LaBombard v. Samaritan Health System

• Decision Date: 06 August 1998
• Docket Number: No. 1 CA-CV 97-0473.,1 CA-CV 97-0473.
• Citation: 195 Ariz. 543,991 P.2d 246
• Parties: Tammy J. LABOMBARD, Defendant-Appellant, v. SAMARITAN HEALTH SYSTEM (dba Good Samaritan Regional Medical Center, Maryvale Samaritan Medical Center, and Thunderbird Samaritan Medical Center and Samaritan Air Evac), Defendant-Appellee.
• Court: Arizona Court of Appeals

991 P.2d 246

195 Ariz. 543

Tammy J. LABOMBARD, Defendant-Appellant, v. SAMARITAN HEALTH SYSTEM (dba Good Samaritan Regional Medical Center, Maryvale Samaritan Medical Center, and Thunderbird Samaritan Medical Center and Samaritan Air Evac), Defendant-Appellee.

No. -0473.

Court of Appeals of Arizona, Division 1, Department A.

August 6, 1998.

Review Denied January 4, 2000.

Gulinson Law Offices by Gene G. Gulinson, Phoenix, for Defendant-Appellant.

Gammage & Burnham, P.L.C. by Richard B. Burnham and Cameron C. Artigue, Phoenix, for Defendant-Appellee.

OPINION

THOMPSON, Judge.

¶ 1 This appeal arises from an interpleader action filed by State Farm Mutual Automobile Insurance Company (State Farm) to determine who is entitled to receive $20,674.78 in interpleaded funds. We hold that Tammy LaBombard has failed to show detrimental reliance and therefore Samaritan Health System (Samaritan) is not estopped to assert its medical lien. Because Samaritan holds a medical lien it is entitled to collect all of its "customary charges" from the proceeds of Tammy LaBombard's settlement with State Farm's insured. However, Samaritan must pay a proportionate share of the attorneys' fees incurred in obtaining the settlement. Additionally, we remand to the trial court to determine whether Samaritan's "billed charges"—i.e., the charges based on the schedule of rates and charges filed with the Department of Health Services—are the same as its "customary charges."

FACTUAL AND PROCEDURAL HISTORY

¶ 2 Because the trial court ruled on cross-motions for summary judgment, the facts generally (though not without exception) are undisputed. Nevertheless, to the extent that the parties disagree or that we are required to draw inferences from the undisputed facts, we view the evidence in the light most favorable to the party against whom the summary judgment was entered, in this case LaBombard. See Pioneer Annuity Life Ins. Co. v. Rich, 179 Ariz. 462, 464, 880 P.2d 682, 684 (App.1994).

¶ 3 On August 23, 1991, LaBombard was riding in a Jeep driven by Shane Rogers. Rogers lost control of the Jeep, the Jeep ran off the road and overturned, and LaBombard was ejected from the Jeep and injured.

¶ 4 Maricopa County paid some of the initial costs of emergency treatment for LaBombard. LaBombard later was admitted and treated for her injuries at the Samaritan medical facilities, as a patient under the Arizona Health Care Cost Containment System (AHCCCS). AHCCCS pays care providers a percentage of billed charges, based on a statutory formula.¹ The amount paid is generally, but not always, substantially less than Samaritan's billed charges. In this case, Samaritan's total billed charges were approximately $30,000, and AHCCCS paid Samaritan approximately $9500.

¶ 5 AHCCCS, Maricopa County, and Samaritan all filed liens against any judgment or settlement LaBombard might receive in connection with any claim for damages for the injuries necessitating the medical treatment, pursuant to Arizona's lien statutes. Ariz.Rev.Stat.Ann. (A.R.S.) 33-931 (health care provider lien statute) and 36-2915 (AHCCCS lien statute). Samaritan perfected liens totaling $20,674.78. AHCCCS perfected liens in the amount of $26,000.00, reflecting amounts paid to Samaritan and others.

¶ 6 LaBombard pursued a personal injury claim against Rogers. LaBombard and Samaritan stipulated in this interpleader action that LaBombard's claim for damages arising out of the Jeep accident was worth $500,000.00. Rogers's State Farm insurance policy, however, provided coverage in the amount of only $50,000.00. In an attempt to ensure that LaBombard would actually receive any sums recovered from Rogers and/or his insurer, LaBombard's attorney worked out compromises with AHCCCS to reduce the amount of its lien before settling LaBombard's claim against Rogers. AHCCCS reduced its lien to $4,000.00. In December 1994, a person from LaBombard's attorney's office contacted Samaritan, and Samaritan stated that there was no balance due on LaBombard's account.

¶ 7 LaBombard settled her claim against Rogers for his insurance policy limit of $0,000.00, plus a parcel of property in Prescott Valley and the Jeep. State Farm paid $4,000.00 to AHCCCS, $200.00 to Maricopa County, $11,390.80 in fees plus $1,864.77 in costs to LaBombard's attorneys, and $11,390.81 to LaBombard. Because Samaritan asserted that its perfected liens entitled it to recover the remaining $20,674.78 as payment for its uncollected billed charges for services rendered to LaBombard, while Labombard asserted that she was entitled to receive those funds, State Farm filed this interpleader action in February 1995 to determine the payee for the $20,674.78.

¶ 8 Samaritan and LaBombard filed cross-motions for summary judgment, each alleging their entitlement to the proceeds as a matter of law. LaBombard alleged that (1) Samaritan had waived or was estopped to assert its lien by stating that no balance was due on her medical bills; (2) Samaritan's "billed charges" are not its "customary charges" and therefore Samaritan was not entitled to recover the full amount of its billed charges under the medical lien statute; and (3) if Samaritan's lien is enforceable, Samaritan's recovery should be equitably apportioned. Samaritan argued that the lien statute provides that health care providers are entitled to be paid their "customary charges" in full from the patient's recovery from third parties, and that "customary charges" means "billed charges."

¶ 9 In May 1997, the trial court entered judgment in favor of Samaritan. LaBombard moved for a new trial, arguing that Samaritan's recovery should be equitably apportioned. The trial court denied LaBombard's motion for a new trial, and LaBombard timely appealed. This court has jurisdiction pursuant to A.R.S. 12-2101(B).

DISCUSSION

¶ 10 On appeal from a motion for summary judgment, we review the trial court's application of the law de novo. Pioneer, 179 Ariz. at 464, 880 P.2d at 684. We begin with the language of the relevant lien statute, A.R.S. 33-931:

A. Every individual, partnership, firm, association, corporation or institution or any governmental unit maintaining and operating or providing health care services in this state, which has been duly licensed by this state or any political subdivision or private entity with ambulances operated, licensed, or registered pursuant to title 36, chapter 21.1, is entitled to a lien for the customary charges for care and treatment or transportation of an injured person, upon any and all claims of liability or indemnity except health insurance for damages accruing to the person to whom the services are rendered, or to the legal representative of such person, on account of injuries giving rise to such claims and which necessitated such services.

B. The lien entitlements authorized by subsection A are applicable to all customary charges by hospitals or ambulances of political subdivisions, but restricted to customary charges in excess of two hundred fifty dollars by all other providers and privately owned ambulance companies excluding interest and service charges. Liens perfected pursuant to this article by a hospital have priority for payment over all other liens authorized by this article.

A.R.S. 33-931 (1990) (footnote omitted). A hospital may perfect its lien pursuant to this statute by recording a verified statement with the office of the county recorder in the county where the injuries were incurred, within thirty days after the patient is discharged from the hospital. A.R.S. 33-932 (1990). The verified statement must provide certain specific information, and the hospital must send a copy of the lien by certified mail to the injured person. Id.

¶ 11 The parties do not dispute that Samaritan recorded hospital liens pursuant to these statutes totaling $20,674.78 and mailed copies to LaBombard. LaBombard, however, argues that Samaritan's liens are unenforceable because (1) Samaritan confirmed a "zero balance" due on LaBombard's account and therefore is estopped from enforcing its liens; (2) Samaritan is precluded from enforcing its lien for the entire lien amount under the doctrine of equitable apportionment; (3) Samaritan should at least be required to pay its fair share of the attorneys' fees under the "common fund" doctrine; and (4) Samaritan's "customary charges" are not the same as its "billed charges," and Samaritan did not provide evidence of its "customary charges for care and treatment," to support its claim to over $20,000.00 for hospital services rendered.

A. Estoppel

¶ 12 "A claim for estoppel arises when one by his acts, representations or admissions intentionally or through culpable negligence induces another to believe and have confidence in certain material facts and the other justifiably relies and acts on such belief causing him injury or prejudice." St. Joseph's Hosp. and Med. Ctr. v. Reserve Life Ins. Co., 154 Ariz. 307, 317, 742 P.2d 808, 818 (1987) (citations omitted). "Detrimental reliance is an essential ingredient of estoppel, without which there can be no estoppel." In re Musgrove, 144 Ariz. 168, 172, 696 P.2d 720, 724 (App.1985). Thus, to prevail on her estoppel claim, LaBombard must show that she suffered injury or prejudice because she took some action in reliance on Samaritan's statement that she owed no balance.

¶ 13 LaBombard asserts that Samaritan's statement that she owed no balance "cleared the way for a settlement" with Rogers, since AHCCCS and Maricopa County already had agreed to equitably apportion their claims. Thus, she argues, Samaritan should be estopped from now asserting a balance due.

¶ 14 LaBombard, however, has not alleged any legally cognizable injury or prejudice that resulted from any action she took in reliance on this belief, nor have we found any, even viewing the facts in the light most favorable to LaBombard. She admits that she settled the claim for the limits of the insurance policy; she thus did...