Re: Medical Indigency Application of C.H. (Gem County Case No. 16-026)
BOARD OF COMMISSIONERS OF GEM COUNTY, IDAHO, Defendant-Respondent. ST. LUKE'S HEALTH SYSTEM, LTD., Plaintiff-Appellant,
from the District Court of the Third Judicial District of the
State of Idaho, Gem County. Hon. George A. Southworth,
Board's Amended Determination of Approval for Benefits is
vacated, and the case is remanded.
Troxell Ennis & Hawley, LLP, Boise, for appellant. Mark
C. Peterson argued.
Thomson, Gem County Prosecuting Attorney, Emmett, for
respondent. Tahja Lee Jensen argued.
appeal arises from a medical indigency application filed by
St. Luke's with Gem County. On January 26, 2016, St.
Luke's accepted an indigent patient suffering from
meningitis, seizures, and brain lesions. The patient was
ready for transfer to another medical facility by February
18, 2016, but was refused by multiple care providers because
they did not want to admit an indigent patient without a
payor source. St. Luke's finally contracted with Life
Care, another medical facility, to take the patient on the
condition that St. Luke's would guarantee payment for a
thirty day period. The patient was transferred to Life Care
on March 9, 2016.
Luke's applied for medical indigency benefits covering
the period of time from the patient's initial
hospitalization until she was transferred to the Life Care
facility. Gem County initially approved the application for
benefits through February 3, 2016. St. Luke's appealed
that determination, and after a hearing, the Board approved
medical indigency benefits from January 26, 2016, until
February 18, 2016. The Board entered a written determination
titled "Amended Determination of Approval for County
Assistance" which set forth the various bills that were
approved for payment, but did not in any way reflect the
denial of benefits or the reasoning of the Board.
Luke's then sought judicial review of the Amended
Determination before the district court, which affirmed the
Board's decision. St. Luke's appealed. We vacate the
Board's Amended Determination because it does not reflect
the partial denial of benefits and because there are no
findings of fact or conclusions of law setting forth the
basis for the Board's denial.
FACTUAL AND PROCEDURAL BACKGROUND
January 26, 2016, emergency medical personnel transported a
63 year-old woman to Valor Health because she was
unresponsive. She had a tonic-clonic seizure en route. She
was then transferred to St. Luke's Meridian Medical
Center and began treatment for meningitis and brain lesions.
Her health improved over the next several weeks.
St. Luke's and Gem County agree that the patient did not
require care from an acute care inpatient hospital after
February 18, 2016. However, while St. Luke's made
multiple attempts to place her with another, lower care
facility, she was consistently denied by providers citing
concerns over payment. Ultimately, Life Care agreed to accept
the patient on the condition St. Luke's would guarantee
payment for daily care for a period of thirty days. St.
Luke's agreed and transferred her to Life Care on March
9, 2016. The discharge report explained it was unsafe for the
patient to return home at that time. St. Luke's sought
reimbursement from Gem County pursuant to Idaho's Medical
Indigency Act for care provided from the time the patient was
hospitalized through March 9, 2016.
an investigation, the Gem County Clerk of the Board, filed a
cursory statement of findings with the Board indicating that
the patient was an indigent county resident, the services
were medically necessary, the application was complete, and
the county was the last resource. The Board approved St.
Luke's application five days later for dates of service
from January 26, 2016, through February 3, 2016. St.
Luke's appealed that decision approximately ten days
clerk had Dr. Doug Dammrose, a utilization management
reviewer retained by counties and the State Catastrophic
Health Care Program, examine the patient's medical
records at four different times, with each of his successive
reports expanding the medical record before the Board as St.
Luke's submitted new records. In his medical reviews, Dr.
Dammrose changed the recommended cutoff date for medically
necessary services from February 3 to February 12, and
finally to February 18. He explained his last opinion only in
the following summary:
The additional clinical notes indicate the patient was
medically stable on 02/19 and it appears she no longer needed
the services of an acute care inpatient hospital. Her medical
care was at a maintenance level, and her needs were
rehabilitative in nature. The inpatient stay from 02/19/2016
to 03/09/2016 is ...