Is a “Rehabilitation Hospital” a “Nursing Home”?

Bermudez v. Kessler Institute for Rehabilitation, 439 N.J. Super. 35 (App. Div. 2015).  The different ways in which legislative language, even relatively precise definitions, can be seen to be ambiguous or unclear seem endless.  In today’s decision, the issue was whether the Kessler Institute, a rehabilitation hospital as defined in N.J.A.C. 8:33-1.3, was sued by a former patient who alleged that he sustained injuries, including falls and fractures, while a patient at Kessler.  Plaintiff brought common law negligence and other claims, but the focus of the appeal was plaintiff’s attempt to hold Kessler liable under the Nursing Home Responsibilities and Rights of Residents Act, N.J.S.A. 30:13-1 to -17 (“the Nursing Home Act”).  Unlike plaintiff’s other claims, the Nursing Home Act allows treble damages and attorneys’ fees.

Kessler moved for summary judgment on the Nursing Home Act claims, asserting that it was a rehabilitation hospital and not a nursing home.  The Law Division denied the motion.  Kessler sought leave to appeal, and the Appellate Division reversed.  Judge Waugh wrote the panel’s opinion.

Since this was a purely legal issue of statutory interpretation, the de novo or plenary standard of review applied.  Judge Waugh began by quoting two Supreme Court opinions about statutotory interpretation, invoking the familiar principles that a court’s “main objective is to further the Legislature’s intent,” that unambiguous plain language will be given its ordinary meaning, that if plain meaning does not yield “a clear and unambiguous result,” legislative history and other extrinsic evidence is to be considered, and that “when a literal interpretation of individual statutory terms or provisions would lead to results inconsistent with the overall purpose of the statute, that interpretation should be rejected.”

Judge Waugh then compared the statutory definition of “nursing home” with the New Jersey Administrative Code defintion of “rehabilitation hospital.”  A “nursing home” is defined as an institution that “maintains and operates facilities for extended medical and nursing treatment or care for two or more nonrelated individuals who are suffering from acute or chronic illness or injury, or are crippled, convalescent or infirm and are in need of such treatment or care on a continuing basis.”  A “rehabilitation hospital” is a hospital licensed “to provide comprehensive rehabilitation services to patients for the alleviation or amelioration of the disabling effects of illness.”  “Comprehensive rehabilitation,” in turn, is defined to mean “services offered by a licensed rehabilitation hospital and characterized by the coordinated delivery of multidisciplinary care intended to achieve the goal of maximzing the self-sufficiency of the patient.”

There was no dispute, Judge Waugh found, that Kessler was a rehabilitation hospital.  But he concluded that the statutory definition of “nursing home” does not “clearly and unambiguously include a comprehensive rehabilitation hospital,” as defined in the Administrative Code.  “The two types of facility are commonly understood to be different entities.”  The panel cited a lengthy comparison of the two in In re Conroy, 98 N.J. 321 (1985), and another statute, to illustrate that difference.

Because ambiguity remained, however, Judge Waugh turned to a lengthy analysis of the legislative history of the Nursing Home Act.  He concluded that that history “contains nothing from which we can conclude that the Legislature sought to include an entity such as a rehabilitation hospital” in the definition of “nursing home,” despite the breadth of that definition.  Had the Legislature so intended, “it would undoubtedly have used a more inclusive term than ‘nursing home,’ such as ‘health care entity,’ in the title and text of the legislation.”  Accordingly, the panel reversed the Law Division, entered summary judgment on all claims based on the Nursing Home Act, and remanded the case for further proceedings on the remaining claims.