STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

In re: The matter of the billing ) submitted to Gadsden ) County by Tallahassee )

Memorial Hospital ) CASE NO. 78-394 concerning the patient )

DUNYA SAFFORD )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, G. Steven Pfeiffer, held a final hearing in this case on June 2, 1978, in Quincy, Florida.

The following appearances were entered: John D. Buchanan, Tallahassee, Florida, for Tallahassee Memorial Hospital of Tallahassee; and John Shaw Curry, Quincy, Florida, for Gadsden County, Florida.

On March 3, 1978, Gadsden County filed a petition and request for hearing. The County therein alleged that the Tallahassee Memorial Hospital had submitted a bill to the county with respect to medical services provided by the hospital to a patient named Dunya Safford. The hospital contends that the patient is an indigent resident of Gadsden County, that the hospital performed emergency treatment for the patient, and that the County is liable for payment of a portion of the bill in accordance with the provisions of the Florida Health Care Responsibility Act (Florida Statutes 154.301 et seq.). The County contends that the patient's family is not indigent within the meaning of the Act, and that it, the County, is therefore not liable for the bill.

A pre-hearing conference was conducted on April 7, 1978, and all pending motions have been resolved. The final hearing was scheduled by notice dated March 15, 1978. At the final hearing the hospital called the following witnesses: Timothy Fortunar, a financial counsellor employed by the hospital; Kenneth M. Martin, the hospital's Director of Patient Accounts; Carrie Safford, the patient's mother; and David Safford, Jr., the patient's father. The County called Willie James Johnson, an employee of the Florida Department of Health and Rehabilitative Services Food Stamp Office who serves as a unit supervisor for certification of food stamp eligibility; and recalled David Safford, Jr. and Carrie Safford. Hearing Officer's Exhibits 1-3; TMH Exhibits 1-5; and County Exhibit 1 were all received into evidence. The parties have submitted Post- Hearing Legal Memoranda.

FINDINGS OF FACT

1. Dunya Safford is a resident of Gadsden County, Florida. The parties have stipulated that he was admitted to the Tallahassee Memorial Hospital on December 30, 1977, in an emergency medical condition, and that the treatment performed by the hospital was of an emergency nature. The parties have further stipulated that the Tallahassee Memorial Hospital is a regional referral hospital within the meaning of 154.304(4), Florida Statutes (1977).

2. Dunya Safford, then less than one year old, was admitted to the hospital on December 30, 1977 and discharged on January 4, 1978. Dunya is the child of David and Carrie Safford. The total bill for services rendered by the hospital was $1,816.30. The hospital submitted a bill to Gadsden County in the amount of $633.95 for the services. This latter amount is the portion of the bill which can be billed to the county of residence in accordance with the Florida Health Care Responsibility Act. Gadsden County has refused to pay the bill, contending that the patient was not indigent. The patient has not paid the bill.

   
   

3. The patient's parents have a total of eight children. One of the children married and moved out of the household prior to the patient's hospitalization. Another of the children is Mrs. Safford's child, but not Mr. Safford's child, although Mr. Safford has taken responsibility for complete support of the child. During the six months prior to the hospitalization, Mrs. Safford had no income. Mr. Safford had approximate average weekly income of $95 in his employment as an agricultural worker. The Saffords were, during that period, food stamp recipients. They received $2,552 in food stamps, and paid

   $669 for them. They thus received net food stamp benefits of $2,178, or an average of $363 per month.

   
   

   CONCLUSIONS OF LAW

   
   

4. The Division of Administrative Hearings has jurisdiction over the parties to this action and over the subject matter. Sections 120.57(1), 154.312, 154.314, Florida Statutes (1977).

   
   

5. The burden of proof in an administrative proceeding lies with the party asserting the affirmative of an issue before the administrative tribunal. Tropical Park v. Ratliff, 97 So.2d 169 (Fla, 1957). In the instant matter it is the hospital which is seeking to impose a bill upon the county. The hospital thus has the affirmative of the issue, and the burden of proof lies upon it.

   
   

6. Section 154.308 imposes upon the Department of Health and Rehabilitative Services the duty of promulgating standards for determining indigency of persons admitted to regional referral hospitals in accordance with the Florida Health Care Responsibility Act. The Department originally promulgated emergency rules, and these have now been superseded by permanent rules. Chapter 10C-26 Florida Administrative Code. The indigency income standard is the same under both the emergency and the permanent rules. The rules provide that to be certified as indigent, a family unit must not have monthly gross income exceeding the applicable amount per family unit as listed in Appendix I of the Rules. Rule 10C-26.06(2). There is a legal dispute between the parties as to whether the Saffords' family unit consists of seven or eight persons. The County contends that the child who is not Mr. Safford's son should not be counted within the family unit. Whether that child is counted as within the unit or not is not relevant, because in either case the Saffords' monthly income would fall within the applicable income standard if the value of food stamps received by them is not counted as a part of their gross income, and would fall above the standard if the value of food stamps were included in their gross income. Other than food stamps, the Saffords' only income was Mr. Safford's average weekly earnings of $95.00. If the family unit were considered to be eight persons, then the applicable standard would be $540 per month, and if the unit were considered to be nine persons, the applicable standard would be

   $585. Appendix I to Chapter 10C-26, Florida Administrative Code.

7. The value of food stamps received by the Saffords cannot be considered a part of their gross income. The Federal Food Stamp Program is administered in accordance with the Food Stamp Act, Title VII, United States Code, Section 2011, et seq. Although states and local governments implement the food stamp program, they do so in accordance with the Federal statutes and regulations. Title VII, United States Code, Section 2017(b) provides:

   
   

   The value of the allotment provided any eligible household shall not be considered income or resources for any purpose under any Federal, State, or local laws, including, but not limited to, laws relating to taxation, welfare, and public assistance programs, and no participating State or political subdivision thereof shall decrease any assistance otherwise provided an individual or individuals because of the receipt of an allotment under this act.

   
   

   If the value of any portion of the allotment of food stamps provided the Saffords were considered in determining their income, the statute would be directly offended. The result would be to render the Saffords liable for the total bill for services provided to Dunya Safford, and thus to deprive them of the benefit of a public assistance program.

   
   

8. Gadsden County is liable for the bill rendered by the Tallahassee Memorial Hospital for services rendered by the hospital to Dunya Safford in the amount of $633.95.

RECOMMENDED ORDER

Based upon the foregoing Findings of Fact and Conclusions of Law, it is, RECOMMENDED:

That a final order be entered accepting the bill submitted by the Tallahassee Memorial Hospital for medical services performed for Dunya Safford, and that the bill be paid.

RECOMMENDED this 17th day of July, 1978, in Tallahassee, Florida.

G. STEVEN PFEIFFER Assistant Director

Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301

(904) 488-9675

COPIES FURNISHED:

John Curry, Esquire Post Office Box 706 Quincy, Florida 32351

John D. Buchanan, Jr., Esquire Post Office Drawer 1049 Tallahassee, Florida 32302

Mr. Ben S. Duncan Chairman

Board of County Commissioners Gadsden County, Florida Gadsden County Courthouse Quincy, Florida

Docket for Case No: 78-000394

Orders for Case No: 78-000394