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ST. JOHN'S GENERAL HOSPITAL v. COMMONWEALTH PENNSYLVANIA (02/10/81)

COMMONWEALTH COURT OF PENNSYLVANIA


decided: February 10, 1981.

ST. JOHN'S GENERAL HOSPITAL, PETITIONER
v.
COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, RESPONDENT

Appeal from the Order of the Department of Public Welfare in the case of Appeal of St. John's General Hospital, dated February 11, 1980.

COUNSEL

Edward L. Kochuba, Jr., with him John B. Nicklas, Jr., McCrady, Nicklas & McCrady, for petitioner.

Edward P. Carey, Assistant Attorney General, with him Bruce G. Baron, Assistant Attorney General, for respondent.

Judges Wilkinson, Jr., Blatt and MacPhail, sitting as a panel of three. Opinion by Judge Blatt.

Author: Blatt

[ 56 Pa. Commw. Page 536]

St. John's General Hospital (St. John's) appeals here from an order of the Hearing and Appeals Unit of the Department of Public Welfare which denied the claims of St. John's for reimbursement from the Department of Public Welfare (DPW) for costs which St. John's alleges to have incurred pursuant to DPW's inpatient hospital care program.

Between October of 1971 and January of 1972, St. John's provided inpatient hospital care to 46 heroin addicts, all of whom were hospitalized for periods of from four to seven days each and were treated with methadone to supplant their heroin addiction. The record indicates that the cost of the treatment was about $20,000.

Both St. John's and the DPW submit that St. John's right to reimbursement depends upon an interpretation of Section 9421.5 of DPW's Medical Assistance Manual,*fn1 which provides:

[ 56 Pa. Commw. Page 537]

An essential element in assuring high quality medical care is sound utilization of institutional facilities and professional services. Alternative, less costly arrangements would be utilized whenever hospital-type care is not essential to the well-being of the patient. (Emphasis in original.)

The hearing examiner concluded that inpatient hospital treatment was not essential for the methadone program and denied St. John's claim for reimbursement.*fn2

[ 56 Pa. Commw. Page 538]

Our scope of review in this case is limited by Section 704 of the Administrative Agency Law, 2 Pa. C.S. ยง 704, to a determination of whether or not the adjudication by the DPW was supported by substantial evidence. Ernst v. Department of Public Welfare, 37 Pa. Commonwealth Ct. 643, 391 A.2d 1116 (1978). We have reviewed the record of the hearing below and must conclude that the DPW presented substantial evidence to support the hearing examiner's finding that inpatient hospital care was not essential to the well-being of the patients here concerned.

Dr. Alexander Slavcoff, a DPW medical consultant, testified that St. John's methadone program was not a detoxification program but a maintenance program. That is, heroin addicts were not detoxified, but their dependence on heroin was replaced by the use of methadone. He testified that such a transference could be achieved in an outpatient program because the methadone program does not subject the patient to serious symptoms of drug withdrawal which would require inpatient care. Serious withdrawal symptoms, he said, would occur only in a program which attempts to detoxify a patient completely by substituting for heroin progressively smaller quantities of methadone. Dr. Slavcoff also referred to a 1970 study conducted at methadone centers in Philadelphia and Pittsburgh which indicated that a methadone maintenance program such as St. John's program could be carried out as effectively in an outpatient program as in an inpatient program.

Moreover, although the testimony of the St. John's physician who helped to supervise the methadone program,

[ 56 Pa. Commw. Page 539]

Dr. Marshall Johnson, indicates that inpatient care does yield better results than does outpatient care, largely because the patients do not have access to heroin, he also testified that inpatient care is not essential to achieve methadone maintenance of heroin addicts.

We believe that the hearing examiner's finding that St. John's inpatient methadone program was not essential to the well-being of the patients was based on substantial evidence and must therefore be affirmed.

Order

And, Now, this 10th day of February, 1981, the order of the Department of Public Welfare Hearing and Appeals Unit in the above-captioned case is affirmed.

Disposition

Affirmed.


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