No Relief on Appeal in Iowa Health Care Battle

     DES MOINES, Iowa (CN) – A group of uninsured individuals from Iowa failed to have an appeals court revive their class action taking aim at faults in American health care system.
     The four lead plaintiffs behind the suit, led by Porschia Butts, represented a range of medical issues, including injuries from car collisions and a surgery for an appendectomy.
     They claimed that Iowa Health System and Central Iowa Hospital Corp., two entities that operate a combined 13 hospitals in Iowa, charge uninsured individuals like themselves face unreasonable rates for medical care when compared to insured individuals.
     Polk County District Judge Robert Hutchison refused to certify a class, however, and later granted the defendants summary judgment.
     A three-judge panel for the Iowa Court of Appeals affirmed Wednesday, noting that the case has met the same end as the “many similar cases across the country asserting the same claim.”
     The 19-page opinion concludes with a somber passage from the 3rd Circuit’s 2008 decision in DiCarlo v. St. Mary Hospital.
     “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,” that DiCarlo opinion states. “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.”
     In the case at hand, Butts and the other uninsured Iowa plaintiffs pointed to contract language holding patients liable for paying a hospital’s “regular rates” for services.
     Claiming that the open-price term made the contract ambiguous, the plaintiffs said a court would have to certify a class to determine a single reasonable rate.
     The appellate court rejected this claim, however, by pointing to the general rule that, “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.”
     A prospective class is furthermore too diverse to certify, the court found.
     “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 adjucated reasonable, and those who received financial assistance,” Judge Christopher McDonald wrote for the panel.
     The ruling notes as well that each of the hospital systems’ facilities maintain their own databases of prices for services.
     Although patients may end up paying different amounts because of government assistance, insurance coverage or charitable contributions, the hospitals contend that all patients are billed using the same standard.
     Emphasizing the difficulty of determining reasonable rates for services, McDonald said “there is no logical or fair way to determine the reasonableness of the rate charged without holding an individualized hearing on the same.”
     Each “charge will necessarily depend on the individual facts and circumstances regarding each plaintiff’s condition,” the ruling states.

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