Gibson v. United States
| Citation | 499 P.3d 1165,406 Mont. 450 |
| Decision Date | 07 December 2021 |
| Docket Number | OP 21-0316 |
| Parties | Barbara A. GIBSON, as Personal Representative of the Estate of Johnny G. Gibson, and for herself; John Travis Morgan Gibson; Dixie Lee Gibson, Plaintiffs and Appellants, v. UNITED STATES of America, Defendant and Appellee. |
| Court | United States State Supreme Court of Montana |
For Appellants: John M. Morrison, Morrison, Sherwood, Wilson & Deola, PLLP, Helena, Montana
For Appellee: Leif M. Johnson, Acting United States Attorney, Victoria L. Francis, Assistant United States Attorney, Billings, Montana
¶1 The United States Court of Appeals for the Ninth Circuit certified the following questions to this Court:
We accepted certification by order dated June 29, 2021, and now answer "no" to both questions on the facts presented.
¶2 We summarize the undisputed facts from the Ninth Circuit's Certification Order. In September 2015, Johnny Gibson visited the Central Montana Community Health Center, a federally funded health care center in Lewistown, Montana. He reported experiencing chest pain, pain between the shoulder blades, heartburn, and fatigue. The Center's staff did not treat or examine Gibson for potential heart issues before releasing him, and Gibson died one week later from a myocardial infarction
at St. Vincent Hospital in Billings, Montana. Barbara Gibson filed a wrongful death and survival action under the Federal Tort Claims Act, 28 U.S.C. §§ 1346(b), 2672, on behalf of herself, Gibson's estate (Estate), and Gibson's heirs. The government conceded negligence, and the United States District Court for the District of Montana granted summary judgment to the plaintiffs.
¶3 Following a bench trial, the district court awarded $578,248 to the plaintiffs. It declined, however, to award damages for the reasonable value of medical expenses Gibson incurred. The court found that the hospital and the ambulance service forgave $165,661.50 under their charity care programs and did not attempt to collect payment from Gibson's estate or family. Of that amount, $991.28 was for ambulance services and the remainder for hospital services. Although the providers sent Gibson bills for their services, both stated that the amounts were forgiven in full, and both showed a balance of zero. The hospital did not reserve a right to collect payment in the event the Estate recovered from a third-party tortfeasor. Interpreting Montana law, the trial court concluded that the Estate could not recover damages for medical expenses in excess of the amount actually paid, and it limited recovery accordingly.
¶4 On Gibson's appeal, the Ninth Circuit Court of Appeals observed that this Court has not addressed whether a charitable write-off of medical expenses may be recovered as damages or is subject to the collateral source rule. It certified those issues for this Court's determination.
¶5 "When answering a certified question from another qualifying court as permitted by M. R. App. P. 15(3), our review is purely an interpretation of the law as applied to the agreed facts underlying the action." Van Orden v. United Servs. Auto. Ass'n , 2014 MT 45, ¶ 10, 374 Mont. 62, 318 P.3d 1042 (internal quotation and citations omitted).
¶6 Section 27-1-308, MCA (2019), provides in pertinent part:
(1) In an action arising from bodily injury or death when the total award against all defendants is in excess of $50,000 and the plaintiff will be fully compensated for the plaintiff's damages, exclusive of court costs and attorney fees, a plaintiff's recovery must be reduced by any amount paid or payable from a collateral source that does not have a subrogation right.
The Montana Legislature amended the statute in 2021. It now provides that:
a plaintiff's recovery may not exceed amounts actually: (a) paid by or on behalf of the plaintiff to health care providers that rendered reasonable and necessary medical services or treatment to the plaintiff; [and] (b) necessary to satisfy charges that have been incurred and at the time of trial are still owing and payable to health care providers for reasonable and necessary medical services or treatment rendered to the plaintiff[.]
Section 27-1-308(2)(a)-(b), MCA (2021). The bill expressly made the amendment applicable to claims that accrue on or after its effective date. Senate Bill 251: An Act Generally Revising Laws Related to Damages in Lawsuits , 67th Leg. 327, § 6 (2021). Because Gibson's claims accrued and were filed prior to the effective date, and as the Certification Order reflects, we consider and apply the 2019 version of the law. Accordingly, all statutory references are to the 2019 Montana Code Annotated, unless indicated otherwise.1
¶7 1. Under Montana law, for a claim that accrued prior to the effective date of § 27-1-308, MCA (2021), may a plaintiff in a survival action recover the reasonable value of medical care and related services when the costs of such care or services are written off under the provider's charitable care program?
¶8 "Every person who suffers detriment from the unlawful act or omission of another may recover from the person in fault a compensation for it in money, which is called damages." Section 27-1-202, MCA. The law defines "detriment" as "a loss or harm suffered in person or property." Section 27-1-201, MCA.
¶9 Gibson argues that Montana law permits an injured tort victim to recover the reasonable value of medical treatment received because of the tortfeasor's negligence, including any amount written off. Gibson traces this premise to a 1984 case, Kuhnke v. Fisher , 210 Mont. 114, 683 P.2d 916 (1984).
¶10 In Kuhnke , a wrongful death action, we considered whether it was improper for defense counsel to refer to the plaintiff's unpaid funeral bill during the final summation. 210 Mont. at 120, 123, 683 P.2d at 918, 921. We reversed for a new trial, stating, "It was completely irrelevant to the cause of action ... that the funeral bill was not paid at the time of trial[.]" Kuhnke , 210 Mont. at 124-26, 683 P.2d at 921-22. We analogized the payment of funeral expenses to that of medical bills, explaining that "payment of medical bills [is not required] before payment can be recovered in a wrongful death cause." Kuhnke , 210 Mont. at 124, 683 P.2d at 921 (emphasis in original). We explained that "when a person is injured ... the incurrence of the medical bills and the funeral costs, without more, is sufficient to establish a basis for the recovery of damages." Kuhnke , 210 Mont. at 124, 683 P.2d at 921. The mere fact that a funeral bill was unpaid did not foreclose the possibility of the plaintiff's recovery, and therefore it was improper for defense counsel to comment on it. We did not consider whether a plaintiff who was neither charged nor accountable for medical or funeral expenses could recover the reasonable value of those services in damages.
¶11 Both parties discuss a handful of cases we have decided since Kuhnke that address recovery of medical or other expenses, most in the context of insurance contracts. Though none of these cases are dispositive here, we agree they are instructive. Newbury v. State Farm Fire & Casualty Insurance Co. was an action to recover medical expenses arising from an employment-related car accident. 2008 MT 156, ¶¶ 7-8, 343 Mont. 279, 184 P.3d 1021. Newbury incurred $18,405.80 in medical expenses, of which workers’ compensation paid $17,230. Newbury , ¶ 8. He also carried automobile insurance through State Farm, which provided a total medical payment coverage of $10,000. Newbury , ¶ 9. His policy stated that "there is no coverage to the extent workers’ compensation benefits are required to be payable." Newbury , ¶ 9 (quotation omitted). Newbury submitted a claim to State Farm seeking payment of the full $10,000, but State Farm paid only the remaining $1,175.80 of Newbury's medical expenses that the workers’ compensation insurer did not pay. Newbury , ¶ 10. Newbury sued to recover the remaining $8,824.20. We considered whether the workers’ compensation provision violated public policy by violating Newbury's reasonable expectations or by defeating coverage for which valuable consideration was paid, and we held that it did not.
Newbury , ¶¶ 33, 41-42, 48. We concluded that it was not reasonable for Newbury under the terms of his policy to expect compensation for medical payments that were paid in full and for which he was not liable. Newbury , ¶¶ 38-39. We observed that permitting Newbury to recover $8,824.20 in excess of his medical expenses "would result in a windfall[.]" Newbury , ¶ 47.
¶12 Five years after Newbury , we decided Conway v. Benefis Health System , 2013 MT 73, 369 Mont. 309, 297 P.3d 1200. Conway was treated by Benefis for injuries he sustained in a car accident. Conway , ¶ 6. His medical costs totaled $2,073.65. Conway , ¶ 7. Conway had healthcare coverage through TRICARE and automobile coverage through Kemper. Conway , ¶ 7. Benefis accepted $662.74 from TRICARE in full satisfaction of Conway's bill pursuant to a preferred provider agreement. Conway , ¶ 7. Kemper subsequently paid Benefis $1,866.29, and Benefis reimbursed TRICARE's full payment because TRICARE functioned as a secondary payer. Conway , ¶ 7. Conway sued Benefis to...
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