STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

IN RE: SHANDS TEACHING HOSPITAL'S )

Billing Duval County Concerning the ) CASE NO. 79-2045 Patient Varchriser Brown. )

)

RECOMMENDED ORDER

Pursuant to notice, this cause was scheduled to be heard by Linda M. Rigot, the assigned Hearing Officer of the Division of Administrative Hearings, on February 25, 1980, in Gainesville, Florida.

The following appearances were entered: Joseph B. Cramer, Esquire, Gainesville, Florida, on behalf of the Petitioner, Shands Teaching Hospital and Clinics of the University of Florida, for and on behalf or the Board of Regents of the State of Florida; and Thomas MacNamara, Esquire, Jacksonville, Florida, on behalf of the Respondent, Duval County, Florida.

Petitioner, Shands Teaching Hospital and Clinics of the University of Florida, for and on behalf of the Board of Regents of the State of Florida ("Shands"), filed a petition requesting a determination of the responsibility of the Respondent, Duval County, for payment of $560.40, representing the balance of a bill in the amount of $1,729.60 submitted to Respondent by Petitioner for medical services rendered to Varchriser Brown. Petitioner contended that the Respondent was liable for payment under The Florida Health Care Responsibility Act, Sections 154.301, et seq., Florida Statutes. Respondent denied responsibility and requested reimbursement or credit in the amount of $1,179.20, representing partial payment on the bill submitted to Respondent.

Prior to the scheduled hearing, the parties stipulated as to all facts, and the hearing was restricted accordingly to the presentation of argument on behalf of the parties hereto.

The facts stipulated to are as follows:

1. That at all times relevant to this matter, Petitioner was a regional referral hospital a defined in Section 154.304(4), Florida Statutes.

   
   

2. That at all times relevant to this matter, Varchriser Brown, hereinafter referred to as the "patient," was a resident of Duval County, Florida, within the meaning and purview of Chapter 154, Part IV, Florida Statutes.

   
   

3. That on all dates relevant hereto, the patient was an indigent, within the meaning and purview of Chapter 154, Part IV, Florida Statutes.

   
   

4. Respondent, Duval County, operates a regional referral hospital, University Hospital of Jacksonville, as defined by Section 154.304(4), Florida Statutes, and did operate said hospital at all times relevant to this matter.

5. Patient was treated at the emergency room and clinics of University Hospital of Jacksonville approximately nine (9) times from the date of her birth on January 25, 1977, up to May 3, 1978.

   
   

6. In April of 1978, Dr. Saver of University Hospital noted that there was no pediatric biopsy capsule at University Hospital of Jacksonville, with the closest such capsule being at Petitioner's hospital in Gainesville. Dr. Saver felt that this test would be useful in diagnosing the medical problem of the patient. On May 3, 1978, the patient was referred and transferred by University Hospital of Jacksonville to Petitioner's hospital for the purpose of conducting a small bowel biopsy. Such a biopsy was performed at Petitioner's hospital in the month of May and the results were negative. The patient was discharged from Petitioner's hospital on June 7, 1978.

   
   

7. On June 27, 1978, the patient, brought by her mother, again appeared at the emergency room of Petitioner's hospital. At this time, upon examination by the physicians of Petitioner's hospital, it was found that her diarrhea had reoccurred, she had developed impetiginous facial lesions, allegedly was taking foods poorly, appeared dehydrated and was significantly lethargic. On the basis of her appearance at the time and her previous history or multiple admissions at the University Hospital in Jacksonville with clinically significant diarrhea and dehydration, the attending physicians determined that the patient should be admitted for observation and for re-hydration, particularly because her past history suggested a failure to admit the child might lead ultimately to a prolonged period of poor feeding and/or diarrhea, resulting ultimately in a loss of the nutritional gain made to that point. In addition, the history of the patient also implied that her mother was incapable of dealing with the child when she became significantly ill. At the same time as the patient's admission, a report was made to the State Department of Health and Rehabilitative Services, Protective Services Division, to investigate this case because of the examining and admitting physicians' opinion that the child was a victim of possible neglect.

   
   

8. The attending physician determined the patient should be admitted and treated at Petitioner's hospital on an emergency basis because the patient needed treatment, and if the patient was returned to the mother at that time, the patient might not have received the treatment she needed and her condition might have deteriorated.

   
   

9. That during the patient's stay at Petitioner's hospital, the said Division of Protective Services investigated the home from which the patient came, determined that said home conditions were sub-optimal, but that it did not have sufficient evidence at that time upon which to take court action; and the Division of Protective Services instructed Petitioner's hospital, upon the end of treatment, to release the child to the mother so that the Division of Protective Services could follow up the investigation, having the opportunity to investigate the home life when the child was back in the home and under the care of the mother.

FINDINGS OF FACT

The facts, as stipulated to by the parties and as set forth above, are hereby adopted.

CONCLUSIONS OF LAW

1. The Division of Administrative Hearings has jurisdiction over the subject matter and over the parties hereto pursuant to Sections 120.57(1), 154.312, and 154.314, Florida Statutes (1979).

   
   

2. Section 154.306, Florida Statutes (1979), provides in part:

   
   

   However, no county shall be required to pay for services at a regional referral hospital when such services are available at a local hospital in the county where the indigent resides, except that the county where the indi- gent resides shall, in all instances, be liable for the cost of treatment provided to said certified indigent

   at a regional referral hospital for any emergency medical conditior which will deteriorate from failure to pro- vide such treatment and when such condition is determined by the attend-

   ing physician to be of an emergency nature.

   
   

   Respondent's position that it is not responsible for the billing in question since the patient voluntarily chose to receive treatment at Shands when services were available at University Hospital of Jacksonville is without merit. There is no showing in this record that the patient's mother understood that her referral to Shands by University Hospital of Jacksonville was on a temporary basis only. When the need for further treatment arose, it was reasonable for the child's mother to return her to Shands, the hospital from which the child had been released twenty days earlier.

   
   

3. Upon examination of the patient, a seventeen-month-old infant, the attending physicians had a dual concern: the child's physical condition and the causation of that condition. The child's appearance and medical history indicated that the child was a possible victim of neglect by the mother who brought her to Shands. The refusal of admittance or treatment by Shands might well have created an even more severe medical condition since the child's mother could not be reasonably relied upon to take the child to Respondent's regional referral hospital. The possibility of neglect by the mother was strong enough that the Department of Health and Rehabilitative Services, Protective Services Division, was contacted at the same time that the child was admitted to Shands and thereby removed from her mother's control. The circumstances surrounding this patient's admission to Shands clearly constituted an "...emergency medical condition which will deteriorate from failure to provide such treatment. "

   
   

4. When a potentially abused or neglected child, or other dependent person, is brought to a regional referral hospital under circumstances suggesting that person upon whom the patient is dependent may be a causative factor for the condition requiring treatment, the regional referral hospital must admit the child or other dependent person and the county of residence must bear the expense of treatment.

RECOMMENDED ORDER

Based upon the foregoing findings of fact and conclusions of law, it is, RECOMMENDED:

That a final order be entered approving payment by Duval County of $560.40, representing the outstanding balance of the bill submitted by Shands Teaching Hospital and Clinics of the University of Florida, for and on behalf of the Board of Regents of the State of Florida, for services rendered to Varchriser Brown.

RECOMMENDED this 12th day of March 1980, in Tallahassee, Florida.

LINDA M. RIGOT

Hearing Officer

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

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings (904) 488-9675

COPIES FURNISHED:

Joseph B. Cramer, Esquire

207 Tigert Hall University of Florida

Gainesville, Florida 32611

Docket for Case No: 79-002045

Orders for Case No: 79-002045