Our Lady of Lourdes Hosp. v. Franklin County
| Decision Date | 07 January 1993 |
| Docket Number | No. 59246-2,59246-2 |
| Citation | 842 P.2d 956,120 Wn.2d 439 |
| Parties | OUR LADY OF LOURDES HOSPITAL, Respondent, v. FRANKLIN COUNTY, Appellant, and Department of Social & Health Services, Respondents. |
| Court | Washington Supreme Court |
Johnston & Roache, P.S., Mike Johnston, Pasco, for respondent Our Lady of Lourdes Hosp.
Kenneth Eikenberry, Atty. Gen., Melissa Burke-Cain, Asst. Atty. Gen., Olympia, for respondent State.
At issue in this case is the extent to which the Department of Social and Health Services (DSHS) must reimburse Franklin County (County) for the costs of inpatient medical care of two county jail inmates hospitalized in 1986.
In September and October 1986, two county jail inmates were hospitalized at Our Lady of Lourdes Hospital (Hospital). The hospital bills for the two inmates totaled over $43,000. The County refused to pay these costs. The Hospital sued the County, seeking payment of the inmates' medical costs. DSHS was brought in as a third party defendant Although DSHS had previously paid for indigent jail inmates' medical care costs, at the time the two Franklin County inmates were hospitalized WAC 388-100-005 excluded inmates from eligibility for DSHS's Limited Casualty Program for the Medically Indigent (LCP-MI). DSHS maintains that the LCP-MI is the only program under which DSHS can pay medically indigent jail inmates' hospital costs.
with the County asserting a claim against DSHS for reimbursement for any costs the County had to pay.
Cross motions for summary judgment were filed by all three parties. Venue was changed from Franklin County to Thurston County where other similar actions were pending challenging, among other things, the validity of WAC 388-100-005's exclusion of eligibility for jail inmates. This case was joined with the other cases for purposes of oral argument, following which the trial court issued a memorandum opinion on the issues of a city's or county's liability for its jail inmates' health care, and whether DSHS could validly exclude jail inmates from the LCP-MI. The trial court reasoned that under RCW 70.48.130 and this court's opinion in Harrison Mem. Hosp. v. Kitsap Cy., 103 Wash.2d 887, 700 P.2d 732 (1985), a city or county is obliged to fully pay to a hospital the reasonable costs of its inmates' care regardless of whether and to what extent it is reimbursed by DSHS. The trial court further ruled that DSHS could not exclude jail inmates from the LCP-MI and held invalid WAC 388-100-005's exclusion of jail inmates from eligibility.
In this case, the trial court granted summary judgment in favor of the Hospital and against the County for the full costs of the inmates' hospital expenses. The trial court entered judgment against the County in the amount of $43,443. The court also imposed postjudgment interest on this judgment. The trial court granted in part and denied in part the summary judgment motions filed by the County and DSHS. The court ruled that the County was entitled to be reimbursed to the extent that the State provides benefits under the LCP-MI The County appealed. We accepted certification from the Court of Appeals, Division Two. DSHS has not challenged the trial court's ruling that WAC 388-100-005's exclusion of eligibility for jail inmates was invalid.
to nonconfined medically indigent people. DSHS was ordered to provide medical benefits under the LCP-MI to medically indigent confined persons at the same rate and under the same conditions as are provided to nonconfined people. The trial court held that DSHS's duty to reimburse the County was limited to DSHS's fee schedule and the legislative appropriation, if any, applicable to the LCP-MI. The trial court entered judgment against DSHS in the amount of $3,933.88
The following questions must be resolved: (1) Was summary judgment properly granted in favor of the Hospital, i.e., must the County pay the Hospital in full for the jail inmates' medical care costs; (2) was summary judgment properly granted in favor of DSHS on its claim that if it had to reimburse the County, it only had to do so to the same extent it would provide coverage for nonconfined medically indigent persons; (3) should summary judgment have been granted in favor of the County for full reimbursement from DSHS; and (4) was postjudgment interest properly imposed on the amount which the County must pay the Hospital?
We affirm the trial court's holding that the County must pay the Hospital in full for the reasonable medical care costs of the inmates. However, we reverse the trial court's holding that DSHS must reimburse the County only to the same extent as it pays for care for nonconfined medically indigent persons. Summary judgment should have been granted in favor of the County for full reimbursement from DSHS. We reverse the decision imposing postjudgment interest.
Deciding who must pay for the inmates' medical care requires construction of RCW 70.48.130. This case thus presents questions of law which are reviewed de novo on this appeal from summary judgment. Draper Mach. Works, Inc. v. Department of Natural Resources, 117 Wash.2d 306, 311, 815 P.2d 770 (1991).
Under the federal constitution the County must provide necessary and emergency medical care for its jail inmates. Estelle v. Gamble, 429 U.S. 97, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976), reh'g. denied, 429 U.S. 1066, 97 S.Ct. 798, 50 L.Ed.2d 785 (1977). But, "[s]o long as the governmental entity ensures that medical care needed is in fact provided, the constitution does not dictate" who must pay for the care. Harrison Mem. Hosp. v. Kitsap Cy., 103 Wash.2d 887, 889, 700 P.2d 732 (1985) (citing Revere v. Massachusetts Gen. Hosp., 463 U.S. 239, 103 S.Ct. 2979, 77 L.Ed.2d 605 (1983)). Who must pay is a matter of state law. Harrison Mem. Hosp., 103 Wash.2d at 889, 700 P.2d 732.
The County argues that under RCW 70.48.130 it is required to pay for emergency or necessary health care for county jail inmates only to the extent that it is reimbursed for the costs by DSHS. The trial court concluded, however, that the statute unambiguously provides that the duty to pay the costs is on the governing unit. RCW 70.48.130, part of the City and County Jails Act passed in 1977, provides:
Payment for emergency or necessary health care shall be by the governing unit, except that the department of social and health services shall reimburse the governing unit for the cost thereof if the confined person requires treatment for which such person is eligible under the department of social and health services' public assistance medical program.
The governing unit may obtain reimbursement from the confined person for the cost of emergency and other health care to the extent that such person is reasonably able to pay for such care, including reimbursement from any insurance program or from other medical benefit programs available to such person.... PROVIDED, That reimbursement for the cost of such services shall be by the state for state prisoners [under certain circumstances].
....
Under no circumstance shall necessary medical services be denied or delayed pending a determination of financial responsibility.
RCW 70.48.130.
The main goal in construing statutes is to ascertain and give effect to legislative intent. Cowiche Canyon Conservancy In the only case in which we have addressed the statute, we said that the first sentence of RCW 70.48.130 requires payment by a governing unit for its jail inmates' medical care, and then said:
v. Bosley, 118 Wash.2d 801, 813, 828 P.2d 549 (1992). We look to the language of the statute itself. The first part of the first sentence of RCW 70.48.130 provides that the governing unit shall make payment for emergency and other necessary medical care for its jail inmates. The governing unit is the county or city responsible for the operation, supervision, and maintenance of the jail. See RCW 70.48.020(7). The second part of the first sentence in the statute says that DSHS must reimburse costs if the inmate is eligible for public assistance medical care. The statute is clear: The County has the primary obligation to pay for the medical care, and DSHS must reimburse costs under certain circumstances
Additional provisions providing for possible reimbursement to the County by [the inmate], the Department of Social and Health Services, another governmental unit, or another public assistance agency are irrelevant to this action between the health care provider ... and the governing unit....
Harrison Mem. Hosp. v. Kitsap Cy., 103 Wash.2d 887, 890, 700 P.2d 732 (1985).
While it is true that in Harrison Mem. Hosp. we were not faced with the exact question before us in this case, the reasoning in Harrison Mem. Hosp. follows from the plain language of the first sentence in RCW 70.48.130: "Payment for emergency or necessary health care shall be by the governing unit...." (Italics ours.)
The trial court correctly ruled that under RCW 70.48.130 the County must pay the Hospital fully for the inmates' medical care costs. There is no dispute as to the amount or reasonableness of the charges. We affirm the trial court's grant of summary judgment in favor of the Hospital.
The next question is how much reimbursement is due from DSHS. The County argues that under RCW 70.48.130 RCW 70.48.130 alone clearly mandates full reimbursement by DSHS. The statute says that payment shall be by the governing unit, "except that the department of social and health services shall reimburse the governing unit for the cost thereof if the confined person requires treatment for which such person is eligible under the department of social and health services' public assistance medical program." (Italics ours.)
DSHS must fully reimburse the County for the costs of the medical care of its medically
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