Court Opinion

ID: 9688490
Source: CourtListenerOpinion
Date Created: 2023-08-24 17:51:41.468164+00
Date Added: 2024-06-11T12:06:31.201341
License: Public Domain

FINE, J.
¶ 35. {concurring!dissenting). The question in this case is whether Nancy Lynch and her insurer Acuity must, under Hanson v. American Family Mutual Insurance Co., 2006 WI 97, 294 Wis. 2d 149, 716 N.W.2d 866, pay the allegedly unreasonable charges billed by Midwest Neurosurgical Associates, S.C., and Arvind Ahuja, M.D., for their treatment of Lisa Konkel, who was injured in an accident with Lynch. Although I agree with the Majority that Wis. Stat. ch. 655 governs Lynch's and Acuity's claim that they should be reimbursed by Midwest and Dr. Ahuja for Konkel's pain and suffering caused by any unnecessary procedures performed by Dr. Ahuja, see Northwest Gen. Hosp. v. Yee, 115 Wis. 2d 59, 62, 339 N.W.2d 583, 585 (1983) (claims for "bodily injury" are subject to ch. 655), I disagree with the Majority's conclusion that ch. 655 also governs Lynch's and Acuity's contention that they should not pay any unreasonable charges billed by Midwest and Dr. Ahuja.1 Accordingly, I respectfully dissent in part.
*331¶ 36. There is no doubt that if Lynch were a criminal ordered to reimburse a victim for his or her medical bills, Lynch could challenge the reasonableness of those bills. See Wis. Stat. § 973.20(3) ("If a crime considered at sentencing resulted in bodily injury, the restitution order may require that the defendant do one or more of the following: (a) Pay an amount equal to the cost of necessary medical and related professional services and devices relating to physical, psychiatric and psychological care and treatment.") (emphasis added). This is consistent with the well-established principle that all damages awarded must be reasonable. There is no reason why this rule does not apply here. If allowed to stand, the Majority opinion will make Lynch and Acuity pay bills that they assert they can prove are not reasonable.
¶ 37. Yee teaches that Lynch's and Acuity's challenge to the reasonableness of the medical expenses they are asked to pay is not subject to Wis. Stat. ch. 655. Yee held that ch. 655 did not govern a patient's claim against her physician to recover what she asserted were unnecessary charges billed to her by the hospital as a result of the physician's "unreasonable, unnecessary, and negligent" treatment. Yee, 115 Wis. 2d at 60-61, 339 N.W.2d at 584. The key was that the patient's claim did not arise "as a malpractice claim against the doctor" but, "[rJather, it arose from a contract action" brought by the hospital against the patient. Id., 115 Wis. 2d at 62, 66, 339 N.W.2d at 585, 587. By the same token, the claim asserted against Midwest and Dr. Ahuja by Lynch and Acuity did not arise as a malpractice claim but stems from the automobile accident involving Lynch and *332Konkol. Indeed, Lynch and Acuity are not asserting medical-malpractice claims against Midwest and Dr. Ahuja; rather, they object only to paying bills that they contend were inflated. As Yee held: "We find no indication that the legislature envisioned the patients compensation panel as a forum for patients and health care providers, such as Northwest General Hospital, to litigate the necessity, reasonableness, and propriety of a bill for medical care services." Id., 115 Wis. 2d at 66, 339 N.W.2d at 587. I see no reason why this does not apply to Lynch and Acuity as well.
¶ 38. As the Majority notes, Wis. Stat. ch. 655 was enacted to hold down the cost of health-care. We may take judicial notice that run-away health-care expenses have wracked our society and the problem and its horrific ramifications for the uninsured and the under-insured are only getting worse. See Wis. Stat. Rule 902.01(2)(a), (3), (6) (A court may take judicial notice of any "fact generally known within the territorial jurisdiction" of the court, "whether requested or not," and "at any stage of the proceeding."). Making persons like Lynch and her insurer liable for unreasonable costs of medical care will only make things worse — those who have carte blanche to charge what they will, will charge what they want. This will exacerbate the health-care crisis and make those who buy insurance and, inevitably, the taxpayer pay ever burgeoning costs. Certainly, Konkel has no interest or incentive to ensure that the accident-related charges by Midwest and Dr. Ahuja are reasonable because she does not have to pay them. H.L. Mencken once observed, apparently borrowing from the 16th Century British writer John Lyly, that: "Conscience is the inner voice which warns us that somebody may be looking." *333http://www.worldofquotes.com/topic/Conscience/index.html (last visited July 27, 2009). Without scrutiny by Lynch and Acuity no one is watching.

 Lynch and Acuity do not argue that they may use Wis. Stat. ch. 655 to pursue their claims for money they paid for Konkel's pain-and-suffering caused by what they contend were Dr. Ahuja's unnecessary procedures. But see Wisconsin Patients Compensation Fund v. Continental Cas. Co., 122 Wis. 2d 144, 156, 361 N.W.2d 666, 672 (1985) ("[T]he legislature intended that ch. 655 cover actions arising from medical malpractice claims brought by [non-patients] for either contribution or for *331payment of an insurer's proper share of damages" where "[t]he underlying factual issues.. . concern medical malpractice.") (Wisconsin Patients Compensation Fund as an excess insurer).