Home   Federal Cases   State Cases   News   Search   Cart   Log In 
 
Search 591,302 Cases and Articles on TJV!
 
Florida State Categories







Bennett v St. Vincent's Medical Center, Inc.

Case No. SC10-364 (FL S.Ct., Jul. 7, 2011)

The issue in these consolidated cases is whether parents of a severely brain-damaged infant are precluded from suing in a court of law for the damages sustained by alleged malpractice and instead are required to pursue limited compensation in an administrative forum provided by statute under the Florida Birth-Related Neurological Injury Compensation Plan (the NICA Plan). The narrow question is whether the First District Court of Appeal in St. Vincent‟s Medical Center, Inc. v. Bennett, 27 So. 3d 65 (Fla. 1st DCA 2009), interpreted the term “immediate postdelivery period in a hospital,” as that term is used in the statutory scheme, too expansively. The parents (the Bennetts) and the Florida Birth-Related Neurological Injury Compensation Association (NICA), which administers the NICA fund, both assert that the First District interpreted that term too broadly so as to preclude the Bennetts from pursuing their common law remedies in court. We have jurisdiction on the basis of express and direct conflict with the Fifth District Court of Appeal‟s decision in Orlando Regional Healthcare System, Inc. v. Florida Birth-Related Neurological, 997 So. 2d 426 (Fla. 5th DCA 2008). See art. V, § 3(b)(3), Fla. Const. For the reasons that follow, we quash the decision of the First District below.

OVERVIEW



Tristan Bennett, the minor child of Robert and Tammy Bennett, is permanently and substantially brain damaged as a result of alleged medical malpractice on the part of William H. Long, M.D., and St. Vincent‟s Medical Center, Inc., as well as other medical providers. In a narrow category of cases in which a “birth-related neurological injury” occurs, parents‟ common law rights to sue on behalf of their children for medical malpractice are eliminated and replaced by an administrative remedy that provides limited compensation on a no-fault basis. “Birth-related neurological injury” is defined by statute as “injury to the brain . . . caused by oxygen deprivation . . . occurring in the course of labor, delivery, or resuscitation in the immediate postdelivery period in a hospital, which renders the infant permanently and substantially mentally and physically impaired.” § 766.302(2), Fla. Stat. (2001). The question presented is whether, under the factual circumstances of this case, Tristan Bennett suffered a “birth-related neurological injury,” which would require the Bennetts to obtain limited compensation through the NICA Plan instead of full damages in a court of law. That question can be answered only by interpreting the governing statutory provisions.

The First District held that the Bennetts were limited to the administrative remedy provided by the NICA Plan, reversing the decision of the administrative law judge (ALJ), who found that Tristan did not suffer a “birth-related neurological injury” as defined by the NICA Plan. See Bennett, 27 So. 3d at 66. We conclude that the First District‟s statutory construction analysis of the applicable statute was flawed in two separate ways.

First, the district court interpreted the phrase “immediate postdelivery period in the hospital” to mean “an extended period of days when a baby is delivered with a life-threatening condition and requires close supervision.” Id. at 70. Because the First District failed to read the phrase “immediate postdelivery period” as modifying “resuscitation,” the First District expanded the NICA Plan to cover infants beyond the limit contemplated by the express language of the statute. Second, the First District incorrectly held that under section 766.309(1)(a), Florida Statutes (2001), the rebuttable presumption of coverage under the NICA Plan applied to benefit the defendants, even though the Bennetts were not making a claim for compensation under the NICA Plan. Accordingly, in reviewing the facts under the correct interpretation of the statute, we hold that the ALJ‟s finding that Tristan did not sustain a “birth-related neurological injury” under the NICA Plan is supported by competent, substantial evidence.
 

 

Judge(s): Barbara J. Pariente
Jurisdiction: Florida Supreme Court
Related Categories: Civil Procedure , Expert Witness , Torts
 
Supreme Court Judge(s)
Charles Canady
Jorge Labarga
Fred Lewis
Barbara Pariente
James Perry
Ricky Polston
Peggy Quince

 
Appellant Lawyer(s) Appellant Law Firm(s)
Wilbur Brewton Brewton Plante PA
Kelly Plante Brewton Plante PA
Tana Storey Brewton Plante PA
Rebecca Creed Creed & Gowdy PA
James Gustafson Jr. Searcy Denney Scarola Barnhart & Shipley PA

 
Appellee Lawyer(s) Appellee Law Firm(s)
Craig Dennis Dennis Jackson Martin & Fontela PA
William Jackson Dennis Jackson Martin & Fontela PA
William Martin Dennis Jackson Martin & Fontela PA
Scott Tacktill The Unger Law Group PL
Daniel Tressler II The Unger Law Group PL

 

CUSTOM EMAIL ALERTS!

With your FREE registration, you can select an unlimited number of Alert categories for daily, weekly or monthly deliveries of the Federal and State Cases most relevant
to you!

Click Here to sign up.

 



Click the maroon box above for a formatted PDF of the decision.
arose in favor of either party if certain prerequisites were demonstrated and then medical center, inc. v. bennett, 27 so. 3d 65 (fla. 1st dca 2009), is not in legislative intent. bellsouth telecomms., inc. v. meeks, 863 so. 2d compensation, on a no-fault basis, for a limited class of catastrophic and demonstrates the statutory prerequisites, a rebuttable presumption of resuscitation in the immediate postdelivery period " under the statutory scheme. the time between tristans delivery by caesarean section and the events through the overriding statutory construction principle that has been applied to this statute interpretation holding that the injury in question occurred in the course of - 20 - stat. (2001). a claimant for the purpose of the statutory presumption is thus meaningless." (quoting velez, 934 so. 2d at 1165)). however, under the plain was created, and take legal action as necessary to avoid the payment of improper 1984)). further, courts are "without power to construe an unambiguous statute in a the phrase "immediate postdelivery period in a hospital" has been construed to neurological, 973 so. 2d 523, 527 (fla. 5th dca 2007). when to the first district with directions to affirm the aljs final order. so. 3d at 70. it is important to note the significant difference between the facts of result of oxygen deprivation near the time of delivery, it was more likely than not that is, the alj properly determined that the presumption was "rebuttable" and both labor and delivery are clearly not within the immediate postdelivery period. demonstrated: (1) the infant sustained a brain injury caused by oxygen deprivation; sustained by alleged malpractice and instead are required to pursue limited modifying "resuscitation," the first district expanded the nica plan to cover plan. the alj rejected this request, ruling that the statutory presumption is ultimate goal in construing a statutory provision is to give effect to 2,500 grams for a single gestation . . . caused by oxygen deprivation of life were normal, she suffered prolonged and severe decreases in neurologist or neonatologist to address the likely timing of the brain injury, apart deprivation: one on september 26, 2001, and the other on october 3, 2001. nor is cord injury caused by oxygen deprivation or mechanical injury and 766.309(1)(a). bennett, 27 so. 3d at 70-71. further, the first district held that the 766.302(2). in the immediate postdelivery period. plan; in fact, they were seeking a determination that they were not covered by the resuscitation in the immediate postdelivery period in a hospital." abnormalities, including the likely onset of seizure activity. on october 4, after in a hospital, which renders the infant permanently and substantially - 11 - that "tristans profound neurologic impairments resulted from a brain injury although there is no statement of why this rebuttable presumption was purposes of compensability "shall be conclusive and binding as to all questions of statutes (2001), the rebuttable presumption of coverage under the nica plan in the administrative hearing, the critical issue was whether the brain injury scope of the nica plan because, more likely than not, tristans profound not support the aljs decision in this case. section 766.311(1), florida statutes nica was served with the petition in the administrative proceedings. nica artificial respiration. in this case, although the code ended at 1:05 subjects clearly embraced within its terms." fla. birth-related neuro. injury first district alters the plain meaning of the statute, which provides that the injury "immediate postdelivery period." tristan did not exhibit any signs or symptoms of neurological damage until after for petitioner, florida birth-related neurological injury compensation bennett, 27 so. 3d at 70 (emphasis added). it appears, however, that the first (fla. 5th dca 2008), i would discharge this case. court in determining legislative intent). in this case, we have the prior legislative such measures as artificial respiration and cardiac massage." the court concluded that "the time between tristans delivery by caesarean section injuries. 766.301(2), fla. stat. (2001). because the nica plan provides limited active resuscitation continuously until he was placed on the - 10 - injury caused by oxygen deprivation occurring during labor, delivery or nica coverage, the bennetts alleged that long after the postdelivery period had neurological injury" within the scope of section 766.302(2). so. 2d 1116, 1122 (fla. 2008). legislature deleted the paragraph that shifted the burden to the party disagreeing not apply or the presumption was rebutted, competent, substantial evidence does nica statute, this courts standard of review is de novo. see fla. birth-related established that tristan, more likely than not, suffered from oxygen deprivation at that the alj apply a statutory presumption of compensability under the nica nonexistence of the presumed fact is introduced, in which event, the plante, p.a., tallahassee, florida, orlando regl healthcare sys., inc., 997 so. 2d at 431-32. in reversing the aljs canady, c.j., dissenting. provisions should be read together to determine legislative intent, so that if from a case best serves the legislatures intent. on the other hand, involved in an automobile accident. following the accident, the mother was medical center, inc. v. bennett, 27 so. 3d 65 (fla. 1st dca 2009), interpreted the undertook an appropriate statutory construction analysis of the terms birth-related neuro. injury comp. assn, 813 so. 2d 155, 156 n.1 (fla. 4th dca threatening condition and requires close supervision," citing to the fifth districts illustrated medical dictionary similarly defines "resuscitation" as "the mentally and physically impaired, a rebuttable presumption shall arise it is so ordered. during this time did not document any neurological damage, but instead noted that long period after birth is sufficient to qualify under the nica plan. bennett, 27 issue in this case is the type described in section 90.302(1), also known as the two cases: satisfying their burden to establish that tristans brain injury occurred in the course resuscitation in the immediate postdelivery period." the only word that districts interpretation, the statute would be expanded to cover situations where way which would extend, modify, or limit, its express terms or its reasonable and to tristans injuries. i conclude that this statutory presumption may - 9 - defendants. the trial court abated the circuit court proceedings for a determination - 13 - for respondent, st. vincents medical center, inc. her neurological examinations during the first seven days of life were normal. oxygen saturations were very low. she remained in very unstable condition most legislature has limited coverage under the nica plan to a "[b]irth-related impairment. in support of this finding, the alj noted that the record established vs. florida birth-related neurological injury compensation association, further, "immediate" is commonly understood to mean "[n]ext in line that was different from bennett in a significant respect regarding ongoing efforts at presumption." 29 f.a.l.r. at 3879. in orlando regional showed that the infants brain injury occurred as a result of - 34 - flawed in two separate ways. upon the party against whom it operates the burden of proof evidence, we conclude that the aljs order finding that the claim is not consolidate the cases for purposes of this opinion since both cases arise out of a id. at 70-71 (footnote omitted). e.g., dianderas, 973 so. 2d at 527. 766.309(1), which requires the alj to make certain determinations based on "all clearly required resuscitation by ongoing active and continuous artificial applied to benefit the defendants, even though the bennetts were not making a kahns dissent: cord injury caused by oxygen deprivation or mechanical injury and the special care nursery where she remained through october 3. under these facts, two applications for review of the decision of the district court of appeal - meaning."); fla. birth-related neuro. injury comp. assn, 686 so. 2d at 1354. the infant has sustained a brain injury caused by oxygen deprivation that has resolution of the issue without regard to the presumption." 29 f.a.l.r. at 3879. refer to a dictionary to ascertain the plain and ordinary meaning"). (2) a presumption affecting the burden of proof that imposes together with the definitional section of the same statutory scheme. see golf this is, in fact, consistent with how the rebuttable presumption serves to from the observations of the health care providers who were involved in tristans existence or nonexistence of the presumed fact shall be determined of labor, delivery, or resuscitation." in the alternative, the alj held that "credible administering too much iv fluid and failing to test for serum electrolyte part of the law, that intent should prevail, for that, in fact is the will of the compensable under the nica plan. see 766.301(1)(d), fla. stat. (2001) ("the nica plan. accordingly, we hold that where an individual is not seeking and reflects the sum total of points gained on an assessment of heart rate, benefit of claimants, never reached fruition. stated otherwise, the - 16 - under this section, the presumption arises upon the presentation of regular newborn nursery. bennett, 27 so. 3d at 68. although tristan was rejecting this interpretation is consistent with the explanation provided in judge impaired." 766.302(2), fla. stat. (2001). the question presented is whether, injury must take place during labor and delivery, or immediately is likely, more so than not, that tristans profound neurologic different from the literal import of the terms employed to express it in a particular sustained a brain or spinal cord injury caused by oxygen deprivation the issue of the application of the presumption is also a matter of statutory statutory presumption is to aid a claimant in proving the prerequisite elements to a mentally and physically impaired. oxygen deprivation or mechanical injury occurring in the course of october 3 constituted the ,,immediate postdelivery period in the hospital for and unambiguous and conveys a clear and definite meaning, there is no occasion not final until time expires to file rehearing motion, and bonanno, 568 so. 2d 24, 31 (fla. 1990). therefore, the alj was also correct in his immediate postdelivery period" justified excluding the injury suffered by the 41. the medical records, as well as the testimony of the system, inc. v. florida birth-related neurological, 997 so. 2d 426 (fla. 5th dca subsection then includes a rebuttable presumption: been demonstrated" to "if the claimant has demonstrated." id. second, the caused by oxygen deprivation that occurred [on] october 3, 2001." the first dicta in bennett concerning the meaning of the phrase "immediate postdelivery provided by 766.309(1)(a) is to aid a claimant in proving the conclusion, the alj made the following findings in the final order: nica claim, particularly in light of the fact that the nica statute deprives "resuscitation" and "immediate," neither of which is defined by the statute: ____________ birth-related neurological injury compensation plan (the nica plan). the (quoting humana of fla., inc. v. mckaughan, 652 so. 2d 852, 859 (fla. 2d dca from the evidence without regard to the presumption; or presumption and, accordingly, that presumption, enacted for the being near at hand[;] . . . occurring, acting, or accomplished without determining legislative intent. see, e.g., seagrave v. state, 802 so. 2d 281, 288 specifically, the first district stated, "shortly after delivery, tristan was placed in qualified for coverage under the nica plan. in the petition for determination of the first district held that the aljs statutory interpretation was in error transported to a nearby hospital in macclenny, florida, where fetal testing was injury comp. assn, 686 so. 2d at 1354 (quoting mckaughan, 652 so. 2d at 859). 287 (fla. 2003). applying the presumption of compensability in this it seems completely clear that the purpose of the presumption decision of the first district below. fact." on appeal, an aljs findings of fact are upheld if supported by competent, james w. gustafson, jr. of searcy, denney, scarola, barnhart, and shihpley, p.a., presumption, the first district never addressed the aljs alternative finding that - 19 - precondition, "if the claimant has demonstrated . . . ," did not arise. 80 (fla. div. of admin. hrgs. oct. 3, 2007) (emphasis added). - 37 - meaning of the words written, the oxygen deprivation or mechanical for respondents, william h. long, m.d. and north florida obstetrics and intracranial hemorrhage and died. after reviewing the statutory terms and the ongoing efforts related to any form of resuscitation that continued during the week 1356; see also pediatrix med. grp. of fla., inc. v. falconer, 31 so. 3d 310, 312 hearings, 948 so. 2d 705, 709-10 (fla. 2007). the court must begin with the fetal heart rate and saturations on october 3, 2001, she manifested not require that "neurological damage be manifest during ,,labor, delivery, or the american heritage dictionary 1054 (2d ed. 1985). dorlands declined into kidney failure and underwent a caesarean section performed by dr. alert"; on september 30, there was"[n]o evidence of cns [central nervous system claimants of the common law remedy of a tort action. id. therefore, it was neurological impairment resulted from a brain injury caused by the second incident delivered by a participating physician in the course of labor, delivery, or whether tristans brain injury occurred "in the course of labor, delivery, or giving a statutory term its "plain and ordinary meaning." green v. fifth districts decision in orlando regional. bennett, 27 so. 3d at 70. thus, it is following year to its present form to limit the rebuttable presumption to favor only compensation association, bennett, 27 so. 3d at 70. the majority explicitly rejected the contention that the october 5, october 8, october 17, and november 2, and showed abnormalities. a "[n]o focal neuro deficits, active & alert . . . cns: no obvious neuro a birth-related neurological injury where it has been demonstrated, to comp. assn v. fla. div. of admin. hearings, 686 so. 2d 1349, 1354 (fla. 1997) state, 700 so. 2d 370, 372 (fla. 1997) (explaining that "court may basis. "birth-related neurological injury" is defined by statute as "injury to the postdelivery period." 27 so. 3d at 70. nothing in orlando regional or any other renders the infant permanently and substantially mentally and physically of 6 at one minute and a score respiratory distress and no other resuscitative efforts. the physician progress notes single appellate decision and a single set of facts. language of the statute, the history of the prior legislative enactments assists the in jacksonville. the morning of her birth, her mother tammy bennett was derangements until numerous days after the delivery. as required by statute, channel v. jenkins, 752 so. 2d 561, 564 (fla. 2000) ("[r]elated statutory alleviate the high costs of medical malpractice insurance for physicians practicing the alj reviewed both the plain meaning of "resuscitate" and additional neurological abnormalities, leading to neurological testing. specifically, specifically shifted the burden of proof to the party disagreeing with the on our analysis, we approve the analysis in orlando regional to the extent that it is injury to the brain or spinal cord of a live infant weighing at least nursery due to moderate respiratory distress and metabolic acidosis. her in the administrative hearing before the resuscitation in the postdelivery period. see gomez, 41 so. 3d at 185 (stating that by an administrative remedy that provides limited compensation on a no-fault first, the district court interpreted the phrase "immediate postdelivery period in addition to incorrectly interpreting the applicability of the statutory the nica statute. in other words, if a claimant seeks benefits under the nica plan if this specific statutory enactment had been in place, there is no question that the however, those terms are not defined by the statute. when a term is quince and polston, jj., concur in result. a life-threatening condition and requires close supervision." id. at 70. because the (fla. 2001) (although legislative intent must be determined primarily from defined with reference to whether the person is seeking compensation under the rebuttable presumption against an individual who is seeking recovery outside of bag and mask ambu." tristan had an apgar score2 infant there. 997 so. 2d at 431. the orlando regional court did not articulate a petitioner, ____________ - 12 - 4. we exercise our discretion to consider this issue although it is not within mental impairment occurred on september 26, 2001, the day she was born, or artificial respiration. he could not breathe on his own and required birth-related neurological injury." 766.309(1)(a), fla. stat. (2001). that physicians practicing obstetrics are the most severely affected by labor, delivery, or resuscitation in the immediate postdelivery period; and (4) afterward."). in turning to the statutory language, section 766.302(2) defines "[b]irth- comprehensive rule for limiting the scope of "the immediate postdelivery period" undermine that intent. postdelivery period" to only the first resuscitation necessarily profound neurologic impairments resulted from a brain injury caused by oxygen related neurological injury," which would require the bennetts to obtain limited because i conclude that the decision of the first district in st. vincents from the statutes text." heart of adoptions, inc. v. j.a., 963 so. 2d 189, 198 (fla. fact, unless credible evidence sufficient to sustain a finding of the construction of the statutory presumption and disapprove the first districts gynecology, p.a. damaged infant are precluded from suing in a court of law for the damages 643 (2d ed. 1985); see merriam-websters collegiate dictionary 578 resuscitation. both the incident of oxygen deprivation and the brain injury during the immediate postdelivery resuscitative period. however, it is 2010); fla. birth-related neuro. injury comp. assn v. fla. div. of admin. night. on october 5, she had cns tremors and an eeg was ordered, as well as a resulting in a multi-system failure, the first district reads out the requirement that no. sc10-364 to occur, the injury to the brain caused by oxygen deprivation, which renders the vs. comp. assn, 29 so. 3d at 997 ("[t]he statute must be given its plain and obvious consistent with this decision, quash the first districts decision below, and remand that the alj is not qualified to review tristans medical records in making his - 31 - caused by oxygen deprivation that resulted in tristans permanent and substantial facts and procedural history - 36 - we hold that a narrow construction of the statute is the more reasonable - 4 - collected on behalf of the plan, administer the payment of claims on behalf of the the timing of the injury. however, the experts and medical records are all relevant resuscitation in the immediate postdelivery period in the hospital." 29 f.a.l.r. at deprivation she suffered between 12:47 p.m. (when the fetal monitor the hospital." in contrast, in orlando regional, there was ongoing active and even if the rebuttable presumption applied, "there was credible evidence produced seizure activity and neurologic decline thereafter. given the proof, it of fact that at the time of birth there was an incident of oxygen deprivation concerning the nonexistence of the presumed fact. evidence [was] produced (in tristans medical records) to support a contrary related neurological injury. however, this section was specifically amended the granted under the nica plan exclude all other rights and remedies). intervened and took the position that tristan did not suffer a "birth-related however, on october 3, she suffered prolonged and severe acidosis and shortly request for a consultation by a pediatric neurologist was made. tallahassee, florida, and kidneys, this oxygen deprivation did not cause a substantial neurological - 21 - medical depositions, the alj held that the claim was not subject to compensation term "immediate postdelivery period in a hospital," as that term is used in the dorlands illustrated medical dictionary 1145 (26th ed. 1981). case compels the conclusion that, more likely than not, tristan rendered the infant permanently and substantially impaired, the claimant does not 28, her "[n]euro [was] grossly intact"; on september 29, her "[n]euro [was] active under the nica plan. id. at 431-32. because the aljs findings of fact are supported by competent, substantial enactment of the rebuttable presumption statute. specifically, when the on october 4, she had a possible seizure and the note in her record stated that she malpractice occurring during labor and delivery; rather, the immunity is narrowly at 219). likewise, when a court interprets a statute, "it must give full effect to all birth-related neurological injury claims were particularly high. 766.301(1), fla. birth on september 26, resulting in a multi-system failure that included her liver related neurological injury to one occurring in the course of "labor, delivery, or obstetrics. the legislature found that obstetricians were among the most severely (10th ed. 2000) (defining "immediate" as "being next in line or entered a detailed written order finding that tristans injuries were not within the sue on behalf of their children for medical malpractice are eliminated and replaced - 30 - result of birth, is not the statutory prerequisite for compensation, which requires a "immediate," but limited the "resuscitation in the immediate severe impairment. we have jurisdiction on the basis of express and direct conflict "claimant" is defined as "any person who files a claim . . . for compensation" 3880. in making this determination, the alj found that although the record liabilities, its provisions should be strictly construed. fla. birth-related neuro. - 32 - conclusions and that their expert was more qualified to render an opinion regarding accordingly, we hold that in order for a "birth-related neurological injury" injury" as defined by the nica plan. see bennett, 27 so. 3d at 66. we conclude "neurological damage" did not have to be manifest during the labor, delivery, or (quoting velez v. miami-dade cnty. police dept, 934 so. 2d 1162, 1165 (fla. claimant would essentially return the statute to the pre-1989 language. important qualifiers to determining the compensability of a claim. remedy provided by the nica plan, reversing the decision of the administrative and requiring the trier of fact to assume the existence of the presumed the fifth district explained: the bennetts produced expert testimony and medical records to show the frank blood coming from her mouth. her heart rate was extremely low, and her alj, the respondents (the defendants in the medical malpractice case) requested if filed, determined. system of compensation irrespective of fault." id. thus, under the robert bennett, etc., et al., of oxygen deprivation on october 3, 2001, and was not caused during labor, tristan bennett, the minor child of robert and tammy bennett, is delivery, or resuscitation in the immediate postdelivery period in the there any question that she suffered a brain injury that rendered her permanently hemorrhaging and pulmonary arrest. first district failed to read the phrase "immediate postdelivery period" as regarding the statutory presumption, only the individual seeking compensation 766.302(2), fla. stat. (2001) (emphasis added). in applying the statute to this inc., 690 so. 2d 1296, 1297 n.2 (fla. 1997) ("once a court obtains jurisdiction, it statutory scheme, too expansively. the parents (the bennetts) and the florida compensability must be applied on a case-by-case basis." id. at 430. 766.309(1)(a), fla. stat. (1988 supp.). presumption, would have the burden of proving that the injury was not a birth- (2001), provides that an aljs determination as to the qualification of the claim for malpractice on the part of william h. long, m.d., and st. vincents medical obvious implications. to do so would be an abrogation of legislative power." - 5 - nursery at 1:45 p.m., but then at 2:10 p.m., she was transferred to the special care respiratory distress and metabolic acidosis resolved fairly quickly, and by 9:30 actually reflected the opposite--with specific comments stating that on september this court has previously utilized references to dictionaries and brain . . . caused by oxygen deprivation . . . occurring in the course of labor, of the presumption. injury occurred outside of the time period contemplated by statute. the alj in this problems related to respiration in her first few days after birth and do not show any sys., inc., 997 so. 2d at 428. upon delivery, the infant was unable to breathe state, 604 so. 2d 471, 473 (fla. 1992); dianderas v. fla. birth related ended, tristans medical providers committed numerous errors, including regard to the word "resuscitation" preceding it. the first district violates the 1:22 p.m. evidence of a partial placental abruption was noted. according to the the first district in this case erroneously treats the statutory term "in the of different meanings, "this court will apply established principles of statutory the respondents next contend that even if the rebuttable presumption does on october 3, 2001, seven days after her birth, tristan suffered from a section after the infants heart rate rose too rapidly. orlando regl healthcare 3. see 766.303(2), fla. stat. (2001) (stating that the rights and remedies has remained unchanged. (in tristans medical records) to support a contrary conclusion, and to require construction to resolve the ambiguity." barco v. sch. bd. of pinellas cnty., 975 resuscitation in the postdelivery period, but even if the statute required responsibility of the infant to other health care providers." that because the nica plan eliminates common law rights, its provisions should be "claimant" who has demonstrated the statutory prerequisites. the term "claimant" related neurological injury" to mean: stat. (2001). consequently, the legislature created the nica fund to "provide deprivation were within the term "immediate postdelivery period in a hospital." made factual findings that the injury actually occurred on october 3. in 1988, the florida legislature created the nica plan as a means to modifier and not an independent phrase. section 766.302(2) narrows a birth- - 29 - iv. competent, substantial evidence supports the alj's decision furthermore, to the extent that the first district relied on the aljs finding during a second and separate incident of oxygen deprivation that occurred on wilbur e. brewton, kelly brewton plante, and tana duden storey of brewton long, his professional association, st. vincents hospital, and numerous other deprivation on october 3, 2001, following the onset of pulmonary florida birth-related neurological injury nica plan limits the remedies as a statutory substitute for common law rights and transferred again to a neonatal intensive care unit for continued aggressive coverage under the statute. after presentation of evidence by both sides, the alj which renders the infant permanently and substantially impaired. proof to the respondents to prove that the claim was covered by the nica plan. evidence was introduced to rebut the presumption, thereby returning the burden of resuscitation in the immediate postdelivery period. that period does not 1. a rebuttable presumption shall arise that the injury alleged is - 25 - reference to a dictionary. green, 604 so. 2d at 473; see also l.b. v. delivery, or resuscitation in the immediate postdelivery period in a hospital, which prolonged and severe acidosis following her arrest, and she evidenced immediate postdelivery period in the hospital" as a separate time period without eventually sent to the special care nursery, the records do not reveal ongoing "resuscitation in the immediate postdelivery period" where the facts, as found by found that these circumstances "warrant the establishment of a limited showing the onset of seizure activity, which may indicate central nervous system operate. pursuant to florida statute, section 90.302 states: legislature." (internal quotation marks omitted)). under section 766.302, a reasonable to understand the cursory discussion on this point as dicta. the the first district may be correct that the actual evidence of the severe impairment application of the presumption does not depend on when the brain injury occurred. (kahn, j., dissenting). thus, this precondition would not arise where the bennetts that she was delivered atraumatically, responded well to initial resuscitation, and special care nursery where resuscitation efforts continued, and later, he was under this provision, the rebuttable presumption arises in favor of a she responded well to the treatment, was stabilized, and was initially sent to the means through the first resuscitative attempt when harper was claimed is a birth-related neurological injury; (2) whether obstetrical services were were no central nervous system abnormalities noted; and on october 2, there were must be given its plain and obvious meaning." fla. birth-related neuro. injury compensation through the nica plan instead of full damages in a court of law. alj in making these determinations, but instead focus their argument on assertions that the injury is a birth-related neurological injury as defined in s. because of medical problems, even a life-threatening condition occurring as a infant delivered by an obstetrician. no party in this case contends that the statute ii. statutory interpretation of the phrase given such evidence and testimony. physically impaired. this definition shall apply to live births only and no such term occurs. see hayes v. state, 750 so. 2d 1, 4 (fla. 1999) ("we are not we next review whether the first district was correct in its analysis that the contrary reasoning. here, the alj made factual findings that tristan did not suffer a "birth- disappeared. this court therefore, if the claimant seeking benefits under the nica plan knows only that necessary, the plain and ordinary meaning can be ascertained by in any event, orlando regional simply decided that under the circumstances or relation[;] . . . [o]ccuring without delay[;][o]f or near the present electroencephalogram (eeg) and computerized tomography scan (ct) were close supervision." id. in support, the first district relied on language from the encompass an additional "extended period of time when a baby is delivered in a although the first district relied on language from orlando regional, the has held that the nica statute "should be strictly construed to include only those an infant is "transferred from the delivery room" and the "obstetrician relinquishes performed on harper as a result of the code called. however, in lewis, labarga, and perry, jj., concur. dysfunction. tristan suffered permanent and substantial neurological damage. orlando, florida, [heart/lung] bypass. it is not logical to find that "immediate" only this prior legislative enactment made it clear that the rebuttable presumption specifically, the alj found that although there was a multi-system failure as a hemorrhage, was not breathing at times, and had a very low heart rate and oxygen permanently and substantially mentally and physically impaired. statutory presumption. focusing on the phrase "in the immediate postdelivery period." see gomez, 41 so. (fla. 4th dca 2010). alj is required to make the following determinations: (1) whether the injury must by caused by oxygen deprivation or mechanical injury that occurred during abnormalities" noted. on october 3, however, tristan suffered from a pulmonary resuscitation in the immediate postdelivery period" are essential phrases that judge kahn dissented as to this issue, reasoning that the language of the therefore once credible contrary evidence was produced, the presumption administrative law judge, that the infant has sustained a brain or spinal evidence demonstrating the required injury. while it is true that is defined in the statutory scheme and therefore section 766.309 should be read mentally and physically impaired, a rebuttable presumption shall arise abnormality. association (nica) atraumatically, she responded rapidly to resuscitation immediately of the cortex." tristans eegs were also abnormal, suggesting diffuse cerebral statutory presumption in favor of compensability applied, even though the bennetts the asserted conflict between orlando regional and bennett is based on the nica plan does not cover all incidents of brain damage sustained by an analysis scott a. tacktill and daniel a. tressler, ii, of the unger law group, p.l., because the issue involves whether the first district properly interpreted the interpretation, which the court reviews de novo. fla. birth-related neuro. injury case relied significantly upon the fact that according to tristans medical records, despite the absence of such circumstances, the first district apparently 429. he remained on this machine for the next six days, but later suffered from an available evidence." the first determination is "[w]hether the injury claimed is a the specific language of the statutory presumption is found in section and required resuscitation "with bulb, free flow oxygen, mechanical suction, and birth-related neurological injury compensation association (nica), which showing that tristans brain injury was caused by oxygen deprivation "in the i therefore dissent. performed. as a result of that testing, the decision was made to transport the 1354. for all these reasons, we disapprove of the first districts statutory the presumption, adopted to aid claimants, should not be invoked to did not invoke the presumption. judge kahn further stated that the purpose of the if the claimant has demonstrated, to the satisfaction of the jackson, martin and fontela, p.a., tallahassee, florida of days when a baby is delivered with a life-threatening condition and requires permanently and substantially brain damaged as a result of alleged medical bennett, 27 so. 3d at 72 (kahn, j., dissenting). evidence to be considered. the respondents are simply disputing the weight to be p.m. her respiration was noted as unlabored. tristan remained in the special care more possible seizures and central nervous system tremors were noted, an remedies as a statutory substitute for common law rights and liabilities,3 delivery, or resuscitation in the immediate postdelivery period. in support of this statute. it was the respondent doctor and hospital who sought a determination that be compensable under the nica plan. id. at 70. the first district then held that resuscitation in the immediate postdelivery period in a hospital, which if the claimant has demonstrated, to the satisfaction of the labor, delivery, or resuscitation in the immediate postdelivery period and goes the bennetts filed suit in circuit court against their obstetrician, william h. the fifth district noted that while the statute does not define the phrase period" much more expansively, holding that "close supervision" during the week- 766.309(1)(a), fla. stat. (2001). through this presumption, the claimant does relation[;] . . . existing without intervening space or substance[;] . . . claims, among other duties. see generally 766.315(4), fla. stat. (2001). - 18 - - 7 - - 6 - subjects clearly embraced within its terms. see fla. birth-related neuro. injury 766.302(2). with the fifth district court of appeals decision in orlando regional healthcare therefore, the bennetts were not claimants seeking the benefit of the presumption against the mandate that this statute be strictly construed to include only those id. as can be seen by the express wording of the statutory presumption, the interpretation. first, it restricts the impact of the statute to those situations circumscribed by the term "birth-related neurological injury." specifically, the center, inc., as well as other medical providers. in a narrow category of cases in in its statement of findings and intent set forth in section 766.301, the permanent and substantial neurological impairment must result from a brain resuscitation in the immediate postdelivery period. - 23 - district erroneously injected the term "manifest" into the statutory definition when renders the infant permanently and substantially mentally and compensation in an administrative forum provided by statute under the florida or mechanical injury, and that the infant was thereby rendered caused by oxygen deprivation . . . occurring in the course of labor, delivery, or that the infant was thereby rendered permanently and substantially rehabilitation." 766.301(2), fla. stat. as the alj recognized, the "neuro" was "grossly intact." no neurological abnormalities were noted, and no which a "birth-related neurological injury" occurs, parents common law rights to initially revived but no spontaneous respirations could otherwise be the alj, do not demonstrate that there was a continuous, ongoing need of suffered multi-system failure as a consequence of the oxygen prerequisite elements to a nica claim. notably, the statute provides "resuscitation in the immediate postdelivery period" that the infant was thereby rendered permanently and substantially canady, c.j., dissents. respiration until he was finally placed on a heart/lung bypass machine--a fact that been intended, but who has affirmatively elected to reject the benefits hospital. consequently, tristan was not shown to have suffered a resuscitation. id. his status continued to decline, even though he was placed on claimants bear the initial burden of proof under section 766.309(1)(a) compensation under the nica plan, but is instead seeking to establish the right to issue of whether such claims are covered by this act must be determined ____________ created, it is helpful to review the history of legislative changes to this section in case, there is no factual dispute that tristan suffered from two incidents of oxygen term "immediate postdelivery period in a hospital" to include "an extended period decision in orlando regional. bennett, 27 so. 3d at 70. after quoting the aljs life-threatening condition" unless there are ongoing and continuous efforts of individual to compensation under the nica plan cannot invoke the statutory strictly construed. fla. birth-related neuro. injury comp. assn, 686 so. 2d at 2008). see art. v, 3(b)(3), fla. const. for the reasons that follow, we quash the to interpret the rebuttable presumption language in section 766.309(1)(a) to - 15 - dysfunction. from this point forward, physician progress notes documented p.m., harper continued to suffer respiratory failure that required provides immunity from suit to physicians practicing obstetrics for alleged plan, exercise all powers necessary to effect any of the purposes for which the plan physicians and other witnesses, have been thoroughly reviewed. thus, in its interpretation of the time period when the brain injury must occur, the relying on the medical records and the testimony of the doctors and other determining whether the injury is a birth-related neurological injury, section dispensing with the presumption at the request of a claimant would course of labor, delivery, or resuscitation in the immediate postdelivery period." hypothetical circumstance. id. have to establish that the incident occurred during labor, delivery, or resuscitation the first district reversed, holding instead that both incidents of oxygen in the hospital" to mean "an extended period of days when a baby is delivered with the october 3 incident. in fact, the extensive medical records from st. vincent id. at 432 (emphasis added). 2002) (citing dorlands illustrated medical dictionary 1498 (27th ed. 1988)). statutory scheme does "not preclude coverage if neurological damage becomes proof they would encounter in a civil tort proceeding." id. the scope of the conflict. see pk ventures, inc. v. raymond james & assocs., cord; (2) which is caused by oxygen deprivation or mechanical injury; (3) during the first districts holding in bennett turned on its conclusion that the same statutory provision. related neurological injury" as defined by the nica plan because "tristans ct scan, which was performed on october 29, showed multicystic and under the act generally, it is also true that the nica plan is and substantially mentally and physically impaired. the only question becomes was placed in a special care nursery where she remained for a week after her birth, that the injury is a birth-related neurological injury as defined in s. the satisfaction of the deputy commissioner, that the infant has nursery. hospital records, after delivery, tristan did not cry, had minimal respiratory effort, 766.309(1)(a) provides for a rebuttable presumption as follows: under the plan, the terms "resuscitation" and "immediate" are 2007). as this court has often repeated, "when the language of the statute is clear - 27 - involving obstetricians, who are the group of physicians that the nica plan was the operation began at 1:16 p.m. and the baby, tristan, was delivered at opinion in bennett actually conflicts with orlando regional because in bennett, - 35 - deprivation that occurred october 3, 2001, and not during labor, interpretation of the phrase "resuscitation in the immediate postdelivery period," st. vincent's medical center, inc., et al., with the presumption. id. since 1989, the language of the rebuttable presumption to coverage under [the nica plan], as opposed to having to shoulder the burden of rebuttable presumption would arise, and thus the bennetts, who disagreed with the course of labor, delivery, or resuscitation in the immediate postdelivery period in a "rebuttable presumption." here, the bennetts never invoked the high frequency oscillatory ventilation and later a heart/lung bypass machine. id. at this case and those in orlando regional regarding resuscitation. in bennett, while findings that tristan suffered from oxygen deprivation at the time of her birth and dysfunction] at present"; on october 1, her "[n]euro [was] grossly intact" and there available only for the claimants benefit and is not available to "aid other parties in in reviewing the critical facts in the fifth districts decision, the infant petitioners, infants beyond the limit contemplated by the express language of the statute. - 14 - after her birth. 2. an apgar score is a numerical expression of the condition of the newborn (1) a presumption affecting the burden of producing evidence administrative law judge, that the infant has sustained a brain or spinal not defined within a statute, a fundamental construction tool requires relied on the fact that tristan was placed in a special care nursery in order to hold restoration to life or consciousness of one apparently dead; it includes in reviewing the definition provided by section 766.302(2), the phrases the hospital for purposes of the nica plan." id. the bennetts and nica both long, her obstetrician. [july 7, 2011] rising costs of medical malpractice insurance, and the costs of a birth- administers the nica fund, both assert that the first district interpreted that term designed to benefit. otherwise, as nica points out in its brief, under the first every rebuttable presumption is either: 3d at 185 ("courts should avoid readings that would render part of a statute based on our analysis of the statutory scheme, the definition of "claimant," case conflicts with this holding. bypass machine, the court held that the injury qualified under the nica plan. id. established. harper continued to need resuscitation, without - 2 - - 28 - continuous artificial respiration. law. see 766.301, 766.303, fla. stat. as the legislature explained that the second incident of oxygen deprivation was within the statutory period. statute provided a precondition ("[i]f the claimant has demonstrated"). id. at 72 courts should avoid readings that would render part of a statute meaningless). pulmonary hemorrhage, was not breathing at times, and had a large amount of period in a hospital." 27 so. 3d at 70. although the discussion of this point in were barred from seeking damages in court through a medical malpractice action. later showed likely neurological damage, including "multicystic encelphalomalacia 813 so. 2d 155, 160 (fla. 4th dca 2002) ("according to the plain loss or interval of time[;] . . . near or related to the present"). looking at the definition of "resuscitate," it includes measures such as because, pursuant to the statute, the presumption was triggered where the claimant conclusion, and to require resolution of the issue without regard to the 766.302(2), fla. stat. (2001). thus, based on the language of the statute, a birth- [i]njury to the brain or spinal cord of a live infant . . . caused by modify "the injury to the brain" and not each other. in other words, the injury to under the nica plan is entitled to the benefit of the statutory presumption. based the first district held that the bennetts were limited to the administrative impairment until after she experienced profound episodes of oxygen 2006)). another important principle that applies in this case is that because the neurological injury," which it defined as neurological injuries within the meaning of the chapter. "birth-related neurological injury" as defined by the plan, and the encephalomalacia of the cortex. the alj reviewed all of the medical records and and the prior legislative enactment, we conclude that a party seeking to restrict an tristan did not sustain a "birth-related neurological injury" under the nica plan is "immediate postdelivery period" can modify is the term "resuscitation" because legislature first created the nica plan, section 766.309(1) provided: manifest" at a date later than "labor, delivery, or resuscitation in the immediate sought this courts discretionary review, which we granted. injuries that result in unusually high costs for custodial care and under the correct interpretation of the statute, we hold that the aljs finding that substantial evidence. fla. birth-related neuro. injury comp. assn, 686 so. 2d at medical references to interpret other provisions of the statute. see, has the discretion to consider any issue affecting the case."). obliterate the bennetts position in this case that nica does not apply too broadly so as to preclude the bennetts from pursuing their common law exclusively in an administrative proceeding."). in making this determination, the interruption, and that ongoing need creates one time period--the deprivation that occurred [on] october 3, 2001, and not during labor, delivery, or presumption can be invoked only by the claimant: unlikely tristan suffered a brain injury or substantial neurologic the alj has exclusive jurisdiction to determine whether a claim is - 3 - by claiming compensation, and the respondents were not entitled to the benefit of resuscitation in the immediate postdelivery period in a hospital; and (3) the amount spontaneously, and medical providers provided resuscitation. he was moved to a no. sc10-390 did not seek to invoke this presumption.4 "include an extended period of days when a baby is delivered with a life- infant permanently and substantially impaired, must occur during labor, delivery or and the events through october 3 constituted the ,,immediate postdelivery period in and (2) the infant was thereby rendered substantially and permanently impaired. respiratory effort, muscle tone, reflex irritability, and color. see nagy v. fla. under the nica statute, nica is the administrator of the nica plan and claim is not compensable. 766.302(2), fla. stat. see also nagy v. presumption to prove that the injuries were not birth-related neurological injuries. not need to demonstrate that the injury occurred during labor, delivery, or had not suffered obvious central nervous system (cns) dysfunction until the prior under the factual circumstances of this case, tristan bennett suffered a "birth- comp. assn, 29 so. 3d at 997. if the statutory language is ambiguous and capable manifestation of neurological damage in that period, tristans injuries would still related neurological injury has four components: (1) an injury to the brain or spinal bennett might plausibly be viewed as an alternative holding of the case, it is more the period would last "until the infant was stabilized." id. at 431. however, the statute meaningless." gomez v. vill. of pinecrest, 41 so. 3d 180, 185 (fla. 2010) for resorting to the rules of statutory interpretation and construction; the statute the first district defines the phrase "resuscitation in the immediate postdelivery care. of compensation that is awardable. see 766.309(1), fla. stat. (2001). in claim for compensation under the nica plan. accordingly, in reviewing the facts iii. rebuttable presumption of compensability shall not include disability or death caused by genetic or congenital "bursting bubble" presumption. see dept of agric. & consumer servs. v. was crucial to the fifth districts holding. in other words, it was the ongoing need shall have the burden of proving that the injuries are not birth-related tenets of statutory interpretation by reading out the word "resuscitation" and discussion is prefaced by a phrase--"even if"--signaling comments on a witnesses, the alj found that it was more likely than not that the injury did occur pediatric neurological consultation with dr. gama. eegs were performed on the american heritage dictionary defines the term the issue in these consolidated cases is whether parents of a severely brain- compensable under the nica plan is legally and factually correct. "resuscitate" as "[t]o return to consciousness, vigor or life; revive." 42. in so concluding, it is noted that tristan was delivered ____________ of 8 at five minutes, which was considered normal. cord blood gas revealed - 33 - for resuscitation that created the onetime period. id. because the undisputed facts the presumption. intended to reduce malpractice claims brought under traditional tort healthcare system, inc. v. florida birth-related neurological, 997 so. 2d 426 presumption which certainly makes it easier for claimants to prove they are entitled on october 3. the medical providers do not dispute the facts relied upon by the conclusion not be applied against a party for whom the presumption may have in this case, the bennetts were not seeking compensation under the nica remedies in court.1 experts disagreed as to when the infant was stabilized. the fifth district 2. if either party disagrees with such presumption, that party respondents. mother by helicopter to st. vincents hospital. that same day, the mother direct conflict of decisions bennett, 27 so. 3d at 70. to reach this conclusion, the first district interpreted the neuro. injury comp. assn v. dept of admin. hearings, 29 so. 3d 992, 997 (fla. has statutory responsibilities, including the responsibility to administer the funds overview ordered. a pediatric neurologist was consulted on october 5. testing conducted - 24 - under the nica statute for a "birth-related neurological injury." 766.302(3), fla. oxygen deprivation between the time of birth and being placed on the heart/lung supreme court of florida view of the whole law, or from other laws in pari materia the evident intent is compensation will arise in his or her favor. in this case, we approve the aljs mclaughlin v. state, 721 so. 2d 1170, 1172 (fla. 1998) (quoting holly, 450 so. 2d william t. jackson, william peter martin, and craig ashley dennis of dennis, in orlando regional, the fifth district was faced with a factual scenario first district - case nos. 1d07-5557 and 1d07-5561 supported by competent, substantial evidence. bennett v. fla. birth-related neuro. injury comp. assn, 29 f.a.l.r. 3867, 3879- provisions. the bennetts were covered by the nica plan and, accordingly, that the bennetts after delivery, her neurologic examinations during the first seven days inure to the benefit of the respondent and shift the burden of proof back to the second, the first district incorrectly held that under section 766.309(1)(a), florida 1. we consolidated the two separate cases for oral argument and now instructive to review the decision in orlando regional and how it interpreted the expert testimony, but noted that none of the parties offered the testimony of a st. vincent's medical center, inc., et al., actual language in the statute "because legislative intent is determined primarily nica statutory scheme it is "the intent of the legislature to provide language of the statute, the phrase "in the immediate postdelivery period" is a - 26 - sue in a court of law, that individual is not a claimant for the purposes of the labor, delivery, or resuscitation in the immediate postdelivery period and 1:22 p.m. (when tristan was delivered), that likely continued resuscitation from the time of birth to the time of the injury that resulted in the applied the statutory presumption of compensability set forth in section - 22 - related neurological injury are particularly high. the legislature respondents. a strict interpretation of the statutory definition is also necessary based on "caused by" and "occurring in" set forth in the phrase "injury to the brain . . . thereafter evidenced seizure activity and neurological decline. - 17 - tristan bennett was born on september 26, 2001, at st. vincents hospital 1995)). but instead recognized that "the application of this definition in determining plan was disconnected and mrs. bennett was moved to the operating room) or mechanical injury occurring in the course of labor, delivery, or pariente, j. impairments resulted from a brain injury caused by oxygen "reasonable to conclude that the legislature had this in mind when it provided the by the division of administrative hearings as to whether the infants injuries resuscitation. the infant in the orlando regional case was delivered by cesarean profound metabolic acidosis. tristan was initially transferred to the newborn narrow question is whether the first district court of appeal in st. vincents that question can be answered only by interpreting the governing statutory affected by the increasing malpractice insurance premiums and that the costs of "resuscitation in the immediate postdelivery period," all of the experts agreed that immediate postdelivery period," but that is not the issue in this case where the alj rebecca bowen creed of creed and gowdy, p.a., jacksonville, florida; and having done so, it must be resolved that the record developed in this purposes of the nica plan." id. at 70. however, requiring close supervision conditions in the week following her birth, many of which were linked to kidney of the day. by the end of the day, tristan showed signs of possible neurologic district did not directly address these explicit findings, but rejected the aljs resulting from the oxygen deprivation must occur in this time period. further, the first district reversed the alj, holding that the alj should have express and direct conflict with the fifth districts decision in orlando regional that the first districts statutory construction analysis of the applicable statute was at liberty to add words to statutes that were not placed there by the legislature."). - 8 - the medical providers provided initial resuscitation to tristan shortly after birth, and liver damage. however, there is no indication of any ongoing treatment for compensation, on a no-fault basis, for a limited class" of birth-related neurological saturations. she was critically unstable through most of the day and began for petitioner, robert bennett, etc., et al. october 3, 2001. that determination of timing was critical to whether there was of that case, "no reasonable interpretation for the phrase ,,resuscitation in the conclusions, stating that the definition of "birth-related neurological injury" does 90.302, fla. stat. (2001). all the parties agree that the statutory presumption at the revision made two changes. first, it changed the language "where it had the brain must be caused by oxygen deprivation and that injury must occur "in the after tristans initial problems were resolved, she suffered from numerous statutory provisions. courts should avoid readings that would render part of a alternative holding that the presumption disappeared because credible, contrary need not be "manifest" at the time of "labor, delivery or resuscitation in the time[;] . . . [c]lose at hand; near." the american heritage dictionary comp. assn, 29 so. 3d at 997 (quoting holly v. auld, 450 so. 2d 217, 219 (fla. i. background of the nica plan law judge (alj), who found that tristan did not suffer a "birth-related neurological the claimant. see ch. 89-186, 4, laws of fla.


All Content © 2007-2012 The Judicial View, L.L.C. All Right Reserved.
About The Judicial View ®  | Privacy Policy   |  Terms of Use   |  Contact Us  |  Advertise