THE CBE GROUP, INC., Plaintiff-Appellee, vs. STEVE C. BUBECK, Defendant-Appellant.
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IN THE COURT OF APPEALS OF IOWA
No. 7-874 / 07-0868
Filed December 12, 2007
THE CBE GROUP, INC.,
Plaintiff-Appellee,
vs.
STEVE C. BUBECK,
Defendant-Appellant.
________________________________________________________________
Appeal from the Iowa District Court for Dubuque County, Alan L. Pearson,
Judge.
Steve Bubeck appeals from judgment entered against him in an action
brought by The C.B.E. Group, Inc., for debts incurred involving the provision of
medical treatment. AFFIRMED.
Steven Drahozal of Iowa Legal Aid, Dubuque, for appellant.
Kevin Ahrenholz of Beecher Law Firm, Waterloo, for appellee.
Considered by Sackett, C.J., and Vaitheswaran and Baker, JJ.
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BAKER, J.
Steve Bubeck appeals from a judgment entered against him in an action
brought by The C.B.E. Group, Inc., for debts incurred involving the provision of
medical treatment. We affirm.
I. Background and Facts
On May 3, 2005, Steve Bubeck admitted himself to the emergency room at
Mercy Medical Center in Dubuque. He was eventually admitted to the hospital,
and stayed until his discharge on May 9, 2005. Bubeck was billed $398 for his
emergency room visit and $8629.25 for his hospital stay, which he has not paid.
Mercy and Dubuque Emergency Physicians assigned the debt to C.B.E. Group,
Inc.
On June 2, 2006, C.B.E. filed a petition demanding judgment against
Bubeck for the medical bills.
A bench trial was held on April 12, 2007. C.B.E.’s key witness was Kim
Klavitter, the director of patient financial services at Mercy, who testified as to the
amounts and the reasonableness of the charges.
In response to Bubeck’s
interrogatories, Klavitter was described as Mercy’s director of patient financial
services and was listed as a person expected to be called as a witness at the trial
to testify as to facts or opinions relative to the proceeding. He was not disclosed
in discovery as an expert pursuant to Iowa Rule of Civil Procedure 1.508. The
district court entered judgment against Bubeck in favor of C.B.E. for $9027.25,
with interest and court costs.
II. Merits
Bubeck appeals.
He does not deny liability for the bills nor does he
contest the necessity of the services, but contends he should only be liable for
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reasonable charges. Specifically, he argues C.B.E. did not meet its burden of
proof because it failed to offer evidence of the reasonableness of the charges
through a qualified expert witness. He also argues that, because Klavitter was
not disclosed in discovery as an expert witness, his testimony should not have
been admitted.
Whether C.B.E. met its burden of proving the reasonableness of the
charges through a qualified expert witness is a legal question.
Our review,
therefore, is for correction of errors at law. Pexa v. Auto Owners Ins. Co., 686
N.W.2d 150, 155 (Iowa 2004). We apply an abuse of discretion standard to
review a ruling by the district court on the admissibility of expert witness
testimony, giving great deference to the decision of the court. U.S. Borax &
Chem. Corp. v. Archer-Daniels-Midland Co., 506 N.W.2d 456, 461 (Iowa Ct. App.
1993); Oldham v. Shenandoah Cmty. Sch. Dist., 461 N.W.2d 207, 209 (Iowa Ct.
App. 1990).
A. Burden of Proof
Bubeck contends C.B.E. failed to meet its burden of proof because it did
not offer evidence of the reasonableness of the medical charges through a
qualified expert witness. To prove an account for medical services, the burden is
on the plaintiff to prove that the services provided were medically necessary and
the charges were reasonable. See St. Luke’s Med. Ctr. v. Rosengartner, 231
N.W.2d 601, 602 (Iowa 1975) (noting the parties’ stipulation as to the
reasonableness of medical expenses); McIntire v. Muller, 522 N.W.2d 329, 331
(Iowa Ct. App. 1994) (noting proponent’s burden of proving prices charged are
fair and reasonable). “The amount charged, standing alone, is not evidence of
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the reasonable and fair value of the services rendered.” Pexa, 686 N.W.2d at
156.
Such evidence, in the absence of proof of the reasonableness of the
amount charged, will not support recovery of medical expenses. Id.
Expert
testimony is required. Id.
Bubeck stipulated that reasonableness was the only issue in this case.
Necessity, therefore, is not an issue. While Klavitter may not have been qualified
to testify regarding necessity, the issue presented is whether he was qualified to
testify as to reasonableness.
Klavitter has been the director of patient financial services for seventeen
years. He explained his familiarity with the billing and how the charges were
made. He further testified that the charges were fair and reasonable and that
Mercy had never been penalized or even told by reviewers or overseers that its
charges were excessive. He also testified that the charges were consistent with
other charges made by hospitals within Mercy’s system.
In Mercy Hosp. v.
Hansen, Lind & Meyer, P.C., 456 N.W.2d 666, 671 (Iowa 1990), a hospital
administrator who had worked in that capacity for many years and had
experience in hospital management was properly allowed to give expert
testimony about business aspects of hospital administration.
In a similar
Maryland case, a billing manager was found “competent to establish that a
particular bill is fair and reasonable by comparing what other hospitals charge for
a particular procedure.” Desua v. Yokim, 768 A.2d 56, 59 (Md. Ct. Spec. App.
2001). We believe Klavitter was qualified to testify regarding the reasonableness
of the charges.
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Bubeck, on the other hand, provided no evidence that even a single
charge was unreasonable. He cites to studies and reports that indicate problems
with hospital billing practices. None of this, however, is in the record. We find
there was sufficient evidence for the trial court to find that the charges were fair
and reasonable.
B. Admission of Expert Testimony
Iowa Rule of Civil Procedure 1.508(1) provides that “facts known, mental
impressions, and opinions held by an expert whom the other party expects to call
as a witness at trial, . . . acquired or developed in anticipation of litigation or for
trial may be obtained” through interrogatories or by other means. The rule does
not, however, “preclude a witness from testifying as to knowledge of the facts
obtained by the witness prior to being retained as an expert or mental
impressions or opinions formed by the witness which are based on such
knowledge.” Iowa R. Civ. P. 1.508(1). Bubeck contends the district court abused
its discretion in allowing Klavitter to testify because he was not disclosed by
C.B.E. as an expert witness during discovery. 1
While C.B.E. concedes that, pursuant to Rule 1.508(1), an expert witness
retained in anticipation of litigation must be disclosed in pretrial discovery, it
argues that Klavitter’s testimony was not prepared in anticipation of litigation and
he is, therefore, not an expert under the rule and need not be disclosed as such.
At first blush, this argument seems inconsistent with C.B.E.’s contention that it
1
Although C.B.E. contends this issue was not preserved for appeal, the record indicates
the issue was preserved through timely and specific objection. See Roberts v. Newville,
554 N.W.2d 298, 300 (Iowa Ct. App. 1996) (“Error may not be predicated upon a ruling
admitting evidence unless a timely and specific objection is made at trial.”).
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met its burden of proof regarding the reasonableness of the charges by providing
expert testimony from Klavitter. C.B.E. explains this seeming inconsistency by
distinguishing Rule 1.508 experts, whose opinions and testimony are formulated
in anticipation of litigation, from fact or occurrence experts.
Our supreme court has held that Rule 1.508 disclosure procedures do not
apply to cases where an expert’s knowledge is not acquired or developed in
anticipation of litigation or for trial. For example, a treating physician is generally
not considered an expert for such purposes. Day v. McIlrath, 469 N.W.2d 676,
677 (Iowa 1991). Medical technologists, employed by the hospital who were
“called to testify to the procedures employed by the hospital generally in the
testing of blood, and to the specific testing,” are not subject the rule. Duncan v.
City of Cedar Rapids, 560 N.W.2d 320, 323 (Iowa 1997).
Additionally, the
testimony of a city engineer who was not designated as an expert has been
allowed. Graber v. City of Ankeny, 616 N.W.2d 633, 647 (Iowa 2000). We find
Klavitter was “testifying as to facts obtained prior to the litigation and mental
impressions and opinions formed upon the basis of such knowledge.” Id. His
testimony was properly allowed.
III. Conclusion
C.B.E. met its burden of proof by providing evidence of the
reasonableness of the medical charges through a qualified expert witness.
There was, therefore, sufficient evidence for the trial court to find that the charges
were fair and reasonable. Further, Klavitter’s testimony was properly allowed.
AFFIRMED.
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