Charlotte–Mecklenburg Hosp. Auth. v. Talford

• Decision Date: 14 June 2012
• Docket Number: No. 379A11.,379A11.
• Citation: Charlotte–Mecklenburg Hosp. Auth. v. Talford, 727 S.E.2d 866 (N.C. 2012)
• Parties: The CHARLOTTE–MECKLENBURG HOSPITAL AUTHORITY v. Robert M. TALFORD.
• Court: North Carolina Supreme Court

727 S.E.2d 866

The CHARLOTTE–MECKLENBURG HOSPITAL AUTHORITY

v.Robert M. TALFORD.

No. 379A11.

Supreme Court of North Carolina.

June 14, 2012.

Appeal pursuant to N.C.G.S. § 7A–30(2) from the decision of a divided panel of the Court of Appeals, ––– N.C.App. ––––, 714 S.E.2d 476 (2011), affirming in part and reversing in part an order of summary judgment entered on 1 April 2010 by Judge Timothy L. Patti in Superior Court, Mecklenburg County, and remanding for further proceedings. Heard in the Supreme Court on 13 February 2012.

McIntosh Law Firm, P.C., Davidson, by Prosser D. Carnegie, James C. Fuller, and Robert G. McIntosh, for plaintiff-appellant.

Robert M. Talford, pro se, defendant-appellee.

Ott Cone & Redpath, P.A., Greensboro, by Thomas E. Cone, and Brandon W. Leebrick, for Duke University Medical Center, Mission Hospitals, Inc., Moses H. Cone, Memorial Hospital Operating Corporation, North Carolina Baptist Hospital, and WakeMed Medical Center; and Linwood Jones, General Counsel, for North Carolina Hospital Association, amici curiae.

NEWBY, Justice.

In this action to collect payment for the provision of medical services we must ascertain whether the trial court properly entered summary judgment for plaintiff. To do so, we must first determine whether a medical services provider forecasts sufficient evidence of its right to payment when it submits only affidavits from its employees that state the amount of its bill and assert the amount is reasonable. Second, we must decide whether a patient's affidavit that illustrates the differences between the retail price of, and the amount charged by the medical center for, certain medications establishes an issue of material fact regarding the reasonableness of the medical center's fee, thus preventing entry of summary judgment on that issue. We hold that the medical center's affidavits are minimally sufficient and that the patient's affidavit, standing alone, fails to show that an issue of material fact remains for trial. Accordingly, we reverse the decision of the Court of Appeals.

On 15 October 2009, plaintiff sued defendant seeking to recover the value of medical services it provided him while he was admitted to its medical center from 5 November to 8 November 2007. Plaintiff alleged that it “provided hospital care, medical treatment services, medical supplies, and other goods and services” to defendant while he was a patient at the facility. Pleading several theories of recovery, plaintiff contended that defendant owed it “not less than” $14,419.57, which, according to plaintiff, represented the “fair and reasonable value of the goods and services” it provided to defendant. James D. Robinson, plaintiff's Manager of Patient Financial Services, Legal Accounts, verified the complaint and further supported the allegations by a personal affidavit. Plaintiff attached to the complaint a document entitled “Legal Account Balance Summary Sheet” for patient Robert M. Talford, showing an account balance of $14,419.57.

Defendant answered plaintiff's complaint on 28 December 2009, admitting that from 5 November to 8 November 2007 he was a patient at plaintiff's medical center and that plaintiff “provided hospital care, medical treatment services, medical supplies, and other goods and services” to him during that time. Defendant denied, however, that the “fair and reasonable value” of those goods and services was $14,419.57.

On 2 February 2010, plaintiff moved for summary judgment against defendant in the amount of $14,419.57 for the medical care he had received. Plaintiff informed the trial court in its motion that defendant had admitted in his answer to its verified complaint that he had received treatment at plaintiff's facility, but that defendant had made no counterclaim, nor had he admitted the amount owed. Accordingly, the only unresolved issue was the amount of plaintiff's recovery. In support of its contention that it should receive the amount sought, plaintiff submitted several affidavits. Mr. Robinson swore that according to plaintiff's business records, defendant owed $14,419.57. John Baker, M.D., plaintiff's Vice President, Medical Education, stated in his affidavit that the “treatment reflected in [defendant's] medical record was reasonable and medically necessary for the health and well-being of” defendant. Sunny Sain, plaintiff's Director, Revenue Management, averred that the amount plaintiff charged defendant was reasonable because it was consistent with amounts charged to all similarly situated patients, was “within industry norms for similar facilities providing similar services at similar levels of care,” and was “compliant with various published billing and charging regulations and guidelines, including those of the Center for Medicare and Medicaid Services.”

On 24 March 2010, defendant responded by affidavit and unsuccessfully urged the trial court to deny plaintiff's summary judgment motion. In his affidavit defendant asserted that the amount plaintiff charged him “exceed[ed] the charges made and paid by other patients in the defendant's medical condition” and that plaintiff's “charges are not reasonable for the medical care necessary to control the defendant's medical condition.” Additionally, defendant said

2. That [his] hospital bill has a cost of $18.40 for one tablet of Diltiazem, and [his] prescription from CMC Pharmacy cost $23.00 for thirty (30) tablets;

3. That [his] hospital bill has a cost of $406.50 for one unit of Enoxaparin sodium, 120 mg syringe, and the cost for this item is $278.00 for ten units; [and]

4. That [his] hospital bill has a cost of $1.45 per unit for a folic acid 1 mg tablet, and the cost at a local pharmacy is $4.00 for thirty 1 mg tablets[.]

On 1 April 2010, the trial court determined that there was no genuine issue of material fact and that plaintiff was entitled to judgment in the principal amount of $14,419.57, plus interest. Defendant gave notice of appeal.

The Court of Appeals reversed the trial court's decision only on the issue of damages, stating that though defendant did not contest liability, an issue of material fact remained on the amount owed. Charlotte–Mecklenburg Hosp. Auth. v. Talford, ––– N.C.App. ––––, ––––, 714 S.E.2d 476, 478 (2011). The Court of Appeals observed that in North Carolina, a medical provider is generally entitled to recover the “ ‘reasonable value of his services.’ ” Id. at ––––, 714 S.E.2d at 479 (quoting Forsyth Cnty. Hosp. Auth. v. Sales, 82 N.C.App. 265, 266, 346 S.E.2d 212, 214,disc. rev. denied,318 N.C. 415, 349 S.E.2d 594 (1986)). The majority concluded, however, that plaintiff had not forecast sufficient evidence to establish that the amount of its invoice represented the reasonable value of its services, primarily questioning the credibility of plaintiff's affiants. Id. at ––––, ––––, 714 S.E.2d at 480, 483–84. The Court of Appeals majority also observed that defendant generally challenged the reasonableness of the amount he was billed for plaintiff's services and specifically asserted facts indicating that plaintiff billed him an unreasonable amount, thus precluding summary judgment on this issue. Id. at ––––, ––––, 714 S.E.2d at 480, 485–86. The dissenting judge would have affirmed the trial court's decision to grant summary judgment on this issue, id. at ––––, 714 S.E.2d at 487 (Ervin, J., dissenting), contending that plaintiff “forecast sufficient evidence tending to show ... that the amount of that bill was reasonable in light of prevailing market conditions,” id. at ––––, 714 S.E.2d at 492, and that the factual information contained in defendant's affidavit was irrelevant in determining the reasonableness of plaintiff's bill, id. at ––––, 714 S.E.2d at 494. Plaintiff gave notice of appeal based on that dissenting opinion.

Our task now is to determine whether the trial court properly entered summary judgment in favor of plaintiff on the issue of damages. To do so we will analyze de novo the evidentiary forecast on which the trial court relied in making its decision that the fee charged by plaintiff was reasonable. See Variety Wholesalers, Inc. v. Salem Logistics Traffic Servs., LLC, ––– N.C. ––––, ––––, 723 S.E.2d 744, 747 (2012) (citation omitted). Before we do so, however, a brief review of our relevant Rules of Civil Procedure and precedent on summary judgment is in order.

Rule 56 of our Rules of Civil Procedure addresses summary judgment. N.C.G.S. § 1A–1, Rule 56 (2011). Rule 56 states that summary judgment “shall be rendered forthwith if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that any party is entitled to a judgment as a matter of law.” Id.Rule 56(c). Though affidavits are not required, any affidavits submitted in support of or in opposition to a motion for summary judgment “shall be made on personal knowledge, shall set forth such facts as would be admissible in evidence, and shall show affirmatively that the affiant is competent to testify to the matters stated therein.” Id.Rule 56(e).

A trial court may enter summary judgment on a claim in favor of a movant that has the burden of proof so long as certain conditions are met. Kidd v. Early, 289 N.C. 343, 370, 222 S.E.2d 392, 410 (1976).

To be entitled to summary judgment the movant must still succeed on the basis of his own materials. He must show that there are no genuine issues of fact; that there are no gaps in his proof; that no inferences inconsistent with his recovery arise from his evidence; and that there is no standard that must be applied to the facts by the jury. Further, if the affidavits seem inherently incredible; if the circumstances themselves are suspect; or if the need for cross-examination appears, the court is free to deny the summary judgment motion.

Id. If a movant makes an adequate showing, “an adverse party may not rest upon the mere...