St. Paul Ramsey County Medical Center v. Pennington County, S.D.

• Decision Date: 22 September 1988
• Docket Number: 87-5444 and 87-5445,Nos. 87-5421,s. 87-5421
• Parties: ST. PAUL RAMSEY COUNTY MEDICAL CENTER, a Minnesota Hospital, Appellant, v. PENNINGTON COUNTY, SOUTH DAKOTA, and Moody County, South Dakota, Appellees. ST. PAUL RAMSEY COUNTY MEDICAL CENTER, a Minnesota Hospital, Appellee, v. PENNINGTON COUNTY, SOUTH DAKOTA, and Moody County, South Dakota, Appellant. ST. PAUL RAMSEY COUNTY MEDICAL CENTER, a Minnesota Hospital, Appellee, v. PENNINGTON COUNTY, SOUTH DAKOTA, Appellant, and Moody County, South Dakota.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 1185

857 F.2d 1185

ST. PAUL RAMSEY COUNTY MEDICAL CENTER, a Minnesota Hospital, Appellant, v. PENNINGTON COUNTY, SOUTH DAKOTA, and Moody County, South

Dakota, Appellees.

ST. PAUL RAMSEY COUNTY MEDICAL CENTER, a Minnesota Hospital, Appellee, v. PENNINGTON COUNTY, SOUTH DAKOTA, and Moody County, South

Dakota, Appellant.

ST. PAUL RAMSEY COUNTY MEDICAL CENTER, a Minnesota Hospital, Appellee, v. PENNINGTON COUNTY, SOUTH DAKOTA, Appellant, and Moody

County, South Dakota.

Nos. 87-5421, 87-5444 and 87-5445.

United States Court of Appeals Eighth Circuit.

Submitted June 13, 1988.

Decided Sept. 22, 1988.

Craig Pfeifle, Rapid City, S.D., for appellant.

Mark F. Marshall & Gustav K. Johnson, Rapid City, S.D., for appellees.

Before LAY, Chief Judge, BROWN ^*, Senior Circuit Judge, and WOLLMAN, Circuit Judge.

WOLLMAN, Circuit Judge.

St. Paul Ramsey Medical Center (St. Paul Ramsey) appeals the district court's ¹ dismissal of its suit against Pennington County, South Dakota, and Moody County, South Dakota (the Counties), to recover the cost of medical services provided to a South Dakota resident. The Counties appeal the district court's ruling that South Dakota has waived any eleventh amendment immunity possessed by the Counties. We affirm the dismissal.

I.

On March 5, 1983, Carolyn Levitt, a South Dakota resident, was severely burned in an explosion and was taken to a hospital in Flandreau, South Dakota. Because that hospital could not adequately care for her burns, she was transferred to St. Paul Ramsey in St. Paul, Minnesota. On March 10, 1983, St. Paul Ramsey apparently sent each of the Counties notice of Ms. Levitt's admittance. St. Paul Ramsey treated Ms. Levitt for approximately two months and alleges that she incurred medical expenses of $52,384.35. St. Paul Ramsey demanded payment from the Counties for these expenses under South Dakota's County Poor Relief Statute, S.D. Codified Laws Ann. ch. 28-13 (1984). ² When the Counties refused to pay, St. Paul Ramsey filed this diversity action in federal court.

Before the district court, St. Paul Ramsey claimed that chapter 28-13 obligated one of the Counties to pay Ms. Levitt's medical expenses. That chapter establishes a general obligation of each South Dakota county to support its indigent residents. See Sec. 28-13-1. In particular, it provides that "[s]ubject to the provisions of Secs. 28-13-28 to 28-13-32, inclusive, and except as hereinafter expressly provided, whenever hospitalization for an indigent person has been furnished by a hospital in any emergency case, the county where the indigent person has established residency shall be liable to the hospital * * * ." Sec. 28-13-33 (1984) amended by Sec. 28-13-33 (Supp.1988). The chapter, however, defines "hospital" to mean "any hospital in the state of South Dakota * * *," Sec. 28-13-27(1) (1984) amended by Sec. 28-13-27(1) (Supp.1988), ³ and requires that any hospital seeking to recover for the treatment of an indigent have filed with the state secretary of health, at least thirty days prior to the hospitalization, "a detailed statement * * * computing and showing the actual cost to such hospital of quarters, board and hospital services furnished to patients, with each item of such cost shown." ⁴ Sec. 28-13-28.

The Counties moved for dismissal on the grounds that the eleventh amendment protected them from damage claims in federal court, that St. Paul Ramsey had failed to state a claim upon which relief could be granted because it had not alleged compliance with the filing requirement of section 28-13-28, and that St. Paul Ramsey failed to join persons under Fed.R.Civ.P. 19. The district court chose to resolve the issue involving St. Paul Ramsey's failure to file a statement of costs by certifying the question to the South Dakota Supreme Court. The district court also raised, sua sponte, the issue of St. Paul Ramsey's failure to come within section 28-13-27(1)'s definition of "hospital," in that it is not a South Dakota hospital. Thus, the court certified the following question of law:

Whether an out-of-state hospital can recover from a county for emergency medical services provided to an indigent person where that hospital does not come within the statutory definition of a hospital as set forth in SDCL 28-13-27(1) and where the out-of-state hospital has not previously filed a statement of costs as required by SDCL 28-13-28?

The court then ordered all proceedings stayed pending the resolution of the issues certified to the South Dakota Supreme Court.

The South Dakota Supreme Court held that St. Paul Ramsey's failure to file the statement of actual costs precluded it from recovering, see St. Paul Ramsey Medical Center v. Pennington County, 402 N.W.2d 340, 342 (S.D.1987), as did its status as an out-of-state hospital, see id. at 344. St. Paul Ramsey then filed a motion for partial summary judgment. In its brief in support of that motion, St. Paul Ramsey alleged that the statute's definition of "hospital" to include only South Dakota hospitals violated the equal protection and commerce clauses of the United States Constitution and the equal protection clause and equal privileges and immunities provision of the South Dakota Constitution. St. Paul Ramsey also alleged that the Counties' failure to respond to the notices estopped them from denying liability.

In resolving the Counties' motion to dismiss, the district court first assumed, without deciding, that a county is protected from suit by the eleventh amendment. The court held, however, that the state had waived this immunity, thereby giving the court jurisdiction. The court then relied on the South Dakota Supreme Court's answer to the certified question to conclude that St. Paul Ramsey had failed to state a claim upon which relief could be granted by not alleging that it had complied with the filing requirement of section 28-13-28. The court accordingly granted the Counties' motion to dismiss. The district court found resolution of St. Paul Ramsey's motion for partial summary judgment unnecessary in light of its ruling.

On appeal, St. Paul Ramsey raises the same constitutional challenges to section 28-13-27(1), and the same estoppel argument, that it asserted in its brief in support of motion for partial summary judgment. St. Paul Ramsey also argues, for the first time on appeal, that the filing-of-costs requirement of section 28-13-28 violates the due process clauses of the United States and South Dakota constitutions. The Counties argue on appeal that the district court erred in finding a waiver of eleventh amendment immunity.

II.

We first address the district court's ruling that by failing to "allege or infer [sic] that it complied with SDCL 28-13-28," St. Paul Ramsey failed to state a claim upon which relief could be granted. Because the Counties' motion to dismiss was filed after the pleadings had closed, we view it as a motion for judgment on the pleadings. See Fed.R.Civ.P. 12(c); Falls Riverway Realty v. Niagara Falls, 754 F.2d 49, 53 (2d Cir.1985). A defense of failure to state a claim may be raised in such a motion, see Fed.R.Civ.P. 12(h), and we employ the same standard that we would have employed had the motion been brought under Rule 12(b)(6). See Ad-Hoc Committee v. Bernard M. Baruch College, 835 F.2d 980, 982 (2d Cir.1987); 5 C. Wright & A. Miller, Federal Practice and Procedure Sec. 1368, at 688-89 (1969).

Whether a complaint states a cause of action is a question of law which we review on appeal de novo. * * * [A] motion to dismiss a complaint should not be granted unless it appears beyond doubt that the plaintiff can prove no set of facts which would entitle him to relief. We must take the well-pleaded allegations of the complaint as true, and construe the complaint, and all reasonable inferences arising therefrom, most favorably to the pleader.

Morton v. Becker, 793 F.2d 185, 187 (8th Cir.1986) (citations omitted). St. Paul Ramsey correctly concedes that the South Dakota Supreme Court's answer to the certified question made its complaint inadequate. It argues instead that additional allegations made in its brief in support of motion for partial summary judgment, consideration of which the district court found unnecessary, state a claim upon which relief can be granted. ⁵ We disagree.

A.

We first address St. Paul Ramsey's contention that section 28-13-28's filing requirement is unconstitutional. St. Paul Ramsey first challenged section 28-13-28 in its "Response to Defendant Moody County's Brief in Opposition to St. Paul Ramsey's Motion for Partial Summary Judgment," wherein it argued that its constitutional challenges to section 28-13-27(1) applied as well to section 28-13-28 because "[t]he statutes limiting payment to in-state hospitals go hand in hand with the statute requiring a statement of costs be [sic] submitted 30 days prior to admittance." On appeal, however, St. Paul Ramsey shifts theories and argues that section 28-13-28 independently violates due process under the United States and South Dakota constitutions. "As a general rule, we do not consider arguments or theories on appeal that were not advanced in the proceedings below." Wright v. Newman, 735 F.2d 1073, 1076 (8th Cir.1984) (citations omitted). Because we can resolve the issue as a matter of law, however, we have reviewed St. Paul Ramsey's due process argument on appeal and find it unpersuasive.

The filing-of-actual-costs requirement is a mandatory statutory requirement that any hospital seeking to be eligible for reimbursement must satisfy. See Sec. 28-13-28. In reviewing such eligibility requirements under a due process challenge, we must accord the legislature's determination considerable deference and discern only whether the challenged requirement has any rational justification. See Boyd v. Bowen, 797 F.2d 624, 626-27 (8th Cir.1986) (citing Flemming v. Nestor, 363 U.S. 603, 611, 80 S.Ct. 1367, 1372, 4 L.Ed.2d 1435 (1960)). St. Paul Ramsey correctly...