South Carolina              
Administrative Law Court
Edgar A. Brown building 1205 Pendleton St., Suite 224 Columbia, SC 29201 Voice: (803) 734-0550

SC Administrative Law Court Decisions

CAPTION:
Pauline Bolin vs. SCDHHS

AGENCY:
South Carolina Department of Health and Human Services

PARTIES:
Appellant:
Pauline Bolin

Respondents:
South Carolina Department of Health and Human Services
 
DOCKET NUMBER:
04-ALJ-08-0375-AP

APPEARANCES:
For the Appellant: Lewis C. Lanier, Esquire

For the Respondent S.C. Department of Health and

Human Services: Richard G. Hepfer, Esquire
 

ORDERS:

ORDER

________________________

VACATED AND REMANDED

________________________

STATEMENT OF THE CASE

Pursuant to Rule 33 of the Rules of Procedure for the Administrative Law Court (Court or ALC), Pauline Bolin (Appellant) appealed the Final Order and Decision of the South Carolina Department of Health and Human Services (Department) dated October 8, 2004. The Department’s decision upheld the determination by its staff that Appellant did not meet its published Level of Care Criteria for Long Term Care (care in a nursing facility) and therefore did not qualify for Medicaid sponsored skilled or intermediate care in a long term care facility. Oral arguments were heard by the Court on April 26, 2005 in Columbia, South Carolina.

After a review of the entire record, I find that the Department failed to provide detailed findings of fact and conclusions of law in its Order that supported its decision that Appellant did not meet the requirements for skilled or intermediate care. Accordingly, the Order of the Department is vacated and the matter is remanded to the Department to prepare an order, within forty-five (45) days from the date of receipt of this Order, which shall include detailed findings of fact and conclusions of law that clearly explain the reasoning for its decision.

JURISDICTION AND SCOPE OF REVIEW

The standard of review in appeals to the Court is governed by the review criteria of S.C. Code Ann. § 1-23-380(A)(6) (Supp. 2004). Section 1-23-380(A)(6) specifically provides:

The court shall not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact. The court may affirm the decision of the agency or remand the case for further proceedings. The court may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions or decisions are:

(a) in violation of constitutional or statutory provisions;
(b) in excess of the statutory authority of the agency;
(c) made upon unlawful procedure;
(d) affected by other error of law;
(e) clearly erroneous in view of the reliable, probative and substantial evidence on the whole record; or
(f) arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.

Appellant argues that the Department’s decision is not supported by substantial evidence and that a reversal of the Department’s decision is required because Appellant meets various functional deficits as listed in the Department’s Assessment and Level of Care Manual for Medicaid Sponsored Long Term Care Services. The Department seeks affirmance of the Order of the hearing officer. Notwithstanding the arguments, I find that this matter must be remanded to the Department because the hearing officer’s decision fails to make specific findings of fact and fails to explain his rationale in sufficient detail to afford judicial review. Accordingly, the Order of the hearing officer dated October 8, 2004 is vacated and this matter is remanded for further consideration consistent with the explanation below.

SPECIFIC FINDINGS

Final Order and Decision of the Department-

Pursuant to its procedures, the Department appointed a Hearing Officer of its Division of Appeals and Hearings to conduct the hearing, which was held on September 23, 2004. On October 8, 2004, the Department issued a Final Order and Decision (Order) denying Appellant’s eligibility for Medicaid sponsored skilled or intermediate care in a long term care facility.

The Order contained five pages. After some introductory provisions on page one, there is a section captioned “Discussion” which contains a chronology of the events as they occurred as well as the positions by both parties. The next section, captioned “Findings of Fact,” contains three findings of fact which consist of both facts and legal conclusions. Following is a section entitled “Conclusions of Law.” Under it the Hearing Officer included the Department’s definitions of “Intermediate Services” and “Skilled Level of Care.” The final page of the Order contains the “Order” provision. However, at no place in the Order does the Department provide any rationale for its conclusion that Appellant does not meet its requirements to receive skilled or intermediate care.

Applicable Standard-

The standard an administrative body must satisfy in issuing a decision is now well established. Our courts have consistently held that written final orders and decisions issued by an agency after a contested case hearing must comply with the statutory requirements of the Administrative Procedures Act (APA), which requires that they make findings which are sufficiently detailed to enable an appellate court to determine whether the findings are supported by the evidence and whether the law has been applied properly to those findings. Porter v. S.C. Public Serv. Comm'n, 333 S.C. 12, 507 S.E.2d 328 (1998). Further, S.C. Code Ann. § 1-23-350 (2005) of the APA requires that a final decision “include findings of fact and conclusions of law, separately stated.” Section 1-23-350 also states that “[f]indings of fact…shall be accompanied by a concise and explicit statement of the underlying facts supporting the findings.”

Although the APA requires the Department to set forth separate findings of fact and conclusions of law, administrative agencies are not required to set forth their findings of fact and reasoning in any particular format. However, it is better practice to present them in an organized and regimented manner. Porter, supra at 21; see also Seabrook Island Property Owners Ass'n v. South Carolina Public Service Comm'n, 303 S.C. 493, 401 S.E.2d 672 (1991). Thus, what is necessary is that the reviewing body be able to clearly identify the factual findings, the conclusions of law, and the rationale used to reach those findings and conclusions. Here, the Department has not issued an order complying with the required standard.

Furthermore, since the Department has not provided the Court with any reasoning to support its ultimate conclusion that Appellant has not met the requirements for skilled or intermediate case, this Court is unable to conduct a meaningful review of its decision. The Court will not accept an administrative agency's decision at face value without requiring the agency to explain its reasoning. Kiawah Property Owners Group v. Public Service Comm’n of South Carolina, 338 S.C. 92, 96, 525 S.E.2d 863, 865 (1999). The Court also will not sua sponte search the record for substantial evidence supporting the decision by the Department when it has inadequately set forth findings of fact and reasoning, nor is it the Court’s duty to do so. See Porter, supra, n. 3.

While the Hearing Officer may have conducted an orderly analysis in reaching the conclusion, he did not provide such an analysis in his Order. Thus, this appellate body is left to speculate on the basis for the conclusion reached in the Order. Accordingly, for the reasons stated above, the Court must vacate the Order of the Department and remand this matter to the Department to prepare a Final Agency Decision in accordance with this Order to Vacate and Remand.

ORDER

Therefore, it is hereby

ORDERED that the order of the Department dated October 8, 2004 is vacated and this matter is remanded to the Department to consider the entire record below and issue an order, within forty-five (45) days of the date of receipt of this Order, which sets forth detailed findings

of fact and detailed explanations to support it findings and conclusions.

AND IT IS SO ORDERED.

______________________________

Marvin F. Kittrell

Chief Administrative Law Judge

April 28, 2005

Columbia, South Carolina


Brown Bldg.

 

 

 

 

 

Copyright © 2022 South Carolina Administrative Law Court