CA Appeals Court Rules SNF Resident Entitled to Readmission After Hospital Stay Ordered by Hospice

A California appeals court rules that a skilled nursing facility improperly discharged a Medicaid recipient when it refused to readmit her following a period of hospitalization ordered by an affiliated hospice care provider.  St. John of God Retirement & Care Center v. Woods (Cal. App., 2d., Div. 4, No. B265488, Aug. 17, 2016).

Prior to her admission to St. John of God Retirement & Care Center, a skilled nursing facility in Los Angeles, Gloria Glover Woods had been diagnosed with psychosis.   While at St. John, Ms. Woods received hospice care provided by St. Liz Hospice, Inc., an independent entity contractually linked to St. John, for management of issues related to her terminal illness.  Following several episodes of increasingly psychotic behavior, Ms. Woods’ attending physician from St. Liz ordered that she be transferred to a hospital for a psychiatric evaluation and treatment.

After Ms. Woods was treated in the hospital, St. John refused to readmit her, claiming that it was unable to provide her with the specialized services she needed.  The state long-term care ombudsman filed an appeal and complaint on Ms. Woods’ behalf seeking readmission.  Following administrative hearings, a hearing officer determined that St. John’s refusal to readmit Ms. Woods after hospitalization constituted an improper discharge from the facility and ordered that Ms. Woods be admitted to St. John’s first available bed.

St. John appealed the hearing officer’s decision to the superior court, arguing that the decision to transfer Ms. Woods to the hospital had been done by St. Liz and therefore St. John had no duty to readmit her.  The superior court affirmed the hearing officer’s decision and St. John appealed.

The Court of Appeal of the State of California, Second Appellate District, finds that Ms. Woods’ relocation to the hospital was clearly a transfer within the meaning of the law and that St. John was not exempt from the readmission requirements simply because the transfer had been made by St. Liz. The court opines that such an interpretation would lead to results that violate the plain meaning of the statutes and common sense.

For the full text of this decision, go to: https://www.courts.ca.gov/opinions/documents/B265488.PDF

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