*1 ORDER PER CURIAM: Petition January, NOW, day of this 5th
AND whether limited to issue granted, Appeal Allowance of 39:4-50(a) are “of a substan- § 3731 75 Pa.C.S. N.J.S. the Driver’s Article IV of purposes of tially similar nature” is denied. Petition respects, the In all other Compact. License on briefs. to be submitted The matter is A.2d 786 MOORHEAD, of the Estate Jaynet Administratrix A. Baxter, Deceased, Appellant B. of Catherine CENTER, Appellee. MEDICAL CHESTER CROZER Pennsylvania. Supreme Court Argued April 29, 2001. Jan. Decided *3 Fioravanti, Media, for Moor- appellant, Janet Joseph M. head. Morrison, Sheery, Daniel Philadelphia, J.
R. Bruce Medical Center. Crozer Chester CAPPY, ZAPPALA, FLAHERTY, C.J., and Before SAYLOR, NIGRO, CASTILLE, and JJ. NEWMAN OPINION1 CAPPY, Justice. mea appropriate in this case concerns the
The issue expenses. past medical sure reassigned opinion author. 1. was this This reasons, For following we affirm the order Court, although grounds.2 on different (“Baxter”)
Appellant’s decedent Catherine Baxter fell and injured patient was a at Appellee’s facility. herself while she Appellee provided injuries medical services to Baxter for the she Subsequently, received. Baxter commenced a medical malpractice action against Appellee. Following Baxter’s death, estate, Appellant, as administratrix of Baxter’s was trial, plaintiff. proceeded substituted As the case an issue as to appropriate arose of compensatory measure damages for past expenses. Baxter’s The court re- served that issue for and jury, itself submitted the case to the Appellant, returned a verdict favor of awarding $46,500in damages including pain non-economic suffering. “Agreed Upon an Statement Facts Pursuant to Pa. R.A.P.1925”, parties the following established facts with regard compensation to the issue of past expenses: Baxter was covered Medicare as well as a 65” “Blue Cross supplemental plan, for paid premiums. wrhichshe had R. 12a. The fair and value of the medical services rendered $108,668.31. was Baxter Id. The Medicare allowance for $12,167.40. those services was Id. eighty Of percent paid by twenty was percent paid by Medicare and Blue Appellee voluntary Cross Id. was a participant program consequently accepted Medicare in full for the medical rendered. Id. Appellee cannot obtain the difference of the cost of its services (i.e. $96,500.91) and the Medicare allowance from Appellant or *4 any from R. Conversely, other source. 12a-13a. Appellant legally never was and never will obligated pay to more than $12,167.40 for the Appellant medical services. R. 13a. con $108,668.31, tended that she was to entitled the full while Appellee maintained that her was limited to $12,167.40. R. 12a. may
2. We
affirm the
of the
if
order
court below the result reached is
regard
grounds
correct
upon by
without
relied
that court.
Pennsylvania
(Toth),
Game
v. State
Comm’n
Civil Service Comm'n
Pa.19,
(2000) (citations omitted).
888 n.1
Appellant
that
was
agreed
Appellee
trial court
with
actually paid and
$12,167.40,
the amount
recover
entitled
by
services rendered
payment
for
accepted
full
panel
Superior
of the
appeal, a divided
Court
Appellee. On
affirmed,
relying on
grounds.
judges,
Two
but on different
(1994),
Geisinger,
Pa.Super.
Appellant contractually accept bound to the Medicare because was Baxter; no a payment made allowance and therefore existing obligation an presupposes setoff non-existent; rule in this the collateral source case is benefits; precludes Appellee profiting from from Medicare arbitrarily assigns decision Court’s provide citizens claimant status senior who second-class expenses. Appellee counters that their retirement medical correctly trial determined that the court reasonable value 920A, Injured Party”, Payments “Effect of Made to 3. Section entitled provides: by person acting a A made tortfeasor for him to or against person injured liability, as whom he has is credited his tort is, is, subject payments who believes are made another he liability. tort same (2) Payments injured party from made to or benefits conferred against liability, al- other sources are credited the tortfeasor’s though they part all cover or a the harm which the tortfeasor liable.
161 of actually paid, the services was the amount alternative, properly granted Court a setoff. appeal, always subject
On conclusions of law are to our Fiore, (1961). 303, 858, Fiore v. 405 Pa. 174 review. A.2d 859 law, As this issue a question scope involves of our of is review Co., 124, plenary. Phillips v. A-Best Products 665 1167, A.2d we must is issue resolve is this: Appellant entitled to the additional collect amount of $96,500.91, or is recovery her limited to amount actually paid for the medical services? We find that consis principles compensation, tent with of fair is she entitled to the actually paid. amount
Initially,
will
Appellant’s
we
address
contention
Appellee
is bound
“Agreed Upon
Pursuant
Statement
Pa.R.A.P.1925,”
fair
indicates
and reasonable
$108,668.31.
of
the medical
R. 12a. “Parties
may by stipulation
questions
issues,
of
resolve
fact or limit the
and,
stipulations
if the
jurisdiction
do not affect the
court or the due order of the business and
convenience
court, they become the law of the case.” Parsonese v. Mid
Co.,
423,
(1998)
land
Nat’l Ins.
550 Pa.
(citations omitted).
case,
In this
only
the statement was
as to
(R.R. 11a),
facts
and this court’s
of a legal
review
issue cannot
supplanted
stipulation.
See Pittsburgh Miracle Mile
Town & Country Shopping Center v. Board
Property
Assessment, Appeals
Co.,
& Review
Allegheny
Pennsylvania case
See,
Piwoz v.
e.g.,
of medical services.
reasonable value
*6
(1962);
588,
v.
Iannacone,
Fougeray
A.2d 707
178
406
(1934).
controlling
65,
“The as, or in the actually paid, such must be such as have been necessary to in reasonably jury, of the are judgment 191, 192 Co., 1, A. v. Penn. R.R. curred.” Goodhart agreements with pursuant Appellant concedes Cross, contractually obligat Appellee and Medicare Blue as full for services rendered. accept toed for expenses continue to incur plaintiff will When services, for the factfinder to determine appropriate it is compensate plaintiff damages which will amount of reasonably necessary to be incurred.” that “are expenses those where, here, expenses amount has the exact Conversely, have been expenses contract and those been established satisfied, longer any issue as to the amount there is no will be liable. the latter plaintiff for which the expenses case, recovering should be limited injured party Corpus See 25 Juris paid amount for the medical services. (“Where 91(3) (1996 Secundum, Supp.1999) & Damages in accordance with a services is paid amount for medical rates, to that recovery is limited contractual schedule of value of the services although amount the reasonable (footnote omitted). higher.”) is absence of contract of the reasonable value This evaluation Torts, § 911 com- accord with the Restatement (1977), plaintiff seeks to states: ment h “When to third liability or incurred expenditures made recover persons rendered, normally for services the amount recovered is the reasonable services rather than the amount If, however, paid charged. injured person or paid less rate, exchange than the he can no recover more than the paid, except amount when gift the low rate was intended as a to him.” It also is with approach consistent taken in other jurisdictions. Housing Authority See Yolo Coun Hanif 635, ty, 200 Cal.App.3d 246 Cal.Rptr. (declining plaintiff to award actually amount in excess of the amount paid Medi-Cal, stating “when the evidence shows a sum paid certain to have been for past incurred medical care services, whether or by an independent source, that sum plaintiff may certain is the most the recover despite that care may the fact it have been less than the prevailing rate.”); market Bates v. Hogg, Kan.App.2d *7 249, (1996) 921 P.2d rev. den. Kan. 991 (plaintiff 260 properly prohibited from admitting evidence of market value medical services; provider’s because of medical agreement, contractual the amount allowed represented Medicaid customary charge circumstances). under the Appellee’s Given contractu obligations, al the trial court did not in err determining that Appellant was limited to recovering the amount paid accepted as past full for expenses.
Awarding Appellant additional amount of $96,500.91 provide would a her with windfall and would violate just fundamental tenets of compensation. It is a princi basic ple of tort law that “damages are to be to the sustained, full injury extent of the but the award should be limited to compensation and compensation alone.” Incollingo 299, v. 444 Ewing, 306, 206, (citations Pa. 282 A.2d 228 omitted). Appellant has, will, never and never incur the Appellee sum from as an expense. We discern no principled upon basis which to justify awarding that additional amount. approach
Our is with compensa- consistent theories of fair tion Pennsylvania reflected in law, case as following: such put remedies seek to injured person in a position nearly 164 tort, to .the position prior to his or her possible equivalent Comm’n, 539 Pa. Pittsburgh, City v. Civil Service
Trotsky (1995); 356, 813, damages evidence of cannot A.2d 817 652 13, 69, (Maxwell A.2d 73 v. 112 presumed Schaefer, (1955)) reasonably provide in order to precise must be a upon which to base adequate framework jury with an 415 verdict, Pittsburgh, Co. Nakles v. Union Real Estate 50, (1964); cannot 407, injured party 52 an Pa. duplica injury, theory on the for the same recover twice enrichment, Rossi v. unjust State tive results (1983); 386, 8, Co., Pa.Super. A.2d 10 465 Farm Auto. Ins. person compensated sustained should be injured the loss wrongdoer, consistent with with least burden to the injured, Incollingo, person fair compensation idea of 228; damages, plaintiff duty mitigate has 282 A.2d at (1920); 110 A. De Pa. Thompson Long, v. mitigation preclude facts in may and a show such defendant compensation full obtaining from herself, Rupert, see occasioned himself or Robison 523, 525 is inap rule
Additionally, find that collateral source we $96,500.91. The rule plicable to the additional amount of a collateral source shall not payments from “provides wrong from the damages otherwise recoverable diminish the the collateral principle behind [Citation omitted]. doer. plaintiff to wronged for the source rule is that better *8 to potential windfall that for a tortfeasor be relieved receive Beane, wrong.” of for the Johnson responsibility 449, 96, 100 b upon comment Appellant relies (Second) 920A, provides § of Torts which to the Restatement plaintiff responsible “If the was himself pertinent part: in benefit, making by maintaining by his own insurance or the him arrangements, the law allows advantageous employment gift plaintiff If to it himself. the benefit was a the keep law, by or for him he should party from a third established also deprived Appellant that it advantage of the confers.” section, provides c of that cites to comment same
165 Security type Social are the of benefits collateral benefits plaintiffs which cannot be from recovery. subtracted the Clearly, Appellant is entitled to recover paid by on amount which was her behalf and Blue Medicare Cross, the collateral sources. See Restatement of 920A(2), Torts supra, note 2. But the point essential recognize Appellee seeking is that is not Appel- to diminish Rather, recovery by lant’s this amount. the issue is whether Appellant is entitled to collect the additional amount of $96,500.91 expense. as an Appellant pay $96,500.91, did not nor did Medicare Blue Cross pay that amount her behalf. The collateral apply source rule does not to the illusory “charge” of paid since amount was not by any Wallace, collateral source. See McAmis v. F.Supp. 980 (W.D.Va.1997) (collateral 181 rule not require source did plaintiff recover the amount the Medicaid write-off since no amount); Bates, (collateral one incurred the written-off supra apply source rule did not to amount off pursuant written contract). Medicaid
Accordingly,
Court,
we affirm the
Superior
order of the
but
grounds.4
on different
Superior
Geisinger,
of the
Because
Court's reliance on Kashner v.
(1994),
Pa.Super.
reasoning
Justice SAYLOR this matter. decision of in ZAPPALA concurs the result.
Justice dissenting opinion. files a Justice NIGRO NIGRO, Justice, dissenting.. actually paid amount agree I cannot the
Because
(“Crozer”)
in
for the
as
full
accepted by Appellee
($12,167.40)
Appel-
is the amount
services rendered
(“Baxter”)
compensa-
as
is entitled
lant’s
recover
decedent
Instead,
I would
respectfully
I must
dissent.
tory damages,
in which
portion of
Court’s decision
affirm that
the
to the reasonable value
found
is entitled
that Baxter
($108,668.31).
provided
medical services
case is
interpretation in the context of this
at 983. This
A.2d
Brown,
misleading.
court held that
was entitled
In
the trial
expenses
service rendered
damages for
incurred
to recover
although
showing
amount
physicians,
was no evidence
her
there
services,
money expended
nor what the services were reason-
of
error,
sustaining
allegation
ably
of
court held
this
Brown
worth.
they
jury
could
plaintiff must "furnish
evidence from
that the
services,
paid
what
been
for such
or such amounts
determine
had
reasonably
A. at
worth.” 51
services were
Dobbs,
Additionally,
upon
on
court relied
D.
Handbook
the Kashner
Remedies,
(1973)
§
at 543
which stated: "The measure
the Law of
8.1
...
their reasonable val-
is not the cost of services
but
all,
depend
any
at
.[Rjecovery
on whether there is
bill
ue...
does
they
if
liable
even
and the tortfeasor is
value medical services
given
charge,
it is
value and not their cost that
without
since
their
are
indicates
A more recent version
that same treatise
counts.”
said, however,
provider
very
that: "It has been
if
next sentence
intending
charges
less than their value without
of medical services
liability
gift,
Dobbs,
plaintiff's recovery is limited to the
incurred.” D.
(1993)
8.1(3)
§
on the Law of Remedies
at
Handbook
Thus,
omitted).
(footnote
language
quoted
we do not find the
authority
complete
final
on this issue.
to be a
or
Kashner
(Second)
relied
Finally, the Kashner court
Restatement
§
f
which states: "The value medical
Torts
cmt.
although they
necessary
ordinarily
can
be recovered
made
the tort
injured
liability
expense
person,
when a
no
have created
above,
(See
920A).”
§
we
noted
find
physician
his services
As
donates
h,
provision, Restatement
of Torts
cmt. which
another
paid
liability to the
if it is "less than the
limits the tortfeasor's
amount
gift
[the
low
as a
exchange rate” unless "the
rate
intended
injured
applicable
case.
party]”,
be more
to the instant
*10
by
majority,
primary objective
noted
of a com-
As
pensatory damage
provide just compensation
is to
award
loss,
injured party’s
injured party may
so that the
made
be
whole,
position
nearly
possible
and be
to a
as
as
restored
See,
prior
to
equivalent
position
e.g., Trosky
her
to the tort.
v.
Comm’n.,
356,
Pa.
City
Pittsburgh,
Civil Serv.
539
(1995);
813
v.
Feingold
Pennsylvania Transp.
Southeastern
Auth.,
567,
(1986).
end,
512 Pa.
517
1270
To
A.2d
that
compensatory damages are
to
imposed
shift the loss from a
wholly
party
innocent
to one
is at
v.
who
fault. Esmond
Liscio,
200, 213,
793,
209
224
Pa.Super.
A.2d
799-800
personal
plaintiffs
A
injury
recovery for
ex-
past medical
penses
necessary by
made
a
wrongdoing
tortfeasor’s
is limited
to
provided.
the reasonable value of the medical services
See
Clinic,
361,
367-68,
Kashner
Geisinger
Pa.Super.
432
638
980,
A.2d
983 (1994)(discussing plaintiffs right
to recover
reasonable
necessary by
value of
services made
tort-
wrongdoing
noting
feasor’s
that
fact
trier of
must look to
variety of
determining
a
in
factors
the reasonable value of the
provided);
Iannacone,
medical service
see also Piwoz v.
406
588,
(1962);
White,
297,
medical services is entitled to agree I Court Baxter with to her provided value of the medical services reasonable Crozer.2 conclusion, i.e., finding Baxter is reaching different compensatory damages,
only
entitled
initially
the amount
billed
majority determines
where
greater
than
amount
provider
care
plaintiffs
health
litigated
noting
have
It
that Crozer could
bears
provided
could
to Baxter in the trial court and
of the medical services
accepted
argued to
trier of fact that the amount
have
Cross 65 is the most
full
services from Medicare
Blue
for such
calculating
value of the medical
barometer for
the reasonable
accurate
*11
opportunity, and
provided Baxter. But Crozer forewent that
services
to
while
opted
stipulate
of the services
to
to the reasonable value
instead
(1)
compensatory
to
damages should be limited
arguing that:
Baxter’s
65;
payment
Medicare
Blue Cross
and
the
of the
from
and
amount
the
to
in the
of the difference between
it was entitled
a setoff
amount
provided
services
and the amount
value of the medical
reasonable
payment in
from Medicare
Blue Cross 65.
accepted as
full
and
notes, however,
Superior
majority
found that
2. As
the
Court also
the
in
of
the
entitled
a setoff
the amount
the difference between
Crozer is
to
($108,668.31)
provided
and the
value
the medical
reasonable
of
services
($12,167.40).
disagree
accepted
payment
I
with this
in full
amount
only
payment
makes
finding.
"It is
where the tortfeasor himself
a
liability
of
payment
will have the effect
his tort
the
towards
Kashner,
Pa.Super.
reducing
liability.”
at
source 96, (1995), Beane, 449, 456, 664 A.2d 100 v. Johnson where we stated: that from a provides payments collateral source rule
The
damages
diminish the
otherwise
shall not
collateral source
Beech-
wrongdoer.
generally,
See
from the
recoverable
Service,
Contracting
v. Al Hamilton
Inc.
Flying
woods
618,
principle
A.2d 350
Pa.
Corp., 504
that it is
for the
source rule is
better
behind the collateral
for a
windfall than
plaintiff
potential
to receive
wronged
wrong.
for the
responsibility
tortfeasor
be relieved
compensatory damages
other-
By diminishing the amount
payments
on
made
wrongdoer
from a
based
wise recoverable
source,
by a
the new rule
wronged plaintiff
collateral
to the
source
clearly violates the collateral
majority
advanced
provider
majority, when a medical
According
rule.
payor
accept
an amount less
party
contracts with a third
provided
medical services
than the reasonable value
full,
damages is no
purpose
payment
by permitting
injured plaintiff
an
to recover the
longer served
necessary
past
services made
reasonable value of her
medical
majority
conduct. The
provider’s tortious
the medical
expenses paid
on
repeatedly notes that
the actual
totaled
and contends
behalf of Baxter Medicare
in the nature of
any
against
Crozer
further
con-
past
expenses
would
compensatory damages for
majority
empha-
chooses to
Although
a windfall.
stitute
and Blue Cross 65
size the
Medicare
behalf,
proper
Baxter’s
is not the
made to Crozer on
Rather,
prohibits
wrong-
focus.
collateral source rule
against
diminishing
from
recoverable
doer
that a
compensation,
or benefits
payments,
based
wronged plaintiff
on account of
collateral source confers on
See,
and Lake Erie
injury.
e.g.,
Pittsburgh
Hileman
her
(1996)(collateral
Co.,
433, 439,
R.R.
from
prohibits
introducing
defendants
evidence
source rule
on account of his
compensation
received
Beechwoods,
source);
Pa. at
from a
injury
collateral
*13
(collateral
It can hardly argued the benefit conferred Baxter Medicare and Blue Cross equal only 65 was the amount allowed and ultimately Medicare accepted Instead, as payment in full by fully Crozer. services, covering post-injury Baxter’s Medicare and Blue Cross 65 conferred a benefit on equal Baxter provided, reasonable value of the medical services which the parties stipulated $108,668.31. to be The collateral source rule dictates that profit Crozer cannot from the benefit that Baxter insurers, received from her health but exactly that is what the majority today.4 allows conclusion, In support majority of its awarding the also claims that Baxter the additional amount of would violate the tenets of compensation. majority fair claims that its conclusion is consistent damages with several presumed, damages theories: that cannot be reasonably precise, duplicative must be unjust, results in enrichment, injured person that the compensated should be with the wrongdoer, least plaintiff duty burden to the and that a has mitigate damages. fact, presumed damages There were no parties this case. stipulated $108,668.31. expenses: the exact amount injured While party it true that an cannot recover twice for one rule, injury, under the collateral source required pay tortfeasor is causes, all for the harm he compensation even if this creates a double part plaintiff’s injuries. 920A Restatement of Torts Moreover, rule, principle cmt. b. behind the collateral source that it wronged is better for plaintiff to receive a windfall than owes, pay damages tortfeasor to than specifically less he refutes the Beane, 449, 456, majority's contention. Johnson v. Finally, majority principle damage finds mitigation applies in example, the instant majority case. For cites Robison v.
Rupert, (1854), where this Court held that the could compensation receive full caused when the defendant youths shot into a rioting crowd of outside his I fail to home. see how Moreover, applies this rule law to the instant case. stretches *14 to addition, Comment h the majority’s reliance on In the (Second) of the the § of Torts 911 for assessment Restatement is to Baxter provided of services value medical reasonable valuation, generally governs misplaced. While Section recovery of for specifically with the measure h deals Comment tortiously of his for the value plaintiff “who sues a duress, or for the value fraud or by defendant’s obtained the mitigate damages.” attempt in an to rendered of services to instant case. clearly applicable not the is provision That 920A, specifically explains majority ignores Section The by provided collateral sources: the of benefits effects the effect of reduc- benefits] do not have [Collateral-source party’s injured ing recovery against the the defendant. and to the may correspondingly, reduced net loss have been required pay to the total is the defendant extent part a of compensation be a double for may amount there law that a injury. position But it is the of the plaintiffs should not be injured party to the benefit that is directed If the a windfall for the tortfeasor. so as to become shifted benefit, by responsible for the plaintiff was himself ..., him to the law allows maintaining his own insurance ... himself. If the benefit was established keep that it law, of the benefit deprived him he should be nature law not differentiate between the does confers. The benefits, from they did not come long so person acting or a for him. defendant 920A cmt. b. (Second) Torts Restatement of Furthermore, f 924 of the although Comment to Section clearly of states that the “value of Torts Restatement ordinarily can necessary by tort medical services made expense they liability created no although have recovered inexplicably finds Section injured majority person,” Majority to applicable 911 “to be more the instant case.” at 791 n. Opinion, negligence analogize patient injured
bounds relevance to Robison, trespassing plaintiff who was provider injured provoking after the defendant landowner. view, my majority the decision of the improperly limits expenses by creating exception an liability. Although tortfeasor it is responsibili- the tortfeasor’s causes, ty compensate just for all harm that he and not injured loss of party, majority exempts net tortfeasors liability from by injured collateral benefits received plain- analysis, tiffs. Based on the above I portion would affirm that Superior opinion holding Court Baxter entitled ($108,- recover the the medical services 668.31) provided to her Crozer as damages. However, I agree cannot with the Court’s conclusion *15 that Crozer is entitled to a setoff the difference between ($108,668.31) value of the medical services the amount that accepted pursuant Crozer in full voluntary participation to its program ($12,- in the Medicare 167.40). I Accordingly, would award Baxter additional com-
pensatory damages in the amount of which is the difference between the reasonable the medical ser- provided vices to Baxter and the amount of damages for past expenses awarded trial court.
No. 45 DB 2000. Supreme Pennsylvania. Court of
Nov. ORDER PER CURIAM: NOW, November,
AND 30th day this Report The Disciplinary Recommendations Board the Su- preme Pennsylvania Court of 27, 2000, dated October are