Handout 1 - School of Government - University of North Carolina at ...

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settlement or other recovery by the recipient. In this case, because DMA’s claim was for less than one third of the settlement amount, the court ordered full reimbursement. The trustee of the settlement appealed and the court of appeals affirmed. In Arkansas DHS v. Ahlborn, 547 U.S. 268 (2006), the U.S. Supreme Court held that the state could not recover an amount higher than the portion of the settlement that represented medical expenses, in a case in which the parties had stipulated to what that portion was. In Andrews, the trustee argued that when a settlement does not specify the amount that represents medical expenses, the court must conduct a hearing to determine what portion of the settlement amount that is. Held: Affirmed. Affirming the court of appeals, which had affirmed the trial court, the N.C. Supreme Court held that 1. Ahlborn “did not require a specific method for determining the portion of a settlement that represents the recovery of medical expenses.” 2. N.C. law provides that the portion of a settlement that represents payment for medical expenses, when that is not specified, is “the lesser of the State’s past medical expenditures or one-third of the plaintiff’s total recovery.” 3. North Carolina’s approach is reasonable and consistent with the holding in Ahlborn. Medicaid Appeals Meza v. DHHS, ___ N.C. App. ___, 668 S.E.2d 571 (10/21/08). http://www.aoc.state.nc.us/www/public/coa/opinions/2008/070407-1.htm Facts: The appellant had sought judicial review of a final DHHS determination that only the first days of two hospital stays qualified as treatment for medical emergencies and that because she was an unqualified alien, she was not eligible for Medicaid for the additional days in the hospital. The superior court considered the evidence, made findings of fact and conclusions of law, reversed the administrative decision, and ordered DHHS to provide appellant with Medicaid coverage for the full length of both hospital stays. Held: Affirmed. The court of appeals considered only whether the superior court had applied the correct standard of review and affirmed, relying in part on G.S. 108A-79(k), which says that the superior court properly may take testimony and “examine into the facts of the case, to determine whether the final decision is in error under federal and State law, and under [applicable] rules and regulations . . . .” The court declined to consider the merits because error was not assigned to any of the superior court's findings or conclusions Dissent: Judge Steelman dissented on the basis that the superior court should have applied the “whole record” test when reviewing the administrative decision. Martin v. North Carolina Dept. of Health and Human Services, ___ N.C. App. ___, 670 S.E.2d 629 (1/6/09). http://www.aoc.state.nc.us/www/public/coa/opinions/2009/080259-1.htm Facts: The superior court reversed the DHHS final agency decision (which upheld the county DSS decision) terminating petitioner’s Medicaid for Qualified Beneficiary Part B (MQB-B), an eligibility category for those who need help paying their Medicare Part B premiums. The agency decision was based on state guidance that because petitioner’s husband was not eligible for Medicare, petitioner’s income should be evaluated in relation to her as an individual, not in relation to a family of two. Held: Affirmed. The court of appeals affirmed the superior court’s reversal, finding that the state’s interpretation was contrary to the plain language of the federal statute and, the court noted, contrary to the state’s final decision in a previous similar case. 18
Liability – Public Duty Doctrine • The public duty doctrine did not apply to provide immunity to county DSS or its employees in a wrongful death action alleging negligence in a child protective services matter. Christmas v. Cabarrus County, ___ N.C. App. ___, 664 S.E.2d 649 (8/19/08). http://www.aoc.state.nc.us/www/public/coa/opinions/2008/071301-1.htm Facts: DSS received several reports about a young child who had various injuries. DSS investigated on two dates and concluded that the home was “conditionally safe.” Several weeks later, on December 24, a physician reported that the child possibly had suffered a non-accidental trauma. The on-call social worker determined that the child could be released back to the mother’s care and that DSS would assess the case on December 27. A social worker visited the home on December 31 and when no one answered the door, left a note asking the mother to contact DSS. On January 2, EMS was called to the home and declared the child dead. The mother and her boyfriend were criminally convicted in connection with the child’s death. The executor of the child’s estate brought a wrongful death action against DSS, its director, and various other individuals. The trial court granted the individual defendants’ motions to dismiss the claims against them in their individual capacities and denied the motions to dismiss claims against them in their official capacities. Government immunity had been waived by the county’s purchase of insurance, and the trial court rejected defendants’ argument that they had immunity pursuant to the public duty doctrine. Held: Affirmed. Although the appellate courts have extended application of the public duty doctrine at the state level, with respect to local governments the doctrine has been applied only to law enforcement agencies carrying out their general duty to protect the public as a whole. The court declined to extend it in this case. Liability – Insurance Coverage • Alleged negligent supervision claims were not excluded from county’s liability insurance policies. Fulford v. Jenkins, ___ N.C. App. ___, ___ S.E.2d ___ (2/17/09). http://www.aoc.state.nc.us/www/public/coa/opinions/2009/080675-1.htm Facts: A juvenile placed by DSS with his grandmother stabbed a neighbor to death. Plaintiff filed suit against the county, the county DSS and its director, and several social workers, alleging negligent supervision of the 13-year-old juvenile. The trial court granted defendants’ motions to dismiss the action against them in their individual capacities and denied the motion with respect to claims against the county and against individuals in their official capacities. Defendants argued that they were protected by governmental immunity because, even though the county had purchased liability insurance, the actions or inactions complained fell within the exclusions for Public Officials and for bodily injury. Held: Affirmed. The court of appeals held that summary judgment was properly denied because there was still a claim for negligent supervision. The court said that accepting defendants’ reading of the insurance policies would suggest that the county had purchased insurance that provided almost no coverage. Janet Mason School of Government The University of North Carolina at Chapel Hill T: 919.966.4246 F: 919.962.2706 mason@sog.unc.edu 19
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