Knecht v. Medical Service Ass'n

143 A.2d 820, 186 Pa. Super. 456, 1958 Pa. Super. LEXIS 508
CourtSuperior Court of Pennsylvania
DecidedJune 11, 1958
DocketAppeal, No. 90
StatusPublished
Cited by8 cases

This text of 143 A.2d 820 (Knecht v. Medical Service Ass'n) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Knecht v. Medical Service Ass'n, 143 A.2d 820, 186 Pa. Super. 456, 1958 Pa. Super. LEXIS 508 (Pa. Ct. App. 1958).

Opinion

Opinion by

Rhodes, P. J.,

This is an appeal by plaintiff from judgment on the pleadings entered for defendant by the Court of Common Pleas of Lehigh County in an action of assumpsit brought by plaintiff to recover for dental services under a medical-surgical agreement between plaintiff and defendant, known as a “Blue Shield” contract.

[459]*459On February 21 and 22, 1957, plaintiff received dental services from Dr. Edward Weiner, a dentist, at the Allentown Dental Hospital, and a bill for $35 was rendered. The bill was presented to defendant, Medical Service Association of Pennsylvania, Inc. Defendant refused to pay the bill under the contract for the reason that the services were not rendered in an “accredited hospital.”

Plaintiff filed his complaint in assumpsit to recover the sum of $35. The complaint was supplanted by an amended complaint to which defendant filed an answer with new matter. Plaintiff filed a reply to the new matter and moved for judgment on the pleadings. After argument thereon the court below filed its opinion, written by President Judge Henninger, and entered judgment for defendant.

On a motion for judgment on the pleadings under Pa.R.C.P. No. 1034 (b), a court may enter any judgment or order which is appropriate on the pleadings, and it may, as here, enter judgment against the party making the motion. See Boron v. Smith, 380 Pa. 98, 102, 110 A. 2d 169; Rose Township v. Hollobaugh, 179 Pa. Superior Ct. 284, 299, 116 A. 2d 323. While a summary judgment should be entered only where the case is clear and the pleadings are not amendable, the present case is one in which the facts are clear; the issue involves merely the interpretation and application of the law to those facts. See Lehner v. Montgomery, 180 Pa. Superior Ct. 493, 500, 501, 119 A. 2d 626.

The medical-surgical agreement between plaintiff and defendant provided in part: “The Subscriber, when admitted as an In-Patient in an Accredited Hospital or an Accredited Dental Hospital, shall be entitled to oral surgical Services . . . provided by a doctor of dental surgery who is a member of the staff [460]*460of an Accredited Hospital; . . The dental services rendered to plaintiff were of a nature which would have been covered by the contract if they had been furnished in an accredited hospital by a doctor of dental surgery who was a member of the staff of an accredited hospital. An “accredited dental hospital” is defined in the contract as “a dental hospital approved by the Joint Committee on Accreditation of Hospital's and such other dental hospitals as may be approved by Blue Shield. Blue Shield’s determination that a dental hospital is accredited shall be conclusive.” The Allentown Dental Hospital, where the services were performed for plaintiff, is licensed by the Department of Welfare of the Commonwealth of Pennsylvania, Bureau of Homes and Hospitals, as a private hospital under the Act of June 12, 1931, P. L. 510, §§1, 4, as amended, 35 PS §§424, 427, but it has not been accredited by the Joint Committee on Accreditation of Hospitals or by Blue Shield.

Plaintiff admits that the contract between plaintiff and defendant does not, according to its terms, require payment for the services rendered to plaintiff in the Allentown Dental Hospital since it is not an “accredited hospital” as that term has been defined in the contract. Plaintiff questions, however, the authority of defendant to define the term “accredited hospital” in the contract, and contends that such a restricted definition of the term is illegal and not in accord with the Nonprofit Medical and Dental Service Corporation Act of May 12, 1949, P.L. 1261, as it re-enacted and amended the Act of June 27, 1939, P. L. 1125, 15 PS §2851-1501 et seq.1 Since defendant [461]*461association was created under authority of the Act of June 27, 1939, P.L. 1121, as amended by the Act of May 12, 1949, P.L. 1274, 15 PS §2851-219, for the purposes therein expressed (and in the Act of May 12, 1949, P.L. 1261, 15 PS §2851-1501), it may not exceed the authority granted or alter the provisions of the statute.

Section 3 of the Nonprofit Medical and Dental Service Corporation Act, 15 PS §2851-1503,2 provides: “For the purposes of this act only and not for the purposes of defining medical practice or dental practice as such, the terms stated below have the meanings assigned to them, respectively. . . . ‘Dental services’ means the general and usual services rendered by [462]*462doctors of dental surgery serving in the capacity of a staff member of an accredited hospital, provided such services are rendered in an accredited hospital.”3 The Act, however, does not define the term “accredited hospital.”

Plaintiff’s contention is that under the Nonprofit Medical and Dental Service Corporation Act the term “accredited hospital” means a hospital which is licensed by the Commonwealth, and that the defendant could not require a greater degree of accreditation in the contract than the licensing. The issue therefore is whether the Legislature intended the term “accredited hospital” to be synonymous with “licensed hospital” or whether it intended something additional or different. We think it is clear, as hereinafter pointed out, that the Legislature did not intend that the term “accredited hospital” should be synonymous with the term “licensed hospital.” The Act providing for the licensure and regulation of private hospitals by the Department of Welfare, Act of June 12, 1931, P.L. 510, as amended by the Act of April 12, 1956, P.L. (1955) 1460, §2, 35 PS §424, provides: “After the effective date of this act, it shall be unlawful for any person ... to operate for profit, within this Commonwealth, a private nursing home, private convalescent home or private hospital, for persons requiring care, treatment, or nursing by reason of sickness, injury, infirmity, pregnancy, or other disability, without a license as hereinafter required, but this act shall not be construed to apply to any State or State-aided institution or any institution licensed by the Department of Welfare under other statutes.” If in the [463]*463Nonprofit Medical and Dental Service Corporation Act the Legislature intended “accredited” to be synonymous with “licensed,” it would have excluded State hospitals and State-aided institutions which the Act providing for the licensure and regulation of private hospitals (35 PS §424 et seq.) specifically excluded from the requirement of licensure thereunder.4 Plaintiff’s contention that the Acts are in pari materia, and that “accredited” is thus synonymous with “licensed” is without merit. The Acts do not relate to the same subject matter; one relates to medical and dental service, and the other relates to the licensing of private nursing homes, private convalescent homes, and private hospitals.

The term "license," when used with reference to governmental regulation, has been defined: "`Authority to do some act or carry on some trade or business, in its nature lawful but prohibited by statute, except with the permission of the civil authority, but which would otherwise be unlawful.'" Com. v. Mutual Union Brewing Company, 252 Pa. 168, 171, 97 A. 206, 207. The operation of a private hospital, while inherently a lawful pursuit, is prohibited by statute in the absence of permission granted by the Commonwealth in the form of a license.

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Cite This Page — Counsel Stack

Bluebook (online)
143 A.2d 820, 186 Pa. Super. 456, 1958 Pa. Super. LEXIS 508, Counsel Stack Legal Research, https://law.counselstack.com/opinion/knecht-v-medical-service-assn-pasuperct-1958.