MacNeil v. Crestview Hosp. Corp.

292 So.3d 840

George Washington MACNEIL, individually and on behalf of all others similarly situated, Appellant,

v.CRESTVIEW HOSPITAL CORPORATION, a Florida For Profit Corporation doing business as North Okaloosa Medical Center, Appellee.

No. 1D18-1958

District Court of Appeal of Florida, First District.

March 12, 2020

Richard Bennett and Peter Bennett of Bennett & Bennett, Coral Gables, Joshua A. Glickman and Shawn A. Heller of Social Justice Law Collective, PL, Dunedin, and Ginny G. Powell and Gillis Edward Powell, Jr. of Powell, Powell & Powell, Crestview, for Appellant.

Alan D. Lash, Lorelei J. Van Wey, Michael L. Ehren, and Jonathan L. Williams of Lash & Goldberg LLP, Weston, for Appellee.

Ray, C.J.

This is an appeal of a final order dismissing with prejudice the putative class action complaint of George Washington MacNeil for a declaratory judgment and supplemental relief against Crestview Hospital Corporation, d/b/a North Okaloosa Medical Center (the "Hospital"). The complaint seeks a declaration as to whether the Hospital charged MacNeil and other similarly situated patients unreasonable rates for medical services in violation of section 627.736(5)(a), Florida Statutes (the "PIP statute"). The trial court dismissed the complaint with prejudice, reasoning that the PIP statute does not create a private cause of action for an insured to challenge the reasonableness of a health care provider's charges, and therefore any declaration would amount to an improper advisory opinion. For the reasons that follow, we affirm.

I.

In his one-count complaint, MacNeil alleges that he was transported by ambulance to the Hospital's emergency care department after a motor vehicle accident. He had personal injury protection ("PIP") insurance at the time, providing for $10,000 in medical and disability benefits.

Following treatment and discharge, he received an invoice charging $41,484 for four CT scans, in addition to charges for other procedures.

MacNeil contends that the charges for the CT scans were unreasonable under the PIP statute, which provides that hospitals rendering treatment to an injured person covered by PIP insurance "may charge the insurer and injured party only a reasonable amount" for necessary services that "may not exceed the amount the [hospital] customarily charges." § 627.736(5)(a), Fla. Stat. (2017). He alleges that because of the unreasonable charges for the CT scans, he suffered "significant financial injury." Specifically, he alleges that PIP covers only 80% of the reasonable charges up to $10,000, so he is responsible for the remaining 20%. He further alleges that the charges prematurely exhausted his PIP benefits, causing him to be liable for additional medical services rendered by third-party providers that would have otherwise been fully or partially covered by his PIP benefits. He seeks a determination as to the reasonableness of the Hospital's charges as well as their legality under the PIP statute.

The Hospital moved to dismiss the complaint arguing that (1) no private right of action exists under the PIP statute between an insured and a health care provider under the facts alleged; (2) MacNeil failed to state a cause of action for declaratory relief; and (3) the scope and operation of the PIP statute should be decided by the Legislature, not the judiciary. For his part, MacNeil responded that (1) a private cause of action is not necessary to sue for declaratory relief, and (2) the PIP statute created a private cause of action.

After briefing and argument from counsel, the trial court granted the Hospital's motion to dismiss, concluding that "[MacNeil] cannot seek a declaratory judgment directly under section 627.736 and no amended set of allegations could cure [the] defect." The court held that a declaratory judgment action is unavailable to MacNeil because the PIP statute lacks an express or implied private cause of action to enforce its provisions, rendering any declaratory judgment an improper "advisory opinion." This appeal followed.

II.

Under Florida's Declaratory Judgment Act, "[t]he circuit and county courts have jurisdiction within their respective jurisdictional amounts to declare rights, status, and other equitable or legal relations whether or not further relief is or could be claimed." § 86.011, Fla. Stat. (2017). The courts may render declaratory judgments on the existence, or nonexistence:

(1) Of any immunity, power, privilege, or right; or

(2) Of any fact upon which the existence or nonexistence of such immunity, power, privilege, or right does or may depend, whether such immunity, power, privilege, or right now exists or will arise in the future. Any person seeking a declaratory judgment may also demand additional, alternative, coercive, subsequent, or supplemental relief in the same action.

Id. Additionally, any person "whose rights, status, or other equitable or legal relations are affected by a statute ... may have determined any question of construction or validity arising under such statute ... and obtain a declaration of rights, status, or other equitable or legal relations thereunder." § 86.021, Fla. Stat. (2017). By its express terms, the Declaratory Judgment Act must be liberally administered and broadly construed. § 86.101, Fla. Stat. (2017).

Yet while the scope of a court's jurisdiction to issue a declaratory judgment is broad, "it does have limits—one of which is that courts will not render advisory opinions or give legal advice." Golfrock, LLC v. Lee Cty. , 247 So. 3d 37, 40 (Fla. 2d DCA 2018) (citing May v. Holley , 59 So. 2d 636, 639 (Fla. 1952) ). Thus, to state a cause of action for declaratory judgment the plaintiff must show that

(1) there is a bona fide dispute between the parties; (2) the plaintiff has a justiciable question as to the existence or nonexistence of some right, status, immunity, power or privilege, or as to some fact upon which existence of such a claim may depend; (3) the plaintiff is in doubt as to the claim; and (4) there is a bona fide, actual, present need for the declaration.

Ribaya v. Bd. of Trs. of the City Pension Fund for Firefighters & Police Officers in the City of Tampa , 162 So. 3d 348, 352 (Fla. 2d DCA 2015). The extrastatutory elements requiring a "bona fide dispute" between the parties and a "bona fide need" for the declaration ensure that the proceeding is "judicial in nature" and falls "within the constitutional powers of the courts." See May , 59 So. 2d at 639 ; see also Ribaya , 162 So. 3d at 353 (cautioning that "chapter 86 is a statute with ‘special objectives’ that should not be ‘perverted’ by permitting its use as a ‘catch-all’ ").

III.

MacNeil argues on appeal that the trial court erred by dismissing his complaint for the sole reason that the PIP statute does not contain a private cause of action. He contends that the court's decision directly conflicts with this Court's holding in City of Apalachicola v. Franklin Cty. , 132 So. 3d 1217 (Fla. 1st DCA 2014).

In City of Apalachicola , the city sued the county for declaratory and injunctive relief, alleging that the county had failed to comply with requirements of the Florida Governmental Conflict Resolution Act, chapter 164, Florida Statutes. 132 So. 3d at 1218. The city sought a declaration that the county had to participate in the conflict resolution procedures established by the Act. Id. The trial court dismissed the complaint with prejudice because, it ruled, the Act does not create a private cause of action. Id. at 1218-19. On appeal, this Court determined that "[t]he circuit court erred in construing the complaint as asserting a cause of action for relief pursuant to the [Act]. Instead, the complaint seeks declaratory relief, and adequately states a cause of action for such relief." Id. at 1219. The Court reasoned that the Act expressly provides that if the entities fail to resolve their conflict through the statutory procedures, the entities " ‘may avail themselves of any otherwise available legal right,’ " and that "[a] declaratory judgment is an ‘otherwise available legal right.’ " Id. (quoting § 164.1056, Fla. Stat.).

We do not read City of Apalachicola to stand for the broad proposition that an individual can sue for declaratory relief alleging a violation of any statute under which he has no private right of action to enforce its provisions. Nor does City of Apalachicola articulate a per se rule that the existence of a private cause of action is never relevant when determining whether a justiciable claim exists to support a declaratory judgment. In short, City of Apalachicol a does not disturb the long-standing requirement that there must be a "bona fide, actual, present, and practical need for the declaration"—in other words, there must be "some immunity, power, privilege or right of the complaining party" dependent upon the issue to be resolved by declaration. See May , 59 So. 2d at 639.

Notwithstanding the lack of a private right of action under the PIP statute to determine the reasonableness of the Hospital's charges and the legality of its conduct,^* MacNeil contends that he is entitled to a declaration on these matters because of the existence of unspecified, potentially available civil remedies for the Hospital's violation of the statute. Cf. Herrera v. JFK Med. Ctr. Ltd. P'ship , 87 F. Supp. 3d 1299, 1308 (M.D. Fla. 2015) (holding that an insured could challenge the reasonableness of a hospital's charges under the PIP statute under common law theories of breach of contract, breach of the implied covenant of good faith and fair dealing, and a violation of FDUTPA), partially rev'd on other grounds , 648 F. App'x 930 (11th Cir. 2016).

For support, MacNeil relies in part on Adventist Health System/Sunbelt, Inc. v. Blue Cross & Blue Shield , 934 So. 2d 602 (Fla. 5th DCA 2006). In Adventist Health , a hospital brought a declaratory judgment action seeking an interpretation of a statute requiring the defendant HMO to reimburse the hospital for emergency medical...