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[W] Adventist Health System / Sunbelt3/28/2003
This is an appeal of a final order issued by an administrative law judge ("ALJ") finding that Raven Shoaf ("Raven") was not subject to compensation under the Florida Birth-Related Neurological Injury Compensation Plan ("the plan"), because she is not "mentally impaired' within the meaning of the plan. We conclude that the order conflicts with the applicable law and accordingly reverse.
Raven was born at appellant's hospital on November 28, 1997. She was deprived of oxygen during birth and sustained significant and substantial injuries.
Raven's parents (the Shoafs), filed an administrative claim to determine whether their daughter qualified for coverage under the plan. The plan is designed to alleviate obstetricians' medical malpractice insurance premiums by providing an exclusive remedy for "birth related neurological injuries." § 766.301, Fla. Stat. (1995). As applied to this case, a "birth-related neurological injury" is defined as an injury "to the brain . . . of a live infant" which is "caused by oxygen deprivation occurring in the course of labor delivery," "which renders the infant permanently and substantially mentally and physically impaired." § 766.302(2), Fla. Stat. (1995). The Shoafs alleged that Raven did not meet the criteria for coverage under the plan insofar as she had not sustained a permanent and substantial mental impairment.
At the administrative hearing, the evidence clearly showed that Raven had sustained significant physical injuries due to oxygen deprivation at birth. It was essentially undisputed that she has cerebral palsy, which refers to a group of motor disorders caused by an injury to the developing brain. She is unable to walk or talk. She has problems holding her head up and directing her gaze. She cannot crawl or even sit up without assistance. She cannot reach out and hold objects, and will not be able to use a touch screen because of her motor difficulties. She is unable to eat by mouth and must wear a diaper. The most she is able to do on her own is roll over. In short, her physical disabilities are significant and severe.
The dispute in this case concerns whether Raven has a "mental impairment" in addition to her physical impairments. Both sides acknowledged that Raven's CAT scans and MRIs clearly show that she has sustained various severe and permanent injuries to her brain. Her imaging studies show that she has damage to the "deeper structure of the brain," which includes both sides of the basal ganglia and thalmus. There was also damage to the white matter surrounding the basal ganglia (which acts as insulation), the hippocampi, both frontal lobes, both parietal lobes, the corpus callosum, and the cerebral cortex. The witnesses agreed that these injuries have the potential for far-reaching damage.
Raven's parents presented evidence that despite her physical impairments and brain damage shown on the CAT scans, Raven is of normal or above-average intelligence. Other witnesses testified that Raven has an I.Q. as low as 20 or 30 due to her injuries and that she has no understanding of the world around her. One expert felt that her parents' belief that Raven was responsive was nothing more than wishful thinking. Nevertheless, the ALJ concluded that, despite her extensive physical limitations, Raven was not mentally impaired within the meaning of the plan and that her claim was therefore not compensable under the plan.
On appeal, appellants argue that the ALJ erred in concluding that Raven was not mentally impaired within the meaning of the NICA statutes. The question of whether Raven is "mentally impaired" within the meaning of the plan is a mixed question of law and fact. As stated in Nagy v. Florid
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