THE PUBLIC HEALTH TRUST OF DADE COUNTY, FLORIDA, D/B/A JACKSON MEMORIAL HOSPITAL, APPELLANT,
v.
LELAND HOLMES, APPELLEE
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Jackson Memorial Hospital appealed a directed verdict in favor of a patient who challenged the hospital's collection action on grounds of medical necessity. The court held that where a patient signs a guaranty for hospital services, the burden of proving medical necessity as an affirmative defense rests with the patient, not the hospital, and reversed the trial court's erroneous allocation of burden.
Where a patient has signed a guaranty for hospital services, the hospital need not prove medical necessity to enforce the guaranty. The burden of proving the affirmative defense that services were not medically necessary rests with the patient asserting that defense.
[1] A party asserting an affirmative defense bears the burden of proving that defense.
[2] A signed guaranty for payment of services rendered shifts the burden of proving the unreasonableness or lack of necessity of those services to the defendant.
Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“In the instant action, JMH established that the patient signed a guaranty for payment for services rendered and that the services were rendered. Thereafter, the trial court incorrectly placed the burden of proving the defendant's affirmative defense of medical necessity on JMH.”
Establishes that JMH made a prima facie case and identifies the trial court's error in burden allocation
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceA cardiac patient transferred to Jackson Memorial Hospital (JMH) and signed a guaranty for payment of services. His total hospital bill was $26,332.30…
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GODERICH, Judge.
The Public Health Trust of Dade County, Florida, d/b/a Jackson Memorial Hospital [JMH] appeals from an order granting Leland Holmes’ motion to involuntarily dismiss JMH’s action pursuant to Rule 1.420(b), Florida Rules of Civil Procedure. We reverse and remand for a new trial.
The defendant, Leland Holmes [patient], upon his physician’s suggestion, transferred from Jupiter Hospital to JMH in order to receive care from a cardiac specialist. When the patient arrived at JMH, he signed a guaranty for payment for services rendered. Thereafter, he was admitted to the Critical Care Unit [CCU]. The patient’s hospital bill totalled $26,332.30. Following an audit of JMH’s bill by the patient’s insurance carrier and Darryl Ephraim, a registered nurse at JMH, the insurance carrier paid its policy limits of $18,086.11.
JMH filed suit in order to recover the remaining balance of $8,246.19. The complaint contained several counts including a count for failure to pay the bill pursuant to the guaranty. The patient’s answer admitted that he signed the guaranty. The patient also asserted as an affirmative defense that any additional amount over what his insurance carrier paid was “not reasonable and not necessary.”
At the close of JMH’s case, the patient moved for a directed verdict arguing that JMH failed to prove the medical necessity of the services rendered. JMH reopened its case to present testimony as to medical necessity. The trial court ruled that Ephraim, the registered nurse who audited the account, was not qualified to testify as to the medical necessity of a patient’s treatment in CCU. JMH argued that it was not required to prove medical necessity where the patient signed a guaranty for payment for services rendered. The trial court directed a verdict in favor of the patient. This appeal follows.
In the instant action, JMH established that the patient signed a guaranty for payment for services rendered and that the services were rendered. Thereafter, the trial court incorrectly placed the burden of proving the defendant’s affirmative defense of medical necessity on JMH. The burden of proof is placed on the defendant asserting the affirmative defense. Hough v. Menses, 95 So. 2d 410 (Fla.1957); Heitman v. Davis, 127 Fla. 1, 172 So. 705 (Fla.1937); Smith v. Town of Bithlo, 344 So. 2d 1288 (Fla. 4th DCA 1977), cert. denied, 355 So. 2d 517 (Fla.1978); Fortenberry v. Mandell, 271 So. 2d 170 (Fla. 4th DCA 1972), cert. discharged, 290 So. 2d 3 (Fla.1974). Therefore, it was the patient’s burden to prove that the services rendered were not medically necessary. Accordingly, we reverse and remand for a new trial consistent with this opinion.
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Derius v. Allstate Indem. Co., 723 So. 2d 271 (Fla. 4th DCA 1998)…in PIP lawsuits to the issue of the termination of payments to a treating physician. Ewing did not involve an insurance policy that was required to comply with detailed statutory parameters. Similarly, Public Health Trust of Dade County v. Holmes, 646 So. 2d 266 (Fla. 3d DCA 1994), did not deal with a PIP scenario; rather, the plaintiff hospital sued a patient on a written guaranty of payment to recover for services rendered in a critical care unit. That case’s characterization of “medical necessity” as an…1 / 2
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Ellingham v. Fla. Dep't of Child. & Fam. Servs., 896 So. 2d 926 (Fla. 1st DCA 2005)…McDuffy v. Dep’t of Children & Families, 2003 WL 548862, *9 (Fla.Div.Admin.Hrgs. Feb. 7, 2003). The party seeking to assert the affirmative defense has the burden of proof as to that defense. See, e.g., Pub. Health Trust of Dade County v. Holmes, 646 So. 2d 266 (Fla. 3d DCA 1994). Therefore, DCF has the burden to show the funds are unavailable. See Deneale at *4 (noting that DCF had this burden). DCF has not met this burden because the record contains no competent substantial evidence of a lack of availabl…
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Cooper v. Gitte Jensen, 903 So. 2d 273 (Fla. 3d DCA 2005)…. We affirm. The burden to establish the defense of payment remained on Cooper and the trial court correctly so instructed the jury. See Knauer v. Levy, 115 So. 2d 776, 777 (Fla. 3d DCA 1959); see also Public Health Trust of Dade County v. Holmes, 646 So. 2d 266 (Fla. 3d DCA 1994). As to the claim for attorney’s fees, the record supports the trial court’s finding that the later-executed notes memorialized the parties’ agreement and the notes included a fees provision. Alternatively we accept Jensen’s clai…
Authorities Cited
- Hough v. Menses, 95 So. 2d 410 (Fla. 1957)
- Heitman v. Davis, 127 Fla. 1 (Fla. 1937)
- Fortenberry v. Mandell, 271 So. 2d 170 (Fla. 4th DCA 1972)
- Mandell v. Fortenberry, 290 So. 2d 3 (Fla. 1974)
- Smith v. The Town OF Bithlo, 344 So. 2d 1288 (Fla. 4th DCA 1977)