Intermountain Health Care, Inc. v. Board of County Com'rs of Blaine County

• Decision Date: 20 September 1985
• Docket Number: No. 15737,15737
• Citation: 109 Idaho 299,707 P.2d 410
• Parties: INTERMOUNTAIN HEALTH CARE, INC., a nonprofit Utah corporation doing business as Primary Children's Medical Center, Plaintiff-Appellant, v. BOARD OF COUNTY COMMISSIONERS OF BLAINE COUNTY, Idaho, Defendant-Respondent.
• Court: Idaho Supreme Court

Page 410

707 P.2d 410

109 Idaho 299

INTERMOUNTAIN HEALTH CARE, INC., a nonprofit Utah corporation doing business as Primary Children's Medical Center, Plaintiff-Appellant, v. BOARD OF COUNTY COMMISSIONERS OF BLAINE COUNTY, Idaho, Defendant-Respondent.

No. 15737.

Supreme Court of Idaho.

Sept. 20, 1985.

Larry Lee Goins, Idaho Falls, for plaintiff-appellant.

Phillip S. Oberrecht and Glenna M. Christensen, Boise, for amicus curiae (St. Luke's and St. Alphonsus Regional Medical Centers).

Ray Keith Roark, Hailey, for respondent.

Lloyd J. Webb, Twin Falls, for amicus curiae (Twin Falls County).

Greg H. Bower, Boise, for amicus curiae (Ada County).

HUNTLEY, Justice.

This appeal presents several significant issues related to Idaho's medical indigency statutes, Chapters 34 and 35 of Title 31 of the Idaho Code. The medical indigency statutes have required interpretation by the courts numerous times since enactment, because they contain some of the most inartfully drafted and unclear language in the Idaho Code. These statutes could well benefit from legislative redrafting, but in the interim it is the duty of the judiciary to give effect to the legislative intent of the statutes as best it can be ascertained.

The facts are these: Dan and Carla Pritchett are residents of Blaine County. On May 15, 1981, Carla Pritchett gave birth to twins at Magic Valley Memorial Hospital in Twin Falls. Because they were born prematurely and needed extensive specialty care, the twins were transferred to Primary Children's Medical Center, operated by Intermountain Health Care, Inc. ("IHC"), in Salt Lake City. The medical bills at Primary alone eventually totaled over $87,000. Another $20,000 in bills, not at issue here, were incurred at Magic Valley Memorial Hospital. The Pritchetts' health insurance carrier, Mutual of Omaha, eventually paid $32,000, leaving approximately $54,000 due Primary. In June, 1981, the Pritchetts applied to Blaine County for payment to Primary on behalf of the twins.

The Blaine County Board of Commissioners denied the application on the ground that Pritchetts were not medically indigent at the time the infants were hospitalized. IHC then requested a hearing before the Board, after which the Board again denied the application. IHC appealed to the district court. The district court affirmed the Board's denial.

IHC's appeal was first heard by the Court of Appeals, where three substantive issues were presented: first, whether IHC rather than the Pritchetts was the proper party to bring an appeal; second, whether the district court erred in holding that a hospital is required to execute on the personal and real property of the applicant before submitting a billing to the county commissioners; and third, whether Pritchetts are indeed medically indigent. A fourth issue herein is whether IHC is entitled to attorney fees on appeal.

The Court of Appeals determined that IHC was in fact the proper party to bring an appeal. It reversed the district court's holding on submission of the bill to the county, holding instead that the medical indigency statutes make the county liable for the entire bill submitted by the hospital, less any amounts, such as insurance, already actually received by the hospital and that the county then has the right, pursuant to I.C. § 31-3510 and § 31-3510A to seek reimbursement from the applicant and from other responsible third party sources. The Court of Appeals ruled that contrary to the findings of the Board of County Commissioners, the Pritchetts were indigent as a matter of law. As to attorney fees, the Court of Appeals held that the county was justified in defending against the appeal, since the medical indigency statutes are unclear, and IHC was therefore not entitled to attorney fees. The Court of Appeals directed the district court to remand the matter to the Board of County Commissions with an order to grant IHC's request for payment.

The Board petitioned this Court for review of the Court of Appeals' decision, which petition we granted.

We state at the outset that we address here only cases where emergency medical care has been rendered to an applicant for indigency funds. ¹ "Emergency care" is not defined by the medical indigency statutes, but "emergency medical services" is defined by I.C. § 39-141 (in Title 39 dealing with health and safety) as "services utilized in responding to a perceived individual need for immediate care in order to prevent loss of life or aggravation of physiological or psychological illness or injury." Clearly the Pritchett babies were in need of emergency medical services at the time they were transferred to Primary in Salt Lake City.

I.

The Court of Appeals first addressed the question of whether IHC is the proper party to bring an appeal, since the Board contended, and contends before this Court as well, that because the Pritchetts were the applicants for medical assistance, only they were proper parties to perfect the appeal. We agree with the Court of Appeals's ruling that IHC was a proper party to bring this appeal. Here the initial parties, the Pritchetts, and IHC have an identity of interest. The application concerns only the bill from IHC, and in fact the Pritchetts' original application was made at IHC's behest, on a form IHC provided and assisted in filling out. IHC actually rendered the services and is the party entitled to be paid, being subrogated to the interests of the Pritchetts.

II.

The second issue before us is whether the hospital must execute on an applicant's real or personal property before submitting a bill to, and receiving payment from the Board of County Commissioners. We concur with the ruling of the Court of Appeals's that a hospital need not execute on an indigent's assets before submitting a bill to the county. The statutory analysis is as follows: There is an historical obligation of the county to care for its indigents. Idaho Code § 31-3509, as enacted in 1974, required a hospital to make all reasonable efforts to collect on an account incurred by a medically indigent person. That section was amended in 1976 to provide instead that hospitals make all reasonable efforts to determine liability for an account. The Court of Appeals observed that when a statute is amended it is presumed that the legislature intended the statute to have a meaning different from that accorded the statute before amendment and to create a new right or withdraw an existing one, citing Lincoln County v. Fidelity and Deposit Co. of Maryland, 102 Idaho 489, 632 P.2d 678 (1981); and Leonard Construction Co. v. State ex. rel. State Tax Commission, 96 Idaho 893, 539 P.2d 246 (1975). The words "collect" and "determine liability" clearly have different meanings. "Collect" means to gather or assemble. With regard to money, the word implies more than the mere act of receiving the money, but also includes the implied duty to use all ordinary means for collection, such as employment of counsel and institution of suits. See Krieger v. Title Insurance & Trust Co., 260 Ky. 1, 83 S.W.2d 850 (1935); Board of Commissioners of Okfuskee County v. Hazelwood, 79 Okl. 185, 192 P. 217 (1920). The word "determine" as defined by this Court, means "to reach a definite purpose concerning; form the intention of doing or not doing; resolve; decide; [citation omitted] to fix or settle definitely; to make specific or certain [citations omitted]. Western Hospital Association v Industrial Accident Board of the State of Idaho, 51 Idaho 334, 6 P.2d 845 (1931).

Clearly, the implication of the word "collect" is that there would be action on the part of the hospital to pursue money owed it. To "determine liability," on the other hand, would be to identify or decide or settle responsibility for payment, but not necessarily to act in obtaining the money represented by the obligation. The 1976 amendment was a conscious action by the legislature to relieve hospitals of the duty to collect on an account, and instead impose a duty to "determine liability." IHC made reasonable efforts to determine the extent of liability of other parties, such as the insurance company, and has sought to determine the extent of Pritchetts' assets. It has therefore fulfilled its statutory obligation, and may submit its bill to the county without executing on Pritchetts' assets.

I.C. § 31-3508 provides that a hospital bill must show total hospital charges less any amounts which have been received under any federal or state law. If any payments are received thereafter they are to be paid to the county. The county is liable to IHC for the entire bill, but has the right to seek reimbursement from the Pritchetts to the extent permitted by statute. I.C. § 31-3510, for example, provides for the county's right to subrogation to all rights of the hospital and the medically indigent person. Under § 31-3510(A), the county gains the right to...