University of Utah Hospital v. Clerk of Minidoka County , 114 Idaho 662 ( 1988 )

BAKES, Justice.

This is another case in the long and continuing stream of litigation that flows from Idaho’s medical indigency statutes. Appellant Minidoka county appeals from a district court decision which reversed the Minidoka County Commissioners’ denial of medical indigency assistance as claimed by the University of Utah Hospital (hospital) on behalf of an Idaho family. We reverse and remand to the Board of County Commissioners of Minidoka County.

The Hendersons were residents of Minidoka County and on July 9, 1981, Theressa Henderson gave birth to a premature infant at Magic Valley Regional Medical Center in Twin Falls. Subsequent complications resulted in the baby being transferred to the University of Utah Hospital on July 11, 1981, where it remained until August 24, 1981. Both Mr. and Mrs. Henderson were employed, although Mrs. Henderson was on maternity leave from her employment with Ore-Ida Foods. Mrs. Henderson’s employee medical insurance paid $37,563.10 of the $43,824.30 hospital bill, leaving a balance of $6,261.20.

The hospital attempted to collect the balance from the Hendersons. The Hendersons offered to pay $100.00 per month on that balance, but the hospital rejected that offer, suggesting that the Hendersons borrow the money and pay off the balance of the hospital bill. However, the Hendersons were unable to borrow the money to pay off the hospital. In fact, only one payment of $10.00 was ever made to the hospital.

The hospital filed an action against the Hendersons to collect the bill and on August 12, 1982, obtained a judgment for the balance owed. On September 23, 1982, the Hendersons filed a voluntary petition for bankruptcy. A little over two months later, on November 24, 1982, the hospital filed an application for medical indigency assistance on behalf of the Hendersons with Minidoka County. The county denied the application on January 11, 1983, and the hospital requested a hearing before the Minidoka County Commissioners. The hearing was held on March 12, 1984. At the hearing the county commissioners found that the Hendersons were “medically indigent”¹ as early as January, 1982, and that the hospital had failed to meet the “time for filing” requirements set forth in I.C. § 31-3504.

The hospital appealed to the district court. After reviewing the record made before the county commission, the district court concluded that there was no substantial evidence to support the commission’s finding that the Hendersons had become medically indigent as early as January, 1982. The district court concluded that there was no evidence that the Hendersons were medically indigent until the date upon which they filed bankruptcy, September 23, 1982. The district court further held that while the application filed by the hospital on November 24, 1982, did not meet the 30-day deadline of I.C. § 31-3504, the county was not prejudiced by the hospital’s failure to file the application within the 30-day time limit and that under our decision in Carpenter v. Twin Falls County, 107 Idaho 575, 691 P.2d 1190 (1984), the commission erred in denying the application. Accordingly, the district court entered judgment for the hospital in the principal sum of $6,261.20 and prejudgment interest in the amount of $2,754.93.

" 'Medically indigent’ means any person who is in need of hospitalization and who, if an adult, together with his or her spouse, or whose parents or guardian if a minor, does not have income and other resources available to him from whatever source which shall be sufficient to enable the person to pay for necessary medical services.”

Minidoka County appeals from the district court’s judgment asserting (1) that the district court erred in concluding that there was no substantial competent evidence to sustain the commission’s finding that the Hendersons had become medically indigent as early as January, 1982; and (2) that the district court’s application of I.C. § 31-3504, which avoided the statutory time limits set in the statute, was incorrect as a matter of law.

As a preliminary matter we point out that Minidoka County’s assertion that there was substantial competent evidence to support the commission finding that the Hendersons became medically indigent as early as January, 1982, is not necessarily determinative of the final outcome of this case. The record clearly demonstrates that no matter what date the parties point to as the date the Hendersons truly became indigent, the hospital ultimately failed to file an application within either the 30- or 45-day period provided in I.C. § 31-3504.² The final determination of this case rests upon the interpretation of the last sentence of I.C. § 31-3504:

“31-3504. Time for filing applications —Notice to counties. — An application for or on behalf of a medically indigent person receiving emergency medical services may be made any time within forty-five (45) days following the admission of said person to the hospital furnishing said care. If a person becomes medically indigent subsequent to admission to a hospital or subsequent to receiving treatment by a hospital, an application for the person, or on his behalf, shall be made within thirty (30) days of the time the person becomes medically indigent. The chargeable county or counties shall be notified as soon as practicable upon the hospital’s obtaining information disclosing that a patient is medically indigent.” (Emphasis added.)

The statute sets forth a limitation for the filing of claims “for or on behalf of a medically indigent person.” However, the limitation is modified by the last sentence of the statute, which reads, “The chargeable county ... shall be notified as soon as practicable upon the hospital’s obtaining information disclosing that a patient is medically indigent.” This Court has previously determined the meaning of the final sentence of the statute in Carpenter v. Twin Falls County, 107 Idaho 575, 691 P.2d 1190 (1984). In that case we ruled that the county must demonstrate that it was prejudiced by the hospital’s lack of a timely filing before the time limits embodied in I.C. § 31-3504 will be strictly adhered to. In Carpenter we pointed out that under I.C. § 31-3504 failure of an applicant to provide timely notice of claim for medical indigency benefits was not a sufficient reason to deny those benefits absent a showing that the county was prejudiced by the lack of notice. “[Njothing in the statutes provides that the claim may be denied if such notice has not been provided by a hospital____ [Fjailure to provide the notice contemplated by I.C. § 31-3504, does not necessarily defeat a claim for benefits.” Carpenter v. Twin Falls County, 107 Idaho at 582-583, 691 P.2d at 1197-98. The Court further elaborated on that interpretation, stating:

“It is the duty of courts in construing statutes to ascertain the legislative intent and to give effect thereto. Summers v. Dooley, 94 Idaho 87, 481 P.2d 318 (1971). The legislature’s general intent in enacting the medical indigency assistance statutes was two-fold: to provide indigents with access to medical care and to allow hospitals to obtain compensation for services rendered to indigents. I.C. § 31-3501 (‘DECLARATION OF POLICY. — In order to safeguard the public health, safety and welfare, and to provide suitable facilities and provisions for the care and hospitalization of indigent persons in this state, and to provide for the payment thereof, the respective counties of this state shall have the duties and powers as hereinafter provided.’); Braun v. Ada County, 102 Idaho 901, 903-04, 643 P.2d 1071, 1073-74 (1982).

“Given the two-fold purpose of the statutes here in question, it would be clearly inappropriate to hold that a claim against the responsible county for medical indigency benefits can be denied simply because the application submitted does not comply with the technical requirements of I.C. § 31-3404 [and 31-3504].”³ Id. at 582, 691 P.2d at 1197.

Thus, based on Carpenter, the Minidoka County commissioners were not entitled to reject the hospital’s claim because it was not timely filed without first making a factual determination that the county was prejudiced by the hospital’s late filing. Carpenter contemplates a balancing of interests — prejudice to the county balanced against the reasonableness of the hospital’s late filing.⁴

The district court acknowledged that the county was entitled to a hearing on the issue of prejudice resulting from the late filing and stated, “If counsel for the county does not give notice that it wishes to present evidence of prejudice through untimeliness, within fourteen days of trial, counsel should submit their formulations for determining the actual amount of the judgment.” The district court thereby recognized that if the county wanted to raise the issue of prejudice, they were entitled to submit evidence on that issue. In response to the district court’s order, the county did submit an affidavit of the county clerk, setting out its claim that it was prejudiced in several different respects as a result of the failure to timely file by the hospital. The issúe of prejudice having been raised, the matter should have been remanded by the district court to the county commission as required by I.C. § 67-5215(e) for hearing and findings on the issue of prejudice to the county. However, the district court, rather than remanding the case to the county commission, made its own factual determination that the hospital’s late filing did not prejudice the county.⁵ However, such finding must be made in the first instance by the administrative agency. I.C. § 67-5215. Under Idaho’s Administrative Procedures Act, I.C. § 67-5201 et seq., which is made applicable to indigent medical claims by I.C. § 31-3505, when an appeal is brought to a district court and the findings of fact to be reviewed are missing or inadequate the district court should remand the case to the county commission. See Workman Family Partnership v. City of Twin Falls, 104 Idaho 32, 655 P.2d 926 (1982) (stating that failure to hold otherwise would be to authorize the district court to substitute its judgment for that of the agency despite the express provision prohibiting such action in subsection (g) of I.C. § 67-5215).

In its Appellant’s Brief on appeal, pages 19-21, the county cites to several exhibits in the record, together with the unrebutted affidavit filed by the county clerk, and asserts that “these circumstances clearly show how Minidoka county was prejudiced by the dilatory notice provided by the hospital on Henderson’s claim.” Appellant’s Brief, p. 21. From those exhibits the county asks us to conclude that “prejudice to the county from those delays is demonstrated by the record.” Appellant’s Brief, p. 19. However, the resolution of factual issues regarding prejudice to the county cannot be made by this Court on appeal nor by the district court on appeal. Workman Family Partnership v. City of Twin Falls, supra. The Administrative Procedures Act, I.C. § 67-5215(e), (f) and (g), require those findings to be made by the administrative agency. The district court erred when it resolved the issue of prejudice against the county and entered judgment in favor of the hospital.

The judgment of the district court is reversed and the cause remanded to the Minidoka County Commission to make findings on the issue of any prejudice to the county from the late filing, and to enter a final order either allowing or disallowing the hospital’s claim.

HUNTLEY, J., and McQUADE, J. Pro Tem., concur. SHEPARD, C.J., dissents without opinion.

1 . I.C. § 31-3502(1) defines medical indigency as follows:

2 . Although the county argues that the Hendersons were indigent as of February, 1982, there was conflicting evidence in the record. Assuming that we had reviewed the county’s factual findings and found that they were supported by the record the hospital would have been eleven months late in filing. If the date the Hendersons filed their petition for bankruptcy is used to determine the date they became indigent, then the hospital filed 62 days after the fact and once again failed to meet statutory deadlines.

3 . Carpenter applied the same rationale to both statutes (I.C. §§ 31-3404 and 31-3504). "Applying the rationale set forth in Part I, supra, we hold that the failure to provide the notice contemplated by I.C. § 31-3504, does not necessarily defeat a claim for benefits.” Carpenter v. Twin Falls County, supra at 583, 691 P.2d at 1198.

4 . The district court’s de novo review of the factual record correctly attempted to balance the competing interests when it held that: “In this case there were ongoing efforts between the Hendersons and the hospital to settle the bill without county assistance. The Hendersons had offered to pay $100 per month on the bill, but the hospital declined that offer reasoning that that rate of payment would not allow for a reasonable rate of interest on the total bill of $6,261.20. The hospital suggested a bank for obtaining a loan. Eventually the Hendersons filed a petition in bankruptcy as an alternative to borrowing the money. In the opinion of the court these facts show a gradual development of the status of medical indigency which became crystallized by the petition in bankruptcy.

"The law should encourage hospitals to explore with patients alternatives to satisfying medical bills before rushing in with applications for county assistance. This appears to have been the position taken in this case by the hospital.”

5 . The district court did not expressly make a factual finding of lack of prejudice. Rather, the district court, after considering the entire record, including the affidavit of the county clerk asserting prejudice, rendered judgment in favor of the hospital against the county. By entering judgment against the county the court implicitly found against the county on its claim of prejudice. The respondent hospital so asserts in its Respondent's Brief, where it states, “The court specifically found that the county had not been prejudiced by any delay.” Respondent’s Brief, p. 20.