St. Luke's v. Board of Com's

Decision Date04 March 2009
Docket NumberNo. 34953.,34953.
Citation203 P.3d 683,146 Idaho 753
PartiesIn the Matter re Medical Indigency Application Of Violet E. O'BRIEN. ST. LUKE'S REGIONAL MEDICAL CENTER, LTD., Petitioner-Appellant, v. BOARD OF COMMISSIONERS OF ADA COUNTY, Idaho, in their official capacity as the Board of County Commissioners for the County of Ada, State of Idaho, Respondents.
CourtIdaho Supreme Court

Moffatt, Thomas, Barrett, Rock & Fields, Chtd., Boise, for appellant. Mark Peterson argued.

Ada County Prosecuting Attorney's Office, Boise, for respondent. Gene Petty argued.

WALTERS, J. Pro Tem.

Saint Luke's Regional Medical Center, Ltd. (St.Luke's), appeals the order of the district court dismissing its petition for review based on the district court's conclusion that a provider does not have standing to request judicial review of a board of county commissioners' decision to deny a medical indigency application. We vacate the order of dismissal and remand the case for further proceedings.


From May 4, 2006, until June 21, 2006, St. Luke's provided treatment to an eighty-one year old widow, Violet O'Brien, for cervical cancer. O'Brien incurred $88,074.74 in medical and hospital bills over the course of her cancer treatment. The Ada County Medical Advisor found the treatment and services O'Brien received were necessary, non-emergency services. On June 6, 2006, O'Brien filed an application for county assistance with Ada County under the Medical Indigency Act, Idaho Code § 31-3501, et seq. On June 8, 2006, O'Brien submitted a separate application for Medicaid coverage with the Idaho State Department of Health & Welfare. This latter application was denied on the basis that O'Brien's income was too high under Social Security guidelines for her to be eligible for Medicaid.

On July 17, 2006, the Ada County Clerk issued its Initial Determination, denying county assistance to O'Brien. The determination to deny county assistance was based on the clerk's finding that O'Brien's application was untimely under Idaho Code § 31-3505. Under that statute, applications for non-emergency services must be filed ten days prior to receiving services. Because O'Brien had not submitted her application until thirty-nine days after the first day of the provision of necessary medical services, her application was determined to be untimely.

St. Luke's and Diagnostic Pathology Nampa Radiologists appealed the initial decision on August 4, 2006, requesting a hearing before the Ada County Board of Commissioners (the Board). The Board heard the appeal on October 4, 2006. The Board upheld the initial denial, determining that O'Brien's Medicaid application was not bona fide, and that her county application for assistance was therefore untimely. On November 1, 2006, St. Luke's timely filed a petition with the district court for judicial review of the Board's decision. A stipulation resolved a portion of the claim pertaining to medical services for which O'Brien's application was undisputed to be timely. Following a hearing on the petition for review, the district court issued its decision dismissing the petition, ruling that St. Luke's lacked standing to seek judicial review of the Ada County Board of Commissioners' decision under Idaho Code § 31-3505G.

St. Luke's timely appealed the decision of the district court to dismiss its petition for judicial review. The sole issue raised on this appeal is whether a medical provider has standing to seek judicial review under I.C. § 31-3505G of a final decision of a board of county commissioners denying county assistance under the Medical Indigency Act.


This Court freely reviews the interpretation of a statute and its application to the facts. State v. Yzaguirre, 144 Idaho 471, 474, 163 P.3d 1183, 1186 (2007). The primary function of the Court is to determine and give effect to the legislative intent. Such intent should be derived from a reading of the whole act at issue. George W. Watkins Family v. Messenger, 118 Idaho 537, 539-40, 797 P.2d 1385, 1387-88 (1990).

If the statutory language is unambiguous, "the clearly expressed intent of the legislative body must be given effect, and there is no occasion for a court to consider rules of statutory construction." Payette River Property Owners Assn. v. Board of Commrs. of Valley County, 132 Idaho 551, 557, 976 P.2d 477, 483 (1999). The plain meaning of a statute therefore will prevail unless clearly expressed legislative intent is contrary or unless plain meaning leads to absurd results. Gillihan v. Gump, 140 Idaho 264, 266, 92 P.3d 514, 516 (2004).

When a statute is ambiguous, the determination of the meaning of the statute and its application is also a matter of law over which this Court exercises free review. Kelso Irwin, P.A. v. State Insur. Fund, 134 Idaho 130, 134, 997 P.2d 591, 595 (2000); J.R. Simplot Co. v. Western Heritage Ins. Co., 132 Idaho 582, 584, 977 P.2d 196, 198 (1999). If it is necessary for this Court to interpret a statute, the Court will attempt to ascertain legislative intent, and in construing a statute, may examine the language used, the reasonableness of the proposed interpretations, and the policy behind the statute. Kelso Irwin, P.A. at 134, 997 P.2d at 595. To ascertain legislative intent, the Court examines not only the literal words of the statute, but the reasonableness of the proposed interpretations, the policy behind the statute, and its legislative history. Carrier v. Lake Pend Oreille Sch. Dist. No. 84, 142 Idaho 804, 807, 134 P.3d 655, 658 (2006).


Title 31, Chapter 35 of the Idaho Code (Medical Indigency Act) requires counties to provide medical care for indigents either through maintaining county hospitals or by paying providers for medical treatment rendered to indigents. I.C. § 31-3503. The policy behind Chapter 35 is to encourage personal responsibility for medical care and to charge counties with the duty to care for individuals that cannot meet this responsibility. Idaho Code § 31-3501. "In construing [Idaho Code § 31-3501, et seq.], this Court has stated that `the legislature's general intent in enacting the medical indigency assistance statutes is twofold: to provide indigents with medical care and to allow hospitals to obtain compensation for services rendered to indigents.'" University of Utah Hosp. v. Ada County Bd. of Comm'rs, 143 Idaho 808, 810, 153 P.3d 1154, 1156 (2007).

In order to qualify as a medical indigent, an individual or a third party on their behalf must complete, swear to, sign, and file an application with the clerk of the county. I.C. § 31-3504(1), (2). After receiving an application, the clerk conducts an interview and investigation, and files a statement of findings with the board. I.C. § 31-3505A. The board then makes an initial determination on the application. I.C. § 31-3505C. "An applicant or provider may appeal an adverse decision of the board by filing a written notice with the board within twenty-eight days of the initial determination." I.C. § 31-3505D. The board must hold a hearing on the appeal wherein the applicant may produce additional evidence pertaining to eligibility. I.C. § 31-3505E.

Idaho Code § 31-3505G governs judicial review of a board's final decision. It provides:

If, after the hearing as provided in section 31-3505E, Idaho Code, the final determination of the board is to deny an application for financial assistance with necessary medical services, the applicant, or a third party making application on an applicant's behalf, may seek judicial review of the final determination of the board in the manner provided in section 31-1506, Idaho Code.

The referenced statute, I.C. § 31-1506, provides: "Unless otherwise provided by law, judicial review of any act, order or proceeding of the board shall be initiated by any person aggrieved thereby within the same time and in the same manner as provided in chapter 52, title 67, Idaho Code, for judicial review of actions." I.C. § 31-1506(1). Thus, the Idaho Administrative Procedure Act, Idaho Code § 67-5201, et seq., (IDAPA), is applicable to a county board decision of whether to grant an application for medical relief.

The Medical Indigency Act has never explicitly granted providers the right to petition for judicial review. Until 1996, Idaho Code § 31-3505 only provided applicants the right to judicial review. I.C. § 31-3505 (1981) (repealed 1996). At that time, "applicant" was an undefined term within the statute.

However, for over twenty years, Idaho courts have recognized that providers have standing to seek judicial review in the district courts of adverse decisions made by county boards, pursuant to this Court's rulings in Carpenter v. Twin Falls County, 107 Idaho 575, 691 P.2d 1190 (1984) and Intermountain Health Care, Inc. v. Board of County Comm'rs of Blaine County, 109 Idaho 299, 707 P.2d 410 (1985) [hereinafter Intermountain Health Care II]. In both cases this Court ruled that providers have standing to seek judicial review of adverse county board decisions based on providers' expectation of compensation for medical care of indigents under the Medical Indigency Act.

In Carpenter, this Court considered several issues pertaining to the Medical Indigency Act, including whether a provider had standing to appeal an adverse decision of a board of county commissioners. This Court affirmed the decision of the district court granting a hospital standing to apply for financial relief under the Medical Indigency Act, despite the fact that Carpenter had previously filed for bankruptcy. The county board claimed the hospital's standing was derived from the indigent's standing, and since Carpenter's bankruptcy disqualified him for medical indigency benefits, the hospital was similarly disqualified. Carpenter, 107 Idaho at 585, 691 P.2d at 1200.

This Court rejected that argument, holding the hospital possessed a right to pursue a claim independent...

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