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
STEPHEN P. BATES