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On 26 September 2001, an automobile accident occurred involving a woman who was pregnant…cont


The Ruling of the Court:

On the Standard of Review:

As the rules provide, the standard of review of an ALJ’s interpretation of the NICA statutory scheme is de novo. The ALJ’s determination with regard to the qualification of the claim for compensability purposes under the statute is conclusive and binding as to all questions of fact. However, an ALJ’s final order is reversible on appeal where its findings of fact are not supported by competent, substantial evidence.

On the Rebuttal Presumption under Section 766.309(1)(a):

The NICA Plan was established by the Legislature to provide no-fault compensation for birth-related neurological injuries to infants. The purpose of the statutory plan is to limit a participating physician’s exposure to civil liability in cases where the doctor’s professional involvement could make him, or her, a defendant in a lawsuit. The remedies provided under the NICA Plan preclude all other legal remedies available to an injured infant, the parents, or legal representatives. While the benefit paid under the plan is more restricted than the remedies provided by tort law, the plan does not require the claimant to prove malpractice and provides a streamlined administrative hearing to resolve the claim. As the NICA Plan provides, a birth-related neurological injury is an injury to the brain or spinal cord (spinal injury) of a live infant caused by oxygen deprivation or mechanical injury occurring in the course of labor, delivery, or resuscitation in the immediate post-delivery period in a hospital, which renders the infant both permanently and substantially mentally and physically impaired. If the infant’s injury satisfies this statutory definition, the infant qualifies for financial benefits under the NICA Plan. When considering whether a claimed injury is a birth-related neurological injury for the purpose of the plan, an ALJ must consider all available evidence.

Here, the parties stipulated that the subject infant is permanently and substantially mentally and physically impaired. The ALJ found that the injury was a neurological one; that is, it involved the brain or the spinal cord. There was no dispute below concerning whether the infant has sustained a neurological injury. Given the stipulation and the ALJ’s findings of fact, the court holds that the ALJ erred as a matter of law in not applying the presumption of compensability. The court finds that the subject infant indeed suffered multi-system failure as a consequence of the oxygen deprivation she suffered between 12:47 p.m., when the fetal monitor was disconnected and the mother was moved to the operating room, and 1:22 p.m., when she was delivered, that likely continued during the immediate post-delivery resuscitative period. Shortly after delivery, she was placed in the special care nursery where she remained through October 3. The time between the infant’s delivery by caesarean section and the events through October 3 constituted the immediate post-delivery period in the hospital for purposes of the NICA Plan. The court is not persuaded that legal representatives of an injured claimant can ignore or waive the presumption under section 766.309(1)(a). Under this section, the presumption arises upon the presentation of evidence demonstrating the required injury. While it is true that claimants bear the initial burden of proof under section 766.309(1)(a) and under the act generally, it is also true that the NICA Plan is intended to reduce malpractice claims brought under traditional tort law. As the Legislature explained in its statement of findings and intent set forth in section 766.301, physicians practicing obstetrics are the most severely affected by rising costs of medical malpractice insurance, and the costs of a birth-related neurological injury are particularly high. The Legislature found that these circumstances warrant the establishment of a limited system of compensation irrespective of fault. Thus, under the NICA statutory scheme it is the intent of the Legislature to provide compensation, on a no-fault basis, for a limited class of catastrophic injuries that result in unusually high costs for custodial care and rehabilitation. As the ALJ recognized, the ultimate goal in construing a statutory provision is to give effect to legislative intent. Applying the presumption of compensability here best serves the Legislature’s intent. But then again, dispensing with the presumption at the request of a claimant would undermine that intent.

In sum, the court finds that the ALJ erred as a matter of law in failing to apply the rebuttable presumption. Thus, the order of the Division of Administrative Hearings dismissing the petition must be reversed, and the cause must be remanded for further proceedings. On the remaining issues raised on appeal, the court finds them moot in view its ruling.

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