IN THE COURT OF APPEALS OF IOWA
No. 13-1034 Filed March 11, 2015
PORSCHIA BUTTS, CRISTINA TREVINO, STACEY RAMSEY, MARSHELLE WILIAMS, and the Class of Others Similarly Situated, Plaintiffs-Appellants,
vs.
IOWA HEALTH SYSTEM and CENTRAL IOWA HOSPITAL CORP., Defendants-Appellees. ________________________________________________________________
Appeal from the Iowa District Court for Polk County, Robert A. Hutchison,
Judge.
Plaintiffs appeal from the order denying class certification and granting
summary judgment in favor of defendants. AFFIRMED.
Jeffrey M. Lipman of Lipman Law Firm, P.C., Clive, Mark Harding of
Harding Law Office, Des Moines, and Don M. Downing and Kaitlin A. Bridges of
Gray, Ritter & Graham, P.C., St. Louis, Missouri, for appellants.
Stacie M. Codr and Steven Scharnberg of Finley, Alt, Smith, Scharnberg,
Craig, Hilmes & Gaffney, P.C., Des Moines, for appellees.
Heard by Doyle, P.J., and Bower and McDonald, JJ. 2
MCDONALD, J.
The four named plaintiffs filed this class action suit against Iowa Health
System and Central Iowa Hospital Corporation. The gravamen of the amended
class petition is the defendants allegedly implemented a “two-tier pricing scheme”
in which the defendants charged uninsured individuals unreasonable rates for
medical care when compared to insured individuals. The plaintiffs sought class
certification, which the district court denied. The defendants moved for summary
judgment on all claims, which the district court granted. The plaintiffs timely filed
this appeal.
I.
The following facts are supported by the class certification and summary
judgment records. Iowa Health System (hereinafter “IHS”)1 is a regional, non-
profit health care delivery system consisting of twelve hospitals in ten Iowa cities.
IHS is not an operating entity for direct delivery of health care services; health
care services are provided through IHS subsidiaries. The subsidiaries that
operate hospitals are known as “Senior Affiliates.” Central Iowa Hospital
Corporation is a Senior Affiliate that operates Iowa Methodist Medical Center
(hereinafter “IMMC”), Iowa Lutheran Hospital, and Methodist West Hospital, all in
the Des Moines metropolitan area.
IHS provides centralized billing services for its Senior Affiliates, but it does
not set the rates for the services provided. Each IHS hospital maintains a
hospital-specific computer file called a “Chargemaster.” The Chargemaster
1 IHS advises it now does business as UnityPoint Health. 3
includes rate information for the specific hospital’s procedures, services,
supplies, and medications. The record reflects that rate information is available
to patients upon request and that many people call for rate information. All
patients are billed based upon the hospital-specific Chargemaster rates.
At the time of admission to one of the hospitals at issue, all patients sign a
contract agreeing to pay “in accordance with the Hospital’s regular rates and
terms.” The contract also provides:
If I lack insurance coverage for these services, or if I am otherwise unable to pay for these services, I agree to immediately inform the Hospital so that I may be considered for financial assistance from the Hospital or for referral to other agencies to explore the availability of other medical and hospital benefits.
While all patients are charged based upon the hospital-specific Chargemaster
rates, not all patients pay the same amount for the same services. Government
programs, such as Medicare or Medicaid, set the amount they will pay for any
particular charge. Similarly, many health insurance carriers negotiate discounts
for the amount they will pay for any particular charge. In addition, patients who
apply and qualify for financial assistance may receive charity discounts up to
100% of the charge. From the years 2000 through 2010, the total charges to
self-pay, or uninsured patients, of IHS’s Des Moines area hospitals was $202
million dollars. Of this amount, uninsured patients actually paid only $17 million
of the $202 million charged for services due to charitable discounts and write-offs
of uncollectable debt.
The named plaintiffs are four uninsured patients who presented at IMMC
years apart with different medical conditions for which they received different
treatment. All four signed the standard contract at admission and were charged 4
based upon the Chargemaster rates in effect for services rendered at IMMC at
the time of treatment. Cristina Trevino came to the emergency room at IMMC on
December 20, 2006, because of injuries to her back, shoulder, and foot
sustained in a motor vehicle accident. She also received services on December
26. Her medical services included x-rays and intravenous therapy. She was
billed a total of $3808.08. Her bill was paid in full. Porschia Butts went to the
emergency room at IMMC on November 12, 2007, because of injuries to her
hand sustained in a motor vehicle accident. Her medical services included x-
rays. Her total charges were $1097.23. Her bill was paid in full. Marshelle
Williams was treated in the emergency room at IMMC for injures to her head,
neck, and back suffered in a fall on January 4, 2009. As a result of her injuries, a
head CAT scan was performed. She went to the emergency room at IMMC
again on October 16, 2009, complaining of chest pain after a motor vehicle
accident. The medical services she received during her second visit included an
EKG, lab work, and x-rays. Her total charges amounted to $4627.04. No
payments have been made on her account. Stacey Ramsey was hospitalized at
IMMC on September 4, 2009, for an appendectomy. She was billed a total of
$22,299.68 for services. Payments have been made and continue to be made
on her account. Based on the contract provision for requesting financial
assistance, Ramsey applied for assistance, but did not provide all the information
necessary to process her request.
The four named plaintiffs filed suit against the defendants. Plaintiffs
asserted four counts against the defendants: (1) breach of contract; (2) unjust 5
enrichment; (3) declaratory judgment and equitable relief; and (4) and violation of
Iowa’s Consumer Frauds Act, Iowa Code chapter 714H. The nature of the
plaintiffs’ contract claim requires some explication. The plaintiffs argue the
contract to pay the “Hospital’s regular rates and terms” is indefinite or ambiguous
because it contains an open price term. Because the contract has an open price
term, plaintiffs argue, they are required to pay only a reasonable rate for the
services provided. The plaintiffs further contend a single reasonable rate can be
judicially determined on a class basis. Plaintiffs sought to certify the following
putative class: “all Iowa residents from 2000 to the present who were: (1) billed
(or against whom collection efforts were made) for any form of Hospital Services
by, or on behalf of, any hospital or facility owned, operated or managed by
Defendants, and (2) uninsured at the time the Hospital Services were provided.”2
Plaintiffs defined Hospital Services as “all goods and services including all
charges for hospital rooms, equipment, drugs, devices, and all other goods and
services typically provided to patients in a hospital.” The defendants resisted the
motion for class certification and filed a motion for summary judgment as to all
counts.
The district court denied the plaintiffs’ motion for class certification, holding
the plaintiffs failed to prove the prerequisites for class certification. The district
court concluded the plaintiffs failed to prove the putative class is so numerous
2 At hearing on class certification, the plaintiffs’ attorneys limited the class in some respects, e.g., excluding judges and court personnel in the Iowa District Court for Polk County, the Iowa Court of Appeals, and the Iowa Supreme Court. The limitations do not appear material to the resolution of the class certification issue. In their main appeal brief, the plaintiffs define the class as defined in this opinion. 6
that joinder of all members is impracticable. See Iowa R. Civ. P. 1.261(1). The
district court explained the putative class was overbroad because numerous
patients falling within the putative class would not be appropriate class members,
including those who discharged their obligations through bankruptcy, those
whose charges already had been adjudicated reasonable, and those who
received financial assistance. The district court also concluded the plaintiffs
failed to prove questions of law or fact common to the class. See Iowa R. Civ. P.
1.261(2). Specifically, the court held plaintiffs’ claim for breach of contract
involved individualized determinations of intent and individualized determinations
of what constituted a “reasonable price” as “[e]very plaintiff would have a different
claim, involving different services, at different medical facilities, at different points
in time.” Plaintiffs simply failed to prove a common, and acceptable,
methodology to determine “reasonable price.” The district court also concluded
the plaintiffs failed to prove adjudication with respect to individual members of the
class would be dispositive of interests of other members. Finally, the district
court completed its class certification analysis by concluding that certifying a
class (1) presents a greater likelihood of inconsistency than adjudicating
individual cases, (2) poses unusual difficulties, and (3) is impractical and
inefficient.
The district court granted summary judgment for defendants on the
plaintiffs’ claims for breach of contract, unjust enrichment, and consumer fraud.
In resolving the plaintiffs’ contract claim, the court concluded the contract
contained a definite price term and was not ambiguous. The court granted 7
summary judgment with respect to the plaintiffs’ unjust enrichment claim on the
ground the claim would not lie where, as here, there was a contract between the
parties. Finally, with respect to the consumer fraud claim, the district court
concluded chapter 714H did not apply to the defendants and the claim otherwise
failed on the merits.
II.
We review a district court’s class certification ruling for an abuse of
discretion. See Kragnes v. City of Des Moines, 810 N.W.2d 492, 498 (Iowa
2012); see also Vos v. Farm Bur. Life Ins. Co., 667 N.W.2d 36, 44 (Iowa 2003);
Stone v. Pirelli Armstrong Tire Corp., 497 N.W.2d 843, 845 (Iowa 1993). The
district court abuses its discretion only where its grounds for deciding the class
certification issue are clearly unreasonable. See Varner v. Schwan’s Sales
Enters., Inc., 433 N.W.2d 304, 305 (Iowa 1988).
Iowa Rules of Civil Procedure 1.261 through 1.263 set forth the standards
governing the class certification process. These rules “closely resemble Federal
Rule of Civil Procedure 23,” and the court “may rely on federal authorities
construing similar provisions of Federal Rule of Civil Procedure 23.” Vos, 667
N.W.2d at 44. It is the plaintiffs’ obligation to define the class for which class
certification is sought. See Brownell v. State Farm Mut. Ins. Co., 757 F. Supp.
526, 544 (E.D. Pa. 1991) (stating the plaintiffs’ burden is “adequately and
accurately to define an appropriate class”); see also Vaszlavik v. Storage Tech.
Corp., 175 F.R.D. 672, 685 (D. Colo. 1997) (rejecting overbroad definition,
stating “it is not for me to revise the proposed class definition for plaintiffs”). It is 8
also the plaintiffs’ burden to prove certification of the putative class is both
permissible and proper. Stone v. Pirelli Armstrong Tire Corp., 497 N.W.2d 843,
846 (Iowa 1993).
Class certification is permissible only where: (1) “The class is so
numerous or so constituted that joinder of all members, whether or not otherwise
required or permitted, is impracticable”; and (2) “There is a question of law or fact
common to the class.” Iowa R. Civ. P. 1.261. Class certification is proper only if:
(1) the requirements of rule 1.261 have been satisfied, (2) a class action should
be permitted for the fair and efficient adjudication of the controversy, and (3) the
representative parties will fairly and adequately protect the interests of the class.
See Iowa R. Civ. P. 1.262(2). Rule 1.263(1) lists thirteen non-exclusive factors
for the court to consider “[i]n determining whether the class action should be
permitted for the fair and efficient adjudication of the controversy.” Iowa R. Civ.
P. 1.263(a)-(m). The court “need not assign weight to any of the factors listed”
and “need not make written findings as to each factor.” Luitenegger v. Conseco
Fin. Servicing Corp., 671 N.W.2d 425, 437 (Iowa 2003). “Rather, the district
court need only weigh and consider the factors and come to a reasoned
conclusion as to whether a class action should be permitted for a fair adjudication
of the controversy.” Id.
In its thorough and well-reasoned order regarding class certification, the
district court identified numerous legal and evidentiary deficiencies in the
plaintiffs’ request for class certification. In reviewing the record and the parties’
arguments on appeal, we conclude the district court conducted the proper 9
analysis under the rules of civil procedure and did not abuse its discretion in
denying the plaintiffs’ motion for class certification. We need not rehash each of
the district court’s findings and conclusions or the appellants’ arguments
regarding the same; a failure of proof on any one of the prerequisite elements in
rule 1.262(2) is fatal to the request for class certification. See Iowa R. Civ. P.
1.262(2); Stone, 497 N.W.2d at 846. We focus on the prerequisite element of
rule 1.261(2)—whether there is a question of law or fact common to the class—
and also on the secondary issue whether the putative class would be
manageable. See Iowa Rs. Civ. P. 1.261(2); 1.263(1)(f), (k).
The plaintiffs contend there are several questions common to the class:
(1) whether defendants charged the plaintiffs “unreasonable charges . . . in
breach of the contracts,” (2) whether defendants have been unjustly enriched at
the expense of class members, (3) whether defendants should be enjoined from
their improper pricing practices, and (4) whether the defendants’ pricing practices
violate Iowa Code chapter 714H. The plaintiffs’ framing of the common
questions does little to demonstrate the putative class should be certified. First,
the plaintiffs have framed the common questions at a level of abstraction so
general as to be of no value to the court, essentially arguing that the common
questions presented are whether the defendants are liable to the plaintiffs. If this
were sufficient to establish a common question of law or fact, then any putative
class would meet the requirement. Second, the plaintiffs focus on the wrong
issue.
What matters to class certification . . . is not the raising of common questions—even in droves—but, rather the capacity of a classwide 10
proceeding to generate common answers apt to drive the resolution of the litigation. Dissimilarities within the proposed class are what have the potential to impede the generation of common answers.
Wal-Mart Stores, Inc. v. Dukes, 131 S. Ct. 2541 (2011).
We conclude the dissimilarities within the putative class prevent framing
common questions of law or fact of sufficient specificity to generate answers apt
to drive the resolution of the litigation on a class basis. For example, the plaintiffs
contend that the contract each patient signs at admission is ambiguous because
it has an open price term. The plaintiffs contend the court will have to determine
a reasonable rate. The plaintiffs further contend a reasonable rate can be
determined on a class basis by averaging the price actually paid for services by
insured patients. While this has some superficial appeal, the argument ultimately
fails because there is no legal basis for concluding the average amount paid for
all services establishes a reasonable price for the particular service provided to
any proposed class member. See Pexa v. Auto Owners Ins. Co., 686 N.W.2d
150, 156-57 (Iowa 2004) (noting the amount paid “is but one form of probative
evidence” on the reasonable value of medical services—another being expert
testimony). More important, the plaintiffs’ formula does not appear probative of
any question material to the resolution of any claim. For example, with respect to
the named plaintiffs, the plaintiffs cannot answer a simple question: why is a
judicial determination that the rate charged for Ramsey’s appendectomy was or
was not reasonable at all probative of whether the rate charged for Williams’s
CAT scan was or was not reasonable? We see no logical connection between
the two. Any legally sound determination of the reasonableness of a particular 11
charge will necessarily depend on the individual facts and circumstances
regarding each plaintiff’s condition.
Further precluding class certification is the recognition that the
reasonableness of the rates charged the putative class members is not only
dependent upon the medical condition of the plaintiff, the types of services
provided, the hospital at which the services were provided, and the point in time
at which the services were provided, but also dependent upon a host of other
variables, including, but not limited to, the hospital’s attendant internal costs, the
availability of medical care providers for the type of service rendered, the rates of
substitute or similar services, and the rates of competitor’s services. The
defendants provided an affidavit from William Cleverley that discussed different
methods hospitals use to determine and set reasonable charges, including the
cost of the service to the hospital, the cost charged by competitors, the payor mix
(percentage of uninsured, insured, and government program patients), and the
profit needed to continue operating. Any legally sound determination of the
reasonableness of a particular charge at a particular time will thus also depend
on these individualized considerations.
Other courts have addressed the same class certification issue involving
the same or similar claims as those advanced here. In Colomar v. Mercy
Hospital, Inc., 242 F.R.D. 671 (S.D. Fla. 2007), the court explained that
determining the reasonableness of the charges, as desired by the plaintiffs,
necessarily required an individualized determination of the value of the services
provided. The Colomar court reasoned the reasonableness of charges 12
can only be determined by looking at the specific bills in question and analyzing them against factors like the market rate for the same services at other hospitals, Mercy’s internal costs for those particular services, and the prices Mercy charged for those services to patients with health insurance or other benefits. None of the evidence underlying these factors will be the same for any two class members, unless they received the same services during a similar time frame. Therefore, at the level of specificity required to actually resolve the class claims, any commonality breaks down into an individualized inquiry.
Colomar, 242 F.R.D. at 677. The court then gave an example of attempting to
apply a reasonableness analysis to multiple class members:
When all is said and done, even if Plaintiff’s evidence proves that the respiratory care charges are unreasonable, a class member claiming that Mercy’s cardiac services are unreasonable would be no further along in proving his case based on the proof used to satisfy Plaintiff’s burden of establishing her claim. Further complicating matters, even a class plaintiff challenging Mercy’s respiratory services will not benefit from Plaintiff’s proof, if the respiratory services were rendered much earlier or much later in the class period, because the costs and other comparative data will change over time.
Id. at 680; accord Maldonado v. Oshner Clinic Found., 493 F.3d 521, 524-26 (5th
Cir. 2007) (affirming the district court’s denial of class certification, concluding in
part the plaintiffs failed to satisfy the requirement that common questions
predominate over questions affecting individual members); but see Quinn v. BJC
Health Sys., NO. 22052-0821A, 2007 WL 7308622, at *27-28 (Mo. Cir. Ct. March
2, 2007) (finding common questions predominated over individual questions).
We hold the plaintiffs have failed to prove there is a question of law or fact
common to the class, that class certification is thus not permissible, and the
district court did not abuse its discretion in denying the plaintiffs’ motion.
According to the plaintiffs’ theory of the case, the determination of the
“reasonableness” of the charges lies at the heart of the four “common questions” 13
identified by the plaintiffs. Although the individual claims “need not be carbon
copies of each other,” there must be “generalized evidence which proves or
disproves an element on a simultaneous, class-wide basis.” Vos, 667 N.W.2d at
45 (citations omitted). The district court correctly determined that ascertaining
the reasonableness of charges would have to be done on a case-by-case basis,
“considering the patient, financial resources, financial assistance available to the
patient, amount paid, internal costs of the services, the hospital rendering the
services, the comparative data between that hospital and other regional facilities,
and potentially many more unique individualized factors.” No generalized
evidence exists that would prove or disprove the reasonableness of the charges
for the putative class members. The putative class members treated for different
conditions, at different hospitals, at different times, and received different medical
services for their respective individualized medical conditions. Class certification
is thus not permissible.
We also conclude that even if class certification were permissible, it would
not be proper. The management of the proposed class suit would pose unusual
difficulties and would be impractical and inefficient, thereby rendering the class
vehicle inappropriate. Under the plaintiffs’ theory of the case, there is no logical
or fair way to determine the reasonableness of the rate charged without holding
an individualized hearing on the same. “Properly conducted, such an endeavor
would be herculean in scope.” Colomar, 242 F.R.D. at 682. The district court
would have to account for numerous individualized facts, including the nature of
the plaintiff’s medical condition, the treatment provided, the place at which the 14
treatment was provided, the date of the treatment, whether the plaintiff applied
for financial assistance, whether the charge was paid, whether the debt, if any,
was discharged in bankruptcy, and whether there had been a judicial
determination the charge was reasonable. The district court would be required to
receive testimony, perhaps expert testimony, regarding the reasonableness of
the particular charges for the particular services provided at the particular
location at the particular time. In addition, this does not account for the
counterclaims the defendants would be able to assert for unpaid claims. Any
proposed class is simply not manageable, and the district court did not abuse its
discretion in denying class certification.
III.
We review a district court’s grant of summary judgment for corrections of
errors at law. See Boelman v. Grinnell Mut. Reins. Co., 826 N.W.2d 494, 500
(Iowa 2013). Summary judgment should be granted only “if the pleadings,
depositions, answers to interrogatories, and admissions on file, together with the
affidavits, if any, show that there is no genuine issue as to any material fact and
that the moving party is entitled to a judgment as a matter of law.” Iowa R. Civ.
P. 1.981(3).
A.
Plaintiffs contend the district court erred in granting summary judgment on
their breach of contract claim. Under the contracts at issue, the plaintiffs agreed
to pay for medical care according to the “Hospital’s regular rates and terms.”
Plaintiffs argue the contract contains an open price term requiring the court to 15
supply a reasonable price. The plaintiffs contend this is a disputed issue of fact
precluding summary judgment. In support of their position, the plaintiffs contend
Iowa should follow the ruling in Doe v. HCA Health Services of Tennessee, Inc.,
46 S.W.3d 191, 197 (Tenn. 2001) (holding contract term “charges” in sentence “I
am financially responsible to the hospital for charges not covered by this
authorization” was indefinite). The plaintiffs also rely on Quinn, 2007 WL
7308622, at *18-19.
We conclude neither Doe nor Quinn are persuasive. Most courts have
rejected the analysis or otherwise distinguished Doe. See e.g., DiCarlo v. St.
Mary Hosp., 530 F.3d 255 (3rd Cir. 2008) (declining to extend); Banner Health v.
Med. Sav. Ins. Co., 163 P.3d 1096 (Ariz. App. Div. 1 2007) (distinguishing); Allen
v. Clarian Health Partners, Inc., 980 N.E.2d 306 (Ind. 2012) (refusing to follow);
Holland v. Trinity Health Care Corp., 791 N.W.2d 724 (Mich. App. 2010)
(distinguishing); Atherton v. Tenet Healthcare Corp., No. 2005-UP-362, 2005 WL
7084013 (S.C. App. May 25, 2005) (same); Nygaard v. Sioux Valley Hosps. &
Health Sys., 731 N.W.2d 184 (S.D. 2007) (same). Quinn is a trial court order that
is difficult to reconcile with a published Missouri appellate decision, Freeman
Health System v. Wass, 124 S.W.3d 504 (Mo. App. S.D. 2004). Further, the
Quinn case was never resolved on appeal because the parties settled the claim.
Like other courts, we also find Doe is readily distinguishable from this
case. The rationale underlying Doe was that the contract at issue did not contain
any reference to any other document or extrinsic fact. See Doe, 46 S.W.3d at
197 (acknowledging that while the charge master “could be used as a reference” 16
the particular contract at issue did not actually “contain a reference to some
document, transaction or other extrinsic facts from which its meaning may be
made clear”). In contrast, the contract at issue in this case makes explicit
reference to “the Hospital’s regular rates and terms.” The overwhelming weight
of authority holds this explicit reference to the hospital or facility’s rates and terms
sets a definite price term. See, e.g., DiCarlo, 530 F.3d at 264 (finding “the price
term was not in fact open, and that ‘all charges’ unambiguously can only refer to
St. Mary’s uniform charges set forth in its Chargemaster”); Harrison v. Christus
St. Patrick Hosp., 430 F. Supp. 2d. 591, 595 (W.D. La. 2006) (concluding
“regular rates and terms” did not create open-ended contract); Cox v. Athens
Reg. Med. Ctr., Inc., 631 S.E.2d 792. 796-97 (Ga. App. 2006) (finding “in
accordance with the rates and terms of the hospital” is unambiguous); Allen, 980
N.E.2d 306, 309-10 (Ind. 2012) (examining “guarantees payment of the account”
and concluding “an offer [that] appears to be indefinite may be given precision by
usage of trade or by course of dealing between the parties); Holland, 791 N.W.2d
at 730 (finding “usual and customary charges” unambiguously referred to the
Chargemaster charges); Shelton v. Duke Univ. Health Sys., Inc., 633 S.E.2d 113,
115-16 (N.C. App. 2006) (finding “regular rates and terms” was “sufficiently
definite” and implied the regular Chargemaster rates); Nygaard, 731 N.W.2d at
192 (recognizing “if the contract price is fixed and determinable from sources
outside the written agreement, the price term is not open in the sense that it
allows for some imputed, commercially reasonable price term”); Woodruff v. Ft. 17
Sanders Sevier Med. Ctr., 2008 WL 14851 at *3 (Tenn. Ct. App. 2008)
(concluding “facility rates and terms” was not indefinite).
The contract language at issue here, “regular rates and terms,” is identical
to that in Harrison and Shelton, and closely resembles the language in Cox,
Holland, and Woodruff. As a general rule, where there is an agreement to pay
for medical services in accord with the hospital’s regular rates and terms, the
contract is not indefinite. Because the contract language is not indefinite and the
price is contracted for, the court need not supply a “reasonable” rate. See
Heninger & Heninger, P.C., v. Davenport Bank & Trust Co., 341 N.W.2d 43, 48
(Iowa 1983) (“In the absence of specification, a person who performs services
pursuant to request is entitled to the reasonable value of the services.”); Fashion
Fabrics of Iowa, Inc. v. Retail Investors Corp., 266 N.W.2d 22, 27 (Iowa 1978)
(“Contractual obligations may arise from implication as well as from the express
writing of the parties. A contract includes not only what is expressly stated but
also what is necessarily to be implied from the language used; and terms which
may clearly be implied from a consideration of the entire contract are as much a
part thereof as though plainly written on its face.”). Accordingly, the district court
did not err in concluding that defendants were entitled to judgment as a matter of
law on the plaintiffs’ contract claim.
B.
On appeal, the plaintiffs do not advance any argument or cite any
authority regarding unjust enrichment. The issue is deemed waived. See Iowa
Rs. App. P. 6.903(2)(c) (requiring a statement of issues presented for review); 18
6.903(2)(g)(3) (requiring argument and citation to authority on an issue). In
addition, the plaintiffs’ claim for unjust enrichment fails because there is an
express contract between the parties. See Johnson v. Dodgen, 451 N.W.2d 168,
175 (Iowa 1982).
C.
On appeal, plaintiffs do not present any argument or cite any authority
regarding their third “claim” for equitable relief. The claim is deemed waived.
See Iowa Rs. App. P. 6.903(2)(c); 6.903(2)(g)(3).
D.
Plaintiffs’ consumer fraud claims fails because the Consumer Frauds Act
is inapplicable, by its own terms, to the defendants and the services provided.
See Iowa Code § 714H.4(1)(a) (excluding any merchandise offered or provided
by a facility licensed under chapters 135B (hospitals), 135C (health care
facilities), and 148 (physicians)). Although IHS is not a licensed facility under
chapter 135B or chapter 135C, it does not offer or sell consumer merchandise,
and is thus not subject to chapter 714.H. See Iowa Code § 714H.3 (covering
activities “in connection with advertisement, sale, or lease of consumer
merchandise”). The district court thus did not err in granting the defendants’
motion for summary judgment.
IV.
This case is just one of many similar cases across the country asserting
the same claim. As indicated above, the cases largely have been resolved the
same way. 19
This case, and other similar cases being brought throughout the country, arise out of the anomalies which exist in the American system of providing health care. A court could not possibly determine what a “reasonable charge” for hospital services would be without wading into the entire structure of providing hospital care and the means of dealing with hospital solvency. These are subjects with which state and federal executives, legislatures, and regulatory agencies are wrestling and which are governed by numerous legislative acts and regulatory bodies. For a court to presume to address these problems would be rushing in where angels fear to tread. What Plaintiff is asking the Court to do here is, put simply, to solve the problems of the American health care system, problems that the political branches of both the federal and state governments and the efforts of the private sector have, thus far, been unable to resolve. Like other similar suits filed in other federal courts, this action seeks judicial intervention in a political morass.
DiCarlo, 530 F.3d at 264. For the foregoing reasons, we affirm the judgment of
the district court.
AFFIRMED.