Eastern Idaho Regional Medical Center v. Board of Com'rs of Bonneville County, Idaho

• Decision Date: 03 June 1992
• Docket Number: No. 19463,19463
• Parties: EASTERN IDAHO REGIONAL MEDICAL CENTER, Plaintiff-Appellant, v. BOARD OF COMMISSIONERS OF BONNEVILLE COUNTY, IDAHO, Defendant-Respondent. Boise, May 1992 Term
• Court: Idaho Supreme Court

Page 99

833 P.2d 99

122 Idaho 241

EASTERN IDAHO REGIONAL MEDICAL CENTER, Plaintiff-Appellant, v. BOARD OF COMMISSIONERS OF BONNEVILLE COUNTY, IDAHO, Defendant-Respondent.

No. 19463.

Supreme Court of Idaho,

Boise, May 1992 Term.

June 3, 1992.

St. Clair, Hiller, St. Clair & Dalling, Idaho Falls, for plaintiff-appellant. V. Dean Dalling, Jr., argued.

Anderson, Pike & Bush, Idaho Falls, for defendant-respondent. Blake G. Hall, argued.

McDEVITT, Justice.

NATURE OF THE CASE

This case deals with an application for county medical indigency aid. A teenage girl, Nichole Marquez, was admitted to Eastern Idaho Regional Medical Center's (the "hospital") Behavioral Unit. An application for county indigency aid was not filed with Bonneville County ten (10) days prior to the girl's voluntary admittance. The county denied medical indigency aid after a post-admission application was filed within forty-five (45) days after Nichole Marquez's admittance. A hearing was conducted by the Board of Commissioners of Bonneville County (the "board"). After the hearing, the board affirmed the denial, finding that the girl was not admitted on an "emergency" basis and that the county

[122 Idaho 242] was prejudiced by the untimely filing. The district court affirmed, and the Court of Appeals reversed and remanded. This Court granted a petition for review. We affirm the decision of the Board of Commissioners.

BACKGROUND AND PRIOR PROCEEDINGS

A. Events Leading Up To The Application For County Indigency Assistance.

On March 26, 1987, Nichole Marquez was admitted into the hospital after ingesting a large amount of aspirin. As part of her treatment, she began counseling with a social worker named Gary G. McKell.

Several weeks after the March 26, 1987 hospital admission, Nichole Marquez ran away from home. She continued to keep in contact with Mr. McKell, on occasion threatening suicide, but did not contact her mother, Penny Marquez ("Ms. Marquez"). Mr. McKell and Ms. Marquez also kept in contact. In particular, they discussed the need for Nichole Marquez to receive further treatment as well as treatment options, including State Hospital South. Eventually, Mr. McKell talked Nichole Marquez into admitting herself into the Behavioral Unit of the hospital. She did so on May 8, 1987, and remained a patient in the hospital until her discharge on May 29, 1987, incurring hospital charges totalling $6,518.73.

B. The Application For County Medical Indigency Aid.

On June 18, 1987, Ms. Marquez filed an application for county medical indigency aid. Following a county investigation, the board denied the application on July 7, 1987. The July 7, 1987 denial stated that the investigation had revealed that indigency status was undocumented, emergency status was undocumented, that Bonneville County Welfare was not the last resort, as State Hospital South was available, and that Bonneville County does not pay for inpatient psychiatric counseling.

Following the denial of county medical indigency aid, Penny Marquez and the hospital requested a reconsideration hearing. On August 19, 1987, the board issued a second certificate of denial of county aid. In the August 19, 1987 denial, the board stated that reconsideration was denied because no emergency existed and because Bonneville County Welfare was not the last resort.

Following the August 19, 1987 denial, Nichole Marquez and the hospital filed additional requests for a hearing.

On October 27, 1987, the board issued a third certificate of denial for county aid. This time, the board listed five reasons for the denial: (1) indigency not documented; (2) emergency status not documented; (3) whether Bonneville County is the proper county for aid not documented; (4) whether Bonneville County is the last resort not documented; and (5) untimely application.

On November 24, 1987, Penny Marquez filed a request for hearing to reconsider the board's October 27, 1987 denial of county assistance. After hearing dates were set and then continued, the hearing on the denial was finally held before the board on June 1, 1988.

At the hearing, the board allowed the hospital to introduce four affidavits into evidence over the objection of the county. These four affidavits asserted the following:

1. Affidavit of George A. Williams, M.D.: Dr. Williams was the doctor who admitted Nichole Marquez into the hospital on May 8, 1987. In the affidavit, he stated that she was admitted "for emergency hospitalization as [Nichole] Marquez was suffering from depression, reaction of adolescence secondary to parent-child conflict, and suicidal ideation amounting to a life threatening situation if not treated immediately." In addition, Dr. Williams stated that Nichole Marquez's condition, "if untreated, was likely to cause death or serious disability...."

The billing of Nichole Marquez's treatment as well as her medical records were attached to Dr. William's affidavit. A medical record entitled "History and Physical"" 2. Supplemental Affidavit of George M. Williams, M.D.: In his supplemental affidavit, Dr. Williams stated that "there was not time to petition to the county for treatment prior to [Nichole Marquez's] admission." She was admitted to the hospital on an "emergency situation."

                [122 Idaho 243]  stated that "[t]his is a 15 year old female who was admitted to the Behavioral Health Unit at the request of Gary McKell because of runaway, school sloughing, and oppositional behavior."   A medical record entitled "Discharge Summary" stated that "[t]his fifteen year old female was admitted because of runaway and dropping out of school and severe parent-child conflict."
                

3. Affidavit of Gary McKell: In his affidavit, Mr. McKell stated that when Nichole Marquez was admitted into the hospital, it was his opinion "that such was necessary since Nichole [Marquez] was at high risk for suicide and her behavior strongly evidenced a self-destructive pattern." Furthermore, Mr. McKell stated that "Nichole Marquez had run away from home and her location in the Idaho Falls area was unknown and in Affiant's opinion the situation was volatile due to her self-destructive behavior."

Mr. McKell attached a letter that he wrote to Penny Marquez on July 23, 1987, regarding Ms. Marquez's concerns about the hospital bill. In the letter, Mr. McKell stated that at the time Nichole Marquez ran away from home "[i]t was apparent that she was very unstable, ambivalent about getting help, and self-destructive." In addition, during Nichole Marquez's absence from home, Mr. McKell stated that "[s]he also made suicidal threats." Finally, at the time of her admittance into the hospital, Mr. McKell stated that it was his judgment "that Nichole [Marquez] was a high risk for suicide.... Placement seemed urgent in light of her willingness to go to the hospital which in her condition could change at any time."

4. Affidavit of Thomas M. Weiss: Mr. Weiss was the administrator of the hospital. In his affidavit, Mr. Weiss stated that the rates and charges for the services Nichole Marquez received at the hospital were customary and reasonable.

On July 7, 1988, the board issued its findings, conclusions, and order denying Nichole Marquez's application for county medical indigency aid. The board found that "[t]he services rendered to Nichole Marquez were provided in a non-emergency, voluntary admission." In the conclusions, the board recognized that I.C. § 31-3404 requires that an indigent person in need of medical attention must file a written application with the clerk of the board "not less than ten (10) days prior to admission to any health care facility or hospital" except as provided in Section 31-3504. I.C. § 31-3504 provides that "[a]n application for or on behalf of a medically indigent person receiving emergency medical services may be made at any time within forty-five (45) days following the admission of said person to the hospital...." In this regard, the board found that "[n]o written application was made to the county requesting assistance on anticipated medical bills of Nichole Marquez at least ten (10) days prior to May 8, 1987."

The issue as the board saw it was "whether or not the services rendered were rendered under emergency circumstances not requiring an application to be filed until 45 days after services are rendered." "Idaho Code Section 31-3407 provide[s] that '... services rendered in an emergency are defined as those reasonable and necessary to alleviate illness or injury which if untreated is likely to cause death or serious disability....' " The board examined the evidence and concluded that there was a conflict. In particular, the board stated that the affidavit of Dr. Williams and the medical records attached thereto conflicted in that the medical records did not mention "any possibility of suicide or threat of death or serious disability if the child remains untreated." In addition, the board stated that the medical records established that Nichole Marquez was voluntarily admitted into the hospital. Also, the board stated that the testimony of Penny Marquez as well as the records of the Department of Health and Welfare established that the parties knew that Nichole

                [122 Idaho 244]  Marquez needed treatment "no later than April 15, 1987, and probably as early as April 1, 1987" thus giving them "ample opportunity ... to comply with Idaho Code Section 31-3404 which calls for pre-admission."   Finally, the board found that the county was prejudiced by the failure of Ms. Marquez to make a pre-admission application because there could have been other ways to treat Nichole Marquez, such as State Hospital South.  The board affirmed its prior decision of denial and did not reach the issue of whether medical indigency, as defined by I.C. § 31-3502(1), had been established
                

C. Appeal From The Board To The District Court.

On August 5, 1988, the hospital filed a notice of appeal in the District Court for the Seventh Judicial District of the State of Idaho...