OUR LADY OF LOURDES HOSPITAL, Respondent, v. FRANKLIN COUNTY, Appellant, THE DEPARTMENT OF SOCIAL AND HEALTH SERVICES, Respondent.
No. 59246-2
En Banc.
January 7, 1993
120 Wn.2d 439
Johnston & Roache, P.S., by Mike Johnston, for respondent Our Lady of Lourdes Hospital.
Kenneth O. Eikenberry, Attorney General, and Melissa Burke-Cain, Assistant, for respondent State.
BRACHTENBACH, J. — At issue in this case is the extent to which the Department of Social and Health Services (DSHS) must reimburse Franklin County (County) for the costs of inpatient medical care of two county jail inmates hospitalized in 1986.
In September and October 1986, two county jail inmates were hospitalized at Our Lady of Lourdes Hospital (Hospital). The hospital bills for the two inmates totaled over $43,000. The County refused to pay these costs. The Hospital sued the County, seeking payment of the inmates’ medical costs. DSHS was brought in as a third party defendant,
Although DSHS had previously paid for indigent jail inmates’ medical care costs, at the time the two Franklin County inmates were hospitalized WAC 388-100-005 excluded inmates from eligibility for DSHS‘s Limited Casualty Program for the Medically Indigent (LCP-MI). DSHS maintains that the LCP-MI is the only program under which DSHS can pay medically indigent jail inmates’ hospital costs.
Cross motions for summary judgment were filed by all three parties. Venue was changed from Franklin County to Thurston County where other similar actions were pending challenging, among other things, the validity of WAC 388-100-005‘s exclusion of eligibility for jail inmates. This case was joined with the other cases for purposes of oral argument, following which the trial court issued a memorandum opinion on the issues of a city‘s or county‘s liability for its jail inmates’ health care, and whether DSHS could validly exclude jail inmates from the LCP-MI. The trial court reasoned that under
In this case, the trial court granted summary judgment in favor of the Hospital against the County for the full costs of the inmates’ hospital expenses. The trial court entered judgment against the County in the amount of $43,443. The court also imposed postjudgment interest on this judgment. The trial court granted in part and denied in part the summary judgment motions filed by the County and DSHS. The court ruled that the County was entitled to be reimbursed to the extent that the State provides benefits under the LCP-MI
The County appealed. We accepted certification from the Court of Appeals, Division Two. DSHS has not challenged the trial court‘s ruling that WAC 388-100-005‘s exclusion of eligibility for jail inmates was invalid.
The following questions must be resolved: (1) Was summary judgment properly granted in favor of the Hospital, i.e., must the County pay the Hospital in full for the jail inmates’ medical care costs; (2) was summary judgment properly granted in favor of DSHS on its claim that if it had to reimburse the County, it only had to do so to the same extent it would provide coverage for nonconfined medically indigent persons; (3) should summary judgment have been granted in favor of the County for full reimbursement from DSHS; and (4) was postjudgment interest properly imposed on the amount which the County must pay the Hospital?
We affirm the trial court‘s holding that the County must pay the Hospital in full for the reasonable medical care costs of the inmates. However, we reverse the trial court‘s holding that DSHS must reimburse the County only to the same extent as it pays for care for nonconfined medically indigent persons. Summary judgment should have been granted in favor of the County for full reimbursement from DSHS. We reverse the decision imposing postjudgment interest.
Deciding who must pay for the inmates’ medical care requires construction of
Under the federal constitution the County must provide necessary and emergency medical care for its jail inmates. Estelle v. Gamble, 429 U.S. 97, 50 L. Ed. 2d 251, 97 S. Ct. 285, reh‘g denied, 429 U.S. 1066, 50 L. Ed. 2d 785, 97 S. Ct. 798 (1976). But, “[s]o long as the governmental entity ensures that medical care needed is in fact provided, the constitution does not dictate” who must pay for the care. Harrison Mem. Hosp. v. Kitsap Cy., 103 Wn.2d 887, 889, 700 P.2d 732 (1985) (citing Revere v. Massachusetts Gen. Hosp., 463 U.S. 239, 77 L. Ed. 2d 605, 103 S. Ct. 2979 (1983)). Who must pay is a matter of state law. Harrison Mem. Hosp., at 889.
The County argues that under
Payment for emergency or necessary health care shall be by the governing unit, except that the department of social and health services shall reimburse the governing unit for the cost thereof if the confined person requires treatment for which such person is eligible under the department of social and health services’ public assistance medical program.
The governing unit may obtain reimbursement from the confined person for the cost of emergency and other health care to the extent that such person is reasonably able to pay for such care, including reimbursement from any insurance program or from other medical benefit programs available to such person. . . . PROVIDED, That reimbursement for the cost of such services shall be by the state for state prisoners [under certain circumstances].
Under no circumstance shall necessary medical services be denied or delayed pending a determination of financial responsibility.
The main goal in construing statutes is to ascertain and give effect to legislative intent. Cowiche Canyon Conser-vancy v. Bosley, 118 Wn.2d 801, 813, 828 P.2d 549 (1992). We look to the language of the statute itself. The first part of the first sentence of
In the only case in which we have addressed the statute, we said that the first sentence of
Additional provisions providing for possible reimbursement to the County by [the inmate], the Department of Social and Health Services, another governmental unit, or another public assistance agency are irrelevant to this action between the health care provider and the governing unit . . . .
Harrison Mem. Hosp. v. Kitsap Cy., 103 Wn.2d 887, 890, 700 P.2d 732 (1985).
While it is true that in Harrison Mem. Hosp. we were not faced with the exact question before us in this case, the reasoning in Harrison Mem. Hosp. follows from the plain language of the first sentence in
The trial court correctly ruled that under
The next question is how much reimbursement is due from DSHS. The County argues that under
Examination of this statute leads to the conclusion that DSHS must fully reimburse the medical care costs. The statute says that DSHS “shall reimburse” the governing unit, here the County. When used in a statute, “shall” generally imposes a mandatory duty. Department of Ecology v. State Fin. Comm., 116 Wn.2d 246, 252, 804 P.2d 1241 (1991).
The statute requires that reimbursement for medical care is to be “for the cost thereof“, thus commanding full reim-
The statute states that reimbursement is to be made when a jail inmate “is eligible” under the DSHS public assistance medical program. Thus, the determination that a confined person meets eligibility requirements triggers the mandatory obligation of DSHS to reimburse the governing unit. Quite significantly, the statute in no way limits reimbursement to what DSHS would pay for a nonconfined person. While reimbursement is dependent upon whether the inmate meets eligibility requirements for DSHS public assistance medical care, “eligibility” is not the same concept as the rate of reimbursement. Thus, the statute does not support DSHS‘s claim that the Legislature has made reimbursement to cities and counties dependent upon the terms of the Department‘s public assistance medical program.
DSHS argues, however, that
Prior to 1970,
Thus, when the City and County Jails Act,
In 1981, the medical assistance program statutes were modified.
Medical assistance may be provided in accordance with eligibility requirements established by the department of social and health services . . . as defined in the social security Title XIX state plan for mandatory categorically needy persons and: (1) Individuals who would be eligible for cas[h]3 assistance except for their institutional status . . . .
Laws of 1981, ch. 8, § 19.
DSHS maintains that with the amendment of
Following the 1981 amendments and enactments, DSHS continued to provide medical benefits to confined medically indigent persons, as mandated by WAC 388-86-060.
Then, early in 1986, DSHS repealed WAC 388-86-060 and amended WAC 388-100-005 to exclude otherwise eligible persons confined in jails, solely on the basis of their institutional status. The amended version of WAC 388-100-005, which excluded county jail inmates from eligibility, was the WAC challenged in the actions in Thurston County as described above. DSHS states that it attempted to eliminate jail inmate eligibility as part of an effort to reduce expenditures and come within funding limits. The amended WAC came under serious criticism, and in 1989 WAC 388-100-005 was again amended to remove the city and county jail inmate exclusion. However, the inmates whose costs are at issue in this case were treated during the period of time the exclusion was in place.
As noted, the trial court ruled that because of
DSHS now maintains that while the City and County Jails Act prevents DSHS from singling out the inmate population to exclude it from the LCP-MI, the LCP-MI has specific funding limits which the jails act cannot supersede. If legislative appropriations are insufficient, DSHS maintains,
The flaw in DSHS‘s reasoning is that it assumes that the discretion afforded it under
We conclude, however, that the discretion set out in
The trial court erred in ruling that reimbursement of medically indigent jail inmates’ medical care costs must be limited to the rates which DSHS sets under
Having examined
As noted, the parties filed cross motions for summary judgment. Should summary judgment have been granted in favor of the County on the full reimbursement issue? As a matter of statutory construction of
DSHS maintains, however, that it is “undisputed that DSHS received no appropriation to cover jail inmate hospitalization costs from the Legislature.” Brief of Respondent DSHS, at 25. This raises the question whether, despite the mandatory nature of
At this juncture, because we are deciding whether summary judgment should have been granted in favor of the County, we view the County as the moving party and DSHS as the nonmoving party. We engage in the same inquiry as the trial court. Swanson v. Liquid Air Corp., 118 Wn.2d 512, 518, 826 P.2d 664 (1992). Summary judgment is proper if
the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.
CR 56(c); Swanson, at 518. Facts and the reasonable inferences therefrom are considered in favor of the nonmoving party, and summary judgment should be granted in favor of the moving party only if reasonable minds could reach but one conclusion from all the evidence. Swanson, at 518; Wilson v. Steinbach, 98 Wn.2d 434, 437, 656 P.2d 1030 (1982).
From all the evidence, the County is entitled to summary judgment. As explained above, under the statutes, the County is entitled to full reimbursement. Contrary to DSHS‘s claim, this record does not establish as an undisputed fact that legislative appropriations were insufficient, nor does it even raise an issue of material fact as to whether legislative appropriations were insufficient.
In support of its claim of inadequate appropriations, DSHS cites to the Clerk‘s Papers, at 244-57. Nothing in the cited pages supports the claim that there was no available appropriation for reimbursement for the Franklin County Jail inmates’ medical care costs in 1986.
The first item is an unsigned affidavit of the director of the Division of Medical Assistance, Department of Social and Health Services.
Unsigned affidavits should not be considered in ruling on summary judgment motions. See In re Estates of Hibbard, 118 Wn.2d 737, 741 n.7, 826 P.2d 690 (1992). In Mason v. Clark, 920 F.2d 493, 495 (8th Cir. 1990), the court said:
We have no hesitation in stating that an unsigned affidavit is not sufficient evidence in support of a motion for summary judgment. Pension Benefit Guar. Corp. v. Heppenstall Co., 633 F.2d 293, 300 (3d Cir. 1980). In fact, an “unsigned affidavit” is a contradiction in terms. By definition an affidavit is a “sworn statement in writing made . . . under an oath or on affirmation before . . . an authorized officer.” Webster‘s Third New International Dictionary 35 (1965).
Even if the affidavit were proper and could be considered, it would not preclude summary judgment. The director‘s affidavit presents DSHS‘s view that it had authority to decide whether to continue coverage for jail inmates, and that when DSHS was informed in 1986 that cities and counties would expand claims on behalf of jail inmates, coverage for inmates was eliminated and a 23.7 percent reduction in payments for Diagnosis Related Groups hospital payments were made to address a “deficit potential“. Clerk‘s Papers, at 247. The affidavit also refers to bills in the 1986 and 1987 legislative session which would “clarify the responsibilities for jail inmate medical care . . . .” Clerk‘s Papers, at 248. In DSHS‘s view, the affidavit continues, failure of these bills to pass indicated legislative intent in accord with DSHS‘s view of its discretion and authority.4 The affidavit says absolutely nothing about appropriations available to reimburse Franklin County for the 1986 hospitalization costs.
The second item is a point of inquiry contained in the 1982 house journal regarding a senate bill. Clerk‘s Papers, at 249-50. It obviously says nothing about legislative appropriations for the relevant period.
The third item at the cited pages is an excerpt of testimony before the Senate Human Services and Corrections Committee on February 17, 1987. Clerk‘s Papers, at 251-53. The testimony relates to one of the bills referenced above. The testimony again recites DSHS‘s view of its discretion and the need to reduce expenditures. The testimony further states that the proposed bill contained no appropriation. The testimony also states DSHS‘s view that if the bill were not passed, DSHS would view nonpassage as concurrence with DSHS‘s view. Again, this testimony does not establish
The final item relied upon for the proposition that there was no appropriation for inmates’ hospitalization costs is an unsigned affidavit by the office chief of the office of analysis and medical review within the Division of Medical Assistance, Department of Social and Health Services. Clerk‘s Papers, at 254-57. As an unsigned affidavit, this item should not be considered. Even if it was properly considered, it would not preclude summary judgment. This affidavit recounts some of the statutory history outlined above, and contains as an exhibit a “chronology of the major changes to the Medically Indigent program . . . which occurred either at the direction of the legislature or by DSHS in the exercise of its discretion.” Clerk‘s Papers, at 255. The chronology shows some changes in rates and coverage, but plainly does not speak to claims for jail inmates, says absolutely nothing about legislative appropriations, and does not indicate that in 1986 there were insufficient appropriations for DSHS to reimburse the County for the inmates’ costs.
In sum, the materials relied upon by DSHS as showing that there were no legislative appropriations for inmate hospitalization do not do so, nor do they raise a genuine issue of material fact on the matter.5 Once the County estab-
Notes
“(1) To the extent of available funds, medical care may be provided under the limited casualty program to persons not otherwise eligible for medical assistance or medical care services who are medically needy as defined in the social security Title XIX state plan and medical indigents in accordance with medical eligibility requirements established by the department . . . .
“(2) Determination of the amount, scope, and duration of medical coverage under the limited casualty program shall be the responsibility of the department, subject to the following:
“[list of certain standards and requirements]
“(3) The department shall establish standards of assistance and resource and income exemptions.”
We therefore conclude that the County is entitled to summary judgment. DSHS must fully reimburse the County for the two jail inmates’ medical care costs. We note that the parties evidently stipulated below that reimbursement due from DSHS could be paid directly to the health care provider. Although
Finally, we address the County‘s argument that the trial court erroneously imposed postjudgment interest on the judgment which it must pay the Hospital.
The general rule is that as a matter of sovereign immunity, the “state cannot, without its consent, be held to
contain such a line item. DSHS relies upon Legislative Budget Notes, which allocate something over $1.5 million for “Medical for Jail Inmates” for the 1989-91 biennium. Manifestly the notes do not concern 1986. Further, nothing indicates the funds are to be expended at DSHS‘s rate. Also, comment 4 states that “Medical for Jail Inmates [i]ncludes funding for the cost of a settlement of litigation to provide coverage for city and county jail inmates under the department‘s Medically Indigent (MI) program, effective September 1, 1989.” That comment is ambiguous, and may suggest, as the County urges, that the Legislature was in fact providing funding so that DSHS could fully reimburse for inmates’ medical care costs such as those at issue here.
We reverse the trial court‘s ruling imposing postjudgment interest on the judgment which the County must pay the Hospital.
Affirmed in part, reversed in part, and remanded for further proceedings consistent herewith.
UTTER, DOLLIVER, ANDERSEN, DURHAM, SMITH, GUY, and JOHNSON, JJ., concur.
DORE, C.J. (concurring in part, dissenting in part) — I concur with the majority on two issues: First, I agree that the trial court properly granted summary judgment on the issue that the County is primarily responsible for an inmate‘s medical costs. Second, I agree that postjudgment interest cannot be imposed on a sovereign without consent. I dissent, however, on the issue of the Department of Social and Health Services’ (DSHS) obligation to reimburse the County. The trial court properly granted summary judgment on DSHS‘s claim that it need only reimburse the County for the medical care costs to the extent it would provide coverage for nonconfined medically indigent persons. It follows that the County was not entitled to summary judgment for full reimbursement from DSHS.
On the contrary, to say that DSHS must fully reimburse the County for the medical costs of its prisoners is to have the State write a blank check for the health care of the County‘s prisoners. The following brief overview of the law and the applicable health care programs will clarify the issues.
DSHS administers three public assistance medical programs. The first program falls under
LCP-MI is the program of last resort for Washington‘s medically indigent. The Legislature created LCP-MI at the same time that it modified
Returning to
The only possible source of any reimbursement is LCP-MI, and the Legislature probably never intended that program to provide full coverage for the medical care of county prisoners. If the Legislature had intended such a large additional expenditure as full reimbursement for prisoner medical costs it would have appropriated funds earmarked for that purpose or it would have designated such coverage in the enabling legislation. No such appropriation took place. In fact, the Legislature did not designate any appropriations whatsoever for LCP-MI, much less for the medical care of medically indigent prisoners. Rather, the Legislature simply granted DSHS the authority to allocate funds out of its general appropriation to LCP-MI. Moreover, although
Clearly, the majority‘s application of
The majority reconciles these two conflicting statutes by modifying LCP-MI to create full coverage singularly for the medical costs of county prisoners. The majority then dispenses with DSHS authority over the scope of LCP-MI by simply rationalizing that DSHS has that authority except with regard to prison inmates. Finally, the majority ignores the enabling legislation‘s fundamental requirement that LCP-MI spending not exceed “the extent of available funds“. The majority‘s rewriting of LCP-MI ignores at least these mandates of
Rather, the facts persuasively suggest that if the Legislature had intended more reimbursement than allotted by LCP-MI‘s rate schedule, then it would not have made reimbursement dependent upon the terms of the public assistance medical program. As noted, the Legislature did not designate any appropriations whatsoever for LCP-MI, much less for the medical care of medically indigent prisoners. Rather, the Legislature granted DSHS authority to set the amount, scope and duration of LCP-MI “to the extent of available funds“. DSHS has used this authority to implement a rate schedule which provides partial coverage only. Charity care has historically been reimbursed at a rate less than customary fee schedules, and this court has viewed discounted rate schedules as a legislative “fact of life“. Pannell v. Thompson, 91 Wn.2d 591, 589 P.2d 1235 (1979). The discounted rate schedule was authorized by the Legislature to help DSHS meet budgetary constraints. Meeting these constraints has become especially important since the Legislature enacted the budget and accounting act (Budget Act),
Like the legislative circumstances leading up to LCP-MI, public policy does not support the majority‘s interpretation of the issue. As noted, DSHS cannot afford fines under the Budget Act. If fined, LCP-MI would be the first program to experience DSHS cuts because its funding is based on available funds. In turn, if forced to maintain LCP-MI in order to pay the medical costs of prisoners, DSHS would have no choice but to cut coverage for other needy persons under LCP-MI or to cut back on other DSHS services. The program of last resort for Washington‘s most vulnerable citizens would become a program for medically indigent prisoners only. Thus, any interpretation of
The majority could have avoided crippling LCP-MI by holding that
CONCLUSION
In sum, I disagree with the majority on the issue of DSHS‘s obligation to reimburse the County. I hold that the trial court was correct, and that DSHS is requested only to reimburse the County to the dollar amount it would provide coverage for nonconfined medically indigent persons. The Legislature simply did not appropriate the funds necessary to fully reimburse counties for the medical costs of their