Nursing Care Services, Inc. v. Dobos

District Court of Appeal of Florida
380 So. 2d 516 (1980)

ELI5:

Rule of Law:

A party is liable for the cost of services under a quasi-contract (a contract implied in law) if the services were necessary to save the party from serious harm during an emergency where consent was not possible, or if the party knowingly and voluntarily accepted the services.

Facts:

Mary Dobos was admitted to Boca Raton Community Hospital for a serious condition, an abdominal aneurysm.
Her doctor ordered around-the-clock nursing care due to the gravity of her condition.
The hospital contacted Nursing Care Services, Inc., which provided individualized nursing services to Dobos for two weeks while she was in the hospital.
During this in-hospital period, Dobos's health was in a grave state.
After being released, Nursing Care Services provided an additional two weeks of at-home care for Dobos.
During the at-home care period, Dobos was mentally alert, aware of the services being provided, and accepted them without protest.
Dobos never tried to dismiss the nurses, believing that Medicare or another insurer would cover the cost.

Procedural Posture:

Nursing Care Services, Inc. (plaintiff) sued Mary Dobos (defendant) in a Florida trial court to recover payment for nursing services.
At trial, Dobos conceded liability for a 48-hour period of post-release care, but contested liability for the in-hospital and at-home care periods.
Following a non-jury trial, the trial court entered a final judgment for the plaintiff for only the cost of the conceded 48-hour period.
The trial court found that there was insufficient communication with Dobos to make her responsible for the other services.
Nursing Care Services, Inc. (appellant) appealed the trial court's judgment to the District Court of Appeal of Florida, Fourth District, with Mary Dobos as the appellee.

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Issue:

Is a patient liable under a quasi-contract theory for the cost of medically necessary nursing services that she did not expressly authorize, when those services were either rendered during a medical emergency or were knowingly and voluntarily accepted by the patient post-emergency?

Opinions:

Majority - Hurley, Judge

Yes, a patient is liable for such services. A contract implied in law, or quasi-contract, is an obligation imposed by law on the grounds of justice and equity to prevent unjust enrichment. For the in-hospital care, Dobos's grave condition and the necessity of the services fall squarely within the emergency aid exception to the rule that one cannot be forced to pay for unrequested services. This exception allows restitution for necessary services rendered to prevent serious bodily harm when the person is unable to consent. For the at-home care, Dobos was mentally alert and knowingly and voluntarily accepted the benefits of the nursing services. The law presumes that when services are knowingly and voluntarily accepted, they are received with the expectation of payment, implying a promise to pay their reasonable worth. A patient's mistaken assumption that insurance will cover the cost does not absolve her of the underlying responsibility to pay.

Analysis:

This decision solidifies the application of quasi-contract principles in the medical services context within Florida law. It clearly distinguishes between two scenarios for imposing liability without an express contract: the emergency aid exception and the knowing acceptance of benefits. The ruling emphasizes that a patient cannot avoid payment for necessary services by claiming lack of a formal agreement, thereby protecting healthcare providers from unjust losses. It also clarifies that a patient's unilateral, uncommunicated assumption about insurance coverage is not a defense against liability, a principle with significant implications for billing disputes.

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