Butler v. St. Alphonsus Regional Medical Center
MEMORANDUM DECISION AND ORDER Granting 5 MOTION to Dismiss> filed by St. Alphonsus Regional Medical Center, ( Amended Complaint due by 12/21/2012). Signed by Judge B. Lynn Winmill. (caused to be mailed to non Registered Participants at the addresses listed on the Notice of Electronic Filing (NEF) by (jp)
UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF IDAHO
Case No. 1:12-cv-00488-BLW
SAINT ALPHONSUS REIGIONAL
The Court has before it Defendants’ Motion to Dismiss (Dkt. 5). For the
reasons explained below, the Court will grant the motion.
Viewing the information in the Amended Complaint as true, which the Court
must do pursuant to a 12(b)(6) motion, the facts are as follows. Phillip Butler was
involved in a motor vehicle accident on or about July 1, 2012, suffering several
injuries. Pl.’s Am. Compl., Dkt. 4 at 2. Butler was transported to Saint Alphonsus
Regional Medical Center where he received medical treatment. Id.
St. Alphonsus is a participating network provider of TRICARE insurance
and has agreed to provide TRICARE services for a set rate of reimbursement. Id.
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St. Alphonsus must also be a “participating provider” for all TRICARE claims. Id.
Additionally, the participation agreement prohibits St. Alphonsus from billing a
beneficiary for services covered by TRICARE. Id. Finally, the participation
agreement requires St. Alphonsus to accept TRICARE payments as payment in full
for services rendered. Id.
Butler is an active member of the United States military and medically
insured by TRICARE. Id. at 1-2. St Alphonsus was provided with Butler’s
TRICARE insurance information, but in lieu of submitting the charges to
TRICARE, St. Alphonsus filed a hospital lien against Butler’s personal injury
cause of action. Id. at 3. Butler then filed this suit against St. Alphonsus.
Butler seeks (1) a declaration that Idaho’s hospital lien statute is
unconstitutional, and (2) an injunction ordering St. Alphonsus to bill TRICARE
and release its lien. Id. at 4-5. St. Alphonsus asks the Court to dismiss Butler’s
claim under Rule 12(b)(6). Def.’s Mem., Dkt. 5 at 3-5.
Federal Rule of Civil Procedure 8(a)(2) requires only “a short and plain
statement of the claim showing that the pleader is entitled to relief,” in order to
“give the defendant fair notice of what the . . . claim is and the grounds upon which
it rests.” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 1964
(2007). While a complaint attacked by a Rule 12(b)(6) motion to dismiss “does
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not need detailed factual allegations,” it must set forth “more than labels and
conclusions, and a formulaic recitation of the elements of a cause of action will not
do.” Id. at 555. To survive a motion to dismiss, a complaint must contain
sufficient factual matter, accepted as true, to “state a claim to relief that is plausible
on its face.” Id. at 570. A claim has facial plausibility when the plaintiff pleads
factual content that allows the court to draw the reasonable inference that the
defendant is liable for the misconduct alleged. Id. at 556. The plausibility
standard is not akin to a “probability requirement,” but it asks for more than a
sheer possibility that a defendant has acted unlawfully. Id. Where a complaint
pleads facts that are “merely consistent with” a defendant's liability, it “stops short
of the line between possibility and plausibility of ‘entitlement to relief.’ ” Id. at
The Supreme Court identified two “working principles” that underlie
Twombly in Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). First, the court need not
accept as true, legal conclusions that are couched as factual allegations. Id. Rule 8
does not “unlock the doors of discovery for a plaintiff armed with nothing more
than conclusions.” Id. at 678-79. Second, to survive a motion to dismiss, a
complaint must state a plausible claim for relief. Id. at 679. “Determining whether
a complaint states a plausible claim for relief will . . . be a context-specific task that
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requires the reviewing court to draw on its judicial experience and common sense.”
Providing too much in the complaint may also be fatal to a plaintiff.
Dismissal may be appropriate when the plaintiff has included sufficient allegations
disclosing some absolute defense or bar to recovery. See Weisbuch v. County of
L.A., 119 F.3d 778, 783, n. 1 (9th Cir. 1997) (stating that “[i]f the pleadings
establish facts compelling a decision one way, that is as good as if depositions and
other . . . evidence on summary judgment establishes the identical facts”).
A dismissal without leave to amend is improper unless it is beyond doubt
that the complaint “could not be saved by any amendment.” Harris v. Amgen, Inc.,
573 F.3d 728, 737 (9th Cir. 2009) (issued 2 months after Iqbal).1 The Ninth
Circuit has held that “in dismissals for failure to state a claim, a district court
should grant leave to amend even if no request to amend the pleading was made,
unless it determines that the pleading could not possibly be cured by the allegation
of other facts.” Cook, Perkiss and Liehe, Inc. v. Northern California Collection
Service, Inc., 911 F.2d 242, 247 (9th Cir. 1990). The issue is not whether plaintiff
will prevail but whether he “is entitled to offer evidence to support the claims.”
The Court has some concern about the continued vitality of the liberal amendment policy adopted in
Harris v. Amgen, based as it is on language in Conley v. Gibson, 355 U.S. 41, 45-46 (1957), suggesting
that “a complaint should not be dismissed for failure to state a claim unless it appears beyond doubt that
the plaintiff can prove no set of facts in support of his claim. . ..” Given Twombly and Iqbal’s rejection
of the liberal pleading standards adopted by Conley, it is uncertain whether the language in Harris v.
Amgen has much of a life expectancy.
MEMORANDUM DECISION AND ORDER – 4
Diaz v. Int’l Longshore and Warehouse Union, Local 13, 474 F.3d 1202, 1205 (9th
Cir. 2007)(citations omitted).
As stated above, Butler’s Amended Complaint contains two requests for
relief. St. Alphonsus argues that Butler’s constitutional request for relief should be
dismissed for failure to provide sufficient facts as required by Iqbal and Twombly.
Def.’s Mem., Dkt. 5-1 at 5. Specifically, St. Alphonsus argues that Butler’s failure
to identify the challenged hospital lien statutes or code sections does not meet the
required pleading standard. Id. Next, St. Alphonsus contends that because Butler’s
second cause of action is inextricably conditioned upon his first, it too should be
dismissed. Id. at 3. The Court will address each argument in turn below.
Sufficiency of Butler’s Amended Complaint
An integral purpose of the short and plain statement requirement, as required
by Twombly, is to apprise a defendant of the grounds upon which a claim rests.
Twombly, 550 U.S. at 555. The Court recognizes St. Alphonsus’ frustration with
Butler’s vaguely drafted Amended Complaint. Nowhere in Butler’s amended
complaint does he identify the specific statute or code sections he claims are
unconstitutional. As St. Alphonsus points out, there are multiple statutes contained
in Idaho’s hospital and nurse care lien provisions. Def.’s Mem., Dkt. 5-1 at 3.
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Without clarity as to which statute or code sections Butler challenges, St.
Alphonsus is left to its own conjecture in preparing a defense.
However, Butler has also filed a notice with the Attorney General, as
required by F.R.C.P. 5.1, wherein he cites Idaho Code sections 45-701, 702, and
704 as the basis for his constitutional claim. Pl.’s Notice, Dkt. 11. St. Alphonsus
has received a copy of that filing. Id. at 2. Thus, although Butler did not specify
these sections in his Amended Complaint, which would have been less confusing,
his notice to the Attorney General has effectively apprised St. Alphonsus of at least
some of the statutes at issue.
Nevertheless, St. Alphonsus argues that it remains unclear as to whether the
identified statutes comprise all or only some of the statutes at issue. Def.’s Reply,
Dkt. 14 at 4. Although the Court may assume that only Idaho Code sections 45701, 702, and 704 are at issue because those are the only sections listed in the
notice to the Attorney General, the Court cannot be sure. Thus, given the lack of
clarity in the Amended Complaint, the Court will grant the motion to dismiss, but
allow Butler an opportunity to amend. In his second amended complaint, Butler
must clearly designate the code sections at issue.
Request for Injunctive Relief
Butler’s second cause of action asks the Court for an injunction ordering St.
Alphonsus to bill TRICARE and release its lien. Pl.’s Mem., Dkt. 7 at 2. St.
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Alphonsus does not attack the merits or factual sufficiency of Butler’s second
claim. Rather, St. Alphonsus argues that Butler’s second claim must also be
dismissed because it is conditional upon his first. Def.’s Mem., Dkt. 5-1 at 3.
The Court is not going to make a determination as to whether the second
claim is conditional upon the first. Given the Court’s decision to grant the motion
on the first claim, and allow Butler to amend his complaint, such amendment
should also resolve St. Alphonsus’ argument as to injunctive relief.
1. Defendant’s motion to dismiss (Dkt. 5) is GRANTED. Butler may file a
second amended complaint, clarifying the statutes at issue, on or before
December 21, 2012.
DATED: December 11, 2012
B. Lynn Winmill
United States District Court
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