Stafford Health Services, Inc. v. The Estate Of Lawrence X. Sullivan

Court of Appeals of Washington·Decided November 26, 2018·No. 77166-3·Unpublished

Opinion

t

COURT OF APPEALS OIYl

-STATE OF WASHINGTON

2018 NOV 26 AM 10: 1i

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

In the Matter of the Estate of ) No. 77166-3-1 LAWRENCE X. SULLIVAN, )

) DIVISION ONE

Deceased. )

)

STAFFORD HEALTH SERVICES, INC.,) a Washington corporation, d/b/a ) STAFFORD HEALTHCARE AT ) BELMONT, )

)

Respondent/Third Party Defendant,)

)

v. ) UNPUBLISHED OPINION )

THE ESTATE OF LAWRENCE X. ) SULLIVAN and THE LAWRENCE AND ) ARLENE SULLIVAN LIVING TRUST ) and DEANNA MERKATZ AND "JOHN ) DOE" MERKATZ, individually and the ) marital community comprised thereof, )

)

Appellants/Third Party Plaintiffs. ) FILED: November 26, 2018

SCHINDLER, J. — Stafford Health Services Inc.(SHS)filed a creditor's claim for nursing services and care against the Estate of Lawrence X. Sullivan. After the personal representative rejected the claim, SHS filed a Trust and Estate Dispute Resolution Act(TEDRA), chapter 11.96A RCW, petition against the Estate and the Lawrence and Arlene Sullivan Living Trust (collectively, the Estate) and the personal representative of the Estate, Deanna Merkatz, individually. The Estate and Merkatz filed counterclaims against SHS alleging violation of the Consumer Protection Act (CPA), chapter 19.86 RCW,and damages under the abuse of vulnerable adults act (AVA), chapter 74.34 RCW. The court dismissed the counterclaim for violation of the CPA and noneconomic damages under the AVA on a CR 12(b)(6) motion. On summary judgment, the court dismissed the claim for economic damages under the AVA. The court ruled the Estate must pay SHS under the terms of the "Admission and Financial Agreement" and unjust enrichment. The court awarded attorney fees and costs under the terms of the Agreement and TEDRA. We affirm but remand to enter findings of fact and conclusions of law on the reasonableness of the award of attorney fees and costs.

FACTS

In 2013, 94-year-old Lawrence Sullivan lived at an assisted living facility, Crista Shores. Sullivan was admitted to the Harrison Medical Center emergency department on October 23 with "[s]epsis secondary to urinary tract infection," pneumonia, hypertension, and dementia. After nine days in the hospital, Sullivan improved and his "mental status" returned to "baseline." However, Sullivan was "weak and debilitated and unable to return to his prior assisted living arrangements." Harrison Medical Center discharged Sullivan to a skilled nursing facility, Stafford Health Services Inc.(SHS).

SHS admitted Sullivan for treatment and therapy on November 1. Sullivan's niece Deanna Merkatz signed the "Admission and Financial Agreement" as the "POA [(Power of Attorney)] or Responsible Party" and consented to nursing services. The Agreement states the "Resident has the right to consent or refuse medical care provided by the staff, consultants or physicians" and the "undersigned Resident(or the

undersigned responsible party on behalf of Resident)" consents to the "nursing services provided by" SHS. The Agreement states the "Resident or decision maker will be informed of the treatment options, risk and benefits of treatment and of no treatment."

Merkatz promised as the Responsible Party to pay for services provided by SHS and charges not covered by Medicare from "the Resident's income or resources legally available for payment of such obligations." The Admission and Financial Agreement states, in pertinent part:

THIRD PARTY PAYERS - Where third party payers such as Medicare, Medicaid, or insurance pay some or all of the charges, the undersigned hereby agrees to pay the Resident's portion of the covered charges, all charges for any period the Resident is determined to be ineligible for the program involved, all charges which are chargeable to the Resident under any such program, and any balance not paid by third party payers.

Stafford Healthcare cannot and does not guarantee that benefits will be paid by any third party or guarantee the Resident's eligibility for any programs.

RESPONSIBLE PARTY AGREEMENT: The party who manages the Resident's financial affairs and has legal access to the Resident's income or resources available to pay for Facility services is required to sign this agreement in addition to the Resident and in signing this agreement represents that he/she actually manages the Resident's financial affairs and/or has access to the Resident[']s income or resources available to pay for Facility services.

Without incurring personal liability for the Resident's financial obligations to Stafford Healthcare, the undersigned responsible party promises to pay for the items and services provided to the Resident by Stafford Healthcare, from the Resident's income or resources legally available for payment of such obligations. In the event that the undersigned fails to make timely payments from such sources in accordance with terms and conditions of the agreement, the undersigned shall be personally responsible for the amount past due, interest charges on the past due balance and penalties, including reasonable attorney's fees and costs.

On November 25, SHS nurse Prescilla Piete discussed Sullivan's "new baseline ADLsoi" with Merkatz and Crista Shores employee Diana Allen. Piete explained that when Medicare coverage ends, Sullivan would be responsible for those costs.

[Merkatz] stated that she was happy with [Sullivan] remaining in this facility with the possibility of. .. moving to a facility closer to her in Kirkland. [Allen] agreed that [Sullivan] needs more care than Crista Shores can offer. [Allen] &[Merkatz] will communicate with one another;

disclosed to both that I was speaking to each of them & to keep the lines of communication open to best meet the needs of[Sullivan]. [Sullivan] still on Medicare with secondary Tricare for Life; explained to [Merkatz] that [Sullivan] will be private pay when Medicare coverage ends.

SHS determined Medicare would no longer pay benefits for physical and occupational therapy effective December 15. Nothing in the records indicated whether Sullivan could not make the decision to either assume responsibility to pay for the therapy after December 15 or decline to do so. On December 9, SHS employee Laney Beach provided an "Advance Beneficiary Notice" and "Notice of Medicare Non- Coverage" to Sullivan and explained the options to him. The Advance Beneficiary Notice states, in pertinent part:

NOTE: You need to make a choice about receiving these health care items or services.

It is not Medicare's opinion, but our opinion, that Medicare will not pay for the item(s) or service(s) described below. Medicare does not pay for all of your health care costs. Medicare only pays for covered items and services when Medicare rules are met. The fact that Medicare may not pay for a particular item or service does not mean that you should not receive it. There may be a good reason to receive it. Right now, in your case, Medicare probably will not pay for —

Items or Services: [physical therapy] & [occupational therapy] skilled Because: Reached max potential will continue with restorative.

1 Activities of daily living.

The purpose of this form is to help you make an informed choice about whether or not you want to receive these items or services, knowing that you might have to pay for them yourself.

The Advance Beneficiary Notice sets forth two options: "Option 1. YES. I want to receive these items or services" and "Option 2. NO. I will not receive these items or services." Sullivan checked the box next to Option 2 and signed the Advance Beneficiary Notice. Sullivan also signed the Notice of Medicare Non-Coverage that states, "Services Will End: 12/14/2013."

On January 20, 2014, SHS contacted Merkatz about the outstanding amount due. Merkatz disputed the charges for $17,520. On January 28, Merkatz faxed SHS a copy of a "Durable Power of Attorney and Nomination of Guardian" signed by Sullivan and the "Acceptance of Appointment" as Sullivan's attorney-in-fact signed by Merkatz.

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Stafford Health Services, Inc. v. The Estate Of Lawrence X. Sullivan, (Wash. Ct. App. 2018).

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