FILED JANUARY 6, 2026 In the Office of the Clerk of Court WA State Court of Appeals, Division III
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON DIVISION THREE
STEPHEN BRADFORD, on behalf of ) No. 40348-3-III himself and all others similarly situated, ) ) Appellant, ) ) v. ) UNPUBLISHED OPINION ) KADLEC REGIONAL MEDICAL ) CENTER, a Washington Corporation; and ) Does 1 through 25 inclusive, ) ) Respondents. )
FEARING, J. — Stephen Bradford complains that Kadlec Regional Medical Center
(Kadlec) failed to notify him in advance of an emergency room “visitation fee” billed
him. This fee represents payment for overhead and operational expenses to maintain a
twenty-four-hour-a-day emergency room. The fee is separate from services and
treatment provided in the emergency room. Bradford asserts that Kadlec’s failure
constitutes a breach of duty to disclose information important to a transaction and a
violation of the Consumer Protection Act, chapter 19.86 RCW. In addition to denying
such a duty, Kadlec asserts that regulations preclude it from disclosing fees. Perhaps No. 40348-3-III Bradford v. Kadlec
inconsistently, Kadlec also argues it posted the visitation fees in a document called a
chargemaster.
While we disagree with Kadlec Regional Medical Center’s contention that the
federal rules bar it from notifying emergency room patients of potential charges, we agree
that regulations impose limits on publicizing fees. The federal Jekyll and Hyde rules
seek to promote transparency in fees, while shielding emergency room patients from the
worry about the cost of emergency care. We affirm summary judgment dismissal of
Stephen Bradford’s suit based on the regulations. We particularly adopt the reasoning of
a parallel California decision.
FACTS
We take the facts from declarations filed by the parties in support of and in
opposition to summary judgment motions. Stephen Bradford twice visited Richland’s
Kadlec Regional Medical Center’s emergency room.
Shortly after midnight on April 22, 2017, Stephen Bradford arrived in the
emergency department of Kadlec Regional Medical Center, complaining of severe
abdominal pain. Bradford underwent a computed tomography (CT) scan and other tests,
before being released.
2 No. 40348-3-III Bradford v. Kadlec
On entering the emergency room on April 22, Bradford signed a “General Consent
to Treatment and Conditions of Admissions” (Consent and Conditions). The agreement
declared in part:
HOSPITAL CARE AND TREATMENT: I am presenting myself for emergency services or admission to the hospital and I voluntarily consent to the rendering of such care, including diagnostic tests and medical treatment. I understand that any examination and treatment that I receive on an emergency basis is not intended as a substitution or replacement for complete medical care. .... CARE PROVIDED: The practice of medicine is not an exact science and guarantees or promises cannot be made as to the result(s) of care, treatment, testing, surgical intervention or other examinations in the hospital.
Clerk’s Papers (CP) at 512 (boldface omitted) (emphasis added).
The Consent and Conditions contract rendered Bradford financially responsible
for provided emergency “examination and treatment.” CP at 512. The document
repetitively declared:
I further understand that the patient is financially responsible for any charges not paid by a third party insurer/payer or other sources.
CP at 514. Stephen Bradford was uninsured. Paragraph 9 of the Consent and Conditions
agreement contained an attorney fees clause, which read:
I acknowledge failure to meet my financial obligations to Kadlec Regional Medical Center may result in the referral of account(s) to professional collection agencies and consent to Kadlec Regional Medical Center or its designees obtaining a copy of my credit report or any other
3 No. 40348-3-III Bradford v. Kadlec
publicly available data related to my ability to pay. I understand that Kadlec Regional Medical Center, its affiliates, agents or designees may contact me using pre-recorded/artificial voice message and/or automatic dialing services at the telephone number I provided Kadlec Regional Medical Center. In the event of any dispute regarding payment, I agree to pay all collection costs, including but not limited to interest, and attorneys’ fees whether or not a case is filed in court.
CP at 514. Stephen Bradford never read the Consent and Conditions contract before
treatment.
Kadlec Regional Medical Center did not mention any emergency room visitation
fee during Stephen Bradford’s visit nor did the Consent and Conditions signed by
Bradford disclose any potential of being charged such a fee. The document lacks price
terms for any hospital goods and services. Kadlec does not mention on its website the
existence of the visitation fee to the emergency room. Kadlec posts no fees at the
medical center. Kadlec posted a sign in the emergency room that informed patients of the
availability of a “chargemaster” that listed fees charged for various services. Stephen
Bradford did not read the sign.
On April 28, 2017, Kadlec sent Stephen Bradford a statement requesting payment
of $5,491.57. This bill reflected total charges of $7,845.10, less a discount of 30 percent,
or $2,353.53, because Bradford lacked health insurance. The charges reflected Kadlec’s
schedule of standard charges for each procedure and service, commonly known as its
“chargemaster.” CP at 122. The bill listed an itemized charge of $1,425.00 for “HC ED
4 No. 40348-3-III Bradford v. Kadlec
LEVEL 4.” CP at 102. “ED” stands for “emergency department.” The parties refer to
this charge as a “visitation fee.” According to Bradford, he encountered shock when he
noticed the bill’s line item.
In a declaration in support of Kadlec’s summary judgment motion, Spencer Harris,
its Chief Financial Officer, averred that the visitation fee defrays the substantial
costs of staffing, equipping, and operating its emergency department around the clock.
Other hospitals call the same charge a visit fee, an evaluation and management fee, an
emergency room fee, or an ED Level fee. A hospital bases the visitation fee for a
particular visit on the nature and acuity of the patient’s ailment.
When billing a patient for treatment, Kadlec Regional Medical Center, like other
hospitals, assigns a current procedural terminology (CPT) code for services provided.
Emergency room fees are identified by the CPT codes 99281-99285. Spencer Harris
testified that the Centers for Medicare & Medicaid Services, the Children’s Health
Insurance Programs, and the federally facilitated Marketplace employ these codes.
Harris believes that every emergency department in the State of Washington uses the
codes and charges these fees.
In a declaration, Brad Fisher, attorney for Kadlec Regional Medical Center,
appended a page from the Fair Health Consumer website, that identifies the fee of
$1,756.00 for an emergency room visit for an ailment of high severity in Richland,
5 No. 40348-3-III Bradford v. Kadlec
Washington, the location of Kadlec. The CPT code for the service is 99284. We assume
that $1,756.00 is Kadlec’s chargemaster amount for visitation fee charged Stephen
Bradford. Bradford’s bill, however, lists the charge at $1,425.00.
On November 15, 2017, Stephen Bradford, at the advice of his physician, again
visited the Kadlec Regional Medical Center emergency room. The physician worried
that Bradford might be experiencing a heart attack. Bradford returned for additional
testing on November 21. As a result of these subsequent visits, Bradford incurred
approximately $4,300.00 in additional charges, which Kadlec allowed him to pay under a
payment plan covering all his outstanding debt. The charges also included a $1,425.00
emergency room visitation fee.
Stephen Bradford emphasizes the following facts. Kadlec directs all patients
visiting the emergency room to sign the Consent and Conditions agreement. Kadlec
charges the visitation fee to all patients visiting its emergency room. Kadlec gives none
of its emergency room visitors warning that Kadlec will charge a visitation fee in addition
to discrete charges for treatment rendered.
Stephen Bradford underscores that Kadlec Regional Medical Center instructs its
employees not to discuss charges for emergency room services. Kadlec’s employee
Andrew Moreno testified, in a deposition, that the federal Emergency Medical Treatment
and Active Labor Act prohibits emergency room personnel from discussing with patients
6 No. 40348-3-III Bradford v. Kadlec
the cost of emergency room care. Moreno quoted Kadlec’s scripted response to patient
cost inquiries:
“Your health is the most important thing to us right now. You will be provided with medical screening examination and stabilizing treatment for an emergency medical condition regardless of your ability to pay. However, after your examination and emergency treatment, you will be given the opportunity to provide insurance information or make arrangements for the payment of services today.”
CP at 169. Kadlec directs its employees, if a patient asks further, to declare:
“We understand that you would like to know in advance how much you would be charged for the services we provide to you today; however, we are restricted by law from discussing financial arrangements with you prior to your medical screening condition.”
CP at 169 (emphasis omitted).
PROCEDURE
Stephen Bradford filed this class action suit against Kadlec Regional Medical
Center for concealment and billing of a visitation fee to which emergency room patients
never agreed. He contends the Consent and Conditions agreement contained no definite
price for services such that the contract should not be enforced. He seeks recovery under
the Consumer Protection Act. He also seeks a declaratory judgment that Kadlec’s
visitation fee is unlawful and contrary to the Consent and Conditions contract.
Kadlec removed Stephen Bradford’s suit to federal court based on the “Class
Action Fairness Act.” The federal court remanded the case to state court under an
7 No. 40348-3-III Bradford v. Kadlec
exception to the act. Kadlec filed a counterclaim for more than $5,000.00, seeking
recovery of Stephen Bradford’s bill.
The parties brought cross motions for summary judgment. The trial court granted
Kadlec’s summary judgment motion and dismissed Stephen Bradford’s complaint with
prejudice. The court never certified a class. The superior court entered judgment in
favor of Kadlec for the balance owed by Bradford of $6,364.65. The court also awarded
Kadlec $120,778.18 in fees and costs.
LAW AND ARGUMENT
Disclosure of Emergency Room Visitation Fee
On appeal, Stephen Bradford challenges Kadlec Regional Medical Center’s
assessment of the visitation fee on two grounds. First, Bradford characterizes Kadlec as
possessing superior knowledge of the fees it charges to its patients. He argues that, with
this exclusive knowledge, Kadlec held a duty in advance to inform him of the visitation
fee it would charge him for visiting its emergency room. Second, the Consent and
Conditions, an adhesion contract, did not impose any duty on a patient to pay a visitation
fee. Bradford adds that Kadlec’s violation of these duties breached Washington’s
Consumer Protection Act. Bradford seeks reversal of the summary judgment order in
favor of Kadlec and asks for the grant on summary judgment in his favor. He also
challenges the reasonable attorney fees and costs awarded to Kadlec.
8 No. 40348-3-III Bradford v. Kadlec
We suspect that Stephen Bradford violates the Affordable Care Act’s individual
mandate by failing to maintain health insurance. 26 U.S.C. § 5000A. Since 2017, the
law no longer imposes a penalty, however. 26 U.S.C. § 5000A, amended by Pub. L. No.
115-97, 131 Stat. 2060 (2017). We do not consider in our decision any violation of the
mandate by Bradford.
Stephen Bradford’s quest for prominent advance disclosures of billing practices
does not tailor fit a hospital’s emergency room services. In other settings, such as the
banking industry, this court has promoted transparency in charging fees. Feyen v.
Spokane Teachers Credit Union, 23 Wn. App. 2d 264, 276, 515 P.3d 996 (2022), review
granted and dismissed, 1 Wn.3d 1024 (2023). But federal law promotes contrary public
policies concerning prices of emergency room visits. Some of the statutes and
regulations seek to shield the patient from knowledge of charges so as not to discourage
the patient from emergency treatment. At the same time, to promote transparency, some
statutes and regulations require disclosure of emergency room pricing for the patient. But
the patient must know of the availability of the information and engage in an extensive
search to gain this information. Even then, the argotic acronyms used when the hospital
posts the information prevent an ordinary patient from learning the price.
9 No. 40348-3-III Bradford v. Kadlec
We conflate Stephen Bradford’s two causes of action and address them
concurrently. We first quote relevant federal regulations that control a hospital’s billing
practices. We then discuss equivalent foreign decisions.
We locate the relevant federal regulations and guidelines from our own research,
the parties’ briefs, and the comprehensive decision in Capito v. San Jose Healthcare
System, LP, 17 Cal. 5th 273, 561 P.3d 380, 328 Cal. Rptr. 3d 373 (2024). The Centers
for Medicare and Medicaid Services (CMS), a division of the United States Department
of Health and Human Services, administers the nation’s Medicare and Medicaid
programs. In this role, CMS issues rules that cover hospitals accepting Medicare and
Medicaid patients. Kadlec accepts Medicare and Medicaid patients.
Because emergency medical care provides a vital public service necessary for the
protection of the health and safety of all, its provision and pricing have long been subject
to extensive state and federal regulation. Under federal law, qualifying hospitals must
provide emergency care to any person who comes to the emergency department,
including a screening and stabilizing treatment or transfer to a hospital that can provide
that treatment. 42 U.S.C. § 1395dd(a)-(b). A federal regulation also prohibits emergency
room registration procedures that “may . . . unduly discourage individuals from
remaining for further evaluation.” 42 C.F.R. § 489.24(d)(4)(iv).
10 No. 40348-3-III Bradford v. Kadlec
Federal law’s extensive scheme obligates hospitals to disclose the prices of
medical services, including fees for evaluation and management services, or visitation
fees, for emergency room patients. Medicare participating hospitals must publish online
or at the hospital a “chargemaster” listing the uniform charges for its services, regardless
of payer type. 42 U.S.C. § 300gg-18(e); 45 C.F.R. § 180.50. Every listed service must
be labeled with a description, charge, and Current Procedural Terminology (CPT) code.
45 C.F.R. § 180.60(b)(8). CPT codes are standardized five-digit numeric codes
established by the American Medical Association. Health care providers use the codes to
quickly describe to insurers the services for which the provider is billing. People ex rel.
State Farm Mutual Automobile Ins. Co. v. Rubin, 72 Cal. App. 5th 753, 764, 287 Cal.
Rptr. 3d 744 (2021).
Evaluation and management services provided in the emergency department
are assigned five different CPT codes. Medicare Program: Changes to the Hospital
Outpatient Prospective Payment System, 72 Fed. Reg. 66,580, 66,790 (Nov. 27, 2007).
Each code reflects the activities of physicians and does not fully describe the range and
mix of services provided by hospitals during visits of emergency department patients.
72 Fed. Reg. at 66,790. These services must be medically necessary and can include
reviewing test results, reviewing medical history, ordering medications, tests, or
procedures, referring to and communicating with other health care professionals,
11 No. 40348-3-III Bradford v. Kadlec
documenting clinical information in electronic or other health records, and rendering
medical decisions. U.S. CENTERS FOR MEDICARE & MEDICAID SERVICES, EVALUATION
AND MANAGEMENT SERVICES GUIDE 15 (Sept. 2024). Each code relates the intensity of
hospital resources to the different levels of effort represented by the codes, ranging from
straightforward to high level. 72 Fed. Reg. at 66,805.
A hospital’s visitation fee reflects the hospital resources expended in operating a
fully staffed and equipped emergency room department that continuously operates.
Medicare Program; Hospital Outpatient Prospective Payment System, 71 Fed. Reg.
67,960, 68,132 (Nov. 24, 2006). The fee can cover the cost of nursing staff, maintenance
of diagnostic and therapeutic technology, building costs, and administrative overhead
costs. Under federal law, an emergency room must include space for screening
examinations, specialized equipment, full coordination with on-call physicians, lighting,
bathrooms, janitorial services, and security. The CMS recognizes the increased cost of
operating a twenty-four-hour department. The unending operation provides a crucial
safety net in the nation’s health care system. 71 Fed. Reg. at 68,132. CMS recognizes
the difference between a visitation fee and the individual hospital charges incurred as part
of the screening examination and stabilizing services provided to patients, such as x-rays,
medications, surgical procedures, and lab work, by labeling these individual charges as
“separately payable services, ” as opposed to a “visit fee” that covers the bundling of
12 No. 40348-3-III Bradford v. Kadlec
overall “hospital resources” required to operate a fully staffed and equipped emergency
room around the clock. 71 Fed. Reg. at 68,142.
Federal rules embody the importance of, and need for, greater hospital pricing
transparency, with the benefits of promoting competition and reducing medical costs.
Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes, 84
Fed. Reg. 65,524, 65,525-28 (Nov. 27, 2019). Nevertheless, federal laws also seek to
ensure prompt emergency medical care for those in need. Hospitals must stabilize
patients before discussing costs or ability to pay and the only cost notice required in the
emergency room is a sign informing patients of the availability of the hospital’s
chargemaster. 84 Fed. Reg. at 65,536. This isolated and terse notice requirement desires
to discourage patients from weighing costs against the necessity or value of emergency
care. 42 U.S.C. § 1395dd(h); 42 C.F.R. § 489.24(a). Although the Centers for Medicare
and Medicaid Services issued advisory bulletins with the opposite message, one advisory
bulletin to hospitals discusses responding to emergency care cost inquiries from patients:
With regard to a hospital’s handling of patient inquiries regarding the patient’s obligation to pay for emergency services, we recommended in the proposed bulletin that such questions be answered by qualified personnel. . . . . . . This section does not suggest that a patient is not entitled to full disclosure, only that the hospital should always convey to the patient that screening and stabilization are its priorities regardless of the individual’s insurance coverage or ability to pay and that the hospital should discuss, to
13 No. 40348-3-III Bradford v. Kadlec
the extent possible, the medical risks of leaving without a medical screening exam and/or stabilizing treatment.
OIG/HCFA Special Advisory Bulletin on the Patient Anti-Dumping Statute, 64 Fed. Reg.
61,353, 61,355 (Nov. 10, 1999).
The parties’ briefs outline few facts as to the ailment for which Stephen Bradford
entered Kadlec Regional Medical Center. Nor are we given any facts as to the treatment
received by Bradford at the medical center. We assume because of the code that labels
Bradford’s visit to the hospital that he suffered a serious ailment.
At least three other courts have traveled this road before us. We discuss three
foreign decisions. In Krobath v. South Nassau Communities Hospital, 178 A.D.3d 807,
115 N.Y.S.3d 389 (2019), Eric Krobath commenced a class action challenging the billing
practices of South Nassau Communities Hospital on behalf of self-pay patients who
receive emergency treatment. Krobath asserted causes of action for negligent
concealment and violations of New York’s Consumer Protection Act. He complained
that the hospital negligently failed to disclose material facts to him concerning the
hospital’s billing practices.
The New York Supreme Court, Appellate Division, reversed summary dismissal
of the claim under the Consumer Protection Act. The appellate court, however, affirmed
14 No. 40348-3-III Bradford v. Kadlec
dismissal of the cause of action for concealment. The hospital lacked a special
relationship with its patients regarding billing practices.
Stephen Bradford emphasizes that the New York court, in Krobath v. South
Nassau Communities Hospital, reversed a dismissal of Eric Krobath’s Consumer
Protection Act claim. We do not deem this ruling persuasive since the court never
extensively analyzed the claim in the context of federal rules covering hospital care and
billings.
In DiCarlo v. St. Mary Hospital, 530 F.3d 255 (3d Cir. 2008), Justin DiCarlo filed
a class action against St. Mary Hospital, an acute care hospital, alleging breach of
contract, breach of the duty of good faith and fair dealing, unjust enrichment, breach of
fiduciary duty, and violation of the New Jersey Consumer Fraud Act. The federal district
court granted the hospital judgment on the pleadings. The Circuit Court of Appeals
affirmed.
Justin DiCarlo complained that St. Mary Hospital granted a variety of discounted
charges to various payers, including Medicare, Medicaid, and insurance or managed care
plans that had negotiated discounts. He entered the hospital after experiencing an
increased heart rate. DiCarlo lacked medical insurance and did not qualify for any
government or charity program. He signed a consent form that guaranteed payment of all
charges and collection costs for services rendered. DiCarlo received an EKG and
15 No. 40348-3-III Bradford v. Kadlec
underwent blood tests. St. Mary Hospital charged DiCarlo $3,483.00, excluding
separately billed physicians’ fees. The charges greatly exceeded charges paid by
privately insured patients, Medicare or Medicaid patients, or patients eligible for the New
Jersey Charity Care Program.
Justin DiCarlo principally contended that St. Mary Hospital’s practice of charging
uninsured patients significantly higher rates than insured patients and patients covered
under Medicare and Medicaid discriminates against the uninsured. Stephen Bradford
does not assert this argument. Still, the federal appellate court ruled that a hospital lacks
a fiduciary duty to patients in the context of billing practices. The court commented it
could not discern what constituted a “reasonable charge” for hospital services without
wading into the entire structure of hospital care and ensuring hospital solvency. The
court remained sympathetic to the burdens on uninsured patients who need medical care
and recognized the severe economic hardships that the lack of insurance imposed on
them.
The decision most helpful in resolving Stephen Bradford’s appeal is the California
Supreme Court’s one-year-old thorough opinion in Capito v. San Jose Healthcare
System, LP, 17 Cal. 5th 273, 561 P.3d 380, 328 Cal. Rptr. 3d 373 (2024). Taylor Capito
contended that her hospital possessed a duty, beyond the federal regulatory scheme, to
notify emergency room patients in advance of evaluation and management services
16 No. 40348-3-III Bradford v. Kadlec
(EMS) fees by posted signage in the emergency room, on its website, and/or during the
patient registration process. The hospital had charged Capito for two visits to the
hospital’s emergency room. Capito signed an agreement to pay her account at the rates
stated in the hospital’s price list found in the chargemaster. Before discounts, the hospital
billed Capito $41,016.00 for the visits. Each bill included a “‘Level 4’ Evaluation and
Management Services Fee” of $3,780.00. The hospital indicated that the EMS fee
covered emergency room overhead expenses of operating an emergency room not billed
individually. After applying adjustments and discounts, the hospital reduced her bills to
$8,855.38. According to Capito, had she been warned about the EMS fee, she would
have left the hospital and sought less expensive treatment elsewhere.
Taylor Capito alleged the hospital’s failure to provide advance notice on its
website, by signage in the emergency room, or by conversation with the patient violated
California’s unfair competition law. Both the trial court and the Court of Appeal rejected
Capito’s claims. The California Supreme Court affirmed.
In Capito v. San Jose Healthcare System, the California Supreme Court reviewed
both its state and the federal government’s extensive rules controlling operations of
hospitals. The court reasoned that requiring disclosure of fees as proposed by Taylor
Capito would alter the careful balance of competing interests, including price
17 No. 40348-3-III Bradford v. Kadlec
transparency and provision of emergency care without regard to cost, reflected in the
multifaceted scheme developed by state and federal authorities.
The California Supreme Court noted that federal law demanded hospitals to render
publicly available a chargemaster, a uniform schedule of charges represented by the
hospital as its gross billed charge for a given service or item, regardless of payer type.
42 U.S.C. § 300gg-18(e); 45 C.F.R. § 180.50. In her complaint, Taylor Capito agreed
that the hospital listed an EMS fee as a line item in the hospital’s published chargemaster,
but she alleged that the hospital gave no notification or warning that it charged a separate
EMS fee for an emergency room visit. The chargemaster misled the ordinary patient. As
a result, she and other emergency room patients encountered surprise by a substantial
charge added to their bill that they were not expecting and did not agree to pay. The
hospital did not mention the charge in its agreement with the patient.
All three levels of the California courts concluded that a hospital possesses no
duty to disclose EMS fees to emergency room patients beyond that required by the
relevant statutory and regulatory framework. Instead, courts should defer to the
legislative and regulatory determinations of what constitutes requisite notice of the costs
of emergency medical services. Taylor Capito could not sustain a claim under
California’s Consumer Protection Act because the form of pricing notice demanded by
Capito exceeded and displaced the legislative and regulatory requirements. The state and
18 No. 40348-3-III Bradford v. Kadlec
federal legislatures had struck a balance between price transparency and dissuading
patients from avoiding potentially life-saving care due to cost.
Taylor Capito claimed that her hospital’s nondisclosure of the EMS fee to
emergency room patients contravened the public policy in favor of price transparency.
The California Supreme Court recognized the concern for transparency in healthcare.
But price transparency is not the end all. State and federal laws also seek to ensure
that emergency medical care is promptly provided to those in need. The California court
worried that the disclosures demanded by Capito would discourage patients from seeking
emergency care or place patients in the position of evaluating for themselves whether
emergency services, at a particular cost, are warranted in a given circumstance.
Capito’s emphasis on patient choice presumed that emergency room patients can
accurately diagnose whether their ailment is minor and whether they can safely transport
themselves or be transported to a lower acuity facility. The regulatory scheme
discouraged patients from weighing cost against the necessity or value of emergency
care. 42 U.S.C. § 1395dd(h); 42 C.F.R. § 489.24(a).
Despite promoting the need for transparency, the California Supreme Court
downplayed the ability of a hospital to be translucent. The court doubted that a posting
of five possible EMS fees—running from $672.00 to $5,635.00 depending on the severity
of the patient’s condition—would provide reliable notice of actual costs. The numerous
19 No. 40348-3-III Bradford v. Kadlec
discounts available to patients to the chargemaster prices compounded the fickleness of
the accuracy of the chargemaster list. Virtually no patient paid the full amount of the
EMS fee.
Taylor Capito also raised an argument asserted by Stephen Bradford. Because the
hospital possessed exclusive knowledge of the emergency room fee, the hospital
possessed a duty to disclose. Capito cited to cases decided under the California statute
that prohibited unfair and deceptive business practices. CAL. CIV. CODE § 1760. Capito
complained that the tens of thousands of individual billable items listed in the
chargemaster hid the EMS fee and provided no effective notice that such a fee would be
charged. The court rejected these arguments for the same reasons earlier discussed.
Congress and the state legislature had already commandeered the subject matter of notice
requirements for emergency room charges.
Stephen Bradford correctly notes that the federal appeals court, in Henley v. Biloxi
H.M.A., LLC, 48 F.4th 350 (5th Cir. 2022), ruled that, under Mississippi law, the hospital
held an obligation to disclose a facility surcharge billed to emergency care patients in
advance of receiving emergency treatment or services that would trigger such charge.
We deem Capito v. San Jose Healthcare System better reasoned.
Stephen Bradford impliedly concedes that Kadlec Medical Center’s chargemaster
included charges for levels of emergency room care. He complains, nonetheless, that
20 No. 40348-3-III Bradford v. Kadlec
Kadlec hid the nature of its emergency room visitation fee in its billing description:
“HC ED LEVEL 4,” a description meaningless to a patient. Of course, Kadlec sent this
billing description to Bradford after the rendering of the services such that it did not
impact whether Bradford received treatment from Kadlec. Stephen Bradford advances a
better argument that nothing in the Consent and Conditions agreement signed by him
remotely mentioned a visitation fee for the overhead and operation costs of an emergency
room. Also, if he had, in advance of his treatment, reviewed the chargemaster, he could
not have discerned his potential charge. Still, the law as stated defeats these arguments.
When arguing that Kadlec Regional Medical Center possessed a duty to disclose
in advance its emergency room fees, Stephen Bradford relies on Colonial Imports, Inc. v.
Carlton Northwest, Inc., 121 Wn.2d 726, 853 P.2d 913 (1993) and Restatement (Second)
of Torts § 551(2)(e) (A.L.I. 1977). Both recognize a duty of a party to a business
transaction, who possesses superior knowledge, to disclose information to the other party.
We consider the federal hospital regulations to usurp this legal principle.
Stephen Bradford contends that the Consent and Conditions agreement language
imposed no obligation on the patient to pay a visitation fee. We disagree. In so arguing,
Bradford highlights language that read:
I am presenting myself for emergency services or admission to the hospital and I voluntarily consent to the rendering of such care, including diagnostic tests and medical treatment. I understand that any examination
21 No. 40348-3-III Bradford v. Kadlec
and treatment that I receive on an emergency basis is not intended as a substitution or replacement for complete medical care.
CP at 512. Bradford suggests that he need only pay for “examination,” “tests and
treatment” and a visitation fee does not constitute an examination, test, or treatment. But,
under the language, Bradford consented to care in the emergency room. Such care
included, but was not limited to, diagnostic tests and medical treatment. A later provision
in the agreement rendered Bradford responsible for any charges not paid by another
source.
Pitell v. King County Public Hospital District No. 2, 4 Wn. App. 2d 764, 423 P.3d
900 (2018), meets Stephen Bradford’s contentions about an indefinite contract and no
obligation to pay a visitation fee under the agreement. Stephen Pitell sought emergency
medical care at EvergreenHealth. He signed a “consent to care” form in which he agreed
to pay the balance due on his account. But instead of paying, he filed a lawsuit against
EvergreenHealth, claiming that the consent-to-care agreement lacked a definite price
term and was therefore unenforceable. He also sued for concealment and sought class
certification. This court held that EvergreenHealth’s standard list of charges, its
chargemaster, supplied the price term. Thus, the consent-to-care agreement was
enforceable. We affirmed summary judgment dismissing Pitell’s suit and awarding
EvergreenHealth judgment for the bill plus costs and fees. This court followed the
22 No. 40348-3-III Bradford v. Kadlec
almost American uniform rule that a contract’s reference to a hospital’s rates or charges
is sufficiently definite to refer to a chargemaster list for the price term. The rule
recognizes the uniqueness of the market for health care services delivered by hospitals.
Many other cases have held agreements to pay charges of a hospital to be definite
when considering the hospital’s chargemaster list of fees. Limberg v. Sanford Medical
Center Fargo, 2016 ND 140, 881 N.W.2d 658; Holland v. Trinity Health Care Corp.,
287 Mich. App. 524, 791 N.W.2d 724 (2010); Banner Health v. Medical Savings
Insurance Co., 216 Ariz. 146, 163 P.3d 1096, 1101 (Ct. App. 2007); Nygaard v. Sioux
Valley Hospitals & Health Systems, 2007 SD 34, 731 N.W.2d 184; Morrell v. Wellstar
Health Systems, Inc., 280 Ga. App. 1, 633 S.E.2d 68 (2006); Shelton v. Duke University
Health Systems, Inc., 179 N.C. App. 120, 633 S.E.2d 113 (2006). In Burton v. William
Beaumont Hospital, 373 F. Supp. 2d 707 (E.D. Mich. 2005), the patient agreement, like
Kadlec’s Consent and Conditions agreement, obligated the patient to pay all charges not
covered by insurance.
Stephen Bradford faults Kadlec Regional Medical Center for arguing that an
emergency room patient acquires an absolute and unconditional liability for every charge
billed by Kadlec without regard to the legitimacy or correctness of the charge. Kadlec’s
brief does not confirm such an argument. We assume that Kadlec agrees that its charges
23 No. 40348-3-III Bradford v. Kadlec
must be reasonable. Although Bradford challenges the right of Kadlec to charge a
visitation fee, he presents no testimony challenging the reasonableness of the charge.
Attorney Fees at Superior Court
The superior court granted Kadlec Regional Medical Center an award of
reasonable attorney fees and costs as afforded under the Consent and Conditions
agreement. On appeal, Stephen Bradford argues that the contract did not afford Kadlec a
grant of reasonable attorney fees and costs because the contract fee provision only
covered collection actions and because Kadlec’s law firm did not qualify as a collection
agency.
Paragraph 9 of the Consent and Conditions agreement mentions referral of a
patient’s bill to a professional collection agency. But it does not limit recovery of
collection costs to fees owed by Kadlec to a collection agency. Instead, the paragraph
declared: “In the event of any dispute regarding payment, I agree to pay all collection
costs, including but not limited to interest, and attorneys’ fees whether or not a case is
filed in court.” CP at 514. Kadlec filed a counterclaim to collect the amount owed. It
prevailed on the counterclaim. To prevail on its counterclaim, Kadlec needed to defeat
Stephen Bradford’s claim that the contract was not enforceable and Bradford’s request
for declaratory relief that he did not owe the visitation fee.
24 No. 40348-3-III Bradford v. Kadlec
Under Washington law, for purposes of a contractual attorney fees provision, an
action lies on a contract if the action arose out of the contract and if the contract is central
to the dispute. Seattle-First National Bank v. Washington Insurance Guaranty
Association, 116 Wn.2d 398, 413, 804 P.2d 1263 (1991). Bradford’s arguments arise
from the Consent and Conditions agreement’s alleged failure to disclose in advance the
existence of and the amount of the visitation fee.
Stephen Bradford may also challenge the reasonableness of the fees granted by the
superior court but he does not mount a serious contest. Bradford argues that the rate
charged for the services by Kadlec’s attorney should not exceed $300.00 per hour. But
Bradford provides no testimony as to a reasonable fee for the nature of the legal work in
the Benton County community. Bradford complains that Kadlec’s counsel recovered fees
for work performed on claims other than the contract claim. Nevertheless, counsel
reduced from his fee request work performed on erroneously removing the suit to federal
court and tasks performed on the Consumer Protection Act claim.
As a court wishing to reduce the cost of litigation, we flinch at the incurring of
fees in the sum of $120,778.18 in a case with a sum of $6,364.65 in issue. Nevertheless,
Bradford has aggressively litigated the case before the superior court and this court. The
parties engaged in extensive discovery. Bradford, in fact, describes his lawsuit as
25 No. 40348-3-III Bradford v. Kadlec
"intense litigation." Br. of Pet'r at 37. Bradford raised numerous arguments in support
of his position. Kadlec faced a potential class action.
Attorney Fees on Appeal
Kadlec Regional Medical Center requests an award of reasonable attorney fees
and costs incurred on appeal. We grant the request pursuant to the parties' contract,
RCW 4.84.330, and RAP 18.1.
A majority of the panel has determined this opinion will not be printed in the
Washington Appellate Reports, but it will be filed for public record pursuant to
RCW 2.06.040.
Fearing, J.P.T. 1
WE CONCUR:
Lawrence-Berrey, C.J.
Cooney, J.
1 George Fearing, a retired judge of the Washington Court of Appeals, is serving
as a judge pro tempore of this court pursuant to RCW 2.06.150(1).