Silver Hill Hosp., Inc. v. Kessler

• Decision Date: 13 October 2020
• Docket Number: AC 42545
• Citation: 200 Conn.App. 742,240 A.3d 740
• Court: Connecticut Court of Appeals
• Parties: SILVER HILL HOSPITAL, INC. v. Dawn KESSLER

200 Conn.App. 742

240 A.3d 740

SILVER HILL HOSPITAL, INC.

v.Dawn KESSLER

AC 42545

Appellate Court of Connecticut.

Argued May 15, 2020

Officially released October 13, 2020

James T. Baldwin, Fairfield, for the appellant (defendant).

Patrick M. Fahey, with whom, on the brief, was Michael G. Chase, Hartford, for the appellee (plaintiff).

Alvord, Elgo and Pellegrino, Js.

ELGO, J.

The defendant, Dawn Kessler, appeals from the judgment of the trial court, rendered following a trial before an attorney fact finder, in favor of the plaintiff, Silver Hill Hospital, Inc., on the plaintiff's complaint in the amount of $17,087.15. On appeal, the defendant claims that (1) the fact finder's conclusions were not based on evidence presented at trial, (2) the fact finder failed to consider the issue of whether the plaintiff was responsible for resolving a coverage dispute issue with Medicare, (3) the court improperly denied her objections to the fact finder's report, and (4) General Statutes § 19a-673d operates as a statutory bar to the plaintiff's debt collection action. We affirm the judgment of the trial court.

This case concerns a dispute over payment for medical services. The record reflects, and the parties do not dispute, that the plaintiff provided inpatient and outpatient services to the defendant from April 22 to June 6, 2014. The plaintiff's charges for those services totaled $59,291.50. The plaintiff billed Medicare,¹ which initially paid the entire sum. Medicare subsequently informed the plaintiff that, according to its records, the defendant had workers’ compensation coverage for a portion of those medical expenses. On November 2, 2016, Medicare rescinded coverage for certain services and the plaintiff thereafter returned $17,087.15 to Medicare.

The defendant, as well as her son and her daughter-in-law, were informed of this development and were asked to contact Medicare to resolve the coverage dispute. The plaintiff's witness, Shakia Whitehurst, senior financial counselor for the plaintiff, testified at trial that the defendant refused to contact Medicare to resolve the coordination of benefits issue. In her testimony, the defendant acknowledged that she had not submitted any payment to the plaintiff.²

On May 1, 2017, the plaintiff commenced the underlying action to collect unpaid expenses for services provided to the defendant. In its complaint, the plaintiff alleged that it furnished medical services to the defendant from April 22 to June 5, 2014, and that the plaintiff submitted bills to the defendant totaling $59,291.50. By way of relief, the plaintiff sought the unpaid balance of $17,087.15.

On July 31, 2017, the defendant filed an answer in which she admitted that the plaintiff rendered the services in question but denied owing the unpaid balance. In addition to her answer, the defendant asserted eight special defenses including, inter alia, non compos mentis.³ Each special defense contained a single conclusory sentence with no supporting factual allegations.

On August 3, 2017, the plaintiff moved to strike all of the special defenses due to the defendant's alleged failure to plead sufficient facts. The court subsequently granted the motion to strike all of the defendant's special defenses except the non compos mentis defense. The defendant thereafter filed a revised answer and asserted the sole special defense of non compos mentis.

Pursuant to Practice Book § 23-53, the matter was referred to an attorney fact finder, Joseph DaSilva, who presided over a one day trial on July 13, 2018. On October 9, 2018, the fact finder issued his report, in which he found that (1) the defendant owed a balance of $17,087.15 to the plaintiff and (2) the defendant failed to prove the sole special defense of non compos mentis. The fact finder therefore recommended that judgment should enter in favor of the plaintiff.

On October 25, 2018, after the fact finder had submitted his report to the trial court, the defendant filed an objection to the findings of fact, arguing, in part, that the fact finder failed to address the issue of whether it was the plaintiff's responsibility to dispute the coverage issue with Medicare and that unspecified "federal code and regulations" prohibited the plaintiff from collecting from the defendant. Because that objection injected legal issues, which had not been raised in the pleadings or the fact finder's report, the court requested that the plaintiff file a memorandum of law addressing those issues. The court thereafter overruled the defendant's objection, concluding that because those issues were not raised in the pleadings, the fact finder had appropriately confined his analysis to the sole special defense raised by the defendant. The court thus rendered judgment in favor of the plaintiff, and this appeal followed.

Before considering the specific claims raised in this appeal, we begin by noting the applicable standard of review. "Attorney fact finders are empowered to hear and decide issues of fact on contract actions pending in the Superior Court .... On appeal, [o]ur function ... is not to examine the record to see if the trier of fact could have reached a contrary conclusion. ... Rather, it is the function of this court to determine whether the decision of the trial court is clearly erroneous. ... This involves a two part function: where the legal conclusions of the court are challenged, we must determine whether they are legally and logically correct and whether they find support in the facts set out in the memorandum of decision; where the factual basis of the court's decision is challenged we must determine whether the facts set out in the memorandum of decision are supported by the evidence or whether, in light of the evidence and the pleadings in the whole record, those facts are clearly erroneous. ... A finding of fact is clearly erroneous when there is no evidence in the record to support it ... or when although there is evidence to support it, the reviewing court on the entire evidence is left with the definite and firm conviction that a mistake has been committed." (Internal quotation marks omitted.) Walpole Woodworkers, Inc. v. Manning , 126 Conn. App. 94, 98–99, 11 A.3d 165 (2011), aff'd, 307 Conn. 582, 57 A.3d 730 (2012).

"[B]ecause the attorney [fact finder] does not have the powers of a court and is simply a fact finder, [a]ny legal conclusions reached by an attorney [fact finder] have no conclusive effect. ... The reviewing court is the effective arbiter of the law and the legal opinions of [an attorney fact finder], like those of the parties, though they may be helpful, carry no weight not justified by their soundness as viewed by the court that renders judgment." (Internal quotation marks omitted.) Id., at 99, 11 A.3d 165. When the trial court reviews the findings of fact, "[the] reviewing authority may not substitute its findings for those of the trier of the facts." Wilcox Trucking, Inc. v. Mansour Builders, Inc. , 20 Conn. App. 420, 423, 567 A.2d 1250 (1989), cert. denied, 214 Conn. 804, 573 A.2d 318 (1990). A trial court "may not retry a case or pass judgment on the credibility of witnesses, [and] must review the [fact finder's] entire report to determine whether the recommendations contained in it are supported by findings of fact in the report." (Internal quotation marks omitted.) LPP Mortgage, Ltd. v. Lynch , 122 Conn. App. 686, 692, 1 A.3d 157 (2010). "The trial court, as the reviewing authority, may render whatever judgment appropriately follows, as a matter of law, from the facts found by the attorney [fact finder]." (Internal quotation marks omitted.) Beucler v. Lloyd , 83 Conn. App. 731, 735, 851 A.2d 358 (2004), appeal dismissed, 273 Conn. 475, 870 A.2d 468 (2005). With those principles in mind, we turn to the claims presented in this appeal.

I

We begin with the defendant's claim that the fact finder's conclusions were not based on evidence presented at trial. The defendant contends that the fact finder failed to make reference to the witnesses or the exhibits submitted at trial, and that the subordinate facts do not support the conclusions made. We disagree.

Contrary to the contention of the defendant, there is adequate support in the record for the findings of fact reached by the fact finder. The law requires that we determine whether the findings " ‘are supported by the evidence,’ " not whether the fact finder could have reached a contrary conclusion. Walpole Woodworkers, Inc. v. Manning , supra, 126 Conn. App. at 99, 11 A.3d 165. The record before us contains sufficient evidence for the fact finder to conclude that the plaintiff provided inpatient and outpatient medical services to the defendant, that the defendant owes a balance of $17,087.15 for the services rendered, and that the defendant has not paid that balance. We, therefore, conclude that the fact finder's findings were based on evidence presented at trial and consistent with the requirements of Practice Book § 19-8.

II

The defendant also claims that the fact finder improperly failed to consider the defendant's belated contention, which was not raised in the operative pleadings, that the plaintiff had a duty to contact Medicare to resolve the coverage issue. We disagree.

"It is indisputable that the pleadings establish the framework of any legal action." Commerce Park Associates, LLC v. Robbins , 193 Conn. App. 697, 731, 220 A.3d 86 (2019), cert. denied sub nom. Robbins Eye Center, P.C. v. Commerce Park Associates, LLC , 334 Conn. 912, 221 A.3d 447 (2020), and cert. denied sub nom. Robbins Eye Center, P.C. v. Commerce Park Associates, LLC , 334 Conn. 912, 221 A.3d 448 (2020). For that reason, "[t]he court is not permitted to decide issues outside of those raised in the pleadings." Yellow Page Consultants, Inc. v. Omni Home Health Services, Inc. , 59 Conn. App. 194, 200, 756 A.2d 309 (2000). Further, "[o]nce the pleadings have been filed, the evidence proffered must be relevant to the issues raised therein....