Midwest Neurosurgeons, LLC v. April M. Cain

Missouri Court of Appeals·Decided July 2, 2024·No. ED111932·Published

Opinion

In the Missouri Court of Appeals Eastern District

DIVISION ONE

MIDWEST NEUROSURGEONS, LLC, ) No. ED111932 ET AL., )

)

Plaintiffs/Appellants, ) Appeal from the Circuit Court ) of Cape Girardeau County v. ) Cause No. 22CG-AC00544-01 )

APRIL M. CAIN, )

) Honorable Julia M. Koester )

Defendant/Respondent. ) Filed: July 2, 2024

Introduction

Midwest Neurosurgeons, LLC, Midwest Surgery Center, and Southeast Missouri Anesthesia Services, LLC (collectively, “Appellants”) appeal the trial court’s judgment in favor of April Cain following a bench trial in this action for breach of contract, suit on account, and unjust enrichment. Appellants raise three points. First, Appellants argue the trial court erred in excluding the notarized affidavit and attached business records that were filed with the petition, because they were filed with the petition and admissible under RSMo § 490.692. 1 Second, Appellants argue the trial court erred in excluding Exhibits 1, 2, 3, and 4 on hearsay grounds.

1 Unless otherwise indicated, all statutory references are to RSMo (2000) as amended.

Third, Appellants argue the trial court erred in excluding Exhibits 3 and 4 pursuant to the best evidence rule. We affirm the judgment of the trial court.

Factual and Procedural Background Facts

April Cain received medical care from Appellants in June 2014. Prior to receiving medical care, Cain was required to sign a document entitled “Financial Agreement, Assignment of Benefits, and Release of Records.” The financial agreement obligated Cain to pay for the services she received. Also, Cain purportedly signed a form instructing her insurance to pay Appellants directly. Following Cain’s treatment, Appellants billed Cain’s insurance for the services rendered. After insurance, Cain still owed Appellants $35,514.73. Appellants alleged Cain did not pay the outstanding balance.

Procedural History

In September 2021, Midwest Neurosurgeons filed an action for breach of contract, suit on account, and unjust enrichment against Cain to collect the outstanding debt. The case proceeded to a bench trial.

Immediately before trial, Appellants informed the trial court that they had asked Cain to stipulate to the admission of Appellant’s Exhibit 1, which purported to be a business records affidavit and attached business records. Cain refused to stipulate to the admission of Exhibit 1.

At trial, Appellants presented one witness, E.S. E.S. worked on patient accounts for Midwest Medical, which is not one of Appellants here, though Midwest Medical “includes” Appellant Midwest Neurosurgeons. E.S. had worked for Midwest Medical for approximately one year, where she worked on patient collections. E.S. was not directly involved with patient intake, but was aware of the procedures used in the intake process.

During E.S.’s testimony about the intake procedures and paperwork involved, Appellants’

counsel handed E.S. Exhibit 1, a one-page business records affidavit. On the affidavit, the printed name of the party was scratched out and the name “April Cain” was handwritten above the scratched-out name. E.S. testified that D.S., whose name also appeared on the affidavit, was the custodian of records for Midwest Neurosurgeons, and E.S. knew who D.S. was. With that, Appellants offered Exhibit 1 into evidence. Cain objected on hearsay grounds. The trial court sustained the objection and excluded Exhibit 1 from evidence.

Appellants’ counsel then handed E.S. Exhibit 2, entitled “Financial Agreement, Assignment of Benefits, and Release of Records.” E.S. testified that Exhibit 2 was the form typically used for intake. When Appellants’ counsel attempted to ask E.S. if patients filled out this form, Cain objected that E.S. would not have knowledge of Midwest’s 2014 intake practices. Cain also objected on best evidence grounds because Cain disputed the contents of the writing. The trial court did not immediately rule on Cain’s objection and allowed Appellants to attempt to lay additional foundation. Appellants elicited that the form Cain purportedly signed is similar to the one Midwest Neurosurgeons used during E.S.’s employment. Appellants again offered Exhibit 2 into evidence, and Cain maintained her hearsay and best evidence objections. The trial court sustained the hearsay objection and excluded Exhibit 2 from evidence.

Appellants’ counsel then handed E.S. Exhibit 3, an insurance responsibility form. After discussing patient intake procedures and insurance broadly, E.S. observed that Cain purportedly signed the document. E.S. testified that, as a part of the patient intake process, a patient and an employee of Midwest Neurosurgeons would discuss insurance information and billing. Further, E.S. testified that an employee of Midwest Medical would witness the signing of the document.

Appellants offered Exhibit 3 into evidence. Cain objected on hearsay and best evidence grounds. The trial court sustained the objections and excluded Exhibit 3 from evidence.

E.S. then testified that Midwest kept all of its intake records electronically, but did not elaborate. Appellants’ counsel handed E.S. Exhibit 4, which E.S. identified as Cain’s personal medical history. E.S. testified that Exhibit 4 was similar to the forms currently used by Midwest Neurosurgeons, the form would be presented to the patient as part of the intake packet, and a patient would sign the form before receiving care. E.S. answered a few questions about Cain’s delinquent account and the services she received. Appellants then offered Exhibit 4 into evidence. Cain objected on hearsay and best evidence grounds. The trial court sustained the objections and excluded Exhibit 4 from evidence.

After E.S.’s testimony, Appellants presented no further evidence and rested their case. The trial court rendered judgment in favor of Cain for “insufficient evidence to support the allegations contained in all three counts of Plaintiffs’ petition.” Additionally, the court found that Counts 1 and 2, the breach of contract and suit on account claims, were barred by the five-year statute of limitations. Appellants now appeal.

Discussion

Appellants raise three points on appeal. First, Appellants argue the trial court erred in excluding the notarized affidavit, Exhibit 1, and attached business records that were filed with the petition, because the affidavit and business records were filed with the petition and admissible under RSMo § 490.692. Second, Appellants argue the trial court erred in excluding Exhibits 1, 2, 3, and 4 on hearsay grounds. Third, Appellants argue the trial court erred in excluding Exhibits 3 and 4 on best evidence grounds.

Preservation

Cain argues Appellants failed to preserve all three points on appeal because Appellants failed to make an offer of proof following Cain’s objections to, and the trial court’s exclusion of, Exhibits 1, 2, 3, and 4.

“To preserve a claim of improperly excluded evidence, the proponent must attempt to present the excluded evidence at trial and, if it remains excluded, make a sufficient offer of proof.” State v. Karim, 685 S.W.3d 658, 662 (Mo. App. W.D. 2024) (quoting State v. Hunt, 451 S.W.3d 251, 263 (Mo. banc 2014)). “The purpose of an offer of proof is to preserve the evidence so the appellate court understands the scope and effect of the questions and proposed answers.” Id. “Offers of proof must show what the evidence will be, the purpose and object of the evidence, and each fact essential to establishing admissibility.” Id.

Appellants offered Exhibits 1, 2, 3, and 4 into evidence. Each time, the trial court sustained Cain’s objections to the admission of the evidence and did not admit the evidence. Following the exclusion of each exhibit, Appellants failed to make an offer of proof. Thus, as Appellants’ counsel conceded during oral argument, Appellants did not preserve their three points on appeal, and we may review only for plain error. See Denney v. Syberg’s Westport, Inc., 665 S.W.3d 348, 355 (Mo. App. E.D. 2023).

Standard of Review

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Midwest Neurosurgeons, LLC v. April M. Cain, (Mo. Ct. App. 2024).

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