Case Name: RICHARD B. CURNOW, M.D., INC., Plaintiff-Respondent, v. Gary SLOAN, Defendant and Third-Party Plaintiff-Respondent, v. BLUE SHIELD, Defendant-Appellant
Court: Supreme Court of Missouri
Jurisdiction: Missouri
Decision Date: 1981-12-08
Citations: 625 S.W.2d 605
Docket Number: No. 62987
Parties: RICHARD B. CURNOW, M.D., INC., Plaintiff-Respondent, v. Gary SLOAN, Defendant and Third-Party Plaintiff-Respondent, v. BLUE SHIELD, Defendant-Appellant.
Judges: RENDLEN and MORGAN, JJ., concur.
Reporter: South Western Reporter Second Series
Volume: 625
Pages: 605–613

Head Matter:
RICHARD B. CURNOW, M.D., INC., Plaintiff-Respondent, v. Gary SLOAN, Defendant and Third-Party Plaintiff-Respondent, v. BLUE SHIELD, Defendant-Appellant.
No. 62987.
Supreme Court of Missouri, En Banc.
Dec. 8, 1981.
Rehearing Denied Jan. 12, 1982.
Max 0. Bagby, Kansas City, for defendant-appellant.
Vincent F. Igoe, Jr., Liberty, for plaintiff-respondent.
C. David Whipple & David W. Whipple, Kansas City, for defendant and third-party plaintiff-respondent.

Opinion:
HIGGINS, Judge.
In an action in quantum meruit, the court awarded plaintiff physician a judgment against defendant Blue Shield. The Court of Appeals, Western District, per Dixon, J., affirmed the judgment. The case was transferred by this Court on the question of sufficiency of evidence to support the judgment. Affirmed.
In August 1977, Virginia, daughter of defendant Sloan, was treated for an arm fracture at the emergency room of Liberty Hospital by Dr. Voy, an employee of the plaintiff, an orthopedic surgeon in Liberty, Missouri. Plaintiff charged a total of $380.50 made up of $50.00 for emergency room consultation, $68.00 for x-rays, and $262.50 for a closed reduction of the fracture and four office visits.
Mr. Sloan was a member of the United Auto Workers. His union had a health benefit contract with third-party defendant, Blue Shield, which included a "hold harmless" clause whereby Blue Shield would assist and defend the insured in the event that a non-participating physician charged more than Blue Shield felt was usual and customary. Plaintiff was a nonparticipating physician.
Blue Shield did not dispute the x-ray fees, but determined that the total of $312.50 for the emergency room consultation and fracture reduction services was excessive. Under its "peer group" procedures, Blue Shield established a fee of $200.00, leaving a balance of $112.50.
Plaintiff's action against Mr. Sloan was for this balance. He alleged that the total fee charged was the reasonable value of the treatment received by the patient. Mr. Sloan added Blue Shield as a defendant in accordance with the hold harmless provision; Blue Shield stipulated to pay any judgment entered for plaintiff. The court found for plaintiff in the amount of the unpaid balance.
Blue Shield charges the court erred in its judgment "because proof of the reasonable value of the services rendered is essential to recovery in quantum meruit; and plaintiff's failure to present any evidence as to the reasonable value of the services rendered to defendant Sloan's daughter is fatal to plaintiff's recovery in quantum meruit." It argues that plaintiff must prove the reasonable value of his fee in the community where the services are rendered by expert opinion evidence.
Recovery in quantum meruit for services performed is limited to the reasonable value of the services. See St. Charles Floor Co. v. Hoelzer, 565 S.W.2d 844 (Mo. App.1978); Vosevich v. Doro, Ltd., 536 S.W.2d 752 (Mo.App.1976). The question in such a case is whether the evidence is sufficient to support the trial court's judgment that the plaintiff's charge for his services was reasonable. "[T]he decree or judgment of the trial court will be sustained by the appellate court unless there is no substantial evidence to support it, unless it is against the weight of the evidence, . Appellate courts should exercise the power to set aside a decree or judgment on the ground that it is 'against the weight of the evidence' with caution and with a firm belief that the decree or judgment is wrong." Murphy v. Carron, 536 S.W.2d 30, 32 (Mo. banc 1976).
Dr. Curnow testified that he had treated "in the neighborhood of 200" fractures of the type suffered by Virginia Sloan; that his patients generally come "from a wide range — in north Missouri and locally, but mostly from the surrounding counties, primarily from Clay, some from Platte, quite a few from Ray County." He had never experienced a challenge to the reasonableness of this fee for this service by anyone, including Blue Shield and other insurance companies. Only six weeks prior to the present dispute, Blue Shield had paid the same charge in a similar case.
Dr. Curnow also testified that when he began his practice, he used a relative value scale obtained from the Academy of Orthopedic Surgeons in order to establish his fees, and had made adjustments since that time for inflation and other added costs.
Because the question of reasonableness of medical fees is not a matter of common knowledge, expert testimony is necessary to aid the trier of fact in making this determination. Tuttle v. Brayton, 215 S.W.2d 46 (Mo.App.1948). Plaintiff's testimony qualified him as an expert and his qualifications were not questioned. The plaintiff's own testimony, considering his first hand knowledge of this case as well as his professional opinion, establishes the reasonableness of the fee in question. Bodde v. Burnham, 588 S.W.2d 516 (Mo.App.1979).
Blue Shield would have its procedures by which it establishes fees for participating doctors conclusive on the question of reasonability of plaintiff's charges. Such testimony does not warrant reversal of the court's resolution of the question. Opinions of experts, when in conflict, must be weighed by the trier of fact and considered in light of such matters as the experience, knowledge, attention given to the case, and the interest of each. The reasoning underlying the expert's opinion and credibility is important. The trial court, as fact finder, in finding for plaintiff, obviously discounted the contrary evidence on such grounds.
Blue Shield argues that community standards is an essential aspect of reasonableness. It asserts that because the plaintiff offered no testimony explicit on what other physicians charged, his action must fail. Although evidence of what is charged by others in the community can be considered, it is not dispositive. Baker v. Brown's Estate, 294 S.W.2d 22 (Mo.1956) and Vosevich v. Doro Ltd., supra, do consider locality as a factor in determining the reasonableness of fees; however, neither holds this to be a necessary element thereof. If, as the trial court could have found, an estimated 200 patients and insurance companies in the area paid this fee for this particular service without complaint, a finding that it was also charged by some number of other doctors is not required. For that matter, plaintiff testified his initial fee base was that set by a national association of his colleagues, and that provides some additional evidence of a community standard. Each case is different, and plaintiff's testimony alone can establish the reasonable value of his charge, considering the professional base fee upon which it was founded. In this case, plaintiff demonstrated that he did not arbitrarily establish his fees, and that the amount billed to Sloan was the standard charge made by the plaintiff for the services performed for and accepted by patients in the geographical area served by his practice.
The trial court resolved the issue for the plaintiff, and there is nothing in this record to require reversal on the ground that the judgment is unsupported. Rule 73.01; Murphy v. Carrón, supra.
Affirmed.
RENDLEN and MORGAN, JJ., concur.
DONNELLY, C. J., concurs in separate concurring opinion filed.
WELLIVER, J., dissents in separate dissenting opinion filed.
SEILER and BARDGETT, JJ., dissent and concur in separate dissenting opinion of WELLIVER, J.
. Participating physicians agree to accept as full payment for their services a fee in an amount determined to be reasonable, usual and customary by Blue Shield internal procedure.