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The court ruled that additional disclosure requirements might interfere with emergency rooms’ obligation to provide care to people in urgent need regardless of whether they can pay for it.
(CN) — The California Supreme Court on Monday ruled that hospitals in the state don’t need to warn emergency room patients in advance about the fees they may be charged, opting not to tighten existing legislative and regulatory requirements.
In a unanimous decision the court upheld both the trial court’s and an appellate court’s rejection of class claims that San Jose Healthcare Systems, also known as Regional Medical Center San Jose, violated state consumer protection laws.
California’s top court took up the case to settle opposing positions at the appellate courts on whether patients need to be informed of how much they could be charged for emergency medical services before they undergo treatment.
Such a requirement, the court said, could conflict with the importance to provide emergency care to be patients who need it without regard to their ability to pay.
State and federal lawmakers have considered — and declined to impose — the additional duty that plaintiff Taylor Capito claims, Justice Goowin Liu said.
“At a minimum, it is plausible that a duty to provide such disclosures would risk discouraging patients from seeking emergency care or would put patients in the position of evaluating for themselves whether emergency services, at a
particular cost, are warranted in a given circumstance,” he wrote.
Lui pointed out that both the California Legislature and U.S. Congress have already decided what pricing information to make available in a hospital’s emergency room, and just as importantly, they have decided what not to include in those requirements.
“The reason for this extensive statutory and regulatory scheme is to strike a balance between price transparency and dissuading patients from avoiding potentially life-saving care due to cost,” the justice said.
Capito sought to represent other emergency room patients in a class action against the San Jose hospital after she was hit with $41,000 in charges (reduced to $8,900 after adjustments and discounts) for two emergency room visits in June 2019.
She claimed the hospital violated the California Consumers Legal Remedies Act by failing to provide emergency room patients sufficient notice of their emergency medical services fees. She didn’t claim the fees were excessive or that she had to pay for services that weren’t provided.
While California law requires hospitals to publish online or onsite a so-called chargemaster listing the uniform charges for their services, and requires hospitals to “post a clear and conspicuous notice in its emergency department” informing patients that the chargemaster is available for review and how it may be accessed, the law also specifically exempts emergency rooms from mandatory, specific disclosures of costs to uninsured patients.
In addition, the California Supreme Court observed, it’s doubtful how much emergency room patients would benefit from studying the wide range of charges they could be saddled with. As hospital who filed amici briefs with the court have said, the standard emergency services fees are misleading given that virtually no patient ever has to pay the full amount of those fees.
“At bottom, Capito desires notification of the EMS fee as if emergency care were a shoppable service,” Liu wrote. “She does not believe Regional’s notices about its intent to charge the EMS fee —provided in legally mandated pricelists and in a similar fashion that Capito apparently finds suitable for other services — adequately promotes price transparency and informed decision making.”
However, the judge said, the hospital doesn’t need to provide “the best possible notice” to avoid liability under the law. This, he said, is especially so when state and federal lawmakers, who are better situated to tackle the significant policy judgments involved, have already made a reasoned determination of what constitutes sufficient notice in the emergency room context.
An attorney for Capito didn’t immediately respond to a request for comment on the decision.
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