The question presented in this appeal is whether the Michigan Veterans' Facility meets the hospital exception of the governmental immunity statute, thus preventing the facility from claiming immunity from the negligent acts of its employees. Because the facility meets the four-part definition of "hospital" according to the plain language of the statute, we reverse the decision of the Court of Appeals.
On November 8, 1989, Richard Tryc was admitted to the Michigan Veterans' Facility in Grand Rapids, a residential facility designed to provide care for veterans. Tryc was a veteran of the Second World War who suffered from Alzheimer's disease. At the time of his admission, the facility was under the administration of the Department of Public Health.
After his admission to the facility, a long-term care assessment was prepared for Tryc. This assessment indicated that the facility staff could place Tryc in a geriatric chair to keep him in place during meals and when he became "agitated." On March 10, 1990, Tryc was fed his breakfast in the geriatric chair while wearing a "protective vest," which was a restraint that wrapped around him and secured him to the chair. After breakfast, at approximately 8:40 a.m., he was left unattended while the workers assigned to care for him were hearing morning reports and taking a coffee break. During this time,
A tort action was filed by Catherine Tryc, Richard's wife, individually and as personal representative of his estate, against the facility and the Department of Public Health, seeking recovery on the basis of the alleged negligence of the facility's employees. Defendants moved for summary disposition pursuant to MCR 2.116(C)(7),
Plaintiff appealed the Court of Claims decision in the Court of Appeals, which affirmed in an unpublished memorandum opinion, issued June 10, 1994 (Docket No. 145189). Plaintiff sought leave to appeal to this Court, which was granted, limited to the issue "whether the Michigan Veterans' Facility is a `hospital' within the statutory definition found in M.C.L. § 691.1407(4)(b); M.S.A. § 3.996(107)(4)(b).
Defendants asked the Court of Claims for summary disposition pursuant to MCR 2.116(C)(7),
The State of Michigan provides under M.C.L. § 691.1407(1); M.S.A. § 3.996(107)(1) that governmental agencies are immune from tort liability when engaged in the exercise or discharge of a governmental function. This statute provides for broad immunity. Wade, supra at 166, 483 N.W.2d 26; Ross v. Consumers Power Co. (On Rehearing), 420 Mich. 567, 595, 363 N.W.2d 641 (1984).
The hospital exception of the governmental immunity statute provides that a facility and its agents and employees are not immune under the statute if the facility meets the following four-part definition of "hospital": (1) it offers inpatient, overnight care and services; (2) for observation, diagnosis and active treatment; (3) of an individual with a medical, surgical, obstetric, chronic, or rehabilitative condition; (4) requiring the daily direction or supervision of a physician.
The rules of statutory construction are well established. First and foremost, we must give effect to the Legislature's intent. Reardon v. Mental Health Dep't, 430 Mich. 398, 407, 424 N.W.2d 248 (1988). If the language of a statute is clear and unambiguous, the plain meaning of the statute reflects the legislative intent and judicial construction is not permitted. Turner v. Auto Club Ins. Ass'n, 448 Mich. 22, 27, 528 N.W.2d 681 (1995). Further, we are to give statutory language its ordinary and generally accepted meaning. Id. at 27, 528 N.W.2d 681. However, when a statute specifically defines a given term, that definition alone controls. Detroit v. Muzzin & Vincenti, Inc., 74 Mich.App. 634, 639, 254 N.W.2d 599 (1977); Butterfield Theatres v. Revenue Dep't, 353 Mich. 345, 91 N.W.2d 269 (1958).
Applying these principles, the definition of "hospital" supplied in the statute, being clear and unambiguous, controls. Judicial construction is not permitted.
The touchstone of the exception is the type of care offered to and required by an individual, not the general character of the facility.
The dissent suggests that to meet the requirement of daily physician direction or supervision, every resident must be seen by a physician each and every day of a stay at the facility.
The first three elements of a "hospital" under the statute are for the most part undisputed; the facility offers inpatient, overnight care for observation, diagnosis, and treatment of individuals with medical, chronic, or rehabilitative conditions. Defendants dispute whether the facility offers active treatment for conditions requiring the daily direction or supervision of a physician. However, we find that the evidence indicates otherwise.
In this regard, the deposition testimony of Thomas Lindsay, the commandant of the facility, is instructive. Mr. Lindsay would not acknowledge that the facility was a "hospital," insisting instead that it was a long-term care facility.
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In addition to Mr. Lindsay's testimony, brochures from the facility that emphasize the medical care available to residents also indicate that the hospital exception applies. For example, a pamphlet titled "Member Guide Book" states:
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Also, from a booklet titled "Michigan Veterans' Facility, a Century of Caring":
These publications describe active treatment rather than passive or strictly maintenance services. For example, they indicate the availability of physical and occupational therapy. In addition, the listed objectives of care include restoring health, not merely maintaining it. The publications also suggest the availability of daily medical care by staff physicians. The reference to an "organized program of medical care ... available on an ongoing basis ... to meet individual needs," suggests that physicians are available to provide daily direction or supervision for the residents' medical care when such care is needed.
The facility's written policies and procedures, dated January 18, 1989, for physical restraints, like the safety vest worn by Mr. Tryc, is also highly indicative of daily physician direction or supervision. The procedures state that physical restraints may only be ordered "from the physician and must be renewed every 24 hours." Thus, under these procedures, the staff physician was required to reevaluate daily the need for such devices and to reorder them daily.
Finally, Mr. Tryc's medical records also support application of the hospital exception by confirming daily physician direction or supervision in Mr. Tryc's care. For example, the medical records reveal that the staff physician performed a complete history and physical examination of Mr. Tryc, ordered various laboratory studies and x-rays, reviewed the laboratory studies and x-rays, prepared a long-term care assessment and treatment plan, and ordered numerous medications and devices. Prescription order forms were signed by the staff physician on a regular basis. These included orders for medications and devices that were to be administered to Mr. Tryc daily. In sum, Mr.Tryc's medical records reflect ongoing and detailed physician direction and supervision in his care which, when viewed with all the other evidence, establish active treatment under the daily direction or supervision by a physician.
The evidence, consisting of: (1) Mr. Lindsay's deposition testimony, in which he admits that the facility provides services satisfying the four elements enumerated in the statutory definition of "hospital," (2) facility publications describing active and ongoing medical treatment and services available for residents, (3) the facility's policy and procedures regarding the use of physical restraints, and (4) Mr. Tryc's own medical records from the facility, establish that the hospital exception is met. The dissent's suggestion that to meet the exception, the general character of the facility must be akin to an acute-care hospital is not required by the statute. Nor does the statute require that patients in a facility be seen each day throughout their stay by a physician; it merely dictates that at least some of the patients have conditions requiring active treatment under the daily direction or supervision of a physician. Because at least some of the residents of the Michigan Veterans' Facility have chronic or rehabilitative conditions requiring active treatment under the daily direction or supervision of a physician, we hold that the facility is a hospital within the meaning of the hospital exception to governmental immunity and remand for trial.
Reversed and remanded.
LEVIN, MICHAEL F. CAVANAGH and BOYLE, JJ., concur.
RILEY, Justice, dissenting.
I respectfully dissent. I believe that a narrow construction of the public hospital
The Michigan Veterans' Facility was established by statute in 1885, M.C.L. § 36.1 et seq.; M.S.A. § 4.871 et seq., for members of the armed forces "who are disabled by disease, wounds, or otherwise, and who have no adequate means of support, and by reason of their disability are incapable of earning their living and who would be otherwise dependent upon public or private charity...." M.C.L. § 36.11(1); M.S.A. § 4.878(1). In Mason v. Bd. of Managers of Michigan Soldiers' Home, 181 Mich. 347, 353, 148 N.W. 220 (1914), citing Wolcott v. Holcomb, 97 Mich. 361, 56 N.W. 837 (1893), this Court explained the reason for the foundation of this facility:
The State of Michigan provides that governmental agencies are immune from tort liability when engaged in the exercise or discharge of a governmental function. M.C.L. § 691.1407(1); M.S.A. § 3.996(107)(1). This statute provides for broad immunity. Wade v. Dep't of Corrections, 439 Mich. 158, 166, 483 N.W.2d 26 (1992); Ross v. Consumers Power Co. (On Rehearing), 420 Mich. 567, 595, 363 N.W.2d 641 (1984). However, the statute provides a public hospital exception to this rule:
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The appeal in this case is limited to determining whether the facility is a "hospital" within the definition provided by M.C.L. § 691.1407(4)(b); M.S.A. § 3.996(107)(4)(b). Under MCR 2.116(C)(7), the Court of Claims was required to examine the pleadings, affidavits, depositions, and other documentary evidence in answering this question. There was no factual dispute about the particular services the facility provided or about Richard Tryc's medical record. Thus, whether the facility was a "hospital" under the statute did not require a factual finding and, as a matter of pure statutory interpretation, was a question of law subject to de novo review. Cardinal Mooney High School v. Michigan High School Athletic Ass'n, 437 Mich. 75, 80, 467 N.W.2d 21 (1991). Consequently, it was a legal matter for the trial court to decide.
In interpreting the public hospital exception, the majority concludes that the facility
[T]he statute only requires daily physician direction or supervision. [Footnote defining the terms "direction" and "supervision" omitted]. Each time a nurse administers medication, it is done under the direction of a physician. A physician's order directing the daily administration of a medication, or a policy requiring that a given order be renewed daily by a physician, [
Such an interpretation eliminates the significance of the term "daily" from the statute. This Court is bound to read the statute narrowly. Wade, supra at 166, 483 N.W.2d 26. The Court must also read the statute to ensure that every word has meaning and to avoid rendering any word nugatory. Altman v. Meridian, 439 Mich. 623, 635, 487 N.W.2d 155 (1992). The statute provides that a "hospital" offer services for conditions that "requir[e] the daily direction or supervision of a physician." M.C.L. § 691.1407(4)(b); M.S.A. § 3.996(107)(4)(b) (emphasis added). The term "daily" in the statute modifies the kind of direction or supervision that the physician must provide, not the kind of care that the facility's nursing staff must provide while under the supervision of a physician. The physician must daily direct or supervise a patient's treatment. I think this level of care is met when the physician either examines the patient on a daily basis or directs the medical staff on a daily basis to take some action regarding the patient's medical care. The fact that nurses provide daily medical care while under the general direction or supervision of a physician cannot satisfy this definition. Under the majority's interpretation of the statute, the facility would meet the definition of a "hospital" under the public hospital exception if it offers daily medical services for conditions that only require the general direction or supervision of a physician. This totally changes the meaning of the statute.
There is no dispute that at the time of Tryc's death the facility only maintained a single, full-time, on-staff physician for the entire facility. The facility also had a contract with Metropolitan Hospital in Grand Rapids, which provided six other physicians who rotated through the facility. This rotation created the equivalent of two full-time physicians for the facility except for weekends and evenings. The facility's three residential buildings had "accommodations for 763 members...."
The majority concludes that "[t]he touchstone of the exception is the type of care offered to and required by an individual, not the general character of the facility." Op., p. 647. Even conceding this point, there is no evidence to support the claim that on a daily basis the facility's physician, Dr. Winifred Eshragh, directed or supervised Richard Tryc's treatment or the treatment of any other resident at the facility. In particular, using the ordinary meaning of the statute's terms, Dr. Eshragh did not provide direction or supervision for Tryc's medical care every day for four months merely because she had assessed his medical needs after he was admitted and instructed the nurses on that day to provide him daily medical care in accordance with the long-term care assessment.
In examining a similar question before this Court, the Court of Appeals in Winklepleck
The Court of Appeals concluded that the Court of Claims erred by resolving the issue "as a matter of fact and law" about whether the facility was a hospital because the Court of Claims "should have confined itself to deciding whether defendants' motion was properly supported" in that case under MCR 2.116(C)(10). The Court concluded that its "review of the record indicates that [Winklepleck's] proffered evidence does not raise a genuine issue of material fact with regard to this question." Id. at 534, 491 N.W.2d 251. However, whether the facility is a hospital under the public hospital exception is a legal question for the trial court to resolve even though it must examine documentary evidence. The Court in Winklepleck wrongly suggested that if Winklepleck had produced more compelling evidence that the facility was a hospital, this would have created a genuine issue of material fact requiring the jury to make a factual finding regarding whether the facility fit the statutory definition. Yet, the application of this statute only requires statutory interpretation and is not a matter for the jury.
Nevertheless, I believe that the Court in Winklepleck reached the proper result. The Court noted that the medical services provided by the facility, as identified in the Member Guide Book, were "not inconsistent" with the services provided in a nursing home as defined by statute. Id. at 535, 491 N.W.2d 251. The Court persuasively argued this point:
I agree with this reasoning.
On the basis of its interpretation of the meaning of "hospital" under the public hospital exception, the majority concludes that the evidence on the record indicates that the facility offers services to residents with conditions that require the daily direction of supervision of a physician. Op., p. 647. I disagree. In reviewing the same evidence, I believe it only confirms that the facility was not a "hospital" under the statute.
The majority contends from the depositional testimony of Thomas Lindsay, the commandant of the facility, that he admitted that the facility provided active daily treatment of chronic and rehabilitative conditions and that the full-time physician provided daily direction for the medical care of the residents. Op., p. 647. The majority quotes a section of Lindsay's testimony in which he noted that the facility provides daily active treatment for residents who suffer from chronic and rehabilitative problems. Id. However, Lindsay only testified that the facility, or in other words, the nursing staff, cared for the residents on a daily basis. This testimony does not support the claim that Dr. Eshragh examined these patients on a daily basis, or that Dr. Eshragh directed or supervised daily the facility's staff in the nursing care it provided these residents.
Lindsay did testify that the physician at the facility provided daily direction or supervision, but he said only to "[s]ome of the residents on a particular rotation." Contrary to the majority's assertion, Lindsay was not stating that Dr. Eshragh examined a certain selection of residents on a daily basis. Rather,
The majority also relies on the facility's brochures to support its conclusion that it operated as a "hospital" under the statute. However, the Member Guide Book clearly indicated in its introduction the kinds of services the facility provides:
Skilled nursing care, basic nursing care, and supervised personal (domiciliary) care are all provided on th[e] campus [of the Michigan Veterans' Facility].
The list of services the facility offers as identified in the "Michigan Veterans' Facility, A Century of Caring" brochure also contradicts the conclusion that the facility provided the kind of acute care necessary to meet the statute's definition of a "hospital."
The majority also refers to the facility's written policies, suggesting that they were an indication that the facility's physician daily directed or supervised the resident's care. In support of its conclusion, the majority cites the facility's policy manual of January 18, 1989, which required that the use of a restraint, like the vest worn by Tryc, be renewed by a physician every twenty-four hours. Op., p. 648. However, this policy was replaced by a new policy, effective September 26, 1989, more than a month before Tryc was admitted. The new policy did not require that a physician renew his order every twenty-four hours but only required
Moreover, Dr. Eshragh never authorized the use of a physical restraint for Tryc; she only authorized the use of the vest as a "protective device" to protect him from falling out of bed and to allow the staff to feed him. The facility's policies only required that Dr. Eshragh review the vest's use as a protective device on a monthly basis. Even if used as a restraint, these policies still only required that Dr. Eshragh review its use monthly. As the Director of Clinical Programs at the facility, Barbara Winburne, explained, "[d]octors rewrite their orders every 30 days, giving the length of time for it to be in effect or length of time for [the restraint] to be on the patient." She added "[g]enerally [d]octors' orders are written every 30 days" for the use of a restraint.
Finally, the majority contends that Tryc's medical records indicate that he was under the daily supervision and direction of a physician. I disagree. After Tryc's admission to the facility he was given an initial assessment and treatment plan. The majority notes that Dr. Eshragh ordered laboratory studies, an electrocardiogram, and x-rays, and prepared a long-term care assessment. The long-term care assessment directed that Tryc receive medication, wear the protective vest in bed, and use the geriatric chair for meals and agitation. Tryc received medication daily, and the facility staff kept daily records of his feeding and diet. The nursing staff also kept frequent interdisciplinary progress reports regarding his condition. However, there were only seven physician progress notes in his file during the approximately four months Tryc resided at the facility before his death. At one point, more than two months elapsed between physician progress notes: Dr. Eshragh entered the fourth note on November 25, 1989, and the fifth progress note on February 13, 1990. Of the sixteen medication orders
I believe that, under the undisputed facts of this case, the public hospital exception is unambiguous. Its definition of "hospital" does not include the Michigan Veterans' Facility because the facility does not offer services for residents with conditions that required daily physician supervision or direction. Even if the statute were ambiguous about what constitutes "daily" physician supervision or direction, the interpretation that I urge is supported by the principles of statutory construction and by the uncontroverted sworn statements on the record. Moreover, this interpretation also confirms the common-sense conclusion that the Michigan Veterans' facility would be, in ordinary terms, called a nursing home, not a hospital.
The 1986 amendment creating the public hospital exception to the governmental immunity statute used virtually identical language to define "hospital" as the Public Health Code in M.C.L. § 333.20106(5); M.S.A. § 14.15(20106)(5).
The Public Health Code provides a definition of a nursing home under M.C.L. § 333.20109(1); M.S.A. § 14.15(20109)(1) that would accurately define the kind of care the facility provides, except that the code specifically excludes the facility from the definition:
The Public Health Code excludes the Michigan Veterans' Facility from the definition of a nursing home, presumably because the facility has its own statutory scheme governing its operation, M.C.L. § 36.1 et seq.; M.S.A. § 4.871 et seq. Thus, the Legislature's exclusion of the facility from this definition does not indicate that the facility was not performing the same functions as a nursing home.
In addition to defining a nursing home, the Public Health Code, under M.C.L. § 333.21715; M.S.A. § 14.15(21715), requires that a nursing home offer certain kinds of care and services that aptly describe those provided by the facility in this case:
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This description highlights one of the critical differences between the statutory definition of "hospital" and the Public Health Code's definition of "nursing home." A "hospital" treats patients with acute medical needs by providing "active" treatment for patients with conditions "requiring" daily physician direction or supervision. M.C.L. § 691.1407(4)(b); M.S.A. § 3.996(107)(4)(b) and M.C.L. § 333.20106(5); M.S.A. § 14.15(20106)(5). In contrast, a "nursing home" addresses the long-term medical needs of individuals subject to "prolonged suffering" or who are "recovering" from an illness or injury by providing "[a] program of planned and continuing medical care under the charge of physicians." M.C.L. § 333.21715; M.S.A. § 14.15(21715).
By excluding hospitals from its definition of nursing homes, the Public Health Code makes the definitions of these two kinds of health facilities mutually exclusive. In doing so, the Public Health Code is able to require hospitals to seek licensure, M.C.L.
Relying on the definitions of the Public Health Code, this facility performs the same function as a nursing home. It is not a hospital under the Public Health Code and, therefore, is not a hospital under the public hospital exception. Moreover, the Public Health Code is careful to treat hospitals, nursing homes, and the Michigan Veterans' facility separately, recognizing their separate statutory identities. Thus, when the Legislature enacted 1986 P.A. 175, removing governmental immunity from hospitals and from county medical care facilities, it did not remove the facility's governmental immunity because it failed to identify the facility when it excluded these other public institutions from the statute's general protection.
Also, the facility and Michigan Department of Public Health presented the sworn affidavit of Walter Wheeler, Chief of the Bureau of Health Facilities of the Department of Public Health. He noted the distinction between a nursing home and a hospital under the Public Health Code and explained why the Department of Public Health did not consider the facility a hospital. Because the Department of Public Health is responsible for the licensure and certification of health facilities under the Public Health Code, M.C.L. § 333.20131(1); M.S.A. § 14.15(20131)(1), this Court gives great deference to the construction it places on the code as represented by Wheeler's testimony. Breuhan v. Plymouth-Canton Community Schools, 425 Mich. 278, 282-283, 389 N.W.2d 85 (1986).
Wheeler swore that, under the definition of "hospital" in the Public Health Code, the Department of Public Health did not consider the Michigan Veterans' Facility a hospital because it did not provide the requisite degree of daily supervision:
Dr. Wheeler explained that the facility does provide nursing care consistent with the Public Health Code's definition, M.C.L. § 333.21715; M.S.A. § 14.15(21715), but is exempt from licensure as a nursing home, M.C.L. § 333.21711(3); M.S.A. § 14.15(21711)(3).
In requiring that "a patient's chart reflect[ ] daily physician orders, daily physician progress notes, or nursing notes stating that a patient has been seen by a physician on a daily basis," Dr. Wheeler confirms my understanding of what constitutes "daily" physician supervision or direction under the public hospital exception. I think that if this Court concludes that the term "daily" creates an ambiguity in the public hospital exception's definition, it should rely on the sworn statement of an administrator who implements the Public Health Code from which the definition of "hospital" is taken, rather than relying on its own independent knowledge of this area by speculating on what it "would find... surprising" in a rehabilitation hospital or by referring to what "common experience" indicates occurs in a general acute care hospital.
I do not believe that the Michigan Veterans' Facility is a "hospital" under the definition provided in the public hospital exception of the governmental immunity statute. The facility does not provide active treatment of conditions requiring daily physician direction or supervision. I would affirm the decision of the Court of Appeals.
BRICKLEY, C.J., and WEAVER, J., concur.
The claim is barred because of release, payment, prior judgment, immunity granted by law, statute of limitations, statute of frauds, an agreement to arbitrate, infancy or other disability of the moving party, or assignment or other disposition of the claim before commencement of the action.
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The Public Health Code further states that "[t]he term does not include a hospital licensed or operated by the department of mental health." The governmental immunity statute definition instead states, "[t]he term does not include a hospital owned or operated by the department of mental health or a hospital operated by the department of corrections." M.C.L. § 691.1407(4)(b); M.S.A. § 3.996(107)(4)(b).