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St. Luke's Magic Valley Regional Medical Center, Ltd v. Board of County Commissioners of Gooding County

August 16, 2010

ST. LUKE'S MAGIC VALLEY REGIONAL MEDICAL CENTER, LTD, AN IDAHO NONPROFIT CORPORATION PETITIONER-APPELLANT,
v.
BOARD OF COUNTY COMMISSIONERS OF GOODING COUNTY, RESPONDENT.



Appeal from the District Court of the Fifth Judicial District of the State of Idaho, Gooding County. Hon. R. Barry Wood, District Judge.

The opinion of the court was delivered by: Horton, Justice

2010 Opinion No. 93

The decision of the district court is affirmed.

This is an appeal from the district court‟s decision affirming the determination of the Board of County Commissioners of Gooding County (the Board) that Megan Freeman is not medically indigent and that therefore St. Luke‟s Magic Valley Regional Medical Center, LTD., (St. Luke‟s) is not entitled to payment from Gooding County (the County) on Freeman‟s behalf. We affirm.

I. FACTUAL AND PROCEDURAL BACKGROUND

In 2007, St. Luke‟s provided $19,419.91 worth of emergency medical services to Freeman. Pursuant to Chapter 35, Title 31, entitled "Hospitals for Indigent Sick," Freeman filed a Uniform County Medical Assistance Application with the Board, requesting that the County reimburse St. Luke‟s for the cost of her medical care. The Board denied the application.

St. Luke‟s then requested that the pre-litigation screening panel of the Idaho Department of Health and Welfare review the application. The panel did so and concluded that Freeman "appears to be medically indigent." St. Luke‟s next filed a petition for judicial review of the Board‟s denial with the district court. On June 25, 2008, the district court remanded the case to the Board and directed it to make findings of fact that comply with this Court‟s requirements as set out in Crown Point Development, Inc. v. City of Sun Valley, 144 Idaho 72, 156 P.3d 573 (2007).

Upon remand, the Board issued amended findings of fact and conclusions of law. After the Board issued the amended findings, St. Luke‟s again petitioned the district court for review. The district court affirmed the Board‟s decision.

St. Luke‟s appeals, arguing that the Board erred in imputing income to Freeman, who is voluntarily unemployed outside of her home, and in considering her potential income tax refunds in determining that she is not medically indigent. Both parties ask for attorney fees.

II. STANDARD OF REVIEW

Idaho Code § 31-3505G provides that:

If, after a hearing as provided in section 31-3505E, Idaho Code, the final determination of the board is to deny an application for financial assistance with necessary medical services, the applicant, or a third party making application on an applicant‟s behalf, may seek judicial review of the final determination of the board in the manner provided in section 31-1506, Idaho Code.

In turn, Idaho Code § 31-1506 provides that an applicant who is denied by the Board must seek judicial review of the Board‟s decision "within the same time and in the same manner as provided in chapter 52, title 67, Idaho Code, for judicial review of actions." Therefore,

[j]udicial review of [the Board‟s] order is limited to the record. A reviewing court may not substitute its judgment for that of the [Board] on questions of fact, and will uphold [the Board‟s] finding of fact if supported by substantial and competent evidence. A reviewing court may reverse the [Board‟s] decision or remand for further proceedings only if substantial rights of the appellant have been prejudiced. I.C. § 67-5279(4). This Court reviews [the Board‟s] decision independently of the district court‟s appellate decision.

Application of Ackerman, 127 Idaho 495, 496-97, 903 P.2d 84, 85-86 (1995) (internal citations omitted).

When the [Board] was required... to issue an order, the court shall affirm the [Board‟s action] unless the court finds that the [Board‟s] findings, inferences, conclusions, or decisions are: (a) in violation of constitutional or statutory provisions; (b) in excess of the statutory authority of the [Board]; (c) made upon unlawful procedure; (d) not supported by substantial evidence on the record as a whole; or (e) arbitrary, capricious, or an abuse of discretion.

Saint Alphonsus Reg'l Med. Ctr., Inc. v. Bd. of County Comm'rs of Ada Cnty., 146 Idaho 51, 53, 190 P.3d 870, 872 (2008) (quoting Idaho Code § 67-5279(3)). "Determining the meaning of a statute is a matter of law." Id. (citation omitted).

When this Court reviews a decision of a district court acting in its appellate capacity, it reviews the [Board] record to determine whether there is substantial and competent evidence to support the [Board]‟s findings of fact and whether the [Board]‟s conclusions of law follow from those findings. If those findings are so supported and the conclusions follow therefrom and if the district court affirmed the [Board]‟s decision, we affirm the district court‟s decision as a matter of procedure.

Losser v. Bradstreet, 145 Idaho 670, 672, 183 P.3d 758, 760 (2008) (quoting Nicholls v. Blaser, 102 Idaho 559, 561, 633 P.2d 1137, 1139 (1981)).

III. ANALYSIS

St. Luke‟s urges that the district court erred in affirming the Board‟s determination that Freeman is not indigent because the Board erred in imputing income and income tax refunds to Freeman. Both parties ask for attorney fees. We address each issue in turn.

A. The district court did not err in affirming the Board's determination that Freeman is not medically indigent as defined in Chapter 35, Title 31.

St. Luke‟s contends that the Board erred when it determined Freeman is not indigent because it based that decision on the fact that Freeman is voluntarily unemployed outside of her home. St. Luke‟s argues that previous decisions by this Court do not compel the Board to impute income to Freeman in determining whether, under I.C. § 31-3502, she is medically indigent. St. Luke‟s further argues in its reply brief that I.C. § 35-3510A(6), regarding a county‟s ability to require a medically indigent person whose bills the county has paid to obtain employment, is the only provision in Chapter 35 that makes reference to a patient‟s ability to work. St. Luke‟s infers from this single reference that the Legislature did not intend that potential income from employment could be considered when determining whether a patient is indigent under I.C. § 31-3502. St. Luke‟s also contends that the Board erred in considering Freeman‟s potential income tax return in making its determination.

We first address St. Luke‟s argument that the statutory framework governing medical indigency indicates that the Legislature did not intend for the Board to consider Freeman‟s ability to work in considering her application for county assistance.*fn1 Next, we address St. Luke‟s argument regarding the case law interpreting the statutory definition of "medically indigent;" and finally we examine whether the Board erred in considering Freeman‟s potential income tax return as a resource.

In interpreting a statute, it is this Court‟s duty to ascertain and give effect to legislative intent by reading the entire act, including amendments. George W. Watkins Family,118 Idaho at 539-40, 797 P.2d at 1387-88. The definition of "medically indigent" at the time of Freeman‟s application was provided by I.C. § 31-3502(1).*fn2 The statute provides that:

"Medically indigent" means any person who is in need of necessary medical services 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 sufficient to pay for necessary medical services. Nothing in this definition shall prevent the board of county commissioners and administrator from requiring the applicant and obligated persons to reimburse the county and the catastrophic health care costs program, where appropriate, for all ...


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