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Administrative Law Court
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SC Administrative Law Court Decisions

CAPTION:
Shirley Faye Littlejohn vs. SCDHHS

AGENCY:
South Carolina Department of Health and Human Services

PARTIES:
Appellant:
Shirley Faye Littlejohn

Respondents:
South Carolina Department of Health and Human Services
 
DOCKET NUMBER:
97-ALJ-08-0359-AP

APPEARANCES:
Shirley Faye Littlejohn, pro se Appellant

Charles M. Black, Jr., Attorney for Respondent
 

ORDERS:

ORDER
REMANDED FOR FURTHER CONSIDERATION

STATEMENT OF THE CASE

This is an appeal of the June 3, 1997 decision of a Hearing Officer of the South Carolina Department of Health and Human Services (Department). The Department is the state agency charged with administering the Medicaid Program, which is a joint venture between the states and federal government to provide medical assistance to individuals meeting certain criteria. On October 15, 1996, Appellant applied for Medicaid benefits under the disability provision of the ABD (aged, blind or disabled) coverage group, which includes those persons who are over 65 years of age, blind or disabled. The Department dismissed Appellant's appeal of her denial of Medicaid benefits on the ground that the medical disabilities were not severe enough to qualify her for benefits.

Appellant appealed that Department's decision to the Administrative Law Judge Division by letter dated July 1, 1997. The Department filed a Motion to Dismiss on July 21, 1997, which was denied by Order filed August 12, 1997. Appellant filed a Motion to Present Additional Evidence on July 30, 1997, and attached the evidence sought to be presented. On September 18, 1997, Appellant, during a conference call with Respondent and the Court, renewed the request for leave to present additional evidence. On November 19, 1997, a hearing was conducted before the Administrative Law Judge Division in Columbia, South Carolina, at which time oral arguments were heard on the pending Motions and the merits of the appeal. For the reasons stated herein, the decision of the Department's hearing officer is remanded for further consideration.

DISCUSSION

Motion to Dismiss

During oral argument, the Department renewed its Motion to Dismiss on grounds of an insufficient and untimely notice of appeal. The Court, by Order dated August 12, 1997, previously denied the Motion. For the reasons previously set forth in the August 12, 1997 Order, and further stated herein below, the renewed Motion to Dismiss is denied.

The notice of appeal from a final agency decision before the ALJD must contain a general statement of the grounds for appeal as provided in S.C. Code Ann. § 1-23-380(A)(6). The notice of appeal filed by the Appellant was timely and generally referenced the statutory section of the Administrative Procedures Act which sets forth the possible grounds for appeal of administrative orders. While lacking the specificity desired by Respondent, the initial notice of appeal meets the minimum basic requirements of notice by including by reference a recitation of the general statement of grounds of appeal.

The subsequent filings of the Appellant amended and modified the notice to give more specific and detailed grounds for her appeal under ALJD Rule 33, providing Respondent an adequate basis upon which to respond and prepare a defense. ALJD Rule 33(B) provides that the grounds for appeal may be amended, supplemented or modified in the statement of issues in the brief . The Note to ALJD Rule 33 explains: "[T]he statement of issues in the brief shall be considered the final statement of the issues on appeal."

Also, as noted in the Order dated August 12, 1997, in "all cases involving pro se litigants or those without substantial knowledge and experience in administrative matters the administrative law judge shall make reasonable efforts to assist a party so that the hearing is fair." ALJD Rule 10. Appellant is appearing pro se and has attempted to reasonably comply with all notice pleadings and brief requirements.

Motion to Present Additional Evidence

By Motion on July 30, 1997, Appellant requested leave to introduce additional medical records not available for the proceeding before the Hearing Officer. Appellant seeks to introduce eight different items for additional evidence. They are:

A) South Carolina Department of Social Services Vocational Rehabilitation Referral;

B) Attorney letter to Social Security Administration;

C) Summary of Work Wages;

D) Medical Records from Federal Bureau of Prisons;

E) Medical Records from Midway Park Medical Center;

F) Medical Records from Parkland Memorial Hospital (Dallas County);

G) Psychological Evaluation; and

H) Medical Records from Manning Medical Center.

At the time of the contested case hearing, Appellant advised the Hearing Officer of her unsuccessful attempt to acquire these records prior to that proceeding. The record reflects that Items A, B and H were considered by the Hearing Officer or are not eligible for consideration under this Motion. Items C-G (hereinafter collectively referred to as "records" or "medical records") were not available to be presented at the hearing, however, and appear to be material and relevant to the issue of disability.

The evidence indicates the Appellant acted with due diligence in attempting to secure the medical records, but did not come into possession of the records until after the agency hearing was held.

If . . . application is made to the court for leave to present additional evidence, and it is shown to the satisfaction of the court that the additional evidence is material and that there were good reasons for failure to present it in the proceeding before the agency, the court may order that the additional evidence be taken before the agency upon conditions determined by the court.

S.C. Code Ann. § 1-23-380(4) (Supp. 1996).

The transcript and other memorandum reflect that Appellant consistently stated medical records other than those in evidence were made and should be considered, but that they were unavailable and that she was in the process of trying to acquire the additional records. Her statements regarding the unavailability of those records appear genuine. For example, in her pending Social Security claim in Texas, the medical records Appellant seeks to introduce were sent to the Texas state agency responsible for administering the program by the Federal Medical Center under a cover letter that stated: "Do not release copies of the enclosed medical records to the patient, should she request them, unless a physician has determined that release of the records will not result in any possible harm to her or to another person." Furthermore, Appellant's current treating physician was unable to obtain the medical records after requesting them from the federal agency. A letter dated April 28, 1997, from Appellant to the Administrative Director of Medical Records specifically requests all the medical records currently sought to be introduced.

Appellant's application to the court for leave to present additional evidence satisfies the Court that the additional evidence is material and that there were good reasons for failure to present it in the proceeding before the agency. Without making a finding as to the admissibility or probative value of the additional evidence, it appears that these newly acquired records are material. Had they been available for consideration by the Hearing Officer on the issue of disability at the fair hearing to, it is possible that a different outcome could have resulted. Accordingly, this Court may order that the additional evidence be taken before the Department upon conditions determined by the court.

For the foregoing reasons, the Court does not undertake appellate review of the Hearing Officer's decision under the substantial evidence rule of S.C. Code Ann. § 1-23-380(A)(6). Appellant's Motion to Present Additional Evidence is granted and this case is remanded to the Department Hearing Officer for further proceedings consistent with this decision. The Hearing Officer shall reopen the proceedings in this matter to allow Appellant to supplement the existing record with the additional evidence of the medical records and records listed in items C-G above and to allow Respondent to offer evidence in reply thereto, and issue a decision based upon the entire record.

ORDER

IT IS THEREFORE ORDERED that this matter is remanded to the Department of Health and Human Services for further proceedings.





___________________________________

STEPHEN P. BATES

ADMINISTRATIVE LAW JUDGE

December 31, 1997

Columbia, South Carolina


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