Hospital’s Failure to apply for charity care for psychiatric emergency patient leaves hospital holding the bag

DRAFT   MUST REWRITE    text from daily briefingHEALTH CARE LAW

New Jersey has a Charity Care program which pays for hospital care for uninsured individuals who meet the stringent income and asset requirements and also file an application. If an eligible individual enters the hospital as an emergency room admission, the hospital is required to prepare and submit the application and to take measures to obtain the necessary verifications. If an individual is admitted to the hospital without first going through the emergency room, on the other hand, the individual bears that responsibility. The application can be filed by the individual or a responsible party and the hospital, at its discretion, can accept the application up to two years after discharge, which is also the deadline for a hospital to submit the claim to the state program for processing. The regulations are found at N.J.A.C. 10:51-11. This issue was addressed in the recent Appellate Division decision of Newton Med. Ctr. v. D.B.

The patient had been  involuntarily committed to the hospital’s short-term care facility on an emergent basis when the county PESS determined that he was a danger to himself and others. He met the financial qualifications for charity care, and filled out an application. However, due to his condition, he did not submit all the needed documentation within the required time period, and evidently did not seek the help of another person to gather and submit the required verifications. The hospital eventually sued him for the substantial unpaid bill. He argued that the hospital had a duty to submit the application on his behalf because his emergency psychiatric hospitalization placed him in the same category as a medical patient coming in through the emergency room. Although the trial court ruled against him, the Appellate Division reversed.

In a decision which discusses in depth the history and purpose of the Charity Care Program, the court held that the statute did not explicitly limit the category of emergency room hospitalizations  to medical needs as opposed to  psychiatric need, and that the Legislature intended that all patients in such desperate straits who enter a hospital for emergency treatment be relieved of the responsibility to submit their own applications. The Court placed the responsibility upon the hospital staff to follow the procedures mandated in the regulations for all such patients, and dismissed the collections action.

Admission to any hospital  raises the need for a patient to have an advocate and assistant watching out for his or her interests. Careful planning with powers of attorney, records release authorizations, HIPPA authorizations and health care proxies, including psychiatric health care proxies, can add a layer of protection for an individual in the throes of severe illness.

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A Health Care Power of Attorney can be a useful tool

Most people are familiar with the general durable power of attorney (POA), a document in which one person appoints someone who can step in to handle their financial, legal and business type matters. Many people are also familiar with a health care proxy, by which one person appoints another person who is authorized to make the medical decisions for them when the doctors determine that the patient lacks the mental capacity to make a medical decision.

Something is needed to bridge the gap for people who are not  “mentally incapacitated,” but  may be suffering from a  condition that makes it difficult for them to actually make or articulate a medical decision. This could be: difficulty with language; “brain fatigue” caused by illness; or frailty and general dependence on others for supported decision-making. The health care power of attorney would authorize someone to make the medical deicision for a patient who needs that assistance. Unlike a “health care proxy,” there would not need to be a prior detemination of mental incapacity.

The medical POA could be particularly useful for patients who speak English as a second language or speak minimal or no English, and for frail aging patients who would like to defer to a trusted advisor. The medical POA could authorize a child, for instance, to make medical decisions and to communicate with health care personnel on their behalf.  While informal arrangements of this sort may be in place, having it in writing provides greater assurance that the arrangement will be accepted by the health care provider.

A medical POA is not an advance directive or “living Will.” It gives no instructions about what treatments to consent o or refuse. It just appoints a decision-maker. For patients who have chronic psychiatric conditions that could become unstable, they may wish to sign a psychiatric advance directive which also authorizes their proxy to make a decision even without a determination of there being mental incapacity.  incapacity.http://www.finkrosner.com/articles/mental-illness-law.html

Careful planning can prevent a crisis. Call us to discuss your estate planning needs. 732-382-6070