8 Fla. L. Weekly Supp. 217a
Contracts — Health maintenance organizations — HMO subscriber did not demonstrate error in trial court’s decision that, although a medical provider provided a service covered by subscriber’s HMO, billed its services to his HMO, and received customary payment from HMO, it was not a contract provider statutorily barred from billing the subscriber for services covered by his HMO — Balance billing by non-contract providers is not contrary to public policy — Where patient testified that he did not recall executing financial agreement with medical provider and undisputed evidence showed that agreement was signed after administration of medication shortly before surgery, lack of capacity to contract was established
EDWIN PRATTS, Appellant, v. E.S.R. DIAGNOSTICS, INC., Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami Dade County. Case No. 99-386 AP. Opinion filed January 23, 2001. On appeal from the County Court, Miami-Dade County, Florida, Leo A. Adderly, Judge. Counsel: Douglas M. McIntosh, Karen F. Grossman, Brian Pollock and McIntosh, Sawran, Peltz & Cartaya, P.A., for Appellant. Max A. Goldfarb, for Appellee.
(Before LESLIE ROTHENBERG, ELLEN L. LEESFIELD, PETER LOPEZ, JJ.)
(Lopez, J.) Appellant Edwin Pratts, (“Pratts”), defendant below, appeals a final judgment against him for breach of contract. On appeal, Pratts contends the contract was (1) unlawful pursuant to §641.315 Fla. Stat. (1999); (2) voidable as against public policy; and (3) voidable for want of mental capacity on his part.
Background.
Appellant Pratts was admitted to Columbia Regional Hospital for surgery on a herniated disk. Appellee E.S.R. DIAGNOSTICS, INC., (“E.S.R.,”) provided medical services to Pratts during the course of surgery. At trial, Pratts testified that prior to surgery he received medication at approximately 8:55 a.m. Dr. Pratts also testified he had no recollection whatsoever of the financial agreement with E.S.R. executed thirty-five minutes later. It is the enforceability of the financial agreement on which this action turns. Following bench trial the lower court concluded the financial agreement was a valid, binding contract.
Standard of Review.
This Court begins its analysis by noting that the lower court’s decisions are clothed with a presumption of correctness. Applegate v. Barnett Bank of Tallahassee, 377 So. 2d 1150, 1152 (Fla. 1979). The burden is on the appellant to demonstrate error. Id. Because the trial court made no specific findings of fact in the final judgment, we “accept the facts to be those shown by that evidence most favorable” to the prevailing party. Southern Bell Tel. & Tel. Co. v. Broward County, 665 So. 2d 272, 274 (Fla. 4th DCA 1995). Carrying the burden of such law, Pratts has failed to show that the financial agreement conflicts with § 641.315, Fla. Stat. (1999) or that it is otherwise contrary to public policy.
Applicability of §641.315, Fla. Stat. (1999).
Appellee E.S.R. billed Pratts’ Health Maintenance Organization for services rendered and received $813.33. E.S.R. then proceeded to bill Pratts for the balance due, $682.00. Section 641.315, Fla. Stat. (1999) would seem to make such practice unlawful. More specifically, § 641.315(3) states:
No provider of services or any representative of such provider shall collect or attempt to collect from an HMO subscriber any money for services covered by an HMO and no provider or representative of such provider may maintain any action at law against a subscriber of an HMO to collect money owed to such provider by an HMO.
E.S.R. argued and the trial court agreed, that such language did not apply to “non-contract” providers, and that E.S.R. was itself a “non-contract” provider. E.S.R. contends it may be inferred that § 641.315 applies only to contracted providers inasmuch as the statute’s heading refers specifically to “Provider contracts.” Ryder Truck Rental, Inc. v. Bryant, 170 So. 2d 822, 827 (Fla. 1964); but see Santos v. State, 380 So. 2d 1284, 1285 (Fla. 1980) (Differentiating between bill “titles” and publication “headings.”) Appellee seeks further support in the language of § 641.315(1) which applies whenever “a contract exists between a health maintenance organization and a provider” — inferring that § 641.315 applies only where such a contract is proved.
The trial court concluded that § 641.315 applied only when a contract existed between a health maintenance organization and a provider. The trial court’s verdict necessarily determined that Pratts’ HMO had no direct contractual obligation with E.S.R. Appellant has not met the heavy burden of showing otherwise. Thus, while the undisputed evidence shows that E.S.R. provided a service covered by Pratts’ HMO, that E.S.R. billed its services to Pratts’ HMO and that E.S.R. received the customary payment amount, that alone will not allow this Court to reverse the court below and conclude that E.S.R. entered into a contract with Pratts’ HMO. “It is not the prerogative of an appellate court, upon a de novo consideration of the record, to substitute its judgment for that of the trial court.” Shaw v. Shaw, 334 So. 2d 13, 16 (Fla. 1976).
Public Policy.
Having declined to find that the legislature barred all providers to HMO patients from balance billing, this Court likewise declines to read such words into the statute under the guise of public policy.
Pratts’ Capacity to Contract Prior to Surgery.
Pratts’ third contention on appeal is that he lacked the capacity to enter into the agreement because of medications received prior to execution. The disputed agreement was executed by Dr. Pratts at 9:30 a.m., approximately 3 hours prior to surgery. The agreement contained a clause indicating he, Dr. Pratts, was “medication free” when signing. Dr. Pratts directly contradicted this clause by testifying that he received medication at 8:55 a.m. The importance of this discrepancy is clear and undisputed as evidenced by the following excerpt from the testimony of E.S.R.’s only witness, Dr. Rodriguez.
Appellant’s Attorney:
Q: Okay. And do you know what the purpose is of having a time here under the patient’s signature?
A: Sure do.
Q: What is that purpose?
A: The purpose is to determine the time it was signed.
Q: Okay. And isn’t it true that the reason in medical records that a time is included by someone’s signature on an important document like this is to ensure that the person is of clear mind and free of medication.
A: Of course.
Q: Okay. Isn’t it true in this particular agreement, Plaintiff’s Exhibit 4, it says: “I am of clear mind,” and in parentheses, “(medication free),” is that correct?
A: That is correct.
Q. Because it’s the intent of this document that it be — of your company, in the use of this document, that it be signed when the person is medication free; correct?
A: Exactly.
Besides testifying that he had received medication at 8:55, Dr. Pratts testified that he did not recall meeting anyone from E.S.R. on the day of surgery nor recalled seeing or signing the financial agreement. E.S.R. produced no evidence whatsoever to contradict Dr. Pratts’ recollection of the time he received his initial medications and produced no witnesses to testify as to Dr. Pratts’ apparent state of mind.
“Capacity, of course, is vital to the existence and enforceability of a contract.” In re: Guardianship of Gamble, 436 So. 2d 173, 179 (Fla. 2nd DCA 1983), citing Hogan v. Supreme Camp of the American Woodmen, 1 So. 2d 256, 258 (1941). The risk of mental incapacity due to the administration of medication prior to surgery was acknowledged by E.S.R. Dr. Pratts’ testified he had no recollection of executing the financial agreement. E.S.R. had ample opportunity to attack the credibility of Dr. Pratts on re-direct but did not. Dr. Pratts’ testimony, coupled with the undisputed evidence that the agreement was signed after the administration of medication and shortly before undergoing surgery clearly and convincingly established Dr. Pratts was not, in fact, capable of entering into a financial agreement with E.S.R. at the time of execution.
In reaching this conclusion the court has ignored, arguendo, the alleged hearsay testimony of Dr. Pratts. Because we find convincing proof of incapacity without considering such testimony, its admissibility is irrelevant.
Accordingly, the final judgment entered in favor of the Plaintiff below, as well as the order taxing costs and fees, are reversed. In addition, the Plaintiff/Appellee has filed a Motion for Attorney’s Fees alleging entitlement pursuant to the financial agreement and § 59.46, Fla. Stat. (1999). We deny the Motion because we find the financial agreement to be invalid, and as such, the Appellee is not entitled to fees pursuant to § 59.46, Fla. Stat. (1999), because the Appellee did not prevail on appeal. This cause is remanded with instructions to the trial court to enter final judgment in favor of Defendant.
REVERSED and REMANDED with INSTRUCTIONS. (ROTHENBERG and LEESFIELD, JJ., concur.)
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