Russell v. Sebelius

After a hernia-repair surgery, 67-year-old Elizabeth Russell (plaintiff) developed a large wound that would not heal. Russell also tired easily and suffered nausea and pain. Between June 2004 and December 2004, Russell received daily nurse visits in her home to monitor and manage her nonhealing wound. When Russell filed Medicare claims seeking reimbursement for the nurse visits, the claims were denied on the basis that Russell did not qualify for home-health services. Russell sought review by an administrative-law judge (ALJ). Russell and her sister, Joyce Hojohn, submitted affidavits stating that Hojohn visited Russell multiple times per day to take care of Russell’s home and dog. The affidavits also stated that aside from medical appointments, Russell left her home only to accompany Hojohn on 50-foot dog walks and occasional grocery trips. For the short grocery trips, Hojohn did all the driving, lifting, and carrying, and Russell nevertheless returned home exhausted and in need of rest. Nurses’ assessments were also submitted into evidence. Some deemed Russell capable of leaving her home independently, but others described Russell as homebound. The ALJ concluded that despite Russell’s wound, she could leave her home for extended periods for nonmedical activities like shopping. The ALJ also found that Russell’s ability to travel without any assistive device showed that leaving home did not require considerable and taxing effort. The ALJ therefore determined that Russell did not qualify for home-health services and was not entitled to reimbursement. After the Medicare Appeals Council adopted the ALJ’s decision, Russell sued Secretary of Health and Human Services Kathleen Sebelius (defendant), seeking judicial review.