STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

IN RE: Shands Teaching ) Hospital's Billing Duval County )

Concerning the Patient Linda Sue ) CASE NO. 79-2046 Austin. )

)

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 of 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 Respondent, Duval County, for payment of a bill in the amount of $3,102.48 submitted to Respondent by Petitioner for medical services rendered to Linda Sue Austin. Petitioner contended that the Respondent was liable for payment under The Florida Health Care Responsibility Act, Florida Statutes, Sections 154.301, et seq.

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 as stipulated to are as follows:

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

   
   

2. That at all times relevant to this matter, Linda Sue Austin, 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. The patient was receiving out-patient treatment from University Hospital of Jacksonville during 1977, and, pursuant to her personal decision, and the referral of a private physician, was treated as an out-patient at

Petitioner's hospital from October through December 1977. That on January 9, 1978, the patient, without a scheduled appointment, appeared at the emergency room of Petitioner's hospital complaining of a severe headache, at which time she was given codeine and told to report to petitioner's clinic on January 19, 1978, for her previously scheduled out-patient examination. On January 19, 1978, patient appeared at Petitioner's clinic for her previously scheduled appointment, for an electroencephalographic examination, which was slightly abnormal. It was therefore decided to perform a CT Scan, and the results of said procedure showed that the patient had a brain tumor which was in danger of causing transtentorial herniation. Based upon the diagnosis, the attending physician determined the patient to be suffering from an emergency condition which required immediate hospitalization. The patient was administered decadron, and placed under close neurological observation, every two hours, due to the danger of herniation. Subsequently, on the fourth day after her admission to the hospital, and after routine evaluation and lab workup, the patient was operated on for the removal of the brain tumor.

FINDINGS OF FACT

1. The parties further stipulated at the hearing that the billing for which Shands seeks payment does not include charges for services rendered during the months Linda Sue Austin was being treated as an out-patient at Shands. All other facts, as stipulated to by the parties and as set forth above, are hereby adopted.

   
   

   CONCLUSIONS OF LAW

   
   

2. 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).

   
   

3. 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 indigent 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 condition which will deteriorate from failure to provide such treatment and when such condition is determined by the attending physician to be of an emergency nature.

   
   

   In the instant cause, the patient, Linda Sue Austin, voluntarily terminated her treatment at University Hospital of Jacksonville, the regional referral hospital operated by Respondent, and pursuant to her personal decision and the referral of a private physician commenced treatment at Shands. During the several months that the patient received treatment at Shands on an out-patient basis, services were available at Respondent's hospital, and the patient herself determined not to avail herself of those services.

   
   

4. There is no showing in this record as to the condition for which the patient was being treated by Shands prior to January 9, 1978, when she appeared

   at the emergency room at Shands complaining of a severe headache. Clearly, there was no "emergency medical condition" present prior to January 9. On that date, the patient's severe headache was treated with codeine and she was told to return to Shands for her previously scheduled appointment on January 19, 1978.

   Had she been referred by Shands to Respondent's regional referral hospital on January 9, she would not have been at Shands when the brain tumor was diagnosed and the "emergency medical condition" status was attained.

   
   

5. The fact that the "emergency medical condition" upon which Petitioner relies did not arise until several months subsequent to the commencement of treatment by Shands is dispositive of this cause. The clear statutory language quoted above would impose liability on Duval County had the "emergency medical condition" required the patient to seek treatment at Shands. In the instant cause, the "emergency medical condition" of the patient did not determine the regional referral hospital utilized; rather, the voluntary selection of hospitals was made by the patient prior to the time when the "emergency medical condition" arose. Accordingly, Petitioner has failed to carry its burden of proof that the "emergency medical condition" indicated hospitalization at Shands in order for Shands to obtain payment from Duval County for services rendered to the patient under the "emergency medical condition" statutory exception.

   
   

6. Respondent Duval County is not responsible for payment to Petitioner Shands for services rendered to the patient, Linda Sue Austin.

RECOMMENDED ORDER

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

That a final order be entered rejecting 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 Linda Sue Austin.

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

LINDA M. RIGOT, Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301

(904) 488-9675

COPIES FURNISHED:

Joseph B. Cramer, Esquire

207 Tigert Hall University of Florida

Gainesville, Florida 32611

Thomas MacNamara, Esquire 1300 City Hall

Jacksonville, Florida 32202

David Harrell, Esquire President, City Council City Hall, 10th Floor

220 East Bay Street Jacksonville, Florida 32202

Docket for Case No: 79-002046

Orders for Case No: 79-002046