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Hospital Collections: Can Hill-Burton Noncompliance Be Raised by Former Patients as an Affirmative Defense?

Published online by Cambridge University Press:  28 April 2021

Albert Speisman
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The Hill-Burton Program was enacted in 1946 to provide federal assigtance to communities for the purpose of constructing and modernizing health care facilities. As a condition of Hill-Burton funding, the contracting hospital is required to assume obligations of “uncompensated care” and “community service.” Indigents eligible for Hill-Burton free care can, after exhausting administrative remedies, obtain injunctive relief to enforce compliance with the Program's regulations. However, it is unsettled today whether a hospital's noncompliance with these obligations to provide free care can be raised as an affirmative defense in a hospital collection action. Until recently, courts throughout the country have held that a patient could not raise the affirmative defense of Hill-Burton noncompliance. Yet, the 1979 Hill-Burton Regulations, as well as the recent decision in Hospital Center at Orange v. Cook, are indicators of the start of a contrary trend to allow the defense. This article examines the 1979 Regulations and court decisions on the affirmative defense and argues against allowing the defense.

Type
Article
Information
Law, Medicine and Healthcare , Volume 10 , Issue 6 , October 1982 , pp. 216 - 221
Copyright
Copyright © 1982 American Society of Law, Medicine & Ethics

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References

Public Health Service Act. Tit. VI, Pub. L. No. 79-75, 60 Stat. 1040 (1946), codified, as amended, at 42 U.S.C. §§291-291o (1976)Google Scholar
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See, e.g., Saine v. Hosp. Auth. of Hall County, 502 F.2d 1033 (5th Cir. 1974); Euresti v. Stenner, 458 F.2d 1115 (10th Cir. 1972); Cook v. Ochsner Foundation Hosp., 319 F. Supp. 603 (E.D. La. 1970).Google Scholar
An affirmative defense presents new facts and arguments for the defendant without denying the truth of the complaint made by the plaintiff.Google Scholar
42 C.F.R. §124. These Regulations were promulgated by the Secretary of Health, Education and Welfare. The Department was redesignated the Department of Health and Human Services [hereinafter referred to as HHS]. For convenience, the Department of Health, Education and Welfare will be hereinafter referred to as HHS.Google Scholar
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“We … recogniz[e] this jurisdiction's acceptance of the principle that the public policy and public interest intended to be promoted by remedial social legislation are ordinarily advanced by implying therefrom a judicially cognizable cause of action which enforces the legislative purpose. See Lally v. Copygraphics… .” Cook, , supra note 6, at 532 (citation omitted).Google Scholar
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44 Fed. Reg. 29.396 (May 18, 1979). See Brown, , The Hill-Burton Act: Asynchrony in the Delivery of Health Care to the Poor, Maryland Law Review 39(2): 316 (1979). HHS's interpretation of the 1979 Hill-Burton Regulations “suggests that Hill-Burton non-compliance may now be considered a proper affirmative defense to a hospital collection suit;” however “it remains to be seen whether DHEW's interpretation of the new requirement means that this affirmative defense would now be accepted.” Id. at 374.Google Scholar
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42 U.S.C.A. §300s-6 (1979) grants a private right of action to compel compliance if the Secretary of HHS dismisses the complaint or the Attorney General has not brought an action for compliance within six months from the date that the complaint was filed.Google Scholar
Neither the Hill-Burton Act nor 42 U.S.C.A. §300s-6 (1979) creates this right.Google Scholar
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42 C.F.R. §124, 603 (1979).Google Scholar
Defense attorneys may argue, however, that inconvenience alone is insufficient for limiting a patient's rights. Moreover, as one author has argued, prolonged noncompliance “should be readily ascertainable by inspecting hospital records… .[T]o disallow the defense because some cases might be difficult to adjudicate is illogical and unfair.” Koshetz, , supra note 18, at 1008–09.Google Scholar
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42 C.F.R. §124.502 (1979).Google Scholar
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