Thomas v. Archer

Facts

P was admitted to the emergency room and was seen by D, who determined that there was a risk of premature delivery and that P needed an immediate transfer to a facility better equipped to handle her condition. Because of weather conditions in Anchorage, D recommended that Pl be medivacked to Swedish Medical Center in Seattle. Ps told D they could not personally afford the medivac and needed preauthorization from the Ketchikan Indian Corporation Tribal Health Clinic (KIC) and the Alaska Native Medical Center (ANMC) before they could be covered for treatment outside of ANMC's Anchorage facilities. Ps allege that D told them 'she would contact KIC, not to worry, that everything will be taken care of, and that if KIC didn't cover it 'we' will.' According to D, they understood 'we' to mean the hospital. P signed an 'Acknowledgment of Financial Responsibility,' which cautioned that the Guardian Flight medivac charges could be significant. Though naming KIC as the 'Payment Source,' P agreed to be personally responsible for any unpaid charges and to 'save and hold the hospital harmless therefrom.' Ps were eventually billed over $23,000 by Swedish Medical Center and over $69,000 by Guardian Flight, the medivac provider. Ps sought payment from KIC and ANMC under their coverage plan but were denied because: (1) they failed to request preauthorization within 72 hours of beginning treatment or of admission to the healthcare facility; (2) ANMC was 'available and accessible to provide the necessary medical services to the patient'; and (3) Ps lacked a referral or authorization for the transfer from an ANMC physician. Ps admit knowing about the preauthorization requirements and that obtaining preauthorization was ultimately their responsibility. Ps knew that they boarded the flight based on Ds assurances that those requirements would be satisfied by someone else. D did later write KIC and ANMC to explain her decision but not until May 2009, over six months after the transfer. Ps sued Ds alleging breach of fiduciary duty, breach of contract, promissory estoppel, and negligent or intentional infliction of emotional distress. The superior court granted summary judgment to Ds on the fiduciary duty claim, agreeing with Ds' argument that a physician's fiduciary duty is limited to the context of medical treatment. The court later granted summary judgment to Ds on the remaining claims, holding that the facts as alleged did not create an enforceable contract and that there was no actual promise or substantial change in position by Ds sufficient to support their promissory estoppel claim. The court also dismissed the claims for negligent and intentional infliction of emotional distress, noting that Ps had agreed to withdraw them, although they had not yet done so, and had produced no evidence or legal authority to support the claims. The court awarded Ds approximately $25,000 in attorney's fees (20% of the total billings) and over $6,000 in costs. Ps appealed.

Issues

Rule of Law

Holding and Decision

Legal Analysis

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