Emergency Physicians Get A Victory
We got good news yesterday in Emergency Physicians Integrated Care v. Salt Lake County, in the form of a decision in our favor from the Utah Supreme Court. You can read the decision here in the website library. You can read the article reporting on the case in today's Salt Lake Tribune here.
EPIC is a group of ER doctors. Under the federal Emergency Medical Treatment and Active Labor Act (EMTALA), the ER docs must treat to the point of stabilization anyone who shows up at the emergency department regardless of their capacity, or lack, to pay the bill. Salt Lake County, which has over a million people, sends all prisoners of its jails out to receive emergency medical treatment to local hospitals when the need arises. Unless the prisoner has private insurance or the capacity to pay for the services themselves (neither of which is usually the case), the ER docs then bill the County for their services.
Problems arose in about 2001 when the County began telling the ER docs that it would not pay their billed charges but would only reimburse them at the state Medicaid fee schedule rates. Those average between 27% and 36% of the billed charges. The ER docs were not happy. But what could they do? Under EMTALA, they had to treat these inmates. They came to our office for help.
We pursued a claim against the County based on quantum meruit, or unjust enrichment. We argued that not only did the individual prisoner receive a benefit which triggered an obligation to pay, but the County received a significant benefit from EPIC's services. By outsourcing emergency medical care to EPIC, it discharged a Constitutional duty to provide medically necessary treatment to inmates and was able to avoid the cost of providing emergency medical care personnel and supporting services at the jail on a full time basis. Since there was no contract between the County and EPIC, we argued that the County was responsible to pay the reasonable value of the services rather than the substantially lower Medicaid rates.
The trial court rejected these arguments and we appealed. The Supreme Court reversed the trial court and ruled in our favor. The case now goes back to the trial court to determine what is the reasonable value of the EPIC docs services.
One interesting question left: there is case law to suggest the measure of what is the "reasonable value" of EPIC's services is the value of the benefit conferred on the county as opposed to the cost to EPIC of providing the services. What if, as is likely, the cost of duplicating the full range of emergency medical services at the jail, the degree to which the County has been unjustly enriched, is more than the EPIC's billed charges? Could the County be required to pay that larger amount?