CASE NO. 748 CRD-8-88-7Workers’ Compensation Commission
JANUARY 17, 1990
The appeal in the above matter concerned issues between Day Kimball Hospital and the Respondents. Therefore, no appearance on behalf the claimant was necessary.
Day Kimball Hospital was represented by Thomas J. Riley, Esq., Dupont, Tobin, Levin, Carberry O’Malley, P.C.
The respondents Walgren Tree Experts and Orion Group were represented by Brian E. Prindle, Esq.
This Petition for Review from the July 1, 1988 Finding and Award of the Commissioner for the Eighth District was heard September 29, 1989 before a Compensation Review Division panel consisting of the Commission Chairman, John Arcudi, and Commissioners A. Thomas White, Jr. and James J. Metro.
OPINION
JOHN ARCUDI, CHAIRMAN.
At issue here are Day Kimball Hospital charges for services rendered the employee Tanner from July 18 to July 21, 1987. Tanner had incurred a compensable injury while working for the employer Walgren Tree Experts in the Putnam vicinity. Orion Group was Walgren’s insurer. The Day Kimball bill reflected that itemized charges computed as the sum of per diem charges and fees for services were $2,485.60 but under the Connecticut All Payor System, the diagnostic related group legislation [DRG], the charge amounted to $3,999.05.
Respondents paid $2,486.50 and the hospital pursuant to Secs 31-319 and 31-327 requested that the commissioner order payment of the DRG charge. The July 1, 1988 Finding and Award[1] did order the DRG payment. Respondents argue they should have to pay only the $2,485.60.
To resolve the dispute it is necessary to determine how Sec. 31-294, C.G.S. interacts with Sec. 19a-165, C.G.S. The trial commissioner concluded they were irreconcilable and decided the later enacted statute, 19a-165 repealed the earlier 31-294 by implication. We agree with the result but not the statutory analysis.
Chieppo v. Robert E. McMichael, Inc., 169 Conn. 646
(1975) asserts that substantive rights are fixed as of the date of injury. Therefore, we must ascertain respondents’ pecuniary liability for medical care and treatment as of July, 1987.
At that time the Workers’ Compensation Act, Sec. 31-294, provided:
The pecuniary liability of the employer for the medical and surgical service herein required shall be limited to such charges as prevail in the same community or similar communities for similar treatment of injured persons of a like standard of living when such treatment is paid for by the injured person; but the liability of the employer for hospital service shall be the amount it actually costs the hospital to render the service, such amount to be determined by the commissioner. . . . (emphasis ours)
Section 19a-165f(a) provided in pertinent part:
(a) For the rate year commencing in 1987, and for subsequent rate years, hospitals shall charge according to a fee schedule based on a standard fixed charge per case for all inpatient cases except cases in exempt units or cases classified as outliars.
The respondents predicate their argument on the Sec. 31-294 language “the liability of the employer for hospital service shall be the amount it actually costs the hospital to render the service, such amount to be determined by the commissioner” But Sec. 31-294 also states, “the pecuniary liability of the employer for the medical and surgical service. . . shall be limited to such charges as prevail in the same community or similar communities for similar treatment of injured persons of a like standard of living when such treatment is paid for by the injured person. . . .” The latter prevailing community standard concept has been in the act since its inception in 1913. It is also incorporated in Administrative Regulation Sec. 31-279(8).[2] The hospital “actual cost” language was added in 1921.[3] For four decades or more after 1921 it was the commissioners’ custom collectively to determine a per diem charge for each of the hospitals in the state in order to satisfy the “actual cost” statutory criterion.
However, other costs besides room per diem charges, e.g. laboratory tests, blood transfusions, oxygen, drugs, nuclear medicine, operating theater rates, etc., have come to constitute major portions of hospital bills. Consequently for the past two decades at least the commissioners no longer have determined “actual cost” on a per diem basis. Also, the Connecticut Commission on Hospitals and Health Care was established in 1973[4] with rate-setting powers over all hospitals in the state. The rates thus set have become uniform and therefore the prevailing rates for all hospital users in each community. Workers Compensation Commission practice has accepted the Hospital and Health Care Commission rates as conforming to the statutory community standard of Sec. 31-294.
Given the history of the two statutes involved, Sec. 31-294 and Sec. 19a-165f, it is appropriate to cite the principles of statutory construction declared in Windham First Taxing District v. Windham, 208 Conn. 543, 553-4 (1988).
The court must use common sense in construing statutes and must assume that a reasonable and rational result was intended by the promulgating legislature. State v. Campbell, 180 Conn. 557, 567 (1980). If a court can by any fair interpretation find a reasonable field of operation for two allegedly inconsistent statutes, without destroying or preventing their evident meaning and intent, it is the duty of the court to do so. Knights of Columbus Council v. Mulcahy, 154 Conn. 583, 590, (1967); Shanley v. Jankura, 144 Conn. 694, 702, (1957). In addition, “`When two statutes relate to the same subject matter every effort should be made to find a reasonable field for the operation of both statutes. . . [and] where there is a reasonable field of operation for each statute which does not impinge on the domain of the other, it is the court’s duty to give them concurrent effect”‘ In re Juvenile Appeal (85-BC), 195 Conn. 344, 365 (1985). The legislature is presumed to be aware and to have knowledge of all existing statutes and the effect which its own action or nonaction may have on them. Miller v. Eighth Utilities District, 179 Conn. 589, 593-4
(1980).
Covey v. Honiss Oyster House, Inc., 117 Conn. 282, 284
(1933) construed Sec. 31-294, then Sec. 5232, 1930 General Statutes,[5] and its provisions relating to the pecuniary liability of an employer or insurance carrier. That court held purpose was “to prevent charges for medical and surgical services to an injured employee being made at a higher rate than they otherwise would be because they are to be paid by the employer or his insurer.” As shown by our historical summary, the rates set by the Hospital Commission even before the 1984 DRG legislation satisfied the prevailing community standard criterion.
The 1984 General Assembly empowered the Hospital Commission to set a diagnosis related charge for each hospital admission no matter how how few hospital days, no matter how few or how many procedures and services were performed during the patient’s hospital stay after that admission. The theory was that each patient with that diagnosis on admission would pay that average rate. Some would pay more and some less than the charges which would have prevailed under the previously existing system. But everyone in the community admitted to that hospital with that diagnosis would pay the same uniform rate.
Viewed in this light, Sec. 19a-165f is thoroughly consistent with Sec. 31-294. Covey, supra, stated the purpose of the prevailing community standard language enacted in 1913 was to assure that an employee or his insurer would not pay higher medical costs for worker compensation patients than would be paid by similarly situated patients who were not victims of worker injuries. It would be just as wrong under the statute for worker compensation patients or their employers to pay less as the respondents are arguing here. The “actual cost” language ceased to be relevant after 1973 when all hospital rates become subject to the approval of the Hospital Commission. In fact the itemized charges, $2,485.60, for which respondents argue as satisfying the Sec. 31-294 “actual cost” language, are themselves rates approved by the Hospital Commission under the legislative scheme prevailing before the DRG law became effective. Hence those itemized charges are not amounts set by the commissioner in the words of the 1921 enactment.
A second legal basis also supports the conclusion below. That support derives from the amendatory provisions of Public Act 88-357.[6] It amended Sec. 31-294 to include DRG charge language. Ordinarily such amendments would not be applied retrospectively absent a clear legislative intent. See Sec. 55-3, C.G.S.[7] , Schieffelin Co. v. Department of Liquor Control, 194 Conn. 165 (1984) appeal after remand 202 Conn. 405
(1987). But the legislative history of P.A. 88-357 indicates that it was intended to clarify a prior existing law. In such cases retrospective application is permitted. See State v. Magnano, 204 Conn. 259 (1987); State v. Blasko, 202 Conn. 541
(1987).
That part of Substitute Senate Bill 387 which ultimately became Public Act 88-357 was promulgated in Senate Amendment “A” to Substitute Senate Bill 387. During legislative consideration Representative Paul Gionfrido gave the following summation:
In summary, while this amendment looks moderately long and relatively substantive, in fact all it does in (sic) clarify that under the terms of the prospective payment system that we have in place that workers’ compensation carriers are third party carriers or payors and are to be treated as such, as we originally intended in the statute, so it is clarifying in nature. . . .
10 H.R. Proc., Pt 24, 1988 Sess., pp. 8329-30
Additionally note the Office of Legislative Research Bill (OLR) analysis which accompanied Substitute Senate Bill 387:
Senate Amendment “A” clarifies that workers’ compensation payers will pay according to fixed charges where such charges have been established; provides that hospital charges for employment-related injuries are the responsibility of the employer or carriers; and provides that the Workers’ Compensation Commissioner settles disputes concerning liability for hospital services. . . . Connecticut’s hospital prospective payment law requires all payers, except for medicare and medical assistance payers. . . to pay fixed charges under the prospective payment system where such charges have been established. The bill provides that in workers’ compensation cases, all hospital charges for employment-related injuries or diseases are the sole responsibility of the employer or carrier. No claim can be made against the employee for all or any part of the charges. It also gives the workers’ compensation commissioner authority to settle all disputes concerning liability for hospital services in workers’ compensation cases. Currently, application of the prospective payment system to workers’ compensation payers, although not specifically excepted under the law, in unclear. . . .
Comments made in the course of legislative action on a particular bill have been considered “strongly indicative, if not necessarily controlling, on the issue of legislative intent. . . . Statements made on the floor of a law-making body, moreover, can be indicative of the circumstances surrounding a statute’s enactment. . . as well as the purpose the statute is to serve. . . .” Robinson v. Unemployment Security Board of Review, 181 Conn. 1, 8 (1980) (citations omitted). Thus the legislative history corroborates our earlier statutory analysis.
We, therefore affirm the July 1, 1988 Finding and Award ordering the respondents to pay the DRG charge as set under Sec. 19a-165f and dismiss the appeal.
Commissioners A. Thomas White, Jr. and James J. Metro concur.