Bynum v. Magno

101 P.3d 1149, 106 Haw. 81
CourtHawaii Supreme Court
DecidedDecember 2, 2004
Docket25834
StatusPublished
Cited by61 cases

This text of 101 P.3d 1149 (Bynum v. Magno) is published on Counsel Stack Legal Research, covering Hawaii Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bynum v. Magno, 101 P.3d 1149, 106 Haw. 81 (haw 2004).

Opinions

Opinion of the Court by

ACOBA, J.

We have jurisdiction pursuant to Hawai'i Revised Statutes (HRS) § 602-5(2) (1993) and Hawai'i Rules of Appellate Procedure (HRAP) Rule 13(a) (2000)1 to answer the following certified questions by the United States District Court for the District of Ha-wai'i (the district court)2 to this court:

Where a plaintiffs healthcare expenses are paid by Medicare and/or Medical, does the discounted amount paid to a healthcare provider by [Medicare3] and Medi-Cal constitute the amount that should be awarded as medical special damages to a plaintiff in a negligence action? In this circumstance, is evidence of amounts billed in excess of the amount[]paid irrelevant and inadmissible?

For the reasons set forth herein, the answer to both questions is “no.”

[83]*83i.

The questions posed arise out of a medical malpractice action in which Plaintiffs-Appel-lees Joseph Bynum (Joseph) and his wife Lila Bynum (Lila) (collectively the Bynums), sued to recover damages for injuries Joseph allegedly suffered in connection with coronary artery bypass grafting surgery.

While vacationing on the Big Island of Hawai'i in July of 1998, Joseph experienced chest pains. Initially, Joseph went to North Hawai'i Community Hospital for treatment, and was later transferred to the Queen’s Medical Center (Queen’s) in Honolulu, for further treatment. Dr. Joana Magno (Mag-no), a cardiologist at Queen’s, assumed responsibility for coordinating Joseph’s care as his attending physician. Magno consulted with Dr. Michael Dang (Dang), a cardiovascular surgeon, and Dr. John Callan (Callan), a pulmonologist, and recommended that Joseph undergo bypass surgery on an urgent basis. Magno did not advise the Bynums that Joseph could try alternate treatments, such as medical therapy or angioplasty, but presented surgery as his only option. At the time Magno recommended bypass surgery, she knew Joseph had experienced respiratory failure two years earlier, and recognized that his history of lung disease was a “red flag” to bypass surgery.

During the bypass surgery performed by Dang, Joseph suffered respiratory distress, which required him to be placed on mechanical ventilation for the remainder of his life. After spending three months in Queen’s, Joseph was transferred to six different intensive care facilities in California.

From the time of the surgery, Joseph was eligible for Medicare, which initially paid for his medical bills. However, to allow Joseph to become eligible for Medi-Cal, California’s Medicaid program, and to protect their life savings from the costs of Joseph’s ongoing hospitalization, the Bynums legally divorced on February 11,1999.4

Joseph lived in intensive care facilities for over 1,314 days after the surgery, and was dependent upon the ventilator for the rest of his life, passing away on February 21, 2002.

II.

The Bynums filed a lawsuit against Magno, Dang, Callan, and Queen’s (hereinafter, collectively, Defendants), on December 30,1999, prior to Joseph’s death.5 During discovery, the Bynums produced medical bills, which reflected the “standard” or “customary” charges (hereinafter “standard rates”) for the services provided by the medical facilities in which Joseph had resided. Prior to trial, the parties entered into a stipulation regarding those bills,6 in which they agreed, inter alia, that the medical bills “reflect[ed] medical treatment for [Joseph] that was necessary for medical conditions that existed during the time of treatment^]” and were for amounts “similar to charges made by similar or comparable health care providers for like services in the same geographical area.”

On February 6, 2001, Magno and Callan filed a motion in limine to limit Joseph’s recovery of his medical expenses to only those fees actually paid to his healthcare providers as full and final payment for the services. In this regard, Defendants sought to preclude the Bynums from introducing, as evidence of special damages, the standard rates for Bynum’s medical care that might have been billed to other patients for comparable treatment. Additionally, Defendants asserted that “a patient cannot be held liable for any medical expenses that exceed the amount approved by Medicare or actually paid by Medicare and Medi-Cal payments to a healthcare provider.”

The district court denied the motion, and did not limit the evidence of special damages to the amount charged by Medicare/Medic[84]*84aid. Accordingly, when the jury trial commenced on March 13, 2001, the medical bills introduced reflected amounts similar to charges made by comparable health care providers for like services in the same geographical area.

The jury returned it’s verdict on April 4, 2001, and on May 2, 2001, the district court entered judgment against Magno in the amount of $2,063,750.00 for Joseph ($1,462,-500.00 in special damages and $601,250 in general damages), and $107,250 for Lila (in general damages). Additionally, the district court dismissed with prejudice all claims against Callan, Dang, and Queen’s, pursuant to a stipulation for partial dismissal.

Magno appealed the judgment to the United States Ninth Circuit Court of Appeals (the Ninth Circuit), asserting, inter alia, that “the district court erred by submitting the amount of the medical expenses billed by [Joseph’s] healthcare providers to the jury as the reasonable value of their services, instead of the lesser amount negotiated by [Medi-eare/Medicaid].” The Ninth Circuit reversed the district court’s judgment and remanded the ease for a new trial.7 Declining to resolve the issue of special damages, the Ninth Circuit posited that

the novel question under Hawai'i law whether the discounted amount paid to a healthcare provider by Medieaid[8] and Medi-Cal reflects the amount that should be awarded to a plaintiff in a negligence action might well be a suitable candidate for certification.

Accordingly, the district court, upon remand, submitted its certified questions to this court.

III.

Joseph’s healthcare providers, as required of provider participants in the Medicare9 and/or Medicaid10 (hereinafter Medicare/Medieaid) programs, agreed in advance to accept the Medicare/Medicaid approved payments as full and final payment for their services. Such payments are set at rates lower than the standard rates that providers might charge other patients who did not participate in these programs.- These payments then, by definition and as posed by the Ninth Circuit, are “discounted” from the standard rates otherwise charged for comparable medical treatment. Joseph’s healthcare providers, as participants in these programs, were statutorily prohibited from “balance billing” Joseph or any other source for amounts above the Medicare/Medicaid approved charges.

IV.

In response to the certified questions presented, the parties raise several arguments.

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Cite This Page — Counsel Stack

Bluebook (online)
101 P.3d 1149, 106 Haw. 81, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bynum-v-magno-haw-2004.