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MATTER LOUIS AROUNE v. GEORGE G. SIPPRELL (09/10/68)

SUPREME COURT OF NEW YORK, ERIE COUNTY 1968.NY.42839 <http://www.versuslaw.com>; 293 N.Y.S.2d 722; 57 Misc. 2d 826 September 10, 1968 IN THE MATTER OF LOUIS AROUNE, PETITIONER,v.GEORGE G. SIPPRELL, AS COMMISSIONER OF THE ERIE COUNTY DEPARTMENT OF SOCIAL WELFARE, RESPONDENT Offermann, Fallon, Mahoney & Adner (David J. Mahoney of counsel), for petitioner. George M. Nelson, County Attorney (Charles J. Verbanic of counsel), for respondent. Walter J. Mahoney, J. Author: Mahoney


Walter J. Mahoney, J.

Author: Mahoney

 This is a proceeding under CPLR article 78 requesting relief from a decision of the respondent.

Because of the novelty of the problem, an extensive recital of the facts seems necessary. They are as follows: Petitioner, a resident of the City of Buffalo and County of Erie, alleges that the Erie County Commissioner of Social Services failed to perform a duty enjoined upon him by the provisions of title 11 of article 5 of the former Social Welfare Law (now Social Services Law) to direct payment of certain medical expenses, and seeks to compel said respondent to direct payment in accordance with said law.

The following facts embodied in the petition are not controverted by any of the pleadings before this court:

On or about September 30, 1966, the petitioner suffered a sudden stroke, paralyzing his left side. As a result of this, he was rushed in an unconscious condition to Kenmore Mercy Hospital where he was attended by Dr. Anthony P. Santomauro who was called in on an emergency basis.

According to the petition, said doctor found that the petitioner's right carotid artery was partially blocked requiring immediate surgery. Dr. Santomauro certified his condition as an emergency and on the same day the necessary surgical procedure was performed.

Subsequently, the petitioner was discharged from the hospital and continued under treatment by the same doctor.

Once again, on December 6, 1967, petitioner was again admitted under emergency circumstances to Kenmore Mercy Hospital because of a paralysis that had set in on the right half of his body. Once again, his case was certified as an emergency and an operation on the left carotid artery was performed by Dr. Santomauro.

Subsequently, petitioner received a statement from Dr. Santomauro for his services in the sum of $1,020.

According to the petition, this fee is in accordance with the relative value scale established by the Erie County Medical Society for surgery of this nature.

On or before November 1, 1966, petitioner's wife Norma made application to the Erie County Department of Social Welfare for medical assistance under title 11 of article 5 of the former Social Welfare Law (now Social Services Law) popularly known as Medicaid. After the usual processing, a Medicaid identification card was issued by said department, evidencing petitioner's eligibility for Medicaid benefits.

Petitioner learned from Dr. Santomauro that he did not participate in the Medicaid program and would make no exception, although he would co-operate in any application for benefits made by your petitioner directly. Subsequently, petitioner conferred with representatives of the Department of Social Welfare concerning this bill and was informed that unless the doctor completed a form known as K-243-A they would not be able to secure full or partial payment of said bill.

Petitioner consulted his attorney who, after conference with representatives of the Erie County Department of Social Welfare, submitted a formal claim to the proper division of said department dated July 5, 1967.

It is significant that the substance of the claim mentioned above requested that the department pay to the doctor the amount claimed for his services to which petitioner claims he was entitled by way of Medicaid benefits, and since the doctor was not a participating physician in the Medicaid program, and had declined to complete or sign a K-243-A certificate, that ...


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