Court Opinion

ID: 9630635
Source: CourtListenerOpinion
Date Created: 2023-08-22 10:16:08.189882+00
Date Added: 2024-06-11T18:07:41.089750
License: Public Domain

SHEPARD, Justice,
dissenting:
I cannot agree with the result obtained by the majority. It is clear that the hospital entered into a contract with the federal government wherein federal aid was received and the hospital in return therefor agreed to supply a certain minimal level of services to indigent patients. That obligation of the hospital has not been performed. Under the guise of the present action, the hospital in effect seeks to shift to the county its contractual burden of supplying free services.
Indigents are third party beneficiaries of the contract in which the hospital agrees to provide free medical care in exchange for federal assistance. Euresti v. Stenner, 458 F.2d 1115 (10th Cir. 1972). Third party beneficiaries are entitled to have the contract enforced and to sue for any damages that result from a breach of the contract. Just’s, Inc. v. Arrington Construction Co., 99 Idaho 462, 583 P.2d 997 (1978); Bush v. Upper Valley Telecable Co., 96 Idaho 83, 524 P.2d 1055 (1973). As third party beneficiaries, indigents also have a cause of action for damages. Saine v. Hospital Authority of Hall County, 502 F.2d 1033 (5th Cir. 1974). The Hill-Burton Act expressly contemplates that third parties will be able to bring an action to enforce compliance with the hospital’s contractual assurances if certain preliminary procedures are followed. 42 U.S.C. § 300s-6. It is held that an indigent’s right to receive free medical care under Hill-Burton is a property interest entitled to due process protections. Davis v. Ball Memorial Hospital Ass’n, 640 F.2d 30 (7th Cir. 1980); but see Newsom v. Vanderbilt University, 653 F.2d 1100 (6th Cir. 1981).
Hence, I believe an indigent, such as Braun, has a cause of action against the hospital requiring it to provide her with free or reduced cost medical care. The cases uniformly hold that a private right of action exists to force a hospital to provide a reasonable volume of free or reduced cost services. Davis v. Ball Memorial Hospital Ass’n, supra; Euresti v. Stenner, supra; Lugo v. Simon, 453 F.Supp. 677 (N.D.Ohio 1978); Corum v. Beth Israel Medical Center, 359 F.Supp. 909 (S.D.N.Y.1973). The only divergence I perceive is on the issue as to whether or not a hospital can be required to provide services to a particular individual. See Yale-New Haven Hospital v. Matthews, 32 Conn.Sup. 539, 343 A.2d 661 (Conn.C.P.App.Div.1974), cert. denied 423 *906U.S. 1024, 96 S.Ct. 467, 46 L.Ed.2d 398 (1975); Valley Credit Service Inc. v. Mair, 35 Or.App. 637, 582 P.2d 47 (1978); Falmouth Hospital v. Lopes, 376 Mass. 580, 382 N.E.2d 1042 (1978). Those courts so holding generally rely on and cite Saine v. Hospital Authority of Hall County, 502 F.2d 1033 (5th Cir. 1974). It is my opinion that such courts have misinterpreted Sainé. In Sainé the Fifth Circuit upheld an individual plaintiff’s right to sue for damages and injunctive relief for a hospital’s failure to comply with the indigent’s medical care requirements of Hill-Burton. Recently that same court stated that Sainé stands for the proposition that “[t]he free care obligation is legally enforceable, and vests a cause of action in the indigent beneficiaries to sue for the free care.” Presbyterian Hospital of Dallas v. Harris, 638 F.2d 1381, 1384 (5th Cir. 1981). See also Hospital Center at Orange v. Cook, 177 N.J.Super. 289, 426 A.2d 526 (App.Div.1981) (holding that the private right of action available to individual indigents can be used either affirmatively or defensively) (overruling Cooper Medical Center v. Joyner, 165 N.J.Super. 482, 398 A.2d 606 (1979)).
Thus indigents have a cause of action for free medical care and their right to such medical care is a legitimate expectation rising to the level of a property right and requiring due process protections. That, however, does not end the inquiry. It must be determined whether such a right amounts to “other resources available from whatever source” under I.C. § 31-3502(1) so as to prevent Braun from being categorized as “medically indigent”. If Braun is not “medically indigent” the inquiry is at an end and the county is not liable.
Clearly a cause of action is a valuable resource. If a hospital patient seeking assistance from a county was entitled to Medicare, Medicaid, or Social Security benefits, all entitlement programs, there would be resources available to preclude inclusion within the term “medically indigent” in I.C. § 31-3502(1). If an indigent were injured in an automobile accident and had a cause of action against the owner or driver of the other vehicle, such would be a resource available which the county might consider in its determination of medical indigency. See also Webster’s New International Dictionary (2d Ed. 1957) defining resources as “possible sources of revenue”.
Nothing in the record here indicates that Braun ever applied to the hospital to receive free care required to be given under federal law, nor is there any indication that the hospital informed her or any other patient that they might be entitled to such free care. I deem that a county is entitled to require that applicants for assistance at least inquire into the availability of other resources to satisfy their medical bills prior to turning to the county for aid. I.C. § 31-3502(1).