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Lowry v. Secretary of Health and Human Services

September 03, 1999

ERICK LOWRY, A MINOR, BY AND THROUGH HIS LEGAL REPRESENTATIVE, JEAN LOWRY, PETITIONER-APPELLANT,
v.
SECRETARY OF HEALTH AND HUMAN SERVICES, RESPONDENT-APPELLEE.



Before Michel, Gajarsa, Circuit Judges, and Cudahy, *fn1 * Senior Circuit Judge.

The opinion of the court was delivered by: Gajarsa, Circuit Judge.

Appealed from: United States Court of Federal Claims Judge John P. Wiese

DECISION

Petitioner Jean Lowry, as the legal representative of her minor son, Erick Lowry, appeals the order of the United States Court of Federal Claims Docket No. 94-451V, in which the court affirmed the Special Master's dismissal of the petitioner's claim under the National Childhood Vaccine Injury Act of 1986, as amended, 42 U.S.C. § 300aa-1 to 34 (the "Act"). The issue before us is straightforward: whether the provision in the recently enacted Vaccine Injury Compensation Program Modification Act (the "Modification Act") which eliminates the requirement that petitioners show that they "incurred unreimbursable expenses" related to the vaccine injury in excess of $1,000 applies to cases pending when the Modification Act became law. For the reasons stated herein, we hold that this provision of the Modification Act applies to all cases pending when the Modification Act went into effect. We therefore reverse the dismissal of the petitioner's complaint by the Court of Federal Claims and remand the case for further proceedings.

BACKGROUND

On July 12, 1994, petitioner Jean Lowry filed a claim for compensation under the Act, alleging that her son, a California resident, received a Measles-Mumps-Rubella vaccination on July 2, 1991. She further alleged that he thereafter began to suffer from seizures and developmental delays. The petition asserted that he had not suffered from seizures prior to the vaccination. Ms. Lowry further asserted that the Lowrys had incurred over $1,000 in unreimbursable expenses in connection with the vaccine-related medical problems. This assertion was included in the complaint to satisfy the Act's unreimbursable expenditure requirement, which provides that a petitioner must have "incurred unreimbursable expenses due in whole or in part to such [vaccine-related injury] in an amount greater than $1,000" in order to receive an award under the Act. 42 U.S.C. § 300aa-11(c)(1)(D)(i).

Ms. Lowry asserted that she was able to meet the $1,000 threshold by calculating the difference between the amount originally billed by various health care providers for medical service provided to Erick and the amount actually paid by Medi-Cal, the California Medicaid program. Under California law, health care providers are prohibited from seeking payment for any unpaid balances from Medi-Cal participants such as Ms. Lowry. Thus, the petitioner's alleged unreimbursed expenses consisted of the portion of Erick's medical bills that Medi-Cal did not pay and that Ms. Lowry would not have to pay.

The Special Master dismissed the petition for compensation on the sole ground that the petitioner had not satisfied the $1,000 requirement. This decision was based on a statutory interpretation of what constituted "incurred unreimbursable expenses" in the Act. Specifically, the Special Master determined that Ms. Lowry's reliance on expenses that neither she nor anyone else would be expected to pay did not constitute such "unreimbursable" expenses. Ms. Lowry then appealed to the Court of Federal Claims, which affirmed the dismissal as correct as a matter of law.

After the Court of Federal Claims rendered its decision, the Modification Act became law, thereby eliminating the requirement that persons seeking vaccine compensation incur $1,000 in unreimbursable expenses. In their briefs to this court, both parties argue that the unreimbursable expenditure provision of the Modification Act applies to cases pending at the time of its enactment. The parties also argue that this court should reach this issue even though it was not before the Special Master and the Court of Federal Claims because of concerns of judicial and litigant efficiency.

DISCUSSION

The controlling question this appeal presents is whether the provision eliminating the threshold requirement for unreimbursable expenses in the Modification Act applies to cases pending when the statute was enacted. Because this is a legal question, we apply the de novo standard of review in deciding this issue. See Neher v. Secretary of Health and Human Servs., 984 F.2d 1195, 1198 (Fed. Cir. 1993); Munn v. Secretary of Health and Human Servs., 970 F.2d 863, 870 (Fed. Cir. 1992).

The Supreme Court has explained that, in determining whether "a case implicates a federal statute enacted after the events in suit, the court's first task is to determine whether Congress has expressly prescribed the statute's proper reach." Landgraf v. USI Film Prod., 511 U.S. 244, 280 (1994). In determining whether the Modification Act applies to this pending appeal, we must therefore begin with the text of the statute itself. The relevant portion of the Modification Act is as follows:

Section 2111(c)(1)(D)(i) of the Public Health Service Act (42 U.S.C. § 300aa-11(c)(1)(D)(i)) is amended by striking "and incurred unreimbursable expenses due in whole or in part to such illness, disability, injury, or condition in an amount greater than $1,000."

Vaccine Injury Compensation Program Modification Act, Pub. L. No. 105-277, ยง 1502, 112 Stat. 2681, 2681-741. The text of the statute does not, as is evident, manifest an intent that the Modification Act should be applied to cases that were pending before its enactment. A review of ...


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