Bowden v. Med. Ctr., Inc.

Decision Date15 June 2015
Docket NumberNo. S14G1632.,S14G1632.
Citation773 S.E.2d 692,297 Ga. 285
CourtGeorgia Supreme Court

Charles A. Gower, Charles Austin Gower, Jr., David Thomas Rohwedder, Charles A. Gower, P.C., Columbus, David T. Rohwedder, for appellant.

Fischer Scott, Bobby Lee Scott, Columbus, Scott C. Crowley, for appellee.


NAHMIAS, Justice.

Georgia law gives a hospital a lien for the reasonable charges for its care and treatment of an injured person against all causes of action accruing to that person on account of her injuries, and establishes a process for the hospital to perfect its lien for the amount claimed to be due. See OCGA §§ 44–14–470, 4414–471. The Medical Center, Inc. (TMC) provided hospital care to Danielle Bowden, who did not have health insurance, after she was injured in a car wreck, billed her $21,409.59 for her care, and filed a hospital lien for that amount. In a subsequent lawsuit, Bowden sought to invalidate the lien on the ground that the billed charges were grossly excessive and did not reflect the reasonable value of the care she received, while TMC alleged that $21,409.59 was a reasonable amount for Bowden's care and sought a declaratory judgment establishing the validity of its lien.

During discovery, TMC objected to Bowden's requests for, among other things, information and documents regarding the amounts that the hospital charged insured patients for the same type of care. Bowden filed a motion to compel discovery, which the trial court granted subject to the entry of a protective order to ensure confidentiality. On interlocutory appeal, the Court of Appeals reversed, holding that the trial court abused its discretion in granting the motion because “the discovery Bowden seeks is not relevant to her claim that TMC's medical charges for her treatment were unreasonable.” The Medical Center, Inc. v. Bowden, 327 Ga.App. 714, 714, 761 S.E.2d 116 (2014). We granted Bowden's petition for certiorari to review that holding.

As explained below, where the subject matter of a lawsuit includes the validity and amount of a hospital lien for the reasonable charges for a patient's care, how much the hospital charged other patients, insured or uninsured, for the same type of care during the same time period is relevant for discovery purposes. The Court of Appeals erred in concluding otherwise and in holding on that ground that the trial court abused its discretion in granting Bowden's motion to compel. Accordingly, we reverse the Court of Appeals' judgment.

1. On July 1, 2011, the rental car in which Danielle Bowden was a passenger was involved in an accident. At about 10:40 p.m., Bowden, who was 21 years old and did not have health insurance, was taken by ambulance to TMC's hospital in Columbus, Georgia, where she received emergency medical treatment that included surgery for a broken leg. At some point on July 2, Bowden's mother allegedly signed an admission form that said in relevant part:

I, the undersigned, am seeking treatment at The Medical Center, Inc.... for myself or a person for whom I am responsible for his/her medical care.... The undersigned agrees, whether as Agent, Guarantor, or Patient, that in consideration of the services to be rendered to the patient, the undersigned is individually obligated to pay the account in full of the Hospital, and attending physicians, or organizations, or other satisfactory financial arrangements must be made prior to time of patient discharge.

Bowden was discharged from the hospital on July 4. On July 13, she returned to the hospital for physical therapy and allegedly signed the same admission from herself. TMC billed Bowden a total of $21,409.59 for her care and filed a hospital lien for that amount pursuant to OCGA § 44–14–470(b).1

On July 27, 2012, the rental car company (Enterprise) filed a complaint in interpleader against Bowden and TMC and paid $25,000 into the registry of the trial court. The complaint alleged that Enterprise was self-insured with an insurance certificate that provided automobile coverage up to $25,000; that Bowden presented a claim against Enterprise, which Enterprise offered to settle for the policy limit; and that the offer was rejected because Bowden and TMC were unable to agree on how much of the settlement proceeds should go to TMC to release its hospital lien.2

On August 20, 2012, Bowden answered the complaint and filed a crossclaim against TMC, alleging that she was uninsured and indigent at the time of her treatment and that her bill of $21,409.59 was grossly excessive and did not reflect the reasonable value in the community of her treatment. Bowden also alleged that the emergency nature of her injuries and treatment prevented her from utilizing the provisions of OCGA § 31–7–11 to make pre-treatment cost comparisons.3 She denied signing a payment contract with TMC and alleged that any such contract would be void as both procedurally and substantively unconscionable. Bowden asserted a claim against TMC for unjust enrichment and, alternatively, breach of contract and violation of Georgia's version of the Uniform Deceptive Trade Practices Act (“UDTPA”), OCGA §§ 10–1–370 to 10–1–375. As relief, she sought damages and attorney fees and asked that TMC's “lien be dismissed.”

Along with her answer and crossclaim, Bowden served on TMC a request for production of documents and a set of seven written interrogatories, as discovery authorized by the Civil Practice Act. See OCGA §§ 9–11–33 (authorizing interrogatories to parties); 9–11–34 (authorizing, among other things, requests for production of documents). The document request sought: (1) medical records and bills related to Bowden's treatment and the hospital lien; and (2) for its fiscal years 2010, 2011, and 2012, TMC's pricing agreements with Medicaid, Medicare, BlueCross/BlueShield of Georgia, and TRICARE and TMC's own indigent care program prices. The interrogatories asked TMC what Bowden's specific, itemized charges would have been if she were covered by Medicaid, Medicare, BlueCross/BlueShield of Georgia, TRICARE, or TMC's indigent care program; what TMC's total gross revenues were from services billed at the OCGA § 31–7–11 rates and from services billed at less than those rates for the fiscal year prior to Bowden's admission; for fiscal years 2010 and 2011, the percentages of patients who paid the OCGA § 31–7–11 rates and who paid less than those rates; and, since July 1, 2011, how many uninsured patients TMC had treated in its emergency room and how many of those patients TMC had billed for their treatment.

On August 23, 2012, TMC answered Enterprise's complaint and filed a counterclaim alleging that it billed Bowden the “fair and reasonable amount” of $21,409.59 for the care that she received and requesting that the trial court enter a declaratory judgment that its hospital lien for that amount was “valid and attaches to any settlement proceeds received by Danielle Bowden.” On September 21, TMC answered Bowden's crossclaim, denying her allegation that her bill was grossly excessive and did not reflect the reasonable value of her treatment. On the same day, TMC served responses to Bowden's discovery requests. The responses are not contained in the record on appeal, but it appears from other materials in the record that TMC provided Bowden with copies of her medical records and bills but no other documents and that TMC answered none of the interrogatories, instead responding only with boilerplate objections.

On January 16, 2013, Bowden filed a motion under OCGA § 9–11–37(a) to compel the remaining discovery from TMC. On January 17, Bowden served a second set of discovery requests on TMC, seeking a blank copy of every form that TMC used from 2006 to 2012 that asked patients to guarantee or authorize payment for medical treatment or to assign benefits to TMC or that discussed how or at what rates patients or their insurers might be charged, and asking TMC to identify the specific dates during which each form was in use. Bowden also filed a motion to extend the discovery period for 90 days. On February 15, TMC filed a brief opposing Bowden's motion to compel, focusing its objections on relevance and confidentiality. On February 20, TMC responded to Bowden's second set of discovery requests, raising numerous objections but producing no documents and not answering the interrogatory; Bowden then amended her motion to compel to include the second set of requests.

The trial court held a hearing on the motion to compel on May 30, 2013. Bowden argued that information concerning how much TMC charged other patients, whether insured or uninsured, for the same care during the same time period was relevant to the reasonableness of TMC's charges for her care. TMC argued that Bowden's discovery requests sought information that was not relevant to the case and asked the court to enter a protective order in the event that it granted Bowden's motion, noting that many of its agreements with health insurance companies included confidentiality clauses. See OCGA § 9–11–26(c) (authorizing the court to enter, for good cause shown, “any order which justice requires to protect a party or person from annoyance, embarrassment, oppression, or undue burden or expense, including one or more of the following: ... (7) That a trade secret or other confidential research, development, or commercial information not be disclosed or be disclosed only in a designated way....”). On June 20, 2013, the trial court entered an order granting Bowden's motion to compel subject to the entry of an appropriate protective order to ensure confidentiality, which the parties were directed to submit within 20 days. The trial court then granted TMC's request for a certificate of immediate review; the Court of Appeals granted TMC's application for interlocutory appeal; and TMC filed a timely notice of appeal.4

On appeal, the Court of Appeals reversed the trial court's discovery order, holding that the court had abused its...

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