Punctuation as Text: “Goods” and “Services” as Standalone Prohibitions in Pennsylvania’s Workers’ Compensation Anti-Referral Statute

1. Introduction

In 700 Pharm. v. Bur of WC (State Workers' Ins. Fund) (Pa. June 16, 2026), the Supreme Court of Pennsylvania addressed the scope of the Workers’ Compensation Act’s anti-referral provision, 77 P.S. § 531(3)(iii). The consolidated appeals arose from Bureau of Workers’ Compensation fee-review determinations (affirmed by the Commonwealth Court) involving 700 Pharmacy and the Bureau’s Fee Review Hearing Office (State Workers’ Insurance Fund).

Although the merits dispute in the litigation was framed around whether referrals for prescription drugs fall within “goods or services,” Justice Wecht’s dissent focuses on a more foundational interpretive question: whether the statutory phrase “goods or services” is (a) a single qualifying phrase modifying the enumerated items that precede it, or (b) two additional, standalone categories—“goods” and “services”—each independently prohibited when the referring provider has a financial interest in the referral recipient.

2. Summary of the Opinion (Justice Wecht, dissenting)

Justice Wecht rejects the Majority’s conclusion that the anti-referral provision is unambiguous and limited to eight specified categories. In his view, the statute’s punctuation (specifically, the comma that precedes “goods or services”) indicates that “goods” and “services” are separate list items, producing ten distinct prohibitions. He argues the Majority’s “plain language” holding is untenable because it requires ignoring punctuation—an interpretive move incompatible with Pennsylvania’s modern statutory-construction framework.

The dissent further contends that, at minimum, the provision is ambiguous because multiple canons (punctuation, last antecedent, and anti-surplusage) point in different directions. Once ambiguity is conceded, Justice Wecht would interpret the statute in light of the 1993 cost-containment purpose—preventing self-interested referrals—supporting a broader construction that captures referrals for “goods” and “services” beyond the enumerated medical categories.

3. Analysis

3.1 Precedents Cited

Starck v. Union Cent. Life Ins. Co., 19 A. 703 (Pa. 1890)

Justice Wecht cites Starck v. Union Cent. Life Ins. Co. to explain historical skepticism toward punctuation in statutory interpretation, rooted in a time when legislation was often unpunctuated and read aloud. The dissent uses Starck as a contrast case: whatever may have been true in the nineteenth century, Pennsylvania law now permits punctuation to aid interpretation for statutes enacted after 1964.

Cash Am. Net of Nev., LLC v. Pa. Dept. of Banking, 8 A.3d 282 (Pa. 2010)

The dissent relies on Cash Am. Net of Nev., LLC v. Pa. Dept. of Banking as modern confirmation that comma placement can be outcome-determinative in Pennsylvania statutory construction. This supports the dissent’s central thesis: the anti-referral provision’s comma before “goods or services” is part of the enacted text and cannot be treated as disposable when assessing “plain meaning.”

Jackiw v. Soft Pretzel Franchise (W.C.A.B.), 329 A.3d 1152 (Pa. 2025)

Justice Wecht notes the Majority’s reliance on Jackiw v. Soft Pretzel Franchise (W.C.A.B.) to emphasize 1 Pa.C.S. § 1921(a)’s preference to “give effect to all” statutory provisions and avoid surplusage. The dissent accepts surplusage-avoidance as a relevant canon, but argues it cannot override punctuation and grammar to the point of declaring the text “unambiguous.”

McGuire on behalf of Neidig v. City of Pittsburgh, 285 A.3d 887 (Pa. 2022)

The dissent uses McGuire on behalf of Neidig v. City of Pittsburgh to normalize legislative “belt-and-suspenders” drafting—i.e., deliberate redundancy. This precedent undercuts the Majority’s premise that any reading generating overlap between broad and narrow terms must be rejected as implausible. For Justice Wecht, some surplusage may simply reflect legislative drafting style rather than a definitive signal of meaning.

Barnhart v. Thomas, 540 U.S. 20 (2003)

Justice Wecht invokes Barnhart v. Thomas for the “last antecedent rule,” i.e., that a trailing modifier generally applies only to the immediately preceding phrase absent contrary indication. The dissent uses this to argue that the Majority’s approach—making “goods or services” modify every item in the earlier list—conflicts with a widely recognized grammatical default.

Pa. Dept. of Banking v. NCAS of Del., LLC, 948 A.2d 752 (Pa. 2008)

The dissent pairs Pa. Dept. of Banking v. NCAS of Del., LLC with Barnhart to show the last antecedent rule is also familiar in Pennsylvania: the default applies “in absence of evidence of some contrary purpose.” Justice Wecht argues the statute’s punctuation supplies no such contrary evidence; if anything, the comma placement supports treating “goods” and “services” as distinct list items rather than a global modifier.

Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc., 721 A.2d 1061 (Pa. 1998)

Justice Wecht uses Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc. to articulate the legislative mischief targeted by the 1993 reforms: broadly “preven[t] physicians from acting in their own self-interest” in referrals. This precedent becomes decisive in the dissent’s fallback position: if the text is ambiguous, statutory purpose and consequences favor a broader anti-self-referral reading.

3.2 Legal Reasoning

(a) The dissent’s textual claim: punctuation creates two additional prohibitions

The dissent reads 77 P.S. § 531(3)(iii) as a list in which “goods” and “services” are the final two items. The critical detail is the comma before “goods or services.” Under ordinary English usage, inserting that comma suggests a series continues, rather than a trailing modifier that retroactively qualifies each earlier term. On that view, the anti-referral provision prohibits self-referrals for (at least) the enumerated clinical categories and, in addition, self-referrals for “goods” and self-referrals for “services.”

(b) The dissent’s critique of “plain meaning” without punctuation

Justice Wecht argues the Majority cannot call its interpretation unambiguous while simultaneously requiring the reader to disregard punctuation. In his framing, punctuation is not an external aid; it is part of the enacted statutory text for post-1964 legislation (reinforced by 1 Pa.C.S. § 1923(b)). Accordingly, any “plain language” analysis that omits punctuation is incomplete at the threshold.

(c) Competing canons: surplusage vs. punctuation and last antecedent

The Majority (as described in the dissent) prioritizes the rule against surplusage under 1 Pa.C.S. § 1921(a), reasoning that if “goods” and “services” are standalone broad terms, they would swallow the enumerated items, rendering them redundant. Justice Wecht’s response is twofold:

  • Redundancy may be intentional: Legislatures sometimes draft with overlap (citing McGuire on behalf of Neidig v. City of Pittsburgh), so surplusage concerns should not force courts to rewrite grammar or ignore punctuation.
  • Other canons point the other way: punctuation and the last antecedent rule (citing Barnhart v. Thomas and Pa. Dept. of Banking v. NCAS of Del., LLC) support the dissent’s narrower grammatical conclusion about how modifiers attach.

Because these interpretive signals conflict, the dissent concludes that (at minimum) the provision is ambiguous and cannot be resolved by declaring one canon categorically superior without justification.

(d) If ambiguous, purpose controls under the Statutory Construction Act

Justice Wecht emphasizes that once ambiguity is acknowledged, 1 Pa.C.S. § 1921(c)(1)-(8) permits consideration of context, mischief, and consequences. Using Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc., the dissent reads the 1993 anti-referral reforms as designed to broadly deter financially self-interested referral behavior. A construction that narrows the prohibition to a handful of enumerated categories—excluding other “goods” and “services”—is, in the dissent’s view, inconsistent with that cost-containment objective.

3.3 Impact

Justice Wecht’s dissent highlights two practical stakes that may shape future litigation even if the Majority’s interpretation controls:

  • Scope of anti-self-referral enforcement: If “goods” and “services” are not standalone prohibitions, entities providing items not neatly aligned with the enumerated categories (e.g., pharmaceuticals, supplies, or other ancillary offerings) may fall outside the anti-referral restriction, potentially encouraging business models that the 1993 reforms were intended to discourage.
  • Methodology in statutory interpretation: The dissent’s emphasis on punctuation and grammatical canons presses Pennsylvania courts to be explicit about how they prioritize competing interpretive tools. It also signals that labeling a statute “unambiguous” may be vulnerable on appeal when the reasoning requires disregarding textual features like commas.

The dissent also implicitly invites legislative correction: if the General Assembly intends either a broad catch-all or a limited list, clearer drafting (including serial comma usage or restructuring) would reduce recurring disputes and compliance uncertainty for providers and insurers.

4. Complex Concepts Simplified

  • Anti-referral (self-referral) prohibition: A rule preventing a medical provider from sending a patient to a business the provider owns (or has a financial stake in), because the provider might profit from the referral rather than choose the best or most cost-effective option.
  • Oxford (serial) comma: The comma after the second-to-last item in a list (“A, B, and C”). Its presence or absence can change meaning. The dissent uses it to illustrate how list structure can clarify (or obscure) whether the final words are new list items or modifiers.
  • Rule against surplusage: A presumption that the legislature does not include useless words; courts try to interpret statutes so every phrase does some work.
  • Last antecedent rule: A grammatical default that a modifier at the end of a series usually modifies only the nearest reasonable term, not every earlier term in the list.
  • “Plain meaning” vs. ambiguity: A statute is “unambiguous” only when, after applying ordinary textual tools (including punctuation), it has a single reasonable meaning. If multiple canons plausibly point to different readings, courts often treat the statute as ambiguous and consult purpose and consequences under 1 Pa.C.S. § 1921(c).

5. Conclusion

Justice Wecht’s dissent in 700 Pharm. v. Bur of WC (State Workers' Ins. Fund) is a pointed methodological critique: punctuation and grammar are part of statutory text, and a court cannot persuasively declare a provision “unambiguous” while ignoring commas that bear on meaning. Substantively, the dissent would read 77 P.S. § 531(3)(iii) to include two broad, independent anti-referral prohibitions—“goods” and “services”—and, at minimum, would treat the provision as ambiguous and interpret it in light of the 1993 cost-containment goal recognized in Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc..

Whether or not the dissent’s reading prevails in future cases, it crystallizes the interpretive battleground for Pennsylvania’s anti-self-referral regime: how courts reconcile punctuation, grammatical canons, and anti-surplusage principles—especially where the policy aim is to deter financially motivated referrals within the workers’ compensation system.