Appeal from the Order of the Department of Public Welfare in case of Appeal of Presbyterian -- University of Pennsylvania Medical Center, In Re: Benjamin Tinsley, No. 1240 100 TD.
Doris J. Dabrowski, Tabas and Furlong, P.C., for petitioner.
Bruce G. Baron, Assistant Attorney General, for respondent.
Judges Wilkinson, Jr., Blatt and Williams, Jr., sitting as a panel of three. Opinion by Judge Williams, Jr.
[ 54 Pa. Commw. Page 609]
This is an appeal from an order of the Department of Public Welfare (DPW), brought by the Presbyterian-University of Pennsylvania Medical Center (Presbyterian) as attorney-in-fact for Benjamin Tinsley, the named appellant. The DPW order reversed a hearing examiner's decision that Tinsley was eligible for medical assistance payments.
Appellant Tinsley was admitted to Presbyterian on September 21, 1978, complaining that he had swallowed glass. On the day following his admission, an application for medical assistance payments was taken by Presbyterian and on the application it was indicated that the appellant was unemployed and had no resources. The application was signed by Tinsley and mailed to the County Assistance Office (CAO), along with a copy of the hospital admission certification. According to the admission certification the initial diagnosis on admission was that Tinsley had a foreign body in his esophagus. The appellant remained at Presbyterian through September 25, 1978, and was transferred to another hospital on September 26, 1978, for psychiatric evaluation.
The discharge summary from Presbyterian listed Tinsley's diagnosis as follows: "(1) probable ingestion
[ 54 Pa. Commw. Page 610]
of caustic agent (2) paranoid schizophrenic." According to the summary, that diagnosis pertained both to admission and discharge. The discharge summary further indicated that during the appellant's period of hospitalization at Presbyterian he had exhibited bizarre behavior. As examples, the summary cited his refusal to communicate with the admitting physician and eating food from the tray of another patient. According to the summary, at one point psychiatrists from another hospital had to be called into the case. The discharge summary, setting forth this information, was never sent to the CAO.
The record reveals that on December 12, 1978, the CAO requested Tinsley to submit additional financial and personal information relative to the application for assistance. When the appellant did not respond within the required 10 day period, a notice of ineligibility was issued for "failure to provide essential information concerning income and management." This action was based on Section 201.1 of the Public Assistance Eligibility Manual (PAEM), 55 Pa. Code § 201.1.*fn1 From that action an appeal was taken by Presbyterian, to DPW, on behalf of Tinsley.
An appeal hearing was held at which Tinsley did not appear. Testimony at the hearing revealed that the later diagnosis of paranoid schizophrenia did not appear on the admission certification, which had been attached to the application for medical assistance and sent to the CAO. Testimony by a representative from the CAO indicated that had the agency been aware of the appellant's diagnosed mental condition, it ...