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Chatterjee v. Kizer6/28/1991
COURT OF APPEAL OF CALIFORNIA, SECOND APPELLATE DISTRICT, DIVISION ONE
No. B050632
1991.CA.40649 ; 231 Cal. App. 3d 1348; 283 Cal. Rptr. 60
June 28, 1991
SUMITA CHATTERJEE, PLAINTIFF AND APPELLANT,
v.
KENNETH W. KIZER, AS DIRECTOR, ETC., DEFENDANT AND RESPONDENT
Superior Court of Los Angeles County, No. C717373, John Zebrowski, Judge.
Joy Young Stephenson for Plaintiff and Appellant.
Daniel E. Lungren, Attorney General, Robert L. Mukai, Acting Chief Assistant Attorney General, Charlton G. Holland, Assistant Attorney General, John H. Sanders and Phyllis A. Coven, Deputy Attorneys General, for Defendant and Respondent.
Opinion by Spencer, P. J., with Devich and Ortega, JJ., concurring.
Spencer
Introduction
Plaintiff Sumita Chatterjee appeals from an order denying her petition for writ of mandate to compel defendant Kenneth Kizer, M.D., as Director of the Department of Health Services, to set aside his order denying her Medi-Cal benefits for the period of September 1985 through September 1986.
Statement of Facts
Plaintiff applied to Los Angeles County (county) for Medi-Cal benefits based on disability on September 19, 1985. The county forwarded her claim to the Disability Evaluation Division (DED) of the State Department of Health Services (department). The DED determined plaintiff was not disabled; on that basis the county denied her Medi-Cal benefits based on disability.
On April 1, 1986, plaintiff requested a fair hearing from the department; it was held on June 11, 1986. Administrative Law Judge (ALJ) Mike Ossola concluded in his proposed decision plaintiff was disabled and the county's action in denying her Medi-Cal benefits must be set aside. However, defendant did not adopt the proposed decision but ordered that another hearing be held pursuant to Welfare and Institutions Code section 10959. The reason for the further hearing was "to reevaluate [plaintiff's] medical condition and disability status in light of pertinent medical evidence to determine whether [she qualified for Medi-Cal] benefits."
The second hearing was held on April 8, 1987, before ALJ Jack Flanders. He concluded in his proposed decision that plaintiff was disabled from September 1985 to September 1986, and the county's action in denying her Medi-Cal benefits for that period must be set aside. Again, the proposed decision was not adopted by defendant, but he ordered another hearing pursuant to Welfare and Institutions Code section 10959 "to receive additional medical evidence of [plaintiff's] condition."
A third hearing was held on October 28, 1987, before ALJ Patrick Coony. He concluded that while plaintiff was critically ill in September 1985, she had the capacity to return to work in April or May 1986; since the seriousness of her condition did not last a full 12 months, she could not be considered disabled. His proposed decision, dated March 7, 1988, was adopted by defendant on March 14, 1988.
Plaintiff then brought the instant action. The trial court denied her petition for writ of mandate. After applying the independent judgment test, the trial court found: "The evidence is clear that petitioner [plaintiff] fell seriously ill in [September 1985] with lupus characterized by fatigue and bleeding secondary to a severely reduced platelet count. Petitioner was hospitalized for two weeks, and
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