Opinion ID: 1128204
Heading Depth: 1
Heading Rank: 2

Heading: candelaria case.

Text: The Candelaria infant was born two months premature on November 9, 1982, and was critically ill, suffering from complex respiratory system problems. He was transferred to Primary Children's Medical Center. The hospital made a claim for alleged costs not covered by Medicaid, in excess of $25,000. The county denied that claim, and an administrative hearing was held before the Board of County Commissioners. The infant was the son of a single woman whom the county and hospital have, since the release of the infant from Primary, been unable to locate. Medical exhibits tendered by the hospital during the hearing indicate that the mother and father of the infant were separated, that the father lived in Las Vegas, and that the mother had resided in Idaho and was on welfare. During the hearing before the county commissioners, the same credit manager of the hospital as testified in the Gardoski matter testified as to the hospital's procedure in ordering treatment and the nature of the hospital's charges. She admitted, however, that she had no expertise in setting costs of medical care. Following the hearing, the Board of County Commissioners denied reimbursement to the hospital, stating: FINDINGS OF FACT    5. Claimant and Primary have failed to sustain their burden of proving that a readily available resource for payment, the natural father of Michael Candelaria, is indigent. The record indicates little more than a half-hearted attempt on the part of Claimant and Primary to provide the County with sufficient credible information upon which to make a finding of indigency. Claimant's mother failed to respond to a subpoena and registered letter requesting her appearance at the hearing before this Commission. CONCLUSIONS OF LAW 1. Proof of medical indigency is an indispensable part of a claim for relief under the Idaho Medical Indigency Statutes. Both Claimant and Primary have failed to meet their burden of proof on the issue of medical indigency insofar as they have made no bona fide effort to provide the Commission with financial resources or lack thereof of the natural father of Michael Candelaria. It may well be that the natural father is and was during all pertinent times adequately insured to cover this claim, however neither Primary nor Claimant have provided any evidence whatsoever on the financial capability of the natural father as is their duty. 2. An additional part of the proof which a Claimant must make in a claim under the Idaho Medical Indigency Statutes is a credible showing of the medical necessity for the care alleged to have been given and also the reasonableness of the charges for such care. The Commission is bound by law to disburse only such monies as are legally warranted. It cannot speculate or hope that a claim for monies is credible or accurate. It must apply traditional principles of proof on the issue. Before both judicial as well as administrative tribunals, proof of the necessity and reasonable cost of expert services must be established by expert testimony. The profferred witness in the case is by her own admission no expert in medical care or in derivation or establishment of costs for medical services. She is a credit manager and merely seeks to enforce payment on work purportedly done by experts.