at 158; indeed, the “touchstone” of the preservation rule is “procedural fairness to the parties and to the [lower tribunal],” Peeples v. Lampert, 345 Or 209, 220, 191 P3d 637 (2008), and “the reason for the rule is not merely to promote form over substance but to promote efficient administration of justice,” John Hyland Const., Inc. v. Williamsen & Bleid, Inc., 287 Or App 466, 473, 402 P3d 719 (2017).
Here, petitioner did not adequately establish that its argument was preserved and did not assign any error in its opening brief. Because petitioner has not satisfied those
B. B suffered “serious harm” under ORS 441.731(2)(d)(E) .
Putting aside those procedural defects, I also disagree with the majority‘s conclusion that “DHS misconstrued the statute when it concluded that a 48-hour loss of function constituted a ‘long term’ loss of function within the meaning of
As framed by petitioner, the issue on review is whether DHS erred by concluding that B suffered “serious harm” as that term is used in
Petitioner‘s argument centers on the meaning of “long term” as used in
To discern the meaning of the statute most likely intended by the enacting legislature, we examine its text, context, and any relevant legislative history. Id. at 584-85.
The text of
“(1) The Director of Human Services may impose a civil penalty under
ORS 441.710 on a residential care facility or a long term care facility pursuant to this section.“*****
“(2)(b) The director shall assess the severity of a violation using the following criteria:
“*****
“(D) Level 4 is a violation that results in serious harm or death.
“*****
“(2)(d) As used in this subsection:
“*****
“(E) ‘Serious harm’ means harm resulting in long-term or permanent *** loss of physical *** function[.]”
(Emphases added.) As noted above, the parties’ dispute focuses on the meaning of “long term” as used in paragraph (2)(d)(E). That term is not defined by statute, but its ordinary meaning includes “extending over or involving a relatively long period of time,” Webster‘s Third New Int‘l Dictionary 1334 (unabridged ed 2002), and “lasting for or
The majority notes that, “[b]y its nature, ‘long term’ is relative, as its dictionary definition recognizes.” 320 Or App at 160. I agree; however, the relative nature of “long term” must be considered within the context in which that term is used. In
That context is important, because whether an elderly person‘s loss of physical function is “long term” relates, in part, to the particular kind of loss involved, not merely the temporal duration of that loss; a fairly inconsequential loss of function over a certain period of time might not, relatively speaking, represent a “long term” loss of function, whereas a much graver loss of function over that same period might, relatively speaking, be aptly characterized as “long term.” Moreover, had the legislature intended to define the levels of harm purely in terms of temporal duration, I think, as a matter of legislative drafting, it would have provided a quantitative (e.g., “more than 7 days“), rather than qualitative (e.g., “long term“) definition, yet the legislature chose not to do so.
Regarding that contextual relativity, illustration would be helpful. Suppose the loss of physical function involves a relatively minor loss spanning three days, such as losing the ability to articulate one‘s left pinky finger because of a painful but superficial cut. It may be that that loss does not constitute a loss of physical function for “a relatively long period of time.” By contrast, where the loss is graver or involves a more essential physical function—such as losing the ability to move one‘s body without experiencing severe pain, or losing the ability to consume food—a span of three days would, in my view, constitute “a relatively long period of time” in light of the gravity of that particular kind of loss of physical function.
The context of
In the very same enactment that created
“(1) The Legislative Assembly finds that:
“(a) Residents of Oregon‘s community-based care facilities are valued citizens of this state and deserve to live lives of autonomy and dignity[.]
“*****
“(2) The Legislative Assembly finds and declares that it is the policy of this state to:
“(a) Promote the autonomy of residents of Oregon‘s community-based care facilities and accord them honor [and] dignity and the ability to choose freely how they live their lives so as to encourage maximum independence and fulfillment[.]”
Or Laws 2017, ch 679, § 1. Thus, as stated by the legislature, it is this state‘s policy that residents of this state‘s elder-care facilities—who are valued citizens and deserve to live lives of autonomy and dignity—are to be accorded honor and dignity by the care facilities in which they reside. In my view, it is entirely consistent with effectuating that broader legislative policy for DHS to have imposed a “level 4” penalty of $2,500 on petitioner as a consequence for its failure to timely intervene while B suffered increasing pain over a three-day period, missed meals, and lost the ability to lift or stand on her right leg.
In light of the foregoing, I would conclude that, as evidenced by the statutory text and context, DHS‘s
construction of “serious harm” in
For those reasons, I disagree with the majority‘s conclusion that B did not suffer “serious harm” under
