May 23, 2012 -- John Pittas, 47, is fighting a Pennsylvania court's order to pay his mother's $93,000 nursing home stay under a "filial support law" that is in effect in 29 states.
Pennsylvania's statute makes certain family members liable to "care for and maintain or financially assist" certain "indigent" members of the family, a law which some legal experts call "disturbing."
Pittas' mother, Maryann, now 66, was admitted for six months to Liberty Nursing Rehabilitation Center in Allentown, Pa., in September 2007 after breaking two legs in a car accident. In March 2008, Pittas' mother, who was born in the U.S., relocated to Greece, where her two other children live.
As the only remaining family member left in the U.S., Pittas was left to foot the $92,943.41 bill after his mother's Medicaid application was not approved in time. The Health Care & Retirement Corp. of America, which owns Liberty Nursing & Rehabilitation Center, sued Pittas in May 2008 for the money and a trial court sided with the nursing home in 2011.
Pittas appealed but the Superior Court of Pennsylvania issued a verdict earlier this month in favor of the nursing home again.
The restaurant owner said he was "in shock" and "devastated" at the ruling and filed to re-argue his case with the Superior Court on Monday.
"I have a business and family. My wife was pregnant with the second child at the time," Pittas said. "The economy is not what it used to be. I'm very worried about this and stressed."
Pittas said he is keeping his elderly mother, who is recovering from a stroke, and father, 78, both in Greece, out of the legal dispute. His mother had a monthly income of $1,000 from Social Security and her husband's Veteran's Administration benefit. The nursing home argued in court that her income was not enough to provide for the bill and the court established her "indigent" status.
Liberty Nursing and Rehab Center said in a statement: "We do expect to receive payment for services provided. We work with patients and families to help them understand their options and responsibilities. We work with the patient and family on payment options including filing for Medicaid if necessary."
Liberty spokeswoman Julie Beckert said she could not comment about the appeal filed on Monday because it is pending litigation.
According to the statement, the company does not "ask family members to use their own personal funds to pay for their loved ones' care."
"However, family members that are responsible parties for financial issues are responsible to gather needed documents per state guidelines for their loved ones care. We, as well as the state, rely on those family members to provide this information for timely and accurate filing."
In the appeal filed on Monday, Pittas is arguing that the court mistakenly established that he had the "financial ability to support his mother" based on his annual income of $85,000, without taking into account his expenses.
Katherine Pearson, law professor and director of the Elder Protection Clinic at Penn State's Dickinson School of Law, said the Superior Court's decision earlier this month plowed new legal ground.
First, the son's financial obligation imposed by the court was much larger in this case compared to previous Pennsylvania cases involving the filial support law. In Savoy v. Savoy, a suit brought by the mother against her son and decided by the Superior Court in 1994, the court ordered the son to pay $150 a month toward his mother's $10,000 health care debt.
"One of the problems with the Pittas decision is that the Superior Court treats the award as if it was similar to a monthly lien," she said. "That is not how judgments are usually collected."
John Karoly III, Pittas' attorney, said that had Pittas not filed the appeal this week, the collection of the $93,000 would likely have started immediately.
"He would be required to pay the amount immediately upon exhausting all his appeals," Karoly said.
Karoly said interest on the payment is accruing since the date of the judgment at 6 percent per annum.
A surprising aspect of the decision, he said, is that there is no record of "fault" in Pittas' case, unlike previous Pennsylvania filial support cases in which a child has, for example, defrauded an elderly parent, or helped create the debt in question.
Another surprising element of the ruling this month is that it "expressly puts the burden on children to sue their siblings or a parent's spouse if contending that the support duty must be shared."
Pittas said he will discuss with his brother and sister if his latest appeal fails and he must pay the bill.
"I don't think it's a fair law unless these parents' children are made of money," Pittas said of the state's filial support law. "Their families can afford it."
Pennsylvania's law attracted little attention in 2005 when it was transferred into the domestic relations code for the state from its "welfare laws" from the colonial era.
Pearson said there are 29 states that have some type of legal obligation that could, in theory, be used to obligate adult children to provide financial assistance to a needy parent.
At one time as many as 45 states had filial support laws, but most were repealed, abandoned, or fell into obscurity, with the increase in importance for Social Security, Medicare and Medicaid, she said.
Pearson said what is "potentially disturbing" and concerning to her as an academic and lawyer who has studied filial support laws for more than 10 years are the points not addressed in the Superior Court's decision this month, such as the federal Medicaid Laws that prohibit nursing homes from mandating third-party guarantees as a condition of care. Those laws prevent manipulation of families who might otherwise think that if they "guarantee" the parent's bill, the parent will get better care.
Federal law prohibits Medicaid eligibility from considering the "income and resources" of any applicant's relative.
Pearson said families need to be educated about the filial support laws in their states or more adult children will find themselves in a similar situation as that of Pittas.
"I think nursing homes should encourage children to seek competent legal advice on their own, and not to make it sound like the nursing home is working in the family's best interest in filing the application," she said. "In Pennsylvania, seasoned, experienced elder law specialists understand both Medicaid and Pennsylvania's filial support statute and can help families make financially sound decisions that will avoid gaps in coverage. In other states, similarly experienced elder law specialists can explain how that state's Medicaid laws work."