Decision  Byron v. State Bd. of Ret., CR-22-0579

Date:	02/20/2026
Organization:	Division of Administrative Law Appeals
Docket Number:	CR-22-0579

• Petitioner: Allison Byron
• Respondent: State Board of Retirement
• Appearance for Petitioner: Allison Byron, pro se
• Appearance for Respondent: Yande Lombe, Esq.
• Administrative Magistrate: John Wheatley

Summary of Decision

The petitioner is entitled to Group 2 classification for her positions as Licensed Practical Nurse and Registered Nurse II at Tewksbury Hospital, under G. L. c. 32, § 3(2)(g).  The petitioner’s patients had diagnoses of physical ailments, but most of these patients also had significant mental illness diagnoses for which the petitioner provided direct medical care.  The petitioner established by a preponderance of the evidence that her regular and major duties required her to care for patients with mental illness, and she is therefore entitled to Group 2 classification.  See Popp v. State Bd. of Retirement, CR-17-848, 2023 WL 11806173 (Contributory Ret. App. Bd. Nov. 16, 2023).

Decision

The petitioner, Allison Byron, appeals the State Board of Retirement’s denial of her applications for Group 2 classification for her work at Tewksbury Hospital (Tewksbury).  I held and recorded an evidentiary hearing on November 18, 2024, during which I admitted 17 exhibits into evidence.[1] Byron was the only testifying witness.  At the end of the hearing, Byron made a closing statement verbally, and the Board requested to file a closing memorandum.  I received the Board’s memorandum on January 15, 2025, whereupon the administrative record closed.

Findings of Fact

Based on the evidence presented, I make the following findings of fact:

1. In 1984, Allison Byron began working at Tewksbury for the Department of Public Health. (Exhibits 9(a), 9(d), and 9(h).)
   1. Tewksbury provides “comprehensive treatment, care and comfort to adults with medical and/or mental illness.”  (Exhibit 9(g).)
   2. When a patient at Tewksbury is receiving treatment on a psychiatric unit but also needs treatment for a medical diagnosis, hospital staff may transfer that patient to a medical unit.  The transfer may be temporary or permanent.  (Exhibit 8.)
   3. Byron worked on Unit C5 at Tewksbury as a licensed practical nurse (LPN) from July 8, 1984, to December 14, 1991.  (Exhibit 9(a).)
   4. Byron worked on Units C5 and C2 at Tewksbury as a registered nurse II (RN II) from December 15, 1991, to June 17, 2001.  (Exhibit 9(d).)
   5. When the Department of Mental Health assumed control of Unit C5 in 1992, the DPH patients from that unit moved to Unit C2.  Byron moved from Unit C5 to Unit C2 with the patients.  (Testimony.)
   6. Patients came to Unit C5 for medical treatment.  However, Unit C5 was a 60-bed dual diagnosis unit, which meant that patients had both medical illnesses and mental illnesses.  Byron typically cared for between six to eight patients on Unit C5.  (Testimony.)
   7. Unit C2 was also a dual diagnosis unit; there were approximately 40 patients on Unit C2, and Byron typically cared for six of those patients.  (Testimony.)
   8. During the time Byron worked there, some patients at Tewksbury acted in disruptive and violent ways, at times injuring staff or themselves.  Byron had been “threatened and assaulted on numerous occasions due to patients experiencing emotional and psychiatric dysregulation.”  (Exhibits 4, 9(h); Testimony.)
   9. Some patients stayed at Tewksbury for years and some remained until their death.  (Testimony.)
   10. Many patients went to Tewksbury as a last resort (Testimony) because they had “nowhere else to go” (Exhibit 2); they could not remain at inpatient hospitals indefinitely, “were rejected from other healthcare systems due to their very complicated medical, behavioral, and mental issues[,]” and nursing homes were reluctant to admit patients with significant behavioral issues and medical complexities (Exhibits 3-4; Testimony).
   11. Dr. Richard Ma, Tewksbury’s Chief Medical Officer, described the patients on Units C2 and C5 as having diagnoses such as “Huntington’s, stroke, Alzheimer’s, dementia, drug abuse, bipolar disorder, [and] intellectual disabilities[.]”  He also noted that sex offenders and patients with “tendencies towards violence” received treatment on these units, as well as patients with advanced Huntington’s and dementia with psychiatric issues requiring antipsychotic medications and frequent psychiatric evaluation.  He further stated:
2. “These challenging patients are often difficult and referred to us from every facility in Massachusetts. Our staff here deal with a lot of complex cases and . . . most of our patients have significant psychiatric issues that affect their medical issues. Many of our patients end up here due to medical and social issues that are exacerbated by their psychiatric issues.”
3. (Exhibit 2.)
   1. Between 70-75% of Byron’s patients at Tewksbury had a mental illness diagnosis.  Byron estimated that 70% of her patients took psychotropic medications to treat mental illnesses.  Her patients’ diagnoses included schizophrenia, schizoaffective disorder, bipolar disorder, anxiety, antisocial personality disorder, Down syndrome, cerebral palsy, Huntington’s disease, and dementia, among others.  (Exhibits 2-4; Testimony.)
   2. Byron’s duties on both units generally involved getting a report from the previous shift, conducting rounds, delivering and monitoring meals, administering medications that included psychotropics (both routinely and on an as-needed basis), checking on patients’ safety, building rapport with patients, managing difficult behaviors, delivering wound and gastrostomy tube (“G tube”) care, administering breathing treatments, and caring for the “whole person.”  (Testimony.)
   3. When necessary, Byron administered both medication restraints and physical restraints to patients to protect them from injuring themselves or others.  (Exhibit 9(h).)
   4. Byron taught and reinforced coping skills daily to patients.  (Exhibit 9(h).)
   5. Although Byron’s patients had physical ailments, she had to “deal with them emotionally” so that she could provide the appropriate treatment.  The way that she provided care would change based on the patient’s psychiatric presentation.  In addition, she had to build rapport with patients so that they trusted her to care for them, which took more time with some people than with others.  For example, some patients would lash out at her if she approached them too hastily when administering medications, without first spending some time with them.  (Testimony.)
   6. Byron also attended patient care conferences and was present for psychiatric rounds during which the interdisciplinary team discussed behavior issues and potential changes to psychotropic medications.  (Exhibit 9(h).)
   7. Byron continued to care for the same patients when her title changed from LPN to RN II.  (Testimony.)
   8. Similarly, Byron continued to spend the same amount of time with patients when her job title changed from LPN to RN II.  Byron spent at least 80% of her time providing direct care to patients.  (Testimony.)
   9. Some of her job responsibilities changed when she became an RN II.  For example, her supervisory responsibilities shifted; as an LPN she supervised nurse aides and as an RN II she supervised LPNs and nurse aides.  As an LPN, she also responded to more situations that required physical intervention.  (Testimony.)
   10. By applications dated April 4, 2022, Byron applied for Group 2 classification for her positions of LPN (July 8, 1984, through December 14, 1991) and RN II (December 15, 1991, through June 17, 2001).  (Exhibits 9(a) and 9(d).)
   11. The Board denied Byron’s applications in a letter dated November 23, 2022.  (Exhibit 11.)
   12. On December 1, 2022, Byron filed a timely appeal.  (Exhibit 12.)

Analysis

As the petitioner, Byron has the burden of proving by a preponderance of the evidence, or that it is more likely than not, that she qualifies for Group 2 classification.  Section 3(2)(g) of Chapter 32 of the Massachusetts General Laws classifies contributory retirement system members into four groups to determine, in part, what benefits they are entitled to when they retire.  By default, members whose positions do not meet the criteria for the other three groups fall within Group 1, which includes “[o]fficials and general employees including clerical, administrative and technical workers, laborers, mechanics and all others not otherwise classified.”  G. L. c. 32, § 3(2)(g).  Byron seeks Group 2 classification, which includes employees “whose regular and major duties require them to have the care, custody, instruction or other supervision of . . . persons who are mentally ill[.]”  Id.  The focus in this case is on whether Byron falls within Group 1 or Group 2.

Byron has elected to receive pro-rated benefits based on her years of service as an LPN and RN II.  “Any active member as of April 2, 2012, who has served in more than 1 group may elect to receive a retirement allowance consisting of pro-rated benefits based upon the percentage of total years of service that the member rendered in each group.”  G. L. c. 32, § 5(2)(a).  Thus, the analysis of Byron’s service must consider whether her time as an LPN and her time as an RN II meet the requirements for Group 2 classification.   

Regular and major duties.

An employee must “spend[] more than half of his or her time” providing direct care to a Group 2 population for these responsibilities to be part of their “regular and major” duties.  Desautel v. State Bd. of Retirement, CR-18-0080, 2023 WL 11806157, at *2 (Contributory Ret. App. Bd. Aug. 2, 2023).  In addition, the employee must be engaged in direct patient care, “taking on responsibility for some aspect of an individual’s well-being.”  O’Neil v. State Bd. of Retirement, CR-23-0154, 2025 WL 1529241, at *3 (Div. Admin. Law App. May 23, 2025) (internal citation and quotation marks omitted); see also Rebell v. Contributory Retirement Appeal Bd., 30 Mass. App. Ct. 1108, slip op. at 4 (Mar. 20, 1991) (noting that “care” in Section 3(2)(g) indicates “charge, oversight, watchful regard and attention” [unpublished opinion]).

Here, a preponderance of the evidence demonstrates that Byron’s regular and major job duties involved direct patient care.  Her daily tasks included delivering and monitoring patients’ meals, administering medications that included psychotropics (both routinely and on an as-needed basis), checking on patients’ safety, managing difficult behaviors, delivering care for wounds and gastrostomy tubes, and administering breathing treatments.  Byron testified credibly that she spent at least 80% of her time providing direct patient care both as an LPN and as an RN II.  Thus, I find that Byron’s regular and major job duties involved direct patient care for purposes of Section 3(2)(g).

Care of persons who have mental illness.

Byron testified credibly that she worked with the same patients throughout her time at Tewksbury, both as an LPN and as an RN II.  Despite a shift in some of her responsibilities when her job changed, she cared for the same patients in both roles.  Thus, the following analysis of Group 2 classification applies to both of her positions.

In Popp v. State Bd. of Retirement, CR-17-848, 2023 WL 11806173 (Contributory Ret. App. Bd. Nov. 16, 2023), the Contributory Retirement Appeal Board (CRAB) affirmed that a certified nurse assistant caring for patients with a primary diagnosis of hospice was eligible for Group 2 classification.  The Popp decision first notes that people must have a “primary diagnosis” of mental illness to qualify as mentally ill under Section 3(2)(g) and that the mental illness cannot be “merely incidental” to physical illness.  Id. at *3.  Popp then delved into the purpose of the primary diagnosis test, which is to evaluate what “truly drives the patients[’] care, distinguishing mental illness diagnoses which are merely incidental or derivative of physical illnesses from principally mentally ill patients.”  Id. at *4.  Thus, an employee who cares for patients whose mental illnesses “drove and governed their care” is eligible for Group 2 classification.  Hanson v. State Bd. of Retirement, CR-22-0268, 2024 WL 4432417, at *3 (Div. Admin. Law App. Sept. 27, 2024) (attention to patients’ “mental-health-related symptoms and behaviors is at the heart of the care and supervision they require”); see also Niles v. State Bd. of Retirement, CR-20-0236, 2025 WL 2902419 (Contributory Ret. App. Bd. Aug. 20, 2025) (licensed practical nurse working on surgical unit treating medical and psychiatric issues classified in Group 2); Small v. State Bd. of Retirement, CR-22-0113, 2024 WL 4582635 (Div. Admin. Law App. Aug. 9, 2024) (majority of patients had mental illness diagnoses in addition to physical illness); Zelten v. State Bd. of Retirement, CR-22-0457, 2024 WL 664422, at *3 (Div. Admin. Law App. Feb. 9, 2024) (“A member’s group classification . . . flows from the substance of the conditions that the member’s patients are treated for.”).

Byron, a veteran nurse, credibly testified that about 70-75% of the patients on Units C5 and C2 had diagnoses of mental illnesses.  In addition to requiring clinical treatment for their physical ailments, the evidence demonstrates that her patients needed treatment and management of their mental illnesses.  Byron’s patients took psychotropic medications to manage their mental health conditions.  At times, her patients became upset or aggressive and required de-escalation, or in some cases, required physical or chemical restraints.  Byron’s patients were the subjects of weekly mental health rounds with a care team, including a psychiatrist, which discussed the patients’ psychotropic medication regimens.  Finally, her patients’ mental status had an impact on how Byron approached clinical care for their physical ailments.  Though admission to Units C2 and C5 did not require patients to have a primary diagnosis of mental illness, most of the patients on those units had mental illnesses alongside their physical conditions, and their mental illnesses drove and governed the care Byron provided to them.

Conclusion

Byron established by a preponderance of the evidence that her regular and major job duties required her to have the “care, custody, instruction or other supervision” of patients with mental illnesses.  She is therefore entitled to Group 2 classification under G. L. c. 32, § 3(2)(g).  The decision of the Board is reversed.

Dated:  February 20, 2026      

/s/ John G. Wheatley
 _________________________________
 John G. Wheatley
Administrative Magistrate
Administrative Magistrate
Division of Administrative Law Appeals
14 Summer Street, 4th floor
Malden, MA 02148
Tel:  [phone]
www.mass.gov/dala

Appendix – Exhibits Admitted into Evidence

Exhibit 2	Letter from Tewksbury Chief Medical Officer, Richard Ma, M.D.
Exhibit 3	Letter from Tewksbury Assistant Director of Nursing, Victoria Pike
Exhibit 4	Email messages between Victoria Pike and counsel for the Board, Yande Lombe, Esq.
Exhibit 5	Lowell Sun news article regarding incident at Tewksbury on Aug. 8, 2021
Exhibit 6	Letter from State Representative Colleen M. Garry
Exhibit 8	Tewksbury policy #PC-9.02 regarding transfer of psychiatric patients
Exhibit 9(a)	Application for Group Classification for licensed practical nurse position
Exhibit 9(b)	Form 30 - Position Description for Licensed Practical Nurse I, dated Aug. 2000
Exhibit 9(c)	Employee Performance Review Form for fiscal year 1991
Exhibit 9(d)	Application for Group Classification for registered nurse position
Exhibit 9(e)	Form 30 – Position Description for Registered Nurse II, dated Aug. 1994
Exhibit 9(f)	Employee Performance Review Form for 2000-2001
Exhibit 9(g)	Tewksbury policy #LD-1.01 regarding the hospital’s mission and values
Exhibit 9(h)	Petitioner’s narrative submitted to the Board in support of her classification applications
Exhibit 10	Letter from Board Executive Director, Nicola Favorito, to Petitioner, dated Oct. 27, 2022
Exhibit 11	Letter from Board Executive Director, Nicola Favorito, to Petitioner, dated Nov. 23, 2022
Exhibit 12	Petitioner’s letter of appeal to the Division of Admin. Law Appeals, dated Oct. 1, 2022

[1] See the attached appendix for a list of the exhibits admitted in evidence.